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Urologic Oncology Mar 2017To describe the incidence of ascites in metastatic papillary renal cell cancer (pRCC), identify the factors associated with its development and evaluate its prognostic...
OBJECTIVE
To describe the incidence of ascites in metastatic papillary renal cell cancer (pRCC), identify the factors associated with its development and evaluate its prognostic effect on the survival of these patients.
METHODS
A retrospective evaluation of the medical records of patients with metastatic pRCC seen at National Cancer Institute (2000-2014) was undertaken. Logistic regression to identify predictors of the development of malignant ascites and Kaplan-Meier analysis to estimate survival was done.
RESULTS
Overall, 106 consecutive patients with metastatic pRCC were identified; sufficient data were available in 100 patients to enable assessment of ascites. Further, 20% had evidence of malignant ascites. Median age at diagnosis of ascites was 48.0 years (26.1-76.6 years) and median time to development of ascites from initial diagnosis of metastatic disease was 16.0 (0-73.3) months. There was no significant difference in the incidence of ascites between patients with hereditary and sporadic pRCC (P = 0.803) or among patients with different subtypes of pRCC (P = 0.456). Elevated platelet-lymphocyte ratio predicted development of malignant ascites in our cohort (P = 0.009). Median overall survival was shorter for patients who developed ascites [25.0 (10.2-39.8) months] compared with patients who did not develop this complication [42.5 (30.5-54.4) months, P = 0.041].
CONCLUSION
To our knowledge, this is the first systematic evaluation of the incidence, predictors, and prognostic effect of ascites in metastatic pRCC. Malignant ascites is a common manifestation of metastatic pRCC and is associated with a shorter overall survival. An elevated platelet-lymphocyte ratio predicts a higher risk of developing malignant ascites.
Topics: Adult; Aged; Ascites; Carcinoma, Renal Cell; Female; Humans; Incidence; Kaplan-Meier Estimate; Kidney Neoplasms; Lymphocyte Count; Male; Middle Aged; Peritoneal Neoplasms; Platelet Count; Prognosis; Retrospective Studies; Survival Rate; Tomography, X-Ray Computed
PubMed: 27914873
DOI: 10.1016/j.urolonc.2016.10.023 -
International Journal of Molecular... Apr 2022Epithelial ovarian cancer (EOC) is the most lethal gynecologic malignancy and has a unique metastatic route using ascites, known as the transcoelomic root. However,... (Review)
Review
Epithelial ovarian cancer (EOC) is the most lethal gynecologic malignancy and has a unique metastatic route using ascites, known as the transcoelomic root. However, studies on ascites and contained cellular components have not yet been sufficiently clarified. In this review, we focus on the significance of accumulating ascites, contained EOC cells in the form of spheroids, and interaction with non-malignant host cells. To become resistant against anoikis, EOC cells form spheroids in ascites, where epithelial-to-mesenchymal transition stimulated by transforming growth factor-β can be a key pathway. As spheroids form, EOC cells are also gaining the ability to attach and invade the peritoneum to induce intraperitoneal metastasis, as well as resistance to conventional chemotherapy. Recently, accumulating evidence suggests that EOC spheroids in ascites are composed of not only cancer cells, but also non-malignant cells existing with higher abundance than EOC cells in ascites, including macrophages, mesothelial cells, and lymphocytes. Moreover, hetero-cellular spheroids are demonstrated to form more aggregated spheroids and have higher adhesion ability for the mesothelial layer. To improve the poor prognosis, we need to elucidate the mechanisms of spheroid formation and interactions with non-malignant cells in ascites that are a unique tumor microenvironment for EOC.
Topics: Ascites; Carcinoma, Ovarian Epithelial; Cell Line, Tumor; Female; Humans; Neoplasms, Glandular and Epithelial; Ovarian Neoplasms; Spheroids, Cellular; Tumor Microenvironment
PubMed: 35457198
DOI: 10.3390/ijms23084383 -
Science Advances Nov 2023Gastric cancer (GC) with peritoneal metastases and malignant ascites continues to have poor prognosis. Exosomes mediate intercellular communication during cancer...
Gastric cancer (GC) with peritoneal metastases and malignant ascites continues to have poor prognosis. Exosomes mediate intercellular communication during cancer progression and promote therapeutic resistance. Here, we report the significance of exosomes derived from malignant ascites (EXO) in cancer progression and use modified exosomes as resources for cancer therapy. EXO from patients with GC stimulated invasiveness and angiogenesis in an ex vivo three-dimensional autologous tumor spheroid microfluidic system. EXO concentration increased invasiveness, and blockade of their secretion suppressed tumor progression. In -amplified GC, EXO contain abundant MET; their selective delivery to tumor cells enhanced angiogenesis and invasiveness. Exosomal MET depletion substantially reduced invasiveness; an additive therapeutic effect was induced when combined with MET and/or VEGFR2 inhibition in a patient-derived -amplified GC model. Allogeneic MET-harboring exosome delivery induced invasion and angiogenesis in a non-amplified GC model. -amplified patient tissues showed higher exosome concentration than their adjacent normal tissues. Manipulating exosome content and production may be a promising complementary strategy against GC.
Topics: Humans; Stomach Neoplasms; Exosomes; Ascites; Cell Line, Tumor; MicroRNAs
PubMed: 38000030
DOI: 10.1126/sciadv.adk1098 -
Seminars in Cancer Biology Nov 2022The ascites ecosystem in ovarian cancer is inhabited by complex cell types and is bathed in an environment rich in cytokines, chemokines, and growth factors that... (Review)
Review
The ascites ecosystem in ovarian cancer is inhabited by complex cell types and is bathed in an environment rich in cytokines, chemokines, and growth factors that directly and indirectly impact metabolism of cancer cells and tumor associated cells. This milieu of malignant ascites, provides a 'rich' environment for the disease to thrive, contributing to every aspect of advanced ovarian cancer, a devastating gynecological cancer with a significant gap in targeted therapeutics. In this perspective we focus our discussions on the 'acellular' constituents of this liquid malignant tumor microenvironment, and how they influence metabolic pathways. Growth factors, chemokines and cytokines are known modulators of metabolism and have been shown to impact nutrient uptake and metabolic flexibility of tumors, yet few studies have explored how their enrichment in malignant ascites of ovarian cancer patients contributes to the metabolic requirements of ascites-resident cells. We focus here on TGF-βs, VEGF and ILs, which are frequently elevated in ovarian cancer ascites and have all been described to have direct or indirect effects on metabolism, often through gene regulation of metabolic enzymes. We summarize what is known, describe gaps in knowledge, and provide examples from other tumor types to infer potential unexplored roles and mechanisms for ovarian cancer. The distribution and variation in acellular ascites components between patients poses both a challenge and opportunity to further understand how the ascites may contribute to disease heterogeneity. The review also highlights opportunities for studies on ascites-derived factors in regulating the ascites metabolic environment that could act as a unique signature in aiding clinical decisions in the future.
Topics: Female; Humans; Ascites; Ecosystem; Carcinoma, Ovarian Epithelial; Ovarian Neoplasms; Intercellular Signaling Peptides and Proteins; Cytokines; Tumor Microenvironment
PubMed: 35259492
DOI: 10.1016/j.semcancer.2022.03.004 -
Bulletin Du Cancer Jun 2011Malignant ascites are the cancer-associated accumulation of fluids in the peritoneal cavity. The neoplasms most frequently associated with ascites are ovarian, breast,... (Review)
Review
Malignant ascites are the cancer-associated accumulation of fluids in the peritoneal cavity. The neoplasms most frequently associated with ascites are ovarian, breast, colon, stomach and pancreas adenocarcinomas. Symptoms are abdominal distention, nausea, vomiting, anorexia, dyspnea and limbs oedemas. Several pathophysiological mechanisms might be implicated such as peritoneal carcinomatosis, lymphatic vessels' obstruction, portal hypertension or heart failure. Its diagnosis is most often performed in a context of already known neoplasia. Malignant ascites are associated with a pejorative evolution. Ascites which cannot be mobilized or show early recurrence and cannot be prevented by medical treatment are defined as refractory ascites. Therefore, management of refractory malignant ascites takes place in the context of palliative care and aims at improving the quality of life of these patients. This review lists the current data reported on the pathophysiology of malignant ascites and describes the present and future options for refractory malignant ascites management.
Topics: Antineoplastic Agents; Ascites; Breast Neoplasms; Diuretics; Female; Gastrointestinal Neoplasms; Humans; Immunotherapy; Injections, Intraperitoneal; Lung Neoplasms; Male; Molecular Targeted Therapy; Ovarian Neoplasms; Palliative Care; Paracentesis; Peritoneal Cavity; Peritoneovenous Shunt; Quality of Life; Recurrence; Vascular Endothelial Growth Factor A
PubMed: 21636346
DOI: 10.1684/bdc.2011.1373 -
Cancer Science Sep 2016Malignant ascites constitute a unique tumor microenvironment providing a physical structure for the accumulation of cellular and acellular components. Ascites is... (Review)
Review
Malignant ascites constitute a unique tumor microenvironment providing a physical structure for the accumulation of cellular and acellular components. Ascites is initiated and maintained by physical and biological factors resulting from underlying disease and forms an ecosystem that contributes to disease progression. It has been demonstrated that the cellular contents and the molecular signatures of ascites change continuously during the course of a disease. Over the past decade, increasing attention has been given to the characterization of components of ascites and their role in the progression of ovarian cancer, the most malignant gynecologic cancer in women. This review will discuss the role of ascites in disease progression, in terms of modulating cancer cell behavior and contributing to tumor heterogeneity.
Topics: Animals; Ascites; Biomarkers, Tumor; Cell Communication; Disease Progression; Female; Humans; Molecular Targeted Therapy; Ovarian Neoplasms; Precision Medicine; Prognosis; Tumor Microenvironment
PubMed: 27297561
DOI: 10.1111/cas.12987 -
International Journal of Molecular... Jun 2022Ovarian cancer (OC) is one of the most common gynecological cancers, with the worst prognosis and the highest mortality rate. Peritoneal dissemination (or... (Review)
Review
Ovarian cancer (OC) is one of the most common gynecological cancers, with the worst prognosis and the highest mortality rate. Peritoneal dissemination (or carcinomatosis) accompanied by ascites formation is the most unfavorable factor in the progression and recurrence of OC. Tumor cells in ascites are present as either separate cells or, more often, as cell aggregates, i.e., spheroids which promote implantation on the surface of nearby organs and, at later stages, metastases to distant organs. Malignant ascites comprises a unique tumor microenvironment; this fact may be of relevance in the search for new prognostic and predictive factors that would make it possible to personalize the treatment of patients with OC. However, the precise mechanisms of spheroid formation and carcinomatosis are still under investigation. Here, we summarize data on ascites composition as well as the activity of fibroblasts and macrophages, the key stromal and immune components, in OC ascites. We describe current knowledge about the role of fibroblasts and macrophages in tumor spheroid formation, and discuss the specific functions of fibroblasts, macrophages and T cells in tumor peritoneal dissemination and implantation.
Topics: Ascites; Carcinoma; Carcinoma, Ovarian Epithelial; Cell Line, Tumor; Female; Humans; Ovarian Neoplasms; Peritoneal Neoplasms; Tumor Microenvironment
PubMed: 35682890
DOI: 10.3390/ijms23116215 -
Diagnostic and Interventional Imaging May 2012To assess the diagnostic accuracy of the different computed tomography (CT) signs for differentiating between malignant and cirrhotic ascites.
OBJECTIVES
To assess the diagnostic accuracy of the different computed tomography (CT) signs for differentiating between malignant and cirrhotic ascites.
MATERIALS AND METHODS
We performed a retrospective study of 102 CT scans in adults, distributed into two groups based on the cirrhotic or malignant etiology of their ascites. The CT signs studied were ascites volume and relative distribution between the greater peritoneal cavity (GPC) and the omental bursa (OB), the density of the ascites, the thickness of the gallbladder wall, the thickness of the parietal peritoneum and its degree of enhancement, and tethered-bowel sign.
RESULTS
The CT signs associated with malignant ascites were: presence of fluid in the omental bursa (P=0.003), thickening of the peritoneum its degree of enhancement (P=0.005), increased density of the ascites (P=0.01), and loss of mobility of bowel loops in the ascites (P=0.001). There was no difference in gallbladder wall thickness between the two groups.
CONCLUSION
The CT scan can play a role in diagnosing malignant ascites. We confirm the usefulness of the indirect signs composed of distribution of ascites fluid, thickening and enhancement of the parietal peritoneum, and loss of mobility of the bowel loops in the ascites.
Topics: Adult; Aged; Aged, 80 and over; Ascites; Carcinoma; Diagnosis, Differential; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Peritoneal Neoplasms; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 22542208
DOI: 10.1016/j.diii.2012.02.008 -
The Korean Journal of Gastroenterology... Feb 2024Hepatic hydrothorax is a pleural effusion (typically ≥500 mL) that develops in patients with cirrhosis and/or portal hypertension in the absence of other causes. In... (Review)
Review
Hepatic hydrothorax is a pleural effusion (typically ≥500 mL) that develops in patients with cirrhosis and/or portal hypertension in the absence of other causes. In most cases, hepatic hydrothorax is seen in patients with ascites. However, ascites is not always found at diagnosis and is not clinically detected in 20% of patients with hepatic hydrothorax. Some patients have no symptoms and incidental findings on radiologic examination lead to the diagnosis of the condition. In the majority of cases, the patients present with symptoms such as dyspnea at rest, cough, nausea, and pleuritic chest pain. The diagnosis of hepatic hydrothorax is based on clinical manifestations, radiological features, and thoracocentesis to exclude other etiologies such as infection (parapneumonic effusion, tuberculosis), malignancy (lymphoma, adenocarcinoma) and chylothorax. The management strategy involves a stepwise approach of one or more of the following: Reducing ascitic fluid production, preventing fluid transfer to the pleural space, fluid drainage from the pleural cavity, pleurodesis (obliteration of the pleural cavity), and liver transplantation. The complications of hepatic hydrothorax are associated with significant morbidity and mortality. The complication that causes the highest morbidity and mortality is spontaneous bacterial empyema (also called spontaneous bacterial pleuritis).
Topics: Humans; Hydrothorax; Ascites; Pleural Effusion; Liver Cirrhosis; Liver Transplantation
PubMed: 38389460
DOI: 10.4166/kjg.2023.107 -
International Journal of Cancer Oct 2020Malignant ascites is one of the major clinical features of ovarian cancer, which serves as a carrier for the peritoneal dissemination of tumor cells and predicts a poor... (Review)
Review
Malignant ascites is one of the major clinical features of ovarian cancer, which serves as a carrier for the peritoneal dissemination of tumor cells and predicts a poor prognosis in patients. In the microenvironment of ovarian cancer ascites, antitumor immunity is suppressed, which enables the tumor cells to escape from immune surveillance. The metabolic factors, including hypoxia, nutrient deprivation and accumulation of metabolic products, contribute to the immunosuppressive status of malignant ascites. The malignant ascites and ovarian solid tumors exhibit differential metabolic profiles. In this review, we have summarized the most recent findings on the interaction between immune cells and metabolic factors in the ovarian cancer ascites. The effects of metabolic factors on the antitumor functions of T-cells in the malignant ascites were analyzed. Finally, we have discussed the potential directions for future research in this field.
Topics: Ascites; Female; Humans; Neoplasm Grading; Ovarian Neoplasms; T-Lymphocytes; Tumor Escape; Tumor Hypoxia; Tumor Microenvironment
PubMed: 32208517
DOI: 10.1002/ijc.32990