Colorectal cancer (CRC) incidence rates in the United States overall have declined since the mid-1980s because of changing patterns in risk factors (e.g., decreased smoking) and increases in screening. However, this progress is increasingly confined to older adults. CRC occurrence has been on the rise in patients younger than age 50, often referred to as early-onset disease, since the mid-1990s. Young patients are more often diagnosed at an advanced stage and with rectal disease than their older counterparts, and they have numerous other unique challenges across the cancer management continuum. For example, young patients are less likely than older patients to have a usual source of health care; often need a more complex treatment protocol to preserve fertility and sexual function; are at higher risk of long-term and late effects, including subsequent primary malignancies; and more often suffer medical financial hardship. Diagnosis is often delayed because of provider- and patient-related factors, and clinicians must have a high index of suspicion if young patients present with rectal bleeding or changes in bowel habits. Educating primary care providers and the larger population on the increasing incidence and characteristic symptoms is paramount. Morbidity can further be averted by increasing awareness of the criteria for early screening, which include a family history of CRC or polyps and a genetic predisposition.

The utility of cancer cell lines is affected by the similarity to endogenous tumour cells. Here we compare genomic data from 65 kidney-derived cell lines from the Cancer Cell Line Encyclopedia and the COSMIC Cell Lines Project to three renal cancer subtypes from The Cancer Genome Atlas: clear cell renal cell carcinoma (ccRCC, also known as kidney renal clear cell carcinoma), papillary (pRCC, also known as kidney papillary) and chromophobe (chRCC, also known as kidney chromophobe) renal cell carcinoma. Clustering copy number alterations shows that most cell lines resemble ccRCC, a few (including some often used as models of ccRCC) resemble pRCC, and none resemble chRCC. Human ccRCC tumours clustering with cell lines display clinical and genomic features of more aggressive disease, suggesting that cell lines best represent aggressive tumours. We stratify mutations and copy number alterations for important kidney cancer genes by the consistency between databases, and classify cell lines into established gene expression-based indolent and aggressive subtypes. Our results could aid investigators in analysing appropriate renal cancer cell lines.

Objective To compare the oncologic outcomes of patients with upper tract urothelial carcinoma (UTUC) undergoing nephroureterectomy (NU) with and without prior ureteroscopy (URS). Methods We reviewed records of all patients with no prior history of bladder cancer that underwent NU at our institution (n = 201). We compared patients who underwent URS prior to NU to patients who proceeded directly to NU based on imaging alone. After excluding patients undergoing URS with therapeutic intent, we used multivariable Cox proportional hazards models, adjusting for tumor characteristics with cancer specific survival (CSS), intravesical recurrence free survival (IRFS), metastasis free survival (MFS), and overall survival (OS) as endpoints. Results 144 (72%) patients underwent URS prior to NU and 57 (28%) patients proceeded directly to NU. The median follow up time for survivors was 5.4 years from diagnosis. The performance of diagnostic URS prior to NU was significantly associated with IR (HR 2.58; 95% CI 1.47, 4.54; p = 0.001), although it was not associated with CSS, MFS, or OS. The adjusted IRFS probability 3 years after diagnosis is 71% and 42% for patients who did not and did receive URS prior to NU, respectively (adjusted risk difference 30%; 95% CI 13%, 47%). Conclusions We did not find evidence that URS adversely impacts disease progression and survival in patients with UTUC. Although patients are at higher risk for IR after NU when they have undergone prior diagnostic URS, their CSS, MFS, and OS are not significantly affected.

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