Incidence rates for renal cell carcinoma (RCC) have risen steadily over the past three decades, with the majority of this increase seen among localized tumors. Hallmark features of RCC include a predominance of clear cell subtype (ccRCC), a variable clinical course, and limited treatment options beyond surgical excision. Of interest, approximately 35% of patients treated surgically for localized ccRCC will experience disease progression (i.e. develop distant metastases) and most of these will occur within one year of surgery. Related to this, in 2003 we published the Mayo Clinic Progression (PROG) Score, an algorithm that is used to help predict which ccRCC patients will progress after surgery. While the PROG score has demonstrable prognostic value for patients with localized ccRCC, it is based entirely on information from pathologic indices and therefore represents only a surrogate measure of the underlying molecular characteristics that ultimately determine tumor aggressiveness. As such, the PROG score does not provide complete patient stratification nor does it inform on the biology of ccRCC aggressiveness or identify potential targets for therapeutic intervention. These limitations underscore the need to identify molecular prognostic factors that, in isolation or in combination with existing prognostic tools, not only improve prediction of ccRCC progression but also provide potential targets for clinical intervention. In direct response to this need, members of our investigative team employed a variety of discovery methods to identify a panel of seven tumor-based biomarkers of ccRCC aggressiveness (survivin, B7-H1, B7-H4, Ki-67, IGF-IR, IMP3 and CA-IX). More importantly, we have published individual preliminary investigations showing that tumor expression levels of each of these biomarkers are associated with an increased risk of ccRCC progression following surgery for localized disease. Herein, we propose to continue the translation of our biomarker discovery efforts by (1) generating a novel biomarker-based scoring algorithm to predict ccRCC progression, which when integrated with our existing PROG score will result in a more robust and accurate scoring system (BioPROG);(2) externally validating the prognostic value of this new scoring system in two independent populations of ccRCC patients and (3) exploring for the first time the expression of our seven biomarkers in metastatic ccRCC tissues and examining their ability to predict time to death following diagnosis of metastatic disease. To do this, we propose to harness high-quality clinical data and biospecimen resources available through ongoing large patient registries at our institutions. In summation, our overarching goal is to improve prognostic stratification following surgery for patients with localized ccRCC as well as inform on the underlying biology of ccRCC progression. This effort will ultimately enhance patient management/surveillance, allow for more appropriate clinical trial design, inform the molecular underpinnings of ccRCC pathogenesis, provide the rationale for novel therapeutic strategies, and represent a logical platform for the evaluation of patient response to emerging adjuvant therapeutics.

Public Health Relevance

In our proposed application, we will build upon our published work with seven individual biomarkers of ccRCC aggressiveness to develop and externally validate a second generation, biomarker-enhanced scoring system for predicting progression among patients with localized ccRCC (BioPROG). We will then extend the scope of our previous work by examining for the first time the expression of our seven biomarkers in paired samples of primary and metastatic ccRCC and estimating their association with time to death. The short-term clinical benefits of this effort include more appropriate ccRCC patient surveillance/management and clinical trial design, while more long-term benefits include a biologically relevant platform for evaluating response to emerging adjuvant therapeutics and for designing novel combinatorial therapies.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
Project #
Application #
Study Section
Cancer Biomarkers Study Section (CBSS)
Program Officer
Mckee, Tawnya C
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Mayo Clinic Jacksonville
United States
Zip Code
Ho, Thai Huu; Kapur, Payal; Eckel-Passow, Jeanette E et al. (2017) Multicenter Validation of Enhancer of Zeste Homolog 2 Expression as an Independent Prognostic Marker in Localized Clear Cell Renal Cell Carcinoma. J Clin Oncol 35:3706-3713
Ho, T H; Serie, D J; Parasramka, M et al. (2017) Differential gene expression profiling of matched primary renal cell carcinoma and metastases reveals upregulation of extracellular matrix genes. Ann Oncol 28:604-610
Eckel-Passow, Jeanette E; Serie, Daniel J; Cheville, John C et al. (2017) BAP1 and PBRM1 in metastatic clear cell renal cell carcinoma: tumor heterogeneity and concordance with paired primary tumor. BMC Urol 17:19
Serie, Daniel J; Joseph, Richard W; Cheville, John C et al. (2017) Clear Cell Type A and B Molecular Subtypes in Metastatic Clear Cell Renal Cell Carcinoma: Tumor Heterogeneity and Aggressiveness. Eur Urol 71:979-985
Ho, Thai H; Kapur, Payal; Joseph, Richard W et al. (2016) Loss of histone H3 lysine 36 trimethylation is associated with an increased risk of renal cell carcinoma-specific death. Mod Pathol 29:34-42
Joseph, Richard W; Kapur, Payal; Serie, Daniel J et al. (2016) Clear Cell Renal Cell Carcinoma Subtypes Identified by BAP1 and PBRM1 Expression. J Urol 195:180-7
Ho, T H; Park, I Y; Zhao, H et al. (2016) High-resolution profiling of histone h3 lysine 36 trimethylation in metastatic renal cell carcinoma. Oncogene 35:1565-74
Eckel-Passow, Jeanette E; Igel, Daniel A; Serie, Daniel J et al. (2015) Assessing the clinical use of clear cell renal cell carcinoma molecular subtypes identified by RNA expression analysis. Urol Oncol 33:68.e17-23
Ho, Thai H; Kapur, Payal; Joseph, Richard W et al. (2015) Loss of PBRM1 and BAP1 expression is less common in non-clear cell renal cell carcinoma than in clear cell renal cell carcinoma. Urol Oncol 33:23.e9-23.e14
Joseph, Richard W; Kapur, Payal; Serie, Daniel J et al. (2014) Loss of BAP1 protein expression is an independent marker of poor prognosis in patients with low-risk clear cell renal cell carcinoma. Cancer 120:1059-67

Showing the most recent 10 out of 13 publications