Deciphering intratumoral molecular heterogeneity in clear cell renal cell carcinoma with a radiogenomics platform

Durga Udayakumar, Ze Zhang, Yin Xi, Durgesh K. Dwivedi, Michael Fulkerson, Sydney Haldeman, Tiffani McKenzie, Qurratulain Yousuf, Allison Joyce, Asghar Hajibeigi, Hollis Notgrass, Alberto Diaz De Leon III, Qing Yuan, Matthew A. Lewis, Ananth J. Madhuranthakam, Robert C. Sibley, Roy Elias, Junyu Guo, Alana Christie, Renée M. McKayJeffrey A. Cadeddu, Aditya Bagrodia, Vitaly Margulis, James Brugarolas, Tao Wang, Payal Kapur, Ivan Pedrosa

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Purpose: Intratumoral heterogeneity (ITH) challenges the molecular characterization of clear cell renal cell carcinoma (ccRCC) and is a confounding factor for therapy selection. Most approaches to evaluate ITH are limited by two-dimensional ex vivo tissue analyses. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can noninvasively assess the spatial landscape of entire tumors in their natural milieu. To assess the potential of DCE-MRI, we developed a vertically integrated radiogenomics colocalization approach for multi-region tissue acquisition and analyses. We investigated the potential of spatial imaging features to predict molecular subtypes using histopathologic and transcriptome correlatives. Experimental Design: We report the results of a prospective study of 49 patients with ccRCC who underwent DCE-MRI prior to nephrectomy. Surgical specimens were sectioned to match the MRI acquisition plane. RNA sequencing data from multi-region tumor sampling (80 samples) were correlated with percent enhancement on DCE-MRI in spatially colocalized regions of the tumor. Independently, we evaluated clinical applicability of our findings in 19 patients with metastatic RCC (39 metastases) treated with first-line antiangiogenic drugs or checkpoint inhibitors. Results: DCE-MRI identified tumor features associated with angiogenesis and inflammation, which differed within and across tumors, and likely contribute to the efficacy of antiangiogenic drugs and immunotherapies. Our vertically integrated analyses show that angiogenesis and inflammation frequently coexist and spatially anti-correlate in the same tumor. Furthermore, MRI contrast enhancement identifies phenotypes with better response to antiangiogenic therapy among patients with metastatic RCC. Conclusions: These findings have important implications for decision models based on biopsy samples and highlight the potential of more comprehensive imaging-based approaches.

Original languageEnglish (US)
Pages (from-to)4794-4806
Number of pages13
JournalClinical Cancer Research
Issue number17
StatePublished - Sep 1 2021

ASJC Scopus subject areas

  • Medicine(all)


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