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NCI CANCERLIT^® Search: Kidney (Renal Cell) Cancer - June 2002

National Cancer Institute^®
Last Modified: June 1, 2002

Hand-assisted vs. retroperitoneal laparoscopic nephrectomy.
Evaluation of organ sparing operation results from planned indications in patients with kidney cancer.
Laparoscopic radical nephrectomy.
The use of natural veno-venous bypass during surgical treatment of renal cell carcinoma with inferior vena cava thrombus.
No end in sight for German misconduct probe.
Apoptosis and expression of Bcl-2, Bcl-XL, and Bax in renal cell carcinomas.
Impact of renal cryoablation on urine composition.
The reliability of dietary data for self- and next-of-kin respondents.
Childhood cancer in Louisiana 1988-1996.
Quality of life studies and genito-urinary tumors.
[A comparative study of ultrasonography, computed tomography and magnetic resonance imaging in the staging and invasiveness of adjacent
Mutational analysis of the von hippel lindau gene in clear cell renal carcinomas from tuberous sclerosis complex patients.
Interleukin-6, tumour necrosis factor alpha and interleukin-1beta in patients with renal cell carcinoma.
Pregnancy and risk of renal cell cancer: a population-based study in Sweden.
The hereditary renal cell carcinoma 3;8 translocation fuses FHIT to a patched-related gene, TRC8.
pT1 clear cell renal cell carcinoma: a study of the association between MIB-1 proliferative activity and pathologic features and cancer specific
Expression of progranulin and the epithelin/granulin precursor acrogranin correlates with neoplastic state in renal epithelium.
Renal cell carcinoma in patients with prior spinal cord injury.
Preliminary experience with cryoablation of renal lesions smaller than 4 centimeters.
[Organ-sparing surgery of renal cell carcinoma - operative technique and findings in radiological follow-up]
HLA phenotype and cytokine-induced tumor control in advanced renal cell cancer.
Comparison of hand assisted and standard laparoscopic radical nephroureterectomy for the management of localized transitional cell
Renal cell carcinoma invading the urinary collecting system: implications for staging.
[A clinical study on tumor-associated monocyte lineage cells in renal cell carcinoma]
[Prognostic value of serum immunosuppressive acidic protein in renal cell carcinoma]
[Surgical outcomes of nephron-sparing surgery for renal tumors]
Renal cell carcinoma metastatic to the pancreas: results of surgical management.
Growth fractions of human renal cell carcinoma defined by monoclonal antibody Ki-67. Predictive values for prognosis.
High platelet count multiplies risk following renal cell carcinoma treatment.
Expression of thymidine phosphorylase in primary human renal cell carcinoma by ELISA method.
Reduction of postembolization syndrome after ablation of renal angiomyolipoma.
Global increases in kidney cancer incidence, 1973-1992.
Juxtaglomerular cell tumor.
[Value of CT guided renal biopsies: retrospective review of 67 cases]
Low mitochondrial respiratory chain content correlates with tumor aggressiveness in renal cell carcinoma.
Molecular epidemiology of VHL gene mutations in renal cell carcinoma patients: relation to dietary and other factors.
Bone metastases of renal cell carcinoma: the role of surgery.
Expression of genes involved in chemoresistance, proliferation and apoptosis in clinical samples of renal cell carcinoma and correlation
The a posteriori probability of a kidney cancer cluster attributed to trichloroethylene exposure.
Natural history of chronic renal insufficiency after partial and radical nephrectomy.
Interleukin-2: clinical applications.
Therapeutic options in the management of renal cell carcinoma.

1
UI - 11769843
AU - Batler RA; Campbell SC; Funk JT; Gonzalez CM; Nadler RB
TI - Hand-assisted vs. retroperitoneal laparoscopic nephrectomy.
SO - J Endourol 2001 Nov;15(9):899-902
AD - Department of Urology, Northwestern University Medical School, Chicago, Illinois, USA.
PURPOSE: We retrospectively compared our initial experience with the hand-assisted and retroperitoneal laparoscopic nephrectomy techniques to determine if there are important differences between these approaches. PATIENTS AND METHODS: Twenty-four laparoscopic cases consisting of 12 hand-assisted and 12 retroperitoneal nephrectomies were compared. All cases but one were radical nephrectomies with intact specimen extraction performed for suspected stage T1 neoplasms. Data were collected from medical records and a postoperative questionnaire. To determine if significant learning curves existed, the first six nephrectomies in each group were compared with the second six nephrectomies on the basis of operative criteria. The two groups did not differ significantly in age, body mass index, ASA rating, or number of previous abdominal operations. RESULTS: Although the mean tumor volume was greater in the hand-assisted group than the retroperitoneal group, the difference did not quite reach statistical significance (91.19 v 24.7 cc3; P = 0.06). The mean operative time, estimated blood loss, narcotic use (milligrams of intravenous morphine equivalent), hours to oral intake, hospital stay, and estimated percent activity at 2 weeks for the hand-assisted group (238.33 min, 293.75 mL, 35.7 mg, 17.56 hours, 4.4 days, 74.75%, respectively) were not significantly different from the values in the retroperitoneal group (255.83 min, 141.67 mL, 24.5 mg, 22.36 hours, 3.6 days, 76.91%). We found no significant difference in the mean operative times for the first and second six cases in either group. CONCLUSION: In the initial experience and comparison of hand-assisted and retroperitoneal laparoscopic nephrectomy, we found no significant differences in operative time, estimated blood loss, narcotic usage, hours to oral intake, hospital stay, or activity level at 2 weeks postoperatively. A randomized trial is under way at our institution.

2
UI - 11989552
AU - Fryczkowski M; Potyka A; Huk J
TI - Evaluation of organ sparing operation results from planned indications in patients with kidney cancer.
SO - Int Urol Nephrol 2001;32(4):621-7
AD - Department of Urology, Silesian Medical Academy, Zabrze, Poland.
An analysis in 53 patients with kidney cancer has been conducted, a group on which kidney sparing operations have been performed. 25 women and 28 men have been examined at the age of 53.7 in the postoperative period of 7 divided by 130 months. The average observation time without any recurrences or metastases was 48.8 months. 5.7% local and 1.9% remote decease related recurrences have been found. The stage of clinical progression and the degree of histological malignancy are factors determining the five-year survival being 98.0%, while without any recurrences or metastases being 88.4%.

3
UI - 11528172
AU - Allan JD; Tolley DA; Kaouk JH; Novick AC; Gill IS
TI - Laparoscopic radical nephrectomy.
SO - Eur Urol 2001 Jul;40(1):17-23
AD - The Scottish Lithotripter Center, Western General Hospital, Edinburgh, UK.
Laparoscopic radical nephrectomy has gained in popularity as an accepted treatment modality for localized renal cell carcinoma at many centers worldwide. Laparoscopic radical nephrectomy may be performed via a transperitoneal or retroperitoneal approach. Mostly, the transperitoneal approach is used. Current indications for laparoscopic radical nephrectomy include patients with T(1)-T(3a)N(0)M(0) renal tumors. Herein, transperitoneal as well as retroperitoneal laparoscopic approaches are described. Surgical outcomes and complications from published series are reviewed with comparison to open surgery. Special related concerns as oncologic principles, organ retrieval, lymphadenectomy, and concomitant adrenalectomy are addressed. In conclusion, laparoscopic radical nephrectomy is now established with considerable advantages; decreased postoperative morbidity, decreased analgesic requirements, improved cosmesis, shorter hospital stay and convalescence. Although no long-term follow-up is available, short and intermediate follow-up results confirm the effectiveness of laparoscopic radical nephrectomy.

4
UI - 12013295
AU - Ciancio G; Soloway M
TI - The use of natural veno-venous bypass during surgical treatment of renal cell carcinoma with inferior vena cava thrombus.
SO - Am Surg 2002 May;68(5):488-90
AD - Department of Surgery, University of Miami School of Medicine, Florida 33101, USA.
Renal cell carcinoma associated with inferior vena cava thrombus complicates radical nephrectomy. Various approaches have been used to deal with this problem including veno-venous and cardiopulmonary bypass. Using natural veno-venous bypass may prevent the use of another type of bypass. A total of 16 patients underwent removal of renal cell carcinoma and an intracaval tumor thrombus without using veno-venous bypass. One of the natural veno-venous bypasses consisted in the mobilization of the liver off the retrohepatic inferior vena cava to allow enhanced access, vascular control, and hepatic venous drainage. The other natural bypass involved the preservation and use of collateral veins created by the longstanding obstruction of the inferior vena cava. In all 16 patients surgery was successful. Inferior vena cava clamping above and below the tumor thrombus did not result in systemic hypotension. There was no intraoperative mortality. There were no other complications. Mobilization of the liver off the retrohepatic inferior vena cava and preservation of collateral drainage (right testicular or ovarian veins and/or lumbar veins) were useful techniques in dealing with renal cell carcinoma with intracaval thrombus. These natural veno-venous bypasses allow vascular isolation of the inferior vena cava without disturbing the venous return to the heart and thereby help to prevent hemodynamic instability.

5
UI - 11986633
AU - Kerstholt M
TI - No end in sight for German misconduct probe.
SO - Nature 2002 May 2;417(6884):6

6
UI - 12025227
AU - Gobe G; Rubin M; Williams G; Sawczuk I; Buttyan R
TI - Apoptosis and expression of Bcl-2, Bcl-XL, and Bax in renal cell carcinomas.
SO - Cancer Invest 2002;20(3):324-32
AD - Department of Pathology, Mayne Medical School, University of Queensland, Herston Road, Herston, Brisbane 4006, Australia. g.gobe@mailbox.uq.edu.au
There are at present disparate published results with regard to the relevance of the Bcl-2 gene family, levels of apoptosis, and cell proliferation in the development and progression of renal cell carcinoma (RCC). The present study analyses the inter-relationship between the expression of representatives of the anti-apoptotic (Bcl-2, Bcl-XL) or pro-apoptotic (Bax) Bcl-2 proteins, incidence of apoptosis, and mitosis in a selected small group of 22 graded RCCs that had paired normal renal tissue, or non-neoplastic tissue in the renal biopsy specimen. The cases were chosen to determine the feasibility of measuring these parameters as potential surrogate markers of progression or treatment failure of the cancers. The results showed that in approximately 50% of the RCCs, where Bcl-2 and/or Bcl-XL expression was high, apoptosis was not detected, and when expression of these proteins was low or not found, increased levels of apoptosis were seen. In most of the remaining 50% of samples, high levels of Bcl-XL but not Bcl-2 were negatively correlated with low levels of apoptosis (Bcl-XL: r = -0.437, P = 0.07 and Bcl-2: r = +0.560, P = 0.02). For the same group of samples, high Bax expression was found in association with apoptosis (r = +0.578, P = 0.02). A novel finding was an association between low expression of Bcl-2 and/or Bcl-XL in normal tissue and the level of expression of these proteins in the RCCs, an intrinsic variation that may be an individual patient factor. The results indicate that, in RCCs with increased expression of Bcl-2 and/or Bcl-XL, levels of apoptosis are minimal and these combined factors may assist in progression of the cancers and resistance to treatments.

7
UI - 12031362
AU - Ng CS; Gill IS
TI - Impact of renal cryoablation on urine composition.
SO - Urology 2002 Jun;59(6):831-4
AD - Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
OBJECTIVES: To examine prospectively serial urine biochemical parameters in 14 patients (9 men, 5 women) undergoing laparoscopic cryoablation of a small, exophytic solid renal mass. Prior studies have shown that various types of renal injury may predispose to the formation of urinary calculi. The metabolic effects of cryoenergy on the surrounding normal renal parenchyma are unknown. METHODS: Timed 24-hour urine collections were obtained preoperatively and postoperatively on days 1, 30, and 60 to evaluate the following parameters: light microscopic findings, volume, pH, creatinine, protein, beta(2)-microglobulin, calcium, citrate, oxalate, phosphate, uric acid, sodium, and potassium. RESULTS: Urinary beta(2)-microglobulin excretion increased from a preoperative baseline value of 114.8 to 1931.2 microg/L on postoperative day 1, an increase of more than 15-fold (P = 0.05), thus confirming major renal injury. These values sharply decreased at 30 days and returned to near-baseline levels at 60 days postoperatively (P = 0.76). Nevertheless, all lithogenic parameters remained within the normal range throughout the follow-up period, with no significant change in any value. CONCLUSIONS: Our findings suggest that renal cryoablation does not adversely alter urine composition with respect to lithogenic parameters for up to 2 months after surgery. Elevated beta(2)-microglobulin levels indicating significant renal injury immediately postoperatively spontaneously revert to baseline levels within 2 months.

8
UI - 11988417
AU - Fryzek JP; Lipworth L; Signorello LB; Mclaughlin JK
TI - The reliability of dietary data for self- and next-of-kin respondents.
SO - Ann Epidemiol 2002 May;12(4):278-83
AD - International Epidemiology Institute, Rockville, MD 20850, USA. fryzek@iei.ws
BACKGROUND: In case-control studies, recalled dietary data from next-of-kin are sometimes used as a surrogate measure of exposure; however, there is limited evidence comparing the ability of study participants and next-of-kin surrogates for the reliability of their responses with respect to past dietary recall. METHODS: We compared dietary information from 303 subjects who were administered a food frequency questionnaire in 1980 with that from 196 of the same subjects and 107 next-of-kin of deceased subjects 5 years later, but with reference to 1980 diet. Agreement between 1980 and 1985 reporting with respect to food groups, food preparation methods, and adherence to special diets was primarily assessed using the kappa statistic. RESULTS: The concordance between 1980 and 1985 reporting of specific food groups was generally poor. Regarding various methods of cooking meats and the use of different types of cooking fats, next-of-kin respondents showed very poor agreement with the reporting of their deceased relatives, and within-subject agreement was also poor for frying meats, baking meats, and for cooking with margarine and vegetable oil. Subjects and next-of-kin were able to reproduce earlier reporting of a special ulcer diet, but not diabetic or low-salt diets. Overall, subjects tended to have better agreement with their own earlier reporting than did next-of-kin, and spouses were found to be more reliable next-of-kin respondents than other relatives. CONCLUSIONS: Dietary data collected retrospectively from next-of-kin may be unreliable.

9
UI - 12014461
AU - Chen VW; Schmidt BA; Wu XC; Correa CN; Andrews PA; Hsieh MC; Ahmed MN
TI - Childhood cancer in Louisiana 1988-1996.
SO - J La State Med Soc 2002 Mar-Apr;154(2):91-9
AD - Department of Public Health and Preventive Medicine/Louisiana Tumor Registery at Louisiana Health Sciences Center, New Orleans, USA.
Utilizing data from the Louisiana Tumor Registry, cancer incidence among children younger than 15 years of age is presented by major cancer type, according to the primarily histology-based International Classification of Childhood Cancer scheme. Cases include those diagnosed and/or treated at any hospitals and medical facilities in Louisiana, St. Jude Children's Research Hospital in Memphis, M.D. Anderson in Houston, and from neighboring states. Rates were age-adjusted, presented as rates per million, and were compared to the combined rates of the Surveillance, Epidemiology, and End Results (SEER) Program. The significance of rate differences were assessed at 0.05 level. From 1988-1996, about 125 children were diagnosed with cancer each year. In general, rates are higher in younger than older children, males than females, and white children than African-American children. The five most common childhood cancers are: leukemias (28% of total cases), central nervous system malignancies (22%), lymphomas (13%), renal tumors (8.4%), and soft tissue sarcomas (7.6%). Major findings of these cancers and their associated risk factors are presented.

10
UI - 11804384
AU - Bertetto O; Bracarda S; Tamburini M; Cortesi E
TI - Quality of life studies and genito-urinary tumors.
SO - Ann Oncol 2001;12 Suppl 3():S43-8
AD - Medical Oncology Division, Le Molinette Hospital, Turin, Italy.
BACKGROUND: Genitourinary (GU) tumors represent a large proportion of solid cancers (1 of 4) and a wide variety of natural histories, based on various prognostic factors and resulting in different treatment options and end points. In some cases, for the same stage of disease, different treatment strategies do not impact differently on overall survival (OS): surgery vs. radiation, or radical vs. conservative multidisciplinary approach, adjuvant or neoadjuvant, chemotherapy vs. BSC. Quality of life (QoL) is considered a reasonable end point when differences in OS do not seem to be striking. DESIGN: A review of the literature on different disease stages was undertaken to show where and when QoL was used as the end point of treatment efficacy. RESULTS: Very few studies have been performed in prostate, bladder and testicular cancer to show the impact of different treatment approaches on QoL. Although these studies might be considered as non-conclusive, some data may allow a better choice for the patients. CONCLUSIONS: QoL as the principal end point has not been used in clinical trials of GU tumors comparing different treatment approaches. This makes the choice between treatments offering similar survival but different toxicity patterns, body and behavioral consequences more difficult. We suggest that future prospective randomized studies should be planned taking into account the QoL as the main end point.

11
UI - 11723499
AU - Ribeiro SM; Ajzen SA; Trindade JC
TI - [A comparative study of ultrasonography, computed tomography and magnetic resonance imaging in the staging and invasiveness of adjacent structures by renal tumors]
SO - Rev Assoc Med Bras 2001 Jul-Sep;47(3):198-207
AD - Faculdade de Medicina, Universidade Estadual Paulista 'Julio de Mesquita Filho', S. Paulo, SP. sribeiro@fmb.unesp.br
BACKGROUND: Ultrasonography (US), Computed Tomography (CT), and Magnetic Resonance imaging (MR) were compared for the staging of renal tumors. The differences between these imaging techniques were also studied for their ability to detect adenopathies, vascular invasion, distant intra-abdominal metastases, and particularly adjacent organ invasion. METHODS: Thirty-one patients with solid or complex renal masses were prospectively studied using US, CT, and MR. Differences between the results obtained were studied using the COCHRAN G test and the McNEMAR test. The sensitivity and specificity of each diagnostic technique were compared against a "gold standard" of the surgical and histopathological findings. RESULTS: The following sensitivities were obtained: For the detection of adenopathy, US 63.6%, CT and MR 90.9%. For vascular invasion, US 42.8%, CT and MR 85.7%. For the adjacent organ invasion, US 28.5%, CT 85.7%, and MR 71.4%. Some of the criteria that suggest invasion of adjacent structures include: the envelopment of the adjacent structures by the tumor, tumor extension into the adjacent structures with an irregular appearance, and alterations in shape, size, and density of adjacent structures. Loss of fat planes between the tumor and adjacent structures is not a sign of tumor invasion. CONCLUSIONS: Significant differences were found in the detection capacity of US in relation to CT and MR, which were similar. All three techniques were highly sensitive and specific only in the detection of distant abdominal metastases. In addition to the accuracy of these diagnostic modalities for the detection and staging of tumors, invasiveness, risks and cost should be considered in relation to relative costs and benefits.

12
UI - 11904337
AU - Duffy K; Al-Saleem T; Karbowniczek M; Ewalt D; Prowse AH; Henske EP
TI - Mutational analysis of the von hippel lindau gene in clear cell renal carcinomas from tuberous sclerosis complex patients.
SO - Mod Pathol 2002 Mar;15(3):205-10
AD - Medical Oncology Division, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA.
Tuberous sclerosis complex (TSC) is an autosomal-dominant disorder characterized by seizures, mental retardation, autism, and tumors of multiple organs. Renal disease in TSC includes angiomyolipomas, cysts, and renal cell carcinomas. It is known that somatic mutations in the von Hippel Lindau (VHL) tumor suppressor gene occur in most clear cell renal carcinomas. To determine whether TSC-associated clear cell carcinomas also contain VHL mutations, we analyzed six tumors for loss of heterozygosity in the VHL gene region of chromosome 3p and for mutations in the VHL gene. Four of the patients were women between the ages of 34 and 68 years, and two were males under the age of 21 years. The loss of heterozygosity analysis was performed using polymorphic microsatellite markers, and the mutational analysis was performed using direct sequencing. Chromosome 3p loss of heterozygosity was not detected, and no VHL mutations were identified. These findings suggest that mutations in the TSC1 and TSC2 genes lead to clear cell renal carcinogenesis via an alternate pathway not involving VHL mutations.

13
UI - 11986770
AU - Yoshida N; Ikemoto S; Narita K; Sugimura K; Wada S; Yasumoto R;
TI - Kishimoto T; Nakatani T Interleukin-6, tumour necrosis factor alpha and interleukin-1beta in patients with renal cell carcinoma.
SO - Br J Cancer 2002 May 6;86(9):1396-400
AD - Department of Urology, Osaka City University Medical School, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
As regulators of malignant cell behaviour and communication with stroma, cytokines have proved useful in understanding cancer biology and developing novel therapies. In renal cell carcinoma, patients with inflammatory reactions are known to have poor prognosis. In order to elucidate the relation between renal cell carcinoma and the host, serum levels of inflammatory cytokines, interleukin-6, tumour necrosis factor alpha, interleukin-1beta, were measured. One hundred and twenty-two patients with renal cell carcinoma and 21 healthy control subjects were studied, and serum cytokine levels were measured using a highly sensitive ELISA kit. As a result, in the control group, interleukin-6, tumour necrosis factor alpha and interleukin-1beta levels were 1.79+/-2.03, 2.74+/-0.94 and 0.16+/-0.17 pg ml(-1), respectively. In the renal cell carcinoma patients, they were 8.91+/-13.12, 8.44+/-4.15 and 0.53+/-0.57 pg ml(-1), respectively, and significantly higher. In the comparison of stage, interleukin-6 level was significantly higher in the stage IV group compared to the other stage groups including the control group, while tumour necrosis factor alpha level was significantly higher in each stage group compared to the control group. As for grade, interleukin-6 level was significantly higher in the grade 3 group compared to the control, grade 1 and grade 2 groups, while tumour necrosis factor alpha level was significantly higher in each grade group compared to the control group. All cytokines had a positive correlation with tumour size. In regard to the correlation with CRP, all cytokines had a positive correlation with CRP, while interleukin-6 had a particularly strong correlation. In conclusion, interleukin-6 may be one of the factors for the poor prognosis of patients with renal cell carcinoma. In addition, tumour necrosis factor alpha may be useful in the early diagnosis of renal cell carcinoma and post-operative follow-up. Copyright 2002 Cancer Research UK

14
UI - 11986775
AU - Lambe M; Lindblad P; Wuu J; Remler R; Hsieh CC
TI - Pregnancy and risk of renal cell cancer: a population-based study in Sweden.
SO - Br J Cancer 2002 May 6;86(9):1425-9
AD - Department of Medical Epidemiology, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden. Mats.Lambe@mep.ki.se
Epidemiological findings indicate that hormonal influences may play a role in the etiology of renal cell cancer (RCC). The possible effect of childbearing remains enigmatic; while some investigators have reported a positive association between number of births and renal cell cancer risk, others have not. A case-control study, nested within a nation-wide Fertility Register covering Swedish women born 1925 and later, was undertaken to explore possible associations between parity and age at first birth and the risk of renal cell cancer. Among these women a total of 1465 cases of RCC were identified in the Swedish Cancer Register between 1958 and 1992 and information on the number of live childbirths and age at each birth was obtained by linkage to the Fertility Database. For each case, five age-matched controls were randomly selected from the same register. Compared to nulliparous women, ever-parous women were at a 40% increased risk of RCC (Odds Ratio [OR]=1.42; 95% CI 1.19-1.69). The corresponding OR for women of high parity (five or more live births) was 1.91 (95% CI 1.40-2.62). After controlling for age at first birth among parous women, each additional birth was associated with a 15% increase in risk (OR=1.15; 95% CI 1.08-1.22). The observed positive association between parity and renal cell cancer risk is unlikely to be fully explained by uncontrolled confounding, but warrants further evaluation in large studies, with allowance for body mass index. Copyright 2002 Cancer Research UK

15
UI - 9689122
AU - Gemmill RM; West JD; Boldog F; Tanaka N; Robinson LJ; Smith DI; Li F;
TI - Drabkin HA The hereditary renal cell carcinoma 3;8 translocation fuses FHIT to a patched-related gene, TRC8.
SO - Proc Natl Acad Sci U S A 1998 Aug 4;95(16):9572-7
AD - Division of Medical Oncology, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Denver, CO 80262, USA. gemmill@loki.uchsc.edu
The 3;8 chromosomal translocation, t(3;8)(p14.2;q24.1), was described in a family with classical features of hereditary renal cell carcinoma. Previous studies demonstrated that the 3p14.2 breakpoint interrupts the fragile histidine triad gene (FHIT) in its 5' noncoding region. However, evidence that FHIT is causally related to renal or other malignancies is controversial. We now show that the 8q24.1 breakpoint region encodes a 664-aa multiple membrane spanning protein, TRC8, with similarity to the hereditary basal cell carcinoma/segment polarity gene, patched. This similarity involves two regions of patched, the putative sterol-sensing domain and the second extracellular loop that participates in the binding of sonic hedgehog. In the 3;8 translocation, TRC8 is fused to FHIT and is disrupted within the sterol-sensing domain. In contrast, the FHIT coding region is maintained and expressed. In a series of sporadic renal carcinomas, an acquired TRC8 mutation was identified. By analogy to patched, TRC8 might function as a signaling receptor and other pathway members, to be defined, are mutation candidates in malignant diseases involving the kidney and thyroid.

16
UI - 12001115
AU - Cheville JC; Zincke H; Lohse CM; Sebo TJ; Riehle D; Weaver AL; Blute ML
TI - pT1 clear cell renal cell carcinoma: a study of the association between MIB-1 proliferative activity and pathologic features and cancer specific survival.
SO - Cancer 2002 Apr 15;94(8):2180-4
AD - Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. cheville.john@mayo.edu
BACKGROUND: The majority of patients with pT1 clear cell renal cell carcinoma (RCC) are cured with nephrectomy. However, a few patients will die of RCC. In several studies, MIB-1 proliferative activity was identified as an independent predictor of survival in patients with RCC. The objective of the current study was to examine MIB-1 proliferative activity in a large series of patients with pT1 clear cell RCC who were treated uniformly with radical nephrectomy, and to examine the association between proliferative activity and cancer specific survival in a multivariate model incorporating tumor size, nuclear grade, and tumor necrosis. METHODS: Patients with solitary pT1 clear cell RCC who underwent radical nephrectomy between 1970-1997 were eligible for the current study. For each of the 40 patients who died of RCC, a stratified random sample of at least 3 year-matched patients who still were alive or had died of other causes at the time of last follow-up was selected. Patient age at nephrectomy, patient gender, tumor size, nuclear grade, and tumor necrosis were evaluated, and the MIB-1 proliferative activity was assessed using digital image analysis. Univariate and multivariate Cox proportional hazards models were fit to assess the features associated with cancer specific survival. The associations between MIB-1 proliferative activity and pathologic features were assessed using the Wilcoxon rank sum test. RESULTS: The mean MIB-1 value for those patients who died of clear cell RCC was 6.5% compared with 3.6% for those patients who died of other causes or were still alive at the time of last follow-up. Patients whose tumor had an MIB-1 proliferative activity > o r = 5.0% were more than twice as likely to die of RCC than patients whose tumors had a MIB-1 activity < 5% (P = 0.02). However, after adjusting for tumor size, nuclear grade, and necrosis, MIB-1 proliferative activity was not found to be associated significantly with cancer specific survival. There was a significant association between MIB-1 proliferative activity and tumor size, nuclear grade, and necrosis. CONCLUSIONS: After adjusting for tumor size, nuclear grade, and necrosis, MIB-1 proliferative activity was not found to be an independent predictor of outcome in patients with pT1 clear cell RCC who were treated with radical nephrectomy. There was a significant association between MIB-1 and other well established pathologic prognostic features of pT1 clear cell RCC. Copyright 2002 American Cancer Society.

17
UI - 11911241
AU - Donald CD; Laddu A; Chandham P; Lim SD; Cohen C; Amin M; Gerton GL;
TI - Marshall FF; Petros JA Expression of progranulin and the epithelin/granulin precursor acrogranin correlates with neoplastic state in renal epithelium.
SO - Anticancer Res 2001 Nov-Dec;21(6A):3739-42
AD - Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA.
BACKGROUND: Current traditional pathological parameters, including staging and grading, are not sufficient in predicting outcome in patients with renal cell carcinoma (RCC). Acrogranin is an epithelial growth factor and has been demonstrated to play a role in teratocarcinogenesis and tumorigenesis. The aim of this study was to examine levels of acrogranin in renal cancer. MATERIALS AND METHODS: Western blot analysis was performed on renal tissue protein lysates. In addition, immunohistochemical (IHC) analysis of acrogranin expression was conducted on tissue sections of various histological types and grades of RCC. RESULTS: Western analysis showed that acrogranin levels were low in benign renal tissue and increased in malignant renal tissue. In addition, IHC revealed that high-grade RCC exhibited higher levels of expression than low-grade RCC and normal tissue. CONCLUSION: These data suggest that acrogranin may be a functional important growth factor in RCC and may be a potential molecular marker for high-grade RCC.

18
UI - 11944783
AU - Brandes SB; Smith JB; Longo WE; Virgo KS; Johnson FE
TI - Renal cell carcinoma in patients with prior spinal cord injury.
SO - J Spinal Cord Med 2001 Winter;24(4):251-6
AD - Division of Urologic Surgery, Washington University School of Medicine, St Louis, Missouri, USA. brandess@msnotes.wustl.edu
INTRODUCTION: In patients with spinal cord injury (SCI), abdominal diseases such as renal carcinoma are often diagnosed and treated late in their course. METHODS: A population-based retrospective review of SCI patients receiving care for renal cell carcinoma (RCC) in all Department of Veterans Affairs (DVA) medical centers was conducted for fiscal years 1988 to 1998. RESULTS: Of 96 patients identified, 57 were evaluable and 27 met study criteria. The mean patient age was 59 (range, 41-79 years). The mean time between SCI and treatment for RCC was 25 years (range, 1-51 years). All patients were men; 22/27 (81%) had 1 or more comorbid conditions. RCC was an incidental finding on surveillance imaging studies in 81% (22/27) of the patients. All 27 patients were treated surgically, 74% (20/27) by radical nephrectomy and 26% (7/27) by partial nephrectomy. All tumors were renal cell adenocarcinomas. Pathological staging by the tumor, nodes, and metastasis system was possible in 25; 92% (23/25) of tumors were stage I and 8% (2/25) were stage II. Postoperative morbidity occurred in 56% (15/27), and death occurred in 7% (2/27). CONCLUSION: In SCI patients in the DVA system, diagnosis of RCC is usually the result of an incidental finding on surveillance imaging. Tumors are diagnosed at early stages and partial nephrectomy is often feasible. Many of the postoperative complications are related to the SCI, and may be preventable.

19
UI - 12033757
AU - Khorsandi M; Foy RC; Chong W; Hoenig DM; Cohen JK; Rukstalis DB
TI - Preliminary experience with cryoablation of renal lesions smaller than 4 centimeters.
SO - J Am Osteopath Assoc 2002 May;102(5):277-81
AD - MCP Hahnemann University, Philadelphia, PA 19129, USA.
Nephron-sparing surgical techniques represent an attractive treatment approach for small renal lesions that are limited only by potential operative morbidity. This study tests the hypothesis that an alternative strategy of in situ cryoablation of these lesions may further reduce the incidence of complications with similar efficacy. Beginning August 1996,17 patients were enrolled in an institutional review board-approved protocol for open renal cryoablation for lesions smaller than 4 cm in diameter. The median age was 62 years (range, 35-75 years). The median preoperative lesion size was 2.0 cm (range, 1.1-4.2 cm) determined with either computed tomography or magnetic resonance imaging. A double freeze-thaw technique to -180 degrees C was used under direct intraoperative ultrasound monitoring. The median length of follow-up was 30 months (range, 10-60 months), with 8 patients followed up for more than 20 months. The procedure was accomplished in 3 hours (range, 2.25-4.25 hours) through a 5-cm to 7-cm subcostal incision. The median blood loss was 100 mL, and the median hospital stay was 2 days (range, 2-8 days). The median intraoperative lesion was 2.4 cm, which was not statistically different from preoperative measurements. Postoperative serum creatinine levels were unchanged except for a transient increase from 5.5 mg/dL to 7.0 mg/dL in one patient. Follow-up magnetic resonance imaging scans have demonstrated infarction and a reduction of lesion size in 15 of 16 cases. The size of one patient's mass was unchanged after 3 months. Renal cryoablation via an open approach is associated with few complications and represents a viable alternative to extirpative surgical techniques. The open exposure provides an accurate assessment of the renal unit with definitive ultrasound visualization.

20
UI - 11960401
AU - Hallscheidt P; Hansmann J; Schenk JP; Radeleff BA; Kauffmann GW;
TI - Riedasch G [Organ-sparing surgery of renal cell carcinoma - operative technique and findings in radiological follow-up]
SO - Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2002 Apr;174(4):409-15
AD - Abteilung Radiodiagnostik der Radiologischen Klinik der Universitat Heidelberg, Germany.
Nephron-sparing surgery of renal cell carcinoma in the 1970's and 1980's in patients with bilateral renal tumors or reduced renal function (imperative indication) has shown a very low risk of recurrent cancer. Today, nephron-sparing surgery in renal cell carcinoma is considered in an increasing number of patients with expected sufficient renal function after nephrectomy (elective indication). Resection technique, the use of Tabotamp(R) to reduce bleeding, and pseudotumors do complicate the interpretation of the images. It has been not yet defined which diagnostic modality is best suited for follow-up after renal cell carcinoma resection. Follow-up protocols in different institutions show a wide variety. The follow-up of patients after nephron-sparing surgery is performed by annual sonography or MRI every three months. Up to now, CT and ultrasound are the standard methods. MRI with its multiplanar imaging and improved soft tissue contrast seems to have an equal diagnostic value. Additionally, MRI seems to be suited for patients with reduced renal function. The aim of this paper is to give guidelines for the radiologist to understand the different surgical procedures and to evaluate the postoperative findings. Different imaging modalities in the follow-up of patients and special radiological phenomena are discussed.

21
UI - 11776757
AU - Franzke A; Buer J; Probst-Kepper M; Lindig C; Framzle M; Schrader AJ;
TI - Ganser A; Atzpodien J HLA phenotype and cytokine-induced tumor control in advanced renal cell cancer.
SO - Cancer Biother Radiopharm 2001 Oct;16(5):401-9
AD - Department of Hematology and Oncology, Medizinische Hochschule Hannover, Germany. franzke.anke@mh-hannover.de
BACKGROUND: The natural history of malignancies, the response to cytokine-based therapy and survival of patients may be partly determined by the human leukocyte antigen (HLA) phenotype. Here, we investigated in a retrospective analysis the correlation of the HLA phenotype of 73 prognostic favored patients with advanced renal cell carcinoma to (a) the expected HLA distribution in Caucasians, (b) the susceptibility or resistance to metastatic sites, (c) response to cytokine-based therapy and (d) sustained cytokine-induced effective tumor control. METHODS: We retrospectively determined the MHC class I and II antigens in patients with metastatic renal cell carcinoma selected by survival. Antigens were serologically typed by standard lymphocytotoxicity techniques. For statistical analysis, we calculated the probability of the presented HLA antigens in correlation to the expected Caucasian HLA phenotypes. An independent confirmation was performed by using the chi-square and two-tailed Fisher's exact test. RESULTS: Various HLA antigens deviated significantly from the normal distribution in the Caucasian population. HLA.B44 was the only antigen associated (p < 0.01) with the absence of lung and presence of bone metastases, while it did not impact on overall survival or response to therapy. A1 (p < 0.0001, p < 0.002) and B8 (p < 0.009, p < 0.04) alleles were more frequently expressed in responding patients than expected from the normal distribution in Caucasians and that observed in non-responding patients, respectively. The HLA analysis of patients achieving a durable complete remission showed a significantly higher frequency of expression of the A1 and B8 antigens and furthermore of the B14 antigen (p < 0.05). CONCLUSIONS: Our data underline the pivotal role of the MHC complex in controlling and regulating the cellular immune response in renal cell cancer. We could identify HLA antigens, which correlate with response to cytokine-treatment, with a long-lasting effective tumor control and prolonged overall survival.

22
UI - 11992043
AU - Landman J; Lev RY; Bhayani S; Alberts G; Rehman J; Pattaras JG;
TI - Figenshau RS; Kibel AS; Clayman RV; McDougall E Comparison of hand assisted and standard laparoscopic radical nephroureterectomy for the management of localized transitional cell carcinoma.
SO - J Urol 2002 Jun;167(6):2387-91
AD - Division of Urology, Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.
PURPOSE: Hand assisted laparoscopy affords the surgeon tactile sensation and blunt dissection, which are currently limited using the standard laparoscopic technique. Therefore, we compared standard and hand assisted laparoscopic radical nephroureterectomy for localized upper tract transitional cell carcinoma. MATERIALS AND METHODS: The medical records of 27 patients who underwent standard (11) or hand assisted (16) 2001 were retrospectively reviewed. The parameters of efficacy, efficiency, safety and convalescence were compared. RESULTS: Mean patient age was 64 and 66 years (p = 0.72) in the standard and hand assisted groups, and the mean American Society of Anesthesiologists score was 2.5 and 2.7 (p = 0.64), respectively. All standard and 15 of the 16 hand assisted (94%) procedures were successfully completed via laparoscopy. Total operative time was more than 1 hour shorter for hand assisted than for laparoscopic radical nephroureterectomy (4.9 versus 6.1 hours, p = 0.055). Mean estimated blood loss was similar in the standard and hand assisted groups (190 and 201 ml., p = 0.78). In each group 1 patient required blood transfusion. Mean specimen weight was significantly higher in hand assisted cases (576 versus 335 gm., p = 0.036). Mean time to oral intake was similar in patients who underwent standard and hand assisted laparoscopic radical nephroureterectomy (13 and 20 hours, respectively, p = 0.45). The mean analgesic requirement was also similar (29 and 33 mg. morphine sulfate, respectively, p = 0.83). Mean hospital stay in uncomplicated cases was similar for standard and hand assisted surgery (2.9 and 2.5 days, respectively). Overall hospital stay in the 2 cohorts was also similar (3.3 and 4.5 days, respectively, p = 0.59). Four patients per group experienced postoperative complications. There were no deaths in the standard group but 1 patient (6%) in the hand assisted group died postoperatively. Mean time to partial and complete convalescence in the standard and hand assisted groups was 2.4 and 5.2, and 3.5 and 8.0 weeks, while mean followup was 27.4 and 9.6 months, respectively. CONCLUSIONS: Compared with standard laparoscopy hand assisted laparoscopy decreases operative time without significantly altering short-term parameters of convalescence. However, long-term convalescence after hand assisted laparoscopic radical nephroureterectomy is 1 to 3 weeks longer (p = 0.27). Longer followup in the hand assisted cohort is necessary to determine whether there are any differences in the 2 methods in regard to cancer control.

24
UI - 12048933
AU - Hamada I
TI - [A clinical study on tumor-associated monocyte lineage cells in renal cell carcinoma]
SO - Hinyokika Kiyo 2002 Apr;48(4):213-20
AD - Department of Urology, Saitama Medical School.
To investigate the relationship between the ratio of monocytes infiltrating renal cell carcinoma (RCC) and prognosis, in 78 patients who underwent nephrectomy, the positive rate of the following parameters was assessed immunohistochemically under light microscopy: tumor-associated macrophage (TAM), microvessel density (MVD), S-100 cell, HLA-DR cell, apoptosis index (AI) and proliferative index (PI). The relationship between the positive rate of these parameters and prognosis, and intercorrelations among these parameters were analyzed. A positive correlation with prognosis was observed in patients positive for TAM, MVD or PI (r = 0.625). Prognosis was poor for patients with high levels of these parameters. Furthermore, the number of S-100-positive cells was a prognostic factor only in patients with metastatic RCC. Although the role of TAM as a prognostic factor in RCC is clear, no linear relationship was identified between prognosis and other monocytes.

25
UI - 12056039
AU - Matsumoto K; Iwamura M; Muramoto M; Suyama K; Tabata K; Minei S; Hirai
TI - S; Baba S [Prognostic value of serum immunosuppressive acidic protein in renal cell carcinoma]
SO - Nippon Hinyokika Gakkai Zasshi 2002 May;93(4):548-54
AD - Department of Urology, Kitasato University School of Medicine.
BACKGROUND: To determine whether the immunosuppressive acidic protein (IAP) could be a useful marker for renal cell carcinoma (RCC), serum IAP levels were compared with clinicopathological features in RCC patients. Furthermore, IAP cutoff level to predict the recurrence was determined using receiver operating characteristics (ROC) curve analysis. PATIENTS IAP was measured in 123 consecutive patients with PCC at Kitasato University Hospital. Ninety-eight patients were received radical surgery and 86 patients were performed as clinically curable renal cell carcinoma (pT1-pT3N0M0). ROC curve analysis was utilized to set the cutoff value of IAP for prediction of cancer recurrence. Significance of prognostic factors in RCC recurrence was analyzed by Cox proportional hazard model. RESULTS: The mean age of the 123 patients was 58.6 years (range 33 to 90, median 59). The mean follow-up period was 24.8 months (range 1 to 78, median 26). The median IAP levels were 447 ug/ml in stage I, 629 ug/ml in stage II, 588 ug/ml in stage III and 1,150 ug/ml in stage IV (p < 0.05). Tumor size and venous involvement were significantly associated with IAP concentrations (p < 0.05). However, tumor grade did not correlate with IAP level. Of 86 patients with clinically curable tumor, 79 patients were disease-free after median follow-up of 27 months. Using ROC curve analysis, IAP cutoff level for prediction of cancer recurrence was set at 620 ug/ml. Disease-free survival rate in patients with preoperative IAP levels of 620 ug/ml or lower was 98.5% (67/68) at 27 months postoperatively, whereas that in patients with IAP greater than 620 ug/ml was 75.0% (12/18). This difference was statistically significant (p < 0.05). Results of multivariate analysis revealed that preoperative IAP and pT stage were statistically significant factors for tumor recurrence after radical surgery (p < 0.05). CONCLUSIONS: The present study indicates that preoperative IAP level is a useful prognostic marker in patients with RCC. In particular, patients with clinically curable tumors (pT1-3N0M0), whose preoperative IAP levels greater then 620 ug/ml may have high risk for recurrence after radical nephrectomy.

26
UI - 12056040
AU - Minowada S; Homma Y; Takeuchi T; Tomita K; Kameyama S; Ohta N; Kitamura
TI - T [Surgical outcomes of nephron-sparing surgery for renal tumors]
SO - Nippon Hinyokika Gakkai Zasshi 2002 May;93(4):555-61
AD - International Medical Center of Japan.
PURPOSE: We retrospectively assessed the surgical outcomes of nephron-sparing surgery (NSS) for patients with renal tumors. PATIENTS on 94 patients with renal tumors. The patients were divided into three groups. Group I comprised of 22 patients who underwent imperative surgeries for renal cell carcinoma (RCC). The tumors were found in 18 patients bilaterally (including 8 patients with von Hippel-Lindau disease), in 3 with solitary kidney, and in 1 with chronic renal failure. The me

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