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Zusammenfassung Einleitung In den letzten Jahrzehnten ist eine steigende Inzidenz des Nierenzellkarzinoms zu beobachten. Bedingt durch die verbesserten bildgebenden Verfahren und deren häufigeren Einsatz kommt es gleichzeitig zu einer vermehrten Diagnose kleiner Tumoren im Stadium pT1. Es ist jedoch bekannt, dass auch kleine Nierentumore spät rezidivieren und metastasieren können. Die Fragestellung der vorliegenden Studie ist es, unkompliziert zu erhebende klinische und histopathologische Faktoren für die Prognoseeinschätzung kleiner Nierentumore zu identifizieren. Patienten/Methoden Es erfolgte die retrospektive Analyse aller Patienten, die im Zeitraum zwischen 1993 – 2007 an einem Einzelzentrum aufgrund eines pT1-Nierenzellkarzinoms operiert wurden. Klinische und histopathologische Parameter wurden hinsichtlich ihres Einflusses auf das Rezidiv-freie Überleben (RFS), Karzinom-spezifische Überleben (CSS) und das Gesamtüberleben (OS) mittels Kaplan-Meier-Analyse, univariater und multivariater Cox-Regressionsanalyse untersucht. Ergebnisse Insgesamt konnten die Daten von 571 Patienten erhoben werden. Das mediane Follow-up betrug 111 Monate. Die Rezidivrate betrug 7,2 %, 15 % der Rezidive traten nach über 10 Jahren auf. Bezogen auf das RFS zeigten sich höheres Grading (p = 0,031) und Stadium pT1b (p In der multivariaten Analyse zeigte sich das Stadium pT1b als einziger prädiktiver Faktor für ein schlechteres RFS (p = 0,001) und CSS (p = 0,009). Hinsichtlich des Gesamtüberlebens waren Multifokalität (p = 0,041) und das Vorhandensein eines Diabetes mellitus (p Schlussfolgerung Die beschriebenen prognostischen Parameter können helfen, die Nachsorge von Patienten mit kleinen Nierentumoren risikoadaptiert anzupassen.

INTRODUCTION: Transurethral resection of the bladder (TURB) is one of the most common surgical treatments in urology. We examined the TURBs that had been carried out during one year for suspected bladder cancer (first findings and recurrence) and then analysed the further clinical courses of these patients within the first twelve months after TURB. MATERIALS AND METHODS: We recorded retrospectively the course of 160 patients in whom altogether 210 elective TURBs had been performed in our clinic between April 2007 and March 2008 (observation period). In addition, the patients’ further clinical course within the first twelve months after TURB was recorded (follow-up period). All initial and recurrence TURB were carried out with photodynamic diagnosis; the histological evaluation was performed at a university centre. RESULTS: 71 % of the 118 initial resections performed during the observation period showed urothelial cell carcinoma of the bladder - pTa (61 %), pT1 (20 %), pT2-4 (17 %), Cis (2 %) while 60 re-TURBs in the whole period detected 17 % residual tumours. According to the guidelines, 18 patients (14 %) received instillation therapy with mitomycin C, 32 patients (25 %) with Bacillus Calmette-Guerin (BCG). Cystectomies were performed on 23 patients (18 %). 18 TURBs after suspected recurrence in the follow-up period confirmed recurrence in 28 %, which represents a recurrence rate of 4 %. In the same period 5 patients (4 %) developed distant metastases, two patients (2 %) died. Two patients (7 %) with initially benign findings developed bladder cancer in the follow-up period. CONCLUSION: We present an analysis of TURBs performed at a university centre. When bladder cancer is diagnosed in 7 % within one year after urocystitis has been detected in the initial TURB findings, regular follow-up examination of these patients, especially with certain risk profiles, has to be discussed.

PURPOSE: T1G3 bladder cancers show the clinical and biological behaviour of muscle invasive tumours with progression rates of about 30 %. While radical cystectomy in some cases is indicated, other patients can achieve healing with organ preservation. We present a study analysing the influence of the risk factors multifocality, tumour diameter ≥ 3 cm and associated carcinoma in situ (Cis) on the outcome of initial T1G3 bladder cancers treated in various ways. MATERIALS AND METHODS: Of 223 patients with initial T1G3 bladder cancer, 125 patients underwent transurethral resection of the tumour (TURB), second resection and adjuvant bacille Calmette-Guerin (BCG) instillations (TURB group), 98 patients chose initial radical cystectomy (CX group). RESULTS: Median follow-up times were 56 months (TURB group) and 51 months (CX group). 5- and 10-year survival rates (82 % and 65 % in TURB group vs. 75 % and 48 % in CX group) did not show statistically significant differences. In Cox regression analysis no single risk factor showed a prognostic value. While in TURB group the combination of all risk factors (multifocality, tumour diameter ≥ 3 cm and associated carcinoma in situ) was associated with a statistically significantly lower survival rate, the same combination in the CX group was not oncologically relevant. CONCLUSIONS: While initial T1G3 bladder cancer with up to two risk factors after organ-preserving therapy is not associated with a lower tumour specific survival rate in comparison to radical cystectomy, patients with a combination of the three analysed risk factors would profit by an early radical cystectomy.