Search

Background: Partial nephrectomy (PN) for clinical stage T3 tumors is controversial. Radical nephrectomy (RN) has been associated with a greater rate of chronic kidney disease, an increased risk of cardiovascular disease, and increased mortality compared with PN. We present our long-term 2-center experience with PN for stage pT3a tumors and compare the oncologic outcomes with those of similar patients treated with RN., Materials and Methods: We reviewed the data from all patients who had undergone nephrectomy for renal cell carcinoma from 1987 to 2015 in 2 medical centers. The study included 134 patients with pathologic stage T3a tumors, of whom 48 and 86 underwent PN and RN, respectively. We compared the 2 groups (PN and RN) using univariate and multivariate analyses., Results: The tumors of all patients with pathologic stage T3a who had undergone PN had been pathologically upstaged from clinical stage T1 or T2. Univariate and multivariate analyses revealed tumor size was significantly different statistically between the study groups (median, 7.0 cm in RN group vs. 4.0 cm in PN group; P < .001). Surgery type was not a predictor of local recurrence (P = .978), metastatic progression (P = .972), death from renal cancer (P = .626), or death from all causes (P = .974) at the 5-year follow-up point., Conclusion: The results of the present study have shown similar oncologic outcomes between 48 patients with stage pT3a renal cancer who underwent PN and 86 patients who underwent RN. Although PN was not performed on clinical T3a tumors, our findings suggest that PN can also be considered for these tumors and, thus, avoid the long-term complications of RN. However, strict follow-up protocols are mandatory., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Introduction: A relatively high proportion of patients who undergo partial or radical nephrectomy for enhancing renal mass actually have oncocytoma, a benign renal tumor. Several parameters have been shown to be typical for oncocytoma, but only a small number of patients present with these parameters. The aim of our study was to report the clinical, operative and postoperative characteristics of patients who underwent nephron-sparing surgery in our center with a histopathological diagnosis of oncocytoma compared to patients with malignant renal tumor., Patients and Methods: Sixty-three out of 530 patients who underwent nephron-sparing surgery for enhancing renal mass were diagnosed with oncocytoma. Clinical and radiological features and operational data of these patients were compared with patients who had malignant renal tumors., Results: Mean age of patients with histologically proven non-malignant oncocytoma was significantly higher than that in patients with malignant renal cell carcinoma (66.7 vs. 61.4 years). All other analyzed variables showed no significant difference between the 2 groups., Conclusions: No reliable clinical, operative or radiological parameters can differentiate preoperatively between oncocytoma and malignant renal neoplasms., (© 2016 S. Karger AG, Basel.)

Objective: To present our long-term functional and oncological outcomes in open nephron-sparing surgery for complex renal masses., Patients and Methods: We enrolled 584 patients who underwent open partial nephrectomy between January 1995 and May 2014 at our institution; 108 (18.4%) patients had hilar or completely intraparenchymal tumors or both. We compared change in renal function, perioperative complications, and survival outcomes between complex and noncomplex renal masses., Results: Mean tumor diameter was 4.3 and 3.5cm in patients with hilar and completely intraparenchymal lesions, respectively. R.E.N.A.L. nephrometry scores were significantly higher in patients with complex tumors as compared with patients with exophytic tumors. There was no significant difference between mean estimated glomerular filtration rate at last follow-up compared with preoperative mean estimated glomerular filtration rate in any of the groups. The incidence of perioperative complications was similar across all patients groups. Estimated 10-year cancer-specific survival probabilities were 100% in patients with hilar and intraparenchymal tumors. The 10-year recurrence-free survival probabilities were 96% and 95% in patients with hilar and intraparenchymal tumors, respectively. The main limitations include retrospective design and the lack of kidney-specific functional scan., Conclusion: Open nephron-sparing surgery should be considered for complex renal masses yielding excellent functional and oncological outcomes without higher incidence of complications., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: NGAL and KIM-1 are suggested to play a key role in the carcinogenesis and progression of renal cell carcinoma. Attention is currently focused on the potential use of the urinary level of NGAL and KIM-1(uNGAL and uKIM-1, respectively) in making an early diagnosis, establishing a prognosis and determination of the histologic characteristics., Methods: Forty-six patients underwent surgical treatment for renal lesions (n = 37) and for non-functioning kidney (n = 9). uNGAL and uKIM-1 levels were evaluated for clear cell, papillary and chromophobe subtypes of renal cancer patient and also for the control patients. The concentrations were determined by ELISA., Results: uNGAL and uKIM-1 in the control group were not significantly different from those of the patients with kidney cancer. There was no association between tumor size or histologic grade and the uNGAL and uKIM-1 levels. All patients with papillary type RCC had KIM-1 level below 2 ng/mgUcr and uNGAL concentration above 50 ng/mgUcr. Using the same threshold values enables prediction of 100% of patients with chromophobe subtype; 91.6% of the patients with clear cell histology have uNGAL concentration below 50 ng/mgUcr and KIM-1 concentration below 5 ng/mgUce., Conclusion: Combined analysis of uNGAL and uKIM-1 allowed high prediction rate of the histologic subtype of the radiographic-detected masses among cases with kidney cancer. These biomarkers may enable to select the proper therapeutic agents in cases with metastatic disease without the need of pretreatment biopsy.

T5 is a novel splice variant of heparanase, an endo-β-D-glucuronidase capable of cleaving heparan sulfate side chains at a limited number of sites. T5 splice variant is endowed with pro-tumorigenic properties, enhancing cell proliferation, anchorage independent growth and tumor xenograft development despite lack of heparan sulfate-degrading activity typical of heparanase. T5 is over expressed in the majority of human renal cell carcinoma biopsies examined, suggesting that this splice variant is clinically relevant. T5 is thought to assume a distinct three-dimensional conformation compared with the wild type heparanase protein. We sought to exploit this presumed feature by generating monoclonal antibodies that will recognize the unique structure of T5 without, or with minimal recognition of heparanase, thus enabling more accurate assessment of the clinical relevance of T5. We provide evidence that such a monoclonal antibody, 9c9, preferentially recognizes T5 compared with heparanase by ELISA, immunoblotting and immunohistochemistry. In order to uncover the clinical significance of T5, a cohort of renal cell carcinoma specimens was subjected to immunostaining applying the 9c9 antibody. Notably, T5 staining intensity was significantly associated with tumor size (p = 0.004) and tumor grade (p = 0.02). Our results suggest that T5 is a functional, pro-tumorigenic entity.

Background: The occurrence of positive surgical margins (PSMs) after partial nephrectomy (PN) is rare, and little is known about their natural history., Objective: To identify predictive factors of cancer recurrence and related death in patients having a PSM following PN., Design, Setting, and Participants: Some 111 patients with a PSM were identified from a multicentre retrospective survey and were compared with 664 negative surgical margin (NSM) patients. A second cohort of NSM patients was created by matching NSM to PSM for indication, tumour size, and tumour grade., Measurements: PSM and NSM patients were compared using student t tests and chi-square tests on independent samples. A Cox proportional hazards regression model was used to test the independent effects of clinical and pathologic variables on survival., Results and Limitations: Mean age at diagnosis was 61+/-12.5 yr. Mean tumour size was 3.5+/-2 cm. Imperative indications accounted for 39% (43 of 111) of the cases. Some 18 patients (16%) underwent a second surgery (partial or total nephrectomy). With a mean follow-up of 37 mo, 11 patients (10%) had recurrences and 12 patients (11%) died, including 6 patients (5.4%) who died of cancer progression. Some 91% (10 of 11) of the patients who had recurrences and 83% of the patients (10 of 12) who died belonged to the group with imperative surgical indications. Rates of recurrence-free survival, of cancer-specific survival, and of overall survival were the same among NSM patients and PSM patients. The multivariable Cox model showed that the two variables that could predict recurrence were the indication (p=0.017) and tumour location (p=0.02). No other variable, including PSM status, had any effect on recurrence. None of the studied parameters had any effect on the rate of cancer-specific survival., Conclusions: PSM status occurs more frequently in cases in which surgery is imperative and is associated with an increased risk of recurrence, but PSM status does not appear to influence cancer-specific survival. Additional follow-up is needed., (2009 European Association of Urology. All rights reserved.)

Objectives: To determine the feasibility of using serum albumin glutaraldehyde tissue adhesive (BioGlue) to achieve hemostasis and prevent urine leakage during nephron-sparing surgery (NSS)., Methods: From February 1993 to April 2005, 174 NSS operations were performed for renal cell carcinoma at our institute. A total of 143 patients underwent NSS with the traditional suturing technique (suture group) and 31 patients underwent a sutureless BioGlue sealing-only procedure (BioGlue group). We compared the two groups for clinical and tumor characteristics and surgical outcome., Results: The patient and tumor characteristics were similar in both groups. The average maximal tumor diameter was 4.21 cm (range 2.2 to 7) for the suture group and 3.67 cm (range 2 to 6.8) for the BioGlue group. The use of BioGlue reduced the mean warm ischemic time by 8.8 minutes (17.2 versus 26 minutes, P = 0.002). The mean estimated blood loss was 45.1 mL in the BioGlue group and 111.7 mL in the suture group (P = 0.001). Blood transfusion was required in 1 patient (3.2%) of the BioGlue group and 24 (17%) in the suture group (P = 0.014). None of the patients treated with BioGlue developed urinary fistula compared with three (2%) in the suture group., Conclusions: Albumin glutaraldehyde tissue adhesive (BioGlue) alone provided adequate hemostasis during NSS, significantly decreasing the blood loss and transfusion rate, as well as the renal ischemic and operative times. BioGlue was easy to use and safe for sealing the kidney during partial nephrectomy. Future prospective clinical trials are necessary to validate its role during renal surgery.

Purpose: One of the basic principles of nephron sparing surgery for renal cell carcinoma is resection of the tumor with normal tissue margins verified by frozen section analysis. In cases of positive tumor margins the surgeon is committed to complete the local resection or to perform radical nephrectomy. In this study we retrospectively evaluated the yield of frozen section analysis performed during nephron sparing surgeries, especially concerning compatibility with the final histological report and the long-term oncological outcome., Materials and Methods: Between 1988 and 2003, 172 men and 129 women with a mean age of 59 years (range 16 to 83) underwent nephron sparing surgery due to suspected renal tumors. Mean tumor size was 3.56 cm (range 1 to 12.5). Frozen section analysis was routinely performed during surgery., Results: Positive tumor margins in frozen section analysis were found in 2 cases (0.7%). In both cases the tumor was centrally located. Those 2 patients underwent immediate radical nephrectomy but no residual tumor was subsequently found in the radical nephrectomy specimens. Paraffin sections disclosed positive tumor margins in 4 other cases (1.3%) in whom the frozen section analysis had shown tumor negative margins. Of the 4 patients 1 underwent radical nephrectomy for tumor recurrence after 9 months. The other 3 patients showed no evidence of disease recurrence after 26, 59 and 120 months of followup., Conclusions: Our results suggest that frozen section analysis during nephron sparing surgery has minimal clinical significance and hence routine incorporation in urological practice should be reconsidered.

Aim: A contemporary review of the indications, techniques and outcome of the nephron sparing surgical approach in the management of solid renal masses., Material and Methods: Pertinent articles were reviewed using the MEDLINE., Results: Nephron sparing surgery is increasingly being used to treat patients with solid renal lesions. The technical success rate of nephron sparing surgery is excellent, and operative morbidity and mortality are low. For renal cell carcinoma, long-term cancer-free survival is comparable to radical nephrectomy, particularly in patients with low stage disease. The reported incidence of multifocal renal cell carcinoma is approximately 15%, and it depends on tumor size, histology and stage. The risk of multifocal disease is low (less than 5%), when the maximal diameter of the primary tumor is 4 cm or less. Minimally invasive modalities of tumor resection or destruction show promising results, however they should be reserved for selected patients and await improvement in technology. Only when long-term follow-up data is available these methods might become routine clinical practice., Conclusions: Nephron sparing surgery provides effective therapy for patients in whom preservation of renal function is a relevant clinical consideration. Accumulating data in appropriately selected patients suggest a long-term functional advantage gained by the maximal preservation of unaffected renal parenchyma without sacrificing cancer control.

Objective: To evaluate the feasibility of using combined clinical and histomorphometric features to construct a prognostic score for the individual patient with localized renal cell carcinoma., Patients and Methods: We studied 39 patients with pT1 and pT2 RCC who underwent radical nephrectomy between 1974 and 1983. Univariate and multivariate analyses were used to determine the association between various prognostic features and patient survival., Results: The most important and independent predictors of survival were tumor angiogenesis (P = 0.009), nuclear DNA ploidy (P = 0.0071), mean nuclear area (P = 0.013), and mean elongation factor (P = 0.0346). Combination of these variables enabled prediction of outcome for the individual patient at a sensitivity and specificity of 78% and 89%, respectively., Conclusion: Our results indicate that no single parameter can accurately predict the outcome for patients with localized RCC. Combination of neovascularity, DNA content and morphometric shape descriptors enabled a more precise stratification of the patients into different risk categories.

During recent years the use of the new imaging techniques, ultrasonography and computerized tomography, has increased. The accessibility to these methods has changed the pattern of detection of renal lesions. Over 90% of renal masses are now discovered incidentally, while investigating nonurological symptoms. Therefore, most lesions are discovered in their early stages. The gold-standard procedure for removing renal masses is radical nephrectomy, which ensures complete removal of an organ-confined lesion, but involves loss of functional tissue. This might be critical in patients with a single kidney, or reduced nephron function. There are several diseases characterized by multiple renal lesions, such as Von Hippel-Lindau and tuberous sclerosis in which radical treatment may lead to chronic dialysis in young patients. Nephron-sparing surgery was developed in order to preserve as much functional tissue as possible while removing safely any suspicious renal lesion. This new technique, not involving radical surgery, should be evaluated in cases of renal tumors for its ability to achieve the same cancer cures rates. We present our experience with our first 50 patients who underwent nephron-sparing surgery for removal of renal lesions.

Unlabelled: The purpose of this study was to evaluate the amount of functioning renal mass removed and the amount of remaining individual renal function after tumor enucleation., Methods: Renal functional volume, percentage injected dose (%ID) per cubic centimeter of renal tissue and individual renal uptake of 24 operated and 24 contralateral kidneys were studied by two sequential SPECT quantitations of 99mTc-dimercaptosuccinic acid (DMSA) uptake by the kidneys (QDMSA). The first study was before surgery and the second study was 1 to 6 mo (mean 3.5 mo) after surgery. Mean tumor size was 3.4 +/- 0.99 cm and all tumors were confined to the renal parenchyma (stages pT1 and pT2)., Results: In the operated kidneys, there was a statistically significant decrease in renal cortical volume (170 +/- 46 mL after surgery versus 207 +/- 45 mL before surgery, t = 6.2, P < 0.001) and individual renal uptake (10.3% +/- 3.0% after surgery versus 13.0% +/- 2.9% before surgery, t = 5.4, P < 0.001). There was no statistically significant change after surgery compared with before surgery in the %ID per cubic centimeter of renal tissue of the operated kidneys, and in the volume, %ID per cubic centimeter and uptake of the contralateral normal kidneys., Conclusion: The results suggest that QDMSA is a noninvasive method able to assess changes in separate renal function. The limited functioning parenchymal loss after tumor enucleation had no effect on the opposite kidneys.

T-cell subpopulations were evaluated in 10 patients with metastatic renal cell carcinoma treated with recombinant interleukin-2, recombinant interferon-alpha, 5-fluorouracil, and vinblastine. T-cell subpopulation was tested by flow cytometry, and the results were compared with healthy control subjects. Mean T-cell values before treatment as compared with control were as follows: CD3, 68 vs. 73%; CD4, 34 vs. 53%; CD8, 38 vs. 31%; CD4/CD8, 1.1 vs. 1.8; CD4CD69, 20 vs. 47%, and CD8CD69, 24 vs. 19%. The difference in CD4, CD4/CD8, and CD4CD69 was statistically significant. After treatment (8 weeks), the values of CD4/CD8 ratio and CD4CD69 increased. Three patients achieved complete response, two partial response, and two had stabilization of the disease. After treatment, the CD4/CD8 ratio increased in complete responders, from 1.1 to 2.0, and CD4CD69 increased in complete and partial responders, from 11 to 37% and 23 to 31%, respectively. In nonresponders, no similar change was observed. In conclusion, increases in CD4/CD8 ratio and CD4CD69 levels in metastatic renal cell carcinoma patients may be associated with response to immunochemotherapy.

Objectives: To determine the relationship between angiogenesis and various histopathologic features as well as clinical outcome in patients with localized renal cell carcinoma (RCC)., Methods: Microvessel density was quantified by using immunocytochemical staining of endothelial cells for factor VIII-related antigen of 36 specimens taken from patients with pathologic Stage pT1 or pT2 RCC. All patients underwent radical nephrectomy and were followed for a mean time of 97.3 months., Results: No association was noted between microvessel count (MVC) and either cell type, architecture, or tumor size. Inverse correlation was noted between MVC and nuclear area (P = 0.006), nuclear elipticity (P = 0.016), nuclear roughness (P = 0.039), and histologic grade (P = 0.047). Patients having tumors with low MVC had significantly better survival rate compared with those with high MVC neoplasms (P = 0.0014, by Cox proportional hazards method)., Conclusions: Despite lack of correlation with known predictors of survival, MVC provides independent prognostic information for patients with localized RCC.

Objective: To evaluate the feasibility of using nuclear morphometry of primary renal cell carcinoma to differentiate cases with localized tumors from those with metastases., Methods: Using an interactive image analysis system, nuclear morphometry was performed on hematoxylin- and eosin-stained slides of 40 primary renal tumors. There were 18 cases with organ-confined disease and 22 with advanced stage., Results: The most significant shape descriptor to differentiate between the two groups was mean nuclear regularity factor (889.5 +/- 24.4 vs. 701.1 +/- 157.3, p = 0.00015). The combination of mean nuclear area and mean nuclear regularity factor enabled accurate prediction of metastatic potential in 36 (85%) cases., Conclusion: Nuclear morphometry measured by image analysis provides prognostic information on patients with renal cell carcinoma.

Objective: To evaluate the prognostic significance of vimentin intermediary filament expression by tumour cells in patients with renal cell carcinoma (RCC) localized to the kidney., Patients and Methods: Thirty-nine patients with localized RCC (pT1,pT2) were assessed in a retrospective study. Tumour cells were evaluated immunohistochemically for vimentin, epithelial membrane antigen (EMA) and polyclonal cytokeratin expression. The prognosis of cases expressing positive vimentin expression in tumour cells was compared with that of cases with no expression. Additional clinical information and conventional histological grade of the tumours were also included in the survival analysis., Results: Univariate analysis of patient survival and tumour recurrence showed a statistically significant association between vimentin-positive tumours and poor patient outcome; the EMA stain showed borderline significance and histological grade was significantly associated with prognosis. The combination of tumour vimentin expression and histological grade provided a better predictor of prognosis and proved to be the best independent prognosticator of survival by multivariate analysis., Conclusions: Vimentin expression by tumour cells provides important prognostic information for patients with localized RCC; the combination of vimentin expression and histological grade is a better predictor for survival than grade or vimentin expression alone.

Purpose: We investigated the influence of tumor size on clinical outcome in patients with localized renal cell carcinoma treated with radical nephrectomy., Materials and Methods: We reviewed retrospectively the records of 54 patients with pathological T1, T2 renal cell carcinoma for age, sex, histological grade, cell type, architecture, deoxyribonucleic acid ploidy pattern, nuclear morphometry and vimentin expression. Variables found to predict outcome were correlated with tumor size, which was further tested for its prognostic value., Results: The best predictors of prognosis were grade, ploidy pattern, nuclear morphometry and vimentin expression. Small (less than 5 cm.) and large (larger than 5 cm.) tumors had similar distribution of prognostic variable subgroups. No differences in progression rate or survival were noted between the tumor size categories., Conclusions: These results suggest that small renal tumors may follow unfavorable courses and require aggressive treatment.

Nuclear parameters were assessed by computer-assisted image analysis in the cells of abnormal epithelial formations in the acquired cystic kidneys of two dialysis patients, the proximal and distal tubules of a normal kidney and two well differentiated renal cell carcinomas. One acquired cystic kidney contained many small clear celled foci and am 0.9 cm-size clear celled lesion and the second one a papillary microadenoma. The clear celled lesion was cytologically indistinguishable from the carcinomas. The histomorphometrically gauged nuclear parameters were maximal and minimal ferret diameters, averaged ferret diameter, aspect ratio, shape factor, area, volume and specific length and width. Statistical evaluation evidenced that the nuclear area, volume, aspect ration and shape factor allowed for the distinction between benign and malignant epithelial structures. The medians of the nuclear parameters of atrophic tubules, cysts, clear celled foci, papillary adenoma and clear celled lesion in the two acquired cystic kidneys deviation from those of normal renal tubules and in, increasing order of disparity, approached those of the carcinomas.

Objectives: To determine the interrelationship of histological grade and nuclear morphometry and to compare their prognostic significance in patients with localized renal cell carcinoma (RCC)., Patients and Methods: A retrospective prognostic study of 39 patients with localized (pT1, pT2) RCC was performed. Conventional histological grade and nuclear morphometry were assessed independently and the correlation between these grading systems and their impact on the patients' outcome were evaluated., Results: Histological grade and the nuclear morphometric variables were significantly correlated: the strongest association was that between grade and the nuclear regularity factor. The best predictor of disease-free interval and survival (by univariate analysis) was the combination of nuclear area and nuclear elongation factor, followed by conventional tumour grade, nuclear elongation factor, nuclear regularity factor and nuclear area. However, a multivariate analysis showed that the only independent prognosticator for survival was the combination of nuclear area and nuclear elongation factor., Conclusions: This study indicates that nuclear morphometry is prognostically superior to histological grade in patients with localized RCC.

The authors present a case of renal cell carcinoma in a man with a solitary kidney. Three-dimensional computerized tomography instead a selective renal angiography was used preoperatively as a noninvasive technique for visualization of the renal tumor and renal vascularization.

Background: More than one-third of patients with localized renal cell carcinoma (RCC) will have disease progression after nephrectomy. Present histopathologic variables cannot accurately predict the outcome of individual patients., Methods: Nuclear morphometry was performed by an image analyzer on histologic sections from 39 specimens of pathologic T1 and T2 classification RCC. All patients underwent radical nephrectomy and were followed for a mean of 7.6 years. A univariate analysis and then a multivariate stepwise regression method were used to correlate results with patients' outcome., Results: The best predictors of disease free interval were mean nuclear elongation factor (MNEF) (P = 0.023), mean nuclear regularity factor (MNRF) (P = 0.034), and mean nuclear area (MNA) (N = 0.038). Univariate analysis identified a significant correlation between patient survival and MNEF (P = 0.009), MNRF (P = 0.020) and MNA (P = 0.023). Combination of MNEF and MNA was even more strongly associated with survival (P = 0.0013). Multivariate analysis revealed that MNA (P = 0.044) and MNEF (P = 0.045) correlated independently with survival., Conclusion: These results suggest that nuclear morphometry provides objective independent prognostic information for patients with localized RCC.

Objectives: Ipsilateral adrenalectomy is traditionally advocated as part of radical nephrectomy performed for renal cell carcinoma. The current study addresses the controversy of whether ipsilateral adrenalectomy should be performed routinely during radical nephrectomy., Methods: A total of 225 patients were treated surgically for renal cell carcinoma over an 18-year period. Of these patients, 158 underwent nephrectomy and simultaneous ipsilateral adrenalectomy and the other 67 had sparing of the ipsilateral adrenal gland. A retrospective analysis of the medical records and assessment of the clinical and the pathologic data were performed. Rates of survival and progression were evaluated in a subgroup of 109 patients, further subdivided into 54 patients who underwent concomitant adrenalectomy and 55 patients with the ipsilateral adrenal preserved during surgery., Results: Histopathologic abnormalities were detected in seven adrenal specimens (4.4%); however, only 3 patients (1.9%) had involvement of the adrenal by renal cell carcinoma. All cases of adrenal involvement were detected by the preoperative imaging modalities. Ipsilateral adrenalectomy did not improve the outcome in comparison to adrenal preservation., Conclusions: In view of the rarity of ipsilateral adrenal metastasis, the questionable prognostic merits of concomitant adrenalectomy, and the availability of accurate imaging modalities, we conclude that ipsilateral adrenalectomy is not necessary in the majority of the patients undergoing radical nephrectomy for renal cell carcinoma.

Background: The course of patients with renal cell carcinoma may be considerably different. Approximately 50% with presumed localized disease have metastases after nephrectomy. Pathologic stage at diagnosis, histologic grade, and histologic type have been considered the most important predictors of prognosis. Nevertheless, subsets of patients within a specified stage and grade may have considerable differences in disease progression and survival., Methods: Flow cytometric nuclear DNA analysis was used to study pathologic Stage I or II renal cell carcinoma in 54 patients who underwent radical nephrectomy between 1974 and 1983., Results: Sixty-three percent of the tumors were diploid, and 37% aneuploid. A DNA diploid pattern was more common among Stage I tumors than Stage II tumors (69% versus 33%; P < 0.04). Progression occurred in 31% of the diploid tumors, whereas among the aneuploid group the progression rate reached 59% (P < 0.06). Considered as a single indicator, DNA ploidy pattern was strongly associated with patient survival. Ten years after surgery 79% of the patients who had diploid tumors and 50% of those with aneuploid tumors were alive (P < 0.02)., Conclusions: Nuclear DNA ploidy may serve as an important prognostic variable for patients with early stage renal cell carcinoma.