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Background: Although the NWTSG and SIOP studies have included the largest number of patients, several individual institutions have made likewise important contributions to the optimization of Wilms' tumor therapy. The purpose of this study is to present our personal experience obtained in the last 42 years by treating Wilms' tumor in childhood., Patients and Methods: Throughout the period 1965-2006, 65 children with histological confirmation of Wilms' tumour were treated in the Department of Urology, University of Erlangen Medical Centre. The records of all patients presenting to our institution with Wilms' tumour were examined., Results: The results obtained by this study group indicate that prognosis according to age demonstrated no significance, but prognosis according to tumor size, lymph node involvement and distant metastasis was significant. After a 10-year follow-up, our data revealed an 89.4% survival rate. Furthermore, the statistical evaluation performed in order to evaluate the significance of surgical complications following neoadjuvant therapy in comparison to non adjuvant therapy, indicates that there is a significant increase in complications in patients who are not treated with neoadjuvant therapy., Discussion: Although clinicians in the U.S.A. and Europe have different philosophies on preoperative chemotherapy, most patients with Wilms' tumor survive long term, regardless of the sequence of therapeutic interventions. In the absence of a clear choice between up-front nephrectomy and preoperative chemotherapy, it is reasonable to base the timing of resection on factors such as tumor size, the patient's clinical condition, and the experience of the surgeon.

Purpose: The aim of this study was to discover if elderly patients exhibit comparable outcomes and survival benefits to those achieved in younger patients., Materials and Methods: We assessed 35 patients over 80 years old treated by radical nephrectomy or nephroureterectomy for malignant and inflammatory conditions within the previous 4 years. A multivariate analysis regarding survival and recovery was conducted and included various preoperative parameters. The subjective opinion of patients or patient's relatives (in cases where the patient had past away) was estimated by answering the following questions: (a) are you satisfied with your decision to undergo the operation? (b) would you undergo it once more if needed? (c) would you advise it to a patient your age?, Results: The median age was 83.5 years. Radical nephrectomy with a flank approach was performed in 65.7% of cases and nephroureterectomy with a transabdominal approach in 34.3% of cases. The median recovery was 13 weeks. During a median follow-up of 31 months (range 12 to 53), 80% of patients were disease free. The remaining 20% passed away demonstrating a median survival of 25 months (range 13-38). Eighty-eight percent of patients were satisfied with their decision to undergo the operation, 91.4% would undergo it once more if needed and 91.4% would advise it to a patient their age., Conclusions: Radical nephrectomy and nephroureterectomy are safe and effective in well-selected patients over 80 years old. Elderly patients exhibit comparable preoperative outcomes and survival benefits to those achieved in younger patients. Various preoperative clinical variables that effect the survival of patients but not their recovery could be identified.

Wilms tumor can appear with a wide spectrum of morphologic features and can sometimes cover or delay the recognition of other clinicopathologic entities of the kidney. We present a case of a new tumor entity of the kidney, namely the anaplastic sarcoma of the kidney, a tumor of high malignancy.

Introduction: Recent studies suggest that RCC detected in young adults is likely to be more symptomatic and potentially aggressive, since young patients are less likely to undergo radiologic examinations unless they have symptoms. The aim of this study is to identify the clinical, biological and histological entities of RCC in young patients, and to compare survival rates for symptomatic and asymptomatic patients., Patients and Methods: A review of 2,510 records of patients with RCC from 1965 to 2007 was conducted. Thirty-four patients under 35 years old were identified. The Kaplan-Meier system was used to calculate the cumulative survival rate at five and ten years post-surgery as well as the survival prognoses for patients who presented with symptoms and for patients for whom RCC was incidentally diagnosed., Results: The differences in cumulative survival rates at five and ten years between patients who presented with symptoms and patients whom RCC was incidentally diagnosed were not significant (P = 0.06). The Kaplan-Meier system used to calculate the cumulative survival rate at five and ten years postsurgery yielded survival rates of 79.4% at five years and 73.5% at ten years, respectively., Discussion: The biological and histological entities as well as the survival prognosis for RCC in young patients are similar to those for patients who present with RCC in the sixth and seventh decades of life. Additionally, young adults are likely to be more symptomatic, but the difference in survival between patients with symptoms and those without symptoms is not statistically significant.

Wilms' tumors develop from persistent, primitive metanephrogenic stem cells. Their biology and etiology in adults is still unknown even though remnants of primitive metanephrogenic tissue, which tends to malignancy, is suspected, and there are very few scientific studies on the biology of Wilms' tumors in adults. Such a tumor occurs at a rate of 0.2/million adults in Europe and the USA. In this article, we describe the course of the disease in two adults with histologically confirmed Wilms' tumors. Both patients underwent a radical nephrectomy followed by chemotherapy as indicated by the SIOP nephroblastoma study.

Purpose: Monoclonal antibodies are a novel treatment option for certain tumor patients. We evaluated the potential of antibody derivatives against epidermal growth factor receptor and G250, which are 2 candidate antigens on renal cell carcinoma, to recruit effector cells for killing renal cell carcinoma., Material and Methods: As a measure of cytotoxicity, 51chromium release assays against renal cell carcinoma lines were performed using unseparated blood or isolated cell populations as the source of effectors. Blood was obtained from healthy donors, or from patients receiving granulocyte-macrophage colony-stimulating factor or granulocyte colony-stimulating factor for enhancing effector cell function. Parental human IgG1 antibodies against epidermal growth factor receptor and G250 were compared with respective chemically linked bispecific antibodies targeting IgA Fc receptor FcalphaRI (CD89), a novel cytotoxic trigger molecule on polymorphonuclear cells and monocytes/macrophages, which were constructed by chemically crosslinking appropriate F(ab') fragments., Results: Renal cell carcinoma lines were highly resistant to complement dependent lysis. With mononuclear effector cells high levels of renal cell carcinoma killing were observed with a humanized epidermal growth factor receptor directed monoclonal antibody, while the same antibody did not recruit granulocytes (polymorphonuclear cells) for antibody dependent cell mediated cytotoxicity. However, polymorphonuclear cells effectively lysed renal cell carcinoma with [FcalphaRI x epidermal growth factor receptor] bispecific antibody. FcalphaRI mediated killing was significantly enhanced when the blood of patients on granulocyte colony-stimulating factor or granulocyte-macrophage colony-stimulating factor therapy was analyzed. However, G250 mediated only low levels of killing with mononuclear cell but not with polymorphonuclear effector cells., Conclusions: Targeting epidermal growth factor receptor proved to recruit efficiently mononuclear or polymorphonuclear cell mediated killing mechanisms, while G250 directed antibody constructs were significantly less effective. Particularly effective renal cell carcinoma killing was observed with combined [FcalphaRI x epidermal growth factor receptor] bispecific antibody and granulocyte colony-stimulating factor or granulocyte-macrophage colony-stimulating factor.

Background: Given the growing evidence that proliferation indices may be of prognostic significance in renal cell carcinoma and that parameters of cell loss (usually, but not exclusively due to programmed cell death) are biologically relevant, identification and quantitation of apoptosis and possible regulatory factors are of considerable clinical importance., Materials and Methods: Apoptotic cells were identified and quantified in a series of 87 curatively-resected (R0) renal cell carcinomas using the in situ end labeling method in combination with morphological criteria. The proliferative activity was determined by immunohistochemical assessment of the MIB-1 (Ki-67)-and proliferating cell nuclear antigen (PCNA). The immunoreactivity of p53 was analysed using the DO7 antibody. Immunostaining of p53 has been linked to the accumulation of mutant p53 protein. The results obtained were compared with UICC pathohistological stage and grade and finally with disease-related survival rate., Results: In each carcinoma examined, we could demonstrate apoptosis of varying degrees with in a range from 1 to 19 and with a median of 5. Immunostaining of p53 suggested the presence of mutant p53 in 24/87 (28%). A reciprocal correlation was found between apoptosis and p53-positivity in terms of significantly less apoptosis in p53-positive tumors. Positive statistical correlations were seen between the tumor grade and MIB-1/PCNA positivity and apoptosis. In univariate survival analysis, stage and grade, MIB-1 and PCNA index and apoptotic index were significantly related to prognosis. Multivariate Cox disease-related survival analysis revealed that stage of disease and MIB-1 were significant independent prognostic factors., Conclusions: These results indicate that apoptosis and cell proliferation are strongly related in renal cell carcinoma and that the presence of mutant p53 seems to be a negative regulator of apoptosis. In univariant survival analysis, apoptosis was, in addition to other parameters, of prognostic significance. However, multivariate analysis found that only the stage of the disease and MIB-1 were independent prognostic factors.

A combination of increased perioperative morbidity, together with the technical difficulty of an R 0 (curative) resection, is responsible for the poor prognostic factors of supradiaphragmatically extending renal tumors. Six patients aged 53-70 years with vena cava thrombosis extending into the right atrium or ventricle underwent en bloc resection of the primary tumor and tumor thrombus removal. If the atrial tumor mass was large or extended into the ventricle, resection was performed during cardiopulmonary arrest using a cardiopulmonary bypass method with the patient in deep hypothermia (< 18 degrees C). Alternatively if the cardiac tumor infiltration was minimal, resection was performed during an optionally short cardiopulmonary arrest period using a cardiopulmonary bypass method with the patient in hypothermia (23 degrees C). The operative procedure was determined by intracardiac tumor extension, tumor wall adhesions and tumor wall infiltrations, all of which were assessed intraoperatively by vena cava sonography. Six patients were strongly symptomatic preoperatively. Three developed sudden life-threatening cardiopulmonary insufficiency, possibly due to longer-lasting tricuspital valve prolapse with a consecutive right-to-left shunt through a newly reopened foramen ovale. One patient died 14 months postoperatively because of multiple metastases (hepatic, pulmonary and bone). One patient is still alive and has had a local recurrence for 2 months, which was diagnosed 65 months postoperatively. The remaining four patients are alive and well. They have been tumor-free for extended periods of time (29, 34, 62 and 84 months, respectively).

Background: The prognosis for patients with renal cell carcinoma depends mainly on pathological stage and grade of the tumor at the time of surgery. Cellular proliferation may prove to be another measure for predicting biologic aggressiveness and, therefore, the prognosis., Methods: The authors compared four different methods to assess proliferation in a series of 87 curatively resected (R0) renal cell carcinomas: flow cytometry analysis (FCM), silver-stained nucleolar organizer regions (AgNOR), and immunohistochemical assessment of the MIB-1 (Ki-67) antigen, and proliferating cell nuclear antigen (PCNA). The results obtained were compared with pathologic stage (according to the International Union Against Cancer [UICC]) and grade with disease-related survival rate; finally, we assessed whether the methods led to similar results., Results: In each carcinoma examined, we could demonstrate MIB-1, PCNA, and AgNOR dots in varied proportions. Statistical correlations were seen between the tumor grade, the rate of nuclear positivity for MIB-1 and PCNA, and the number of AgNOR dots. Additionally, the MIB-1 index was significantly higher in more advanced tumor stages. A good correlation between MIB-1 and AgNOR as well as for PCNA was found. In univariate survival analysis, tumor stage and grade, MIB-1 and PCNA index, and mean AgNOR number were related significantly to patient survival. On multivariate Cox disease-related survival analysis, stage of disease and MIB-1 were significant independent prognostic factors. Flow cytometry was not related to prognosis nor to other examined parameters., Conclusions: These results indicated that MIB-1 immunostaining is an additional prognostic parameter for patient outcome. MIB-1 and PCNA immunostaining, as well as AgNOR, demonstrated good correlations among themselves. We failed to establish flow cytometry as a method to predict proliferative capacity or prognosis in renal cell carcinoma patients.

We report on 149 patients with supravesical urothelioma (transitional cell carcinoma of the upper urinary tract) treated in our hospital during the years 1967-1991. The introduction shows the distribution of sex and age as well as the localization of the tumor. Main topic of this paper is a new definition of the clinical pathology of supravesical urothelioma by means of the TNM classification published 1987. Based on the pathological pioneer work of P. Hermanek our results are as follows: during the first diagnosis pT3 predominates with 30.2%, followed by pT1 with 25.5% and pTa, pT1 and pT4 with a relatively low incidence. G2 predominates with 47.7%; G1 and G3 have almost the same frequency. The G/pT ratio shows a decreasing linearity for G1 from pTa to pT4; for G2 there is equivalence of pT1-pT3; and pTa and pT4 are relatively rare. With respect to G3, pT3 predominates with 51%, followed by pT4, pT1 and finally pTa with zero frequency. The G/M ratio shows M0 only for G1, 10% M positive for G2 and 15% M positive for G3. The 10-year survival rate for patients with R0 resection and stage pTa is 64% and for pT1-pT4, 33-36%. The 10-year survival rate for patients with G1 tumor is 51%, and that for G3 tumors 30%. Multicentric occurrence and carcinoma in situ have no prognostic significance in our sample. As is well known, papillary growth has a better prognosis than solid infiltration.(ABSTRACT TRUNCATED AT 250 WORDS)

Oncocytomas represent a special category of renal tumors which can be clearly separated from the renal cell carcinomas by their typical histological presentation as well as by their clinical course. A clear cut preoperative diagnosis based on sonography, CT and angiography, however, is not yet possible. Between 1981 and 1990 16 patients (4 men, 12 women) with a mean age of 65 years underwent a radical tumor nephrectomy, with the histopathological diagnosis of an oncocytic adenoma, whose clinical and pathomorphological parameters were completely evaluated. Oncocytomas are rare, although increasingly found, tumors of the kidney with a benign clinical course. Up to date the treatment for these tumors has been nephrectomy, only rarely extirpation.

What is the benefit of an extended dissection of the regional lymph nodes in the treatment of renal cell carcinoma (RCC)? We evaluated the results of 511 consecutive patients which we operated on RCC. The data of 320 patients (SLD) who had an extended dissection of the regional lymph nodes have been compared with those of 191 patients (FLD) who had a dissection of none or only of a few nodes for staging reasons. All patients were nephrectomized under curative intent (M0) with a transabdominal approach. 1. The incidence of N+ in the SLD group was 17.5% and 10% in the FLD group. 2. The overall 5-year survival rates were 58% after FLD and 66% after SLD, the 10-year survival rates 38% after FLD and 54% after SLD (p less than 0.01). 3. The perioperative mortality of patients with extended dissection was 0.9%. We conclude from our data that the extended dissection of the regional lymph nodes significantly improves the prognosis of patients which were operated for RCC.