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Background: The objective of the present study was to investigate the significance of microscopic venous invasion (MVI) as a prognostic factor for patients with renal cell carcinoma (RCC) who underwent radical surgery. Methods: The study included a total of 157 consecutive patients with non-metastatic RCC who underwent radical surgery between January 1986 and December 2002. The median follow-up period was 45 months (range 6-162 months). Microscopic venous invasion was defined by the presence of a cancer cell in blood vessels based on the examination of hematoxylin-eosin stained specimens. Other prognostic variables were assessed by multivariate analysis to determine whether there was a significant impact on cancer-specific and recurrence-free survivals. Results: Microscopic venous invasion was found in 70 patients, and of this number, 17 (24.7%) developed a tumor recurrence and 12 (17.1%) died of cancer progression, while only six (6.9%) of the remaining 87 patients without MVI presented with disease-recurrence and three (3.5%) died of cancer. Among the factors examined, the presence of MVI was significantly associated with age, mode of detection, tumor size, pathological stage and tumor grade; however, only pathological stage was an independent predictor for disease-recurrence, and none of these factors were available to predict cancer-specific survival in multivariate analyses. In 120 patients with pT1 or pT2 disease, MVI was noted in 36 patients. In this subgroup, recurrence-free survival rates in patients with MVI were significantly lower than those in patients without MYI, and MVI was the only independent prognostic predictor for disease-recurrence in a multivariate analysis. Conclusion: Microscopic venous invasion is not an independent prognostic factor in patients with non-metastatic RCC who underwent radical surgery; however, it could be the only independent predictor of disease-recurrence after radical surgery for patients with pT1 or pT2 disease. [ABSTRACT FROM AUTHOR]

Background : The objective of this study was to compare clinical outcomes between patients with symptomatic and incidental renal cell carcinoma (RCC) experienced in a single institution in Japan. Patients and methods : We reviewed the records of 178 consecutive patients who underwent radical or partial nephrectomy for RCC at our institution between April 1984 and March 2002. Several clinicopathological factors of these patients were analyzed according to the mode of presentation at initial diagnosis; that is, symptomatic or incidentally detected RCC. Results : Of the 178 patients, 102 (57.3%) were incidentally discovered. Significant differences between incidental and symptomatic tumors were observed in maximal tumor diameter, distant metastasis, tumorgrade, stage and microscopic venous invasion. Cause-specific survival in patients with incidental tumor was significantly higher than that in those with symptomatic tumor. Moreover, multivariate analysis demonstrated that maximal tumor size, metastasis, and the mode of presentation could be used as independent prognostic predictors in patients undergoing surgical resection of RCC. Conclusion : These findings suggest that incidentally detected tumors are of significantly lower stage and grade than symptomatic tumors, resulting in better survival patients with incidental tumor. Therefore, detection of RCC before symptom onset may contribute to an improved prognosis in RCC patients. [ABSTRACT FROM AUTHOR]

To determine whether the degree of oxidative DNA damage in renal cell carcinoma (RCC) can be used as a useful prognostic predictor for patients who undergo radical nephrectomy.We measured 8-hydroxy-2′-deoxyguanosine (8-OHdG), one of the most commonly used markers for evaluating oxidative stress, in DNA isolated from 72 RCC specimens, as well as adjacent normal kidney tissue using a quantitative sandwich enzyme-linked immunosorbent assay.The mean value of 8-OHdG in RCC was significantly greater than that in the adjacent normal tissue. The level of 8-OHdG in RCC compared with that in normal tissue (8-OHdG ratio) was significantly associated with other prognostic parameters, including mode of detection, maximal tumor size, distant metastasis, pathologic stage, tumor grade, and microscopic venous invasion. Furthermore, cancer-specific survival in patients with an elevated 8-OHdG ratio was significantly lower than that in patients with a normal 8-OHdG ratio; however, multivariate analysis using a Cox proportional hazards model showed that maximal tumor size and distant metastasis could be used as independent predictors of cancer-related death.These findings suggest that despite the lack of independent significance, the 8-OHdG ratio could be a useful prognostic indicator for patients with RCC; therefore, careful follow-up should be considered in those with an elevated 8-OHdG ratio. [Copyright &y& Elsevier]