Investigative urology

Abstract

372Urological Survey Urological Survey 0.918). The 1997 TNM stage, tumor size, presence of a sarcomatoid component, and nuclear grade were significantly associated with death from clear cell, papillary, and chromophobe RCC. Histologic tumor necrosis was significantly associated with death from clear cell and chromophobe RCC, but not with death from papillary RCC. Our results demonstrate that there are significant differences in outcome and associations with outcome for the different histologic subtypes of RCC, highlighting the need for accurate subtyping. Editorial CommentMolecular genetics had an impact on classification of renal cell tumors. The genetic alterations affect the biology of the tumor cells, in respect of proliferation, cell death, differentiation, and cell adhesion; these very properties play a role in determining both the morphology and the behavior of tumors. Most of the pathologists use classifications of renal tumors based on cytomorphologic and genetic characteristics. According to the Heidelberg classification (J Pathol. 1997; 183: 131-3) and the 1997 workshop held in Rochester, Minnesota, USA (Cancer 1997; 80: 987-9) the clasification of renal cell tumors is based on these characteristics. The benign tumors are papillary adenoma (must have < 5mm in greatest diameter), oncocitoma and metanephric adenoma and the malignant tumors are conventional (clear cell) renal carcinoma, papillary renal carcinoma, chromophobe renal carcinoma, collecting duct carcinoma and unclassified cell carcinoma. Sarcomatoid carcinoma is not a particular tumor. Sarcomatoid change has been found to arise in all of the types of carcinoma in this classification, as well as in urothelial carcinoma of the renal pelvic mucosa.The paper of this editorial comment is a timely study to make valuable this classification for the urologists. The authors studied the prognostic features among the several histologic subtypes of renal cell carcinoma. Patients with clear cell renal cell carcinoma had a poorer prognosis compared with patients with papillary and chromophobe renal cell carcinoma with no significant difference in cancer-specific survival between patients with papillary and chromophobe renal cell carcinoma. The paper also disclosed the need and importance for reporting tumor size, sarcomatoid component, grading and tumor necrosis. Tumor size, presence of a sarcomatoid component, and nuclear grade were significantly asociated with death from clear cell, papillary, and chromophobe renal cell carcinoma. Histologic tumor necrosis was significantly associated with death from clear cell and chromophobe renal cell carcinoma, but not with death from papillary renal cell carcinoma. J Urol. 2003; 170: 964-9 Purpose: Of all medical disciplines it is exclusively in urology in which immunotherapy for cancer has an established position today with intravesical bacillus Calmette-Guerin (BCG) against superficial bladder carcinoma recurrences. BCG is regarded as the most successful immunotherapy to date. However, the mode of action has ...