The purpose of the study was to reveal the independent anatomic, histological, and clinical factors of cancer-specific survival in patients with renal-cell carcinoma (RCC). For this, the authors retrospectively analyzed their experience with radical surgical treatments in 73 RCC patients operated on at the Department of Urology and Surgical Andrology, Russian Medical Academy of Postgraduate Education, from January 1, 1999 to December 31, 2004; their outcomes have become known by the present time. There was a statistically significant correlation of cancer-specific survival with its parameters, such as pathological stage of a tumor, its maximum pathological size, differentiation grade, involvement of regional lymph nodes, venous tumor thrombosis, level of thrombocytosis, and degree of the clinical symptoms of the disease. Multivariate analysis of survival in RCC in relation to the prognostic factors could reveal odd ratios for the limit values of significant prognostic factors. The statistically significant prognostic values established in the present study, as well as the molecular factors the implication of which is being now investigated can become in future an effective addition to the TNM staging system to define indications for certain treatments and to predict survival in RCC  

Indications for organ-preserving operations in renal tumors are discussed. The techniques of interventions are described; long-term results of treating 429 patients are given.

The immediate and late results of treating patients with renal metastases with a new intermittent interferon-α (IFN-α) use regimen are presented.

Subjects and methods. The study included 131 patients receiving IFN-α as 3106 IU subcutaneously, days 1—10 at a further 2-week inter- val.

Results. Complete and partial effects were achieved in 11 (8.4%) and 18 (13.7%) patients, respectively; stable disease (≥6 months) was observed in 35 (26.7%). The median time to progression was 23.3 months. The sizes and number of lung metastases were found to have a great impact on survival: with metastases sizing ≤2 cm and their number of ≤10, the median overall survival was 29.9 months. These patients are the most promising candidates for the effective first-line IFN-α therapy.

Background: High and intermediate IL-2 regimens are difficult to recommend because of great toxicity and efficacy is not sufficient. We suggest that a combination of very low-dose cytokines is effective and safe in metastatic renal cell carcinoma (MRCC) patients (pts). A prospective randomized study was started in 2003. The primary end-point was a response rate. Methods: The eligibility criteria included histopathologically confirmed MRCC, ECOG PS 0-2, no autoimmune diseases, no brain metastases, and normal organ function. All pts were randomized in three arms: IL-2 alone, 1.5 MIU, iv, t.i.w., weeks 1—3 or IL-2 1.0 MIU, iv, t.i.w., weeks 1—3 plus IFN 5 MIU, sc, t.i.w, weeks 1—3 or biochemotherapy group 5-FU, 500 mg/m2, iv, once a week, weeks 1—3 plus IL-2 1.0 MIU, iv, t.i.w., weeks 1—3 plus IFN 5 MIU, sc, t.i.w., weeks 1—3. Courses were repeated every three weeks. A response was assessed according to the RECIST every 2 courses.

Results: 64 pts were enrolled, of whom 63 were analyzed. Their median age was 55.4 years (range 16—74). 42.9% of the patients had pre- viously received chemo- or immunotherapy. 55.6 percent of the pts had poor prognosis (according to Motzer et al., 2002). Bone metastases were present in 52.4% of the pts. Sixteen patients treated with IL-2 alone showed no CR, PR, 2 SD, or 14 PD. Of 23 patients in the IL-2+IFN group, there were 5 PR, 8 SD, and 10 PD, with a response rate of 21.7%. Amongst 24 patients in the 5-FU+IL-2+IFN group, there were 1 CR, 3 PR, 10 SD, and 10 PD, with a response rate of 16.7%. One-year survival was 20.0%, 81.3% and 81.0%, respectively. The influenza-like syndrome was the most common side effect in the pts who received IFN (89.1%, grade 1, CTC). Hypotension associated with IL-2 (all groups) was seen in 56.3% (50%, grade 1 and 6.3%, grade 2). The other adverse reactions were 12.7% grade 1 neutropenia and vomiting in 4.7% pts (Group 3).

Conclusion: All regimens are well tolerated. Small-dose IL-2 alone is ineffective. 5-FU does not improve the efficacy of a cytokine combination. Small-dose IL-2 and IFN demonstrate a reasonable efficacy and can be recommend for MRCC pts outside clinical trials.

Background. The perception that older cancer patients may be at higher risk than younger patients of toxic effects from cancer therapy but may obtain less clinical benefit from it may be based on the underrepresentation of older patients in clinical trials and the known toxic effects of cytotoxic chemotherapy. It is not known how older patients respond to targeted therapy.

Methods.  This retrospective subgroup analysis of data from the phase 3, randomized Treatment Approach in Renal Cancer Global Evaluation Trial examined the safety and efficacy of sorafenib in older (age ≥ 70 years, n = 115) and younger patients (age <70 years, n = 787) who received treatment for advanced renal cell carcinoma. Patient demographics and progression-free survival were recorded. Best tumor response, clinical benefit rate (defined as complete response plus partial response plus stable disease), time to self-reported health status deterioration, and toxic effects were assessed by descriptive statistics. Health-related quality of life was assessed with a Cox proportion- al hazards model. Kaplan - Meier analyses were used to summarize time-to-event data.

Results. Median progression-free survival was similar in sorafenib-treated younger patients (23.9 weeks; hazard ratio [HR] for progression compared with placebo = 0.55, 95% confidence interval [CI] = 0.47 to 0.66) and older patients (26.3 weeks; HR = 0.43, 95% CI = 0.26 to 0.69). Clinical benefit rates among younger and older sorafenib-treated patients were also similar (83.5% and 84.3%, respectively) and were superior to those of younger and older placebo-treated patients (53.8% and 62.2%, respectively). Adverse events were predictable and manageable regardless of age. Sorafenib treatment delayed the time to self-reported health status deterioration among both older patients (121 days with sorafenib vs 85 days with placebo; HR = 0.66, 95% CI = 0.43 to 1.03) and younger patients (90 days with sorafenib vs 52 days with placebo; HR = 0.69, 95% CI = 0.59 to 0.81) and improved quality of life over that time.

 Conclusions. Among patients with advanced renal cell carcinoma receiving sorafenib treatment, outcomes of older ( ≥ 70 years) and younger (<70 years) patients were similar.

Objective: to monitor the efficacy of transurethral resection (TUR) of a urinary bladder tumor, which has performed under the standard conditions and by using fluorescence cystoscopy (FCS), to diagnose early bladder cancer (BC), and to determine tumor aggression and prognosis of the disease.

Subjects and methods. 174 BC patients, who had undergone 4-6 weeks postoperatively re-endoscopy comprising routine cystoscopy (CS), FCS, and TUR biopsy of a postoperative scar area and fluorescent portions, were examined. Group 1 included 95 patients who had under- gone routine TUR; Group 2 consisted of 79 patients in whom TUR had performed under fluorescence guidance.  

Results. Re-endoscopy revealed fluorescence portions in 56 (58.9%) patients in Group 1 and in 28 (35.4%) in Group 2. Endothelial tumors were found in 45 (47.4%) patients from Group 1 and in 19 (24.1%) from Group 2. In the latter, residual tumors were less frequently observed than those in Group 1 (24.1 and 47.4%, respectively; p < 0.005). Control endoscopic study of Tis identified in 15 (15.8%) of the 95 examinees in Group 1 and only in 4 (5.1%) of 79 in Group 2 (p < 0.001). There was a significant difference in the frequency of residual tumors (Ta stage) in Groups 1 and 2 patients (16.8 and 8.9%; p < 0.005). The differences in the frequency of residual papillary tumors at T1 stage were also significant in the analyzed groups (10.5 and 6.3%, respectively; p < 0.05). At the same time, the difference was insignificant in the incidence of a recurrence at T2 stage. Amongst 27 Group 1 patients with multiple urinary bladder involvement, residual tumors were identified in 14 (51.9%); these were present only in 4 (18.2%) of 22 patients from Group 2 (p < 0.001).

 Conclusion. Early repeated CS and biopsy under fluorescence guidance should be recommended to patients with BC at stages Tis and Ta— T1 for the timely detection and removal of residual tumors and for the prevention of recurrences.

The results of cystectomy (CE) in bladder cancer, performed in the standard and modified modes, were compared. The case histories of 153 patients operated on, by completely or partially preserving the prostate, were analyzed. With the extent ≤ T2N0, the rates of local and distant dissemination after standard and modified CE was 4%/2.1% and 9.5%/10.9%, respectively; i.e. the values did not differ greatly. The data of the performed analysis suggest that the compared values after modified CE are not worse than those after standard CE with orthotopic cystoplasty and do not allow one to doubt the oncological appropriateness in reducing the volume of an operation in specially selected patients.

Examinations were made in 121 patients, including 76 patients with urinary bladder cancer (UBC) (superficial (T1N0M) (n = 16) and invasive (T2N0M0 and T3aN0M0) (n = 39) carcinomas, carcinoma invading into and out of the bladder wall (n = 21), including T3bN0M0 (n = 14), T3bN1M0 (n = 6), and with T4N1M1 (n = 1)), 10 patients with cystitis, 10 with urolithiasis, and 25 apparently healthy individuals who made up a control group. The patients with UBC were additionally divided into the following groups according to the degree of tumor cell differentiation: 27 with a low-grade tumor (G1), 24 with a moderate-grade tumor (G2), and 25 with a high-grade tumor (G3). The levels of oncomarkers (urinary bladder carcinoma antigen (UBCA), tissue polypeptide antigen (TPA), tissue-specific polypeptide antigen (TSPA), cytokines (interleukin (IL)-12, tumor necrosis factor-a (TNF-α), and angiogenetic factors (vascular endothelial growth factor (VEGF), transforming growth factor-α (TGFα), fibroblast growth factor (FGF), and insulin-like growth factor-I (IGF-I) were studied by solid-phase enzyme immunoassay. It has been established that measuring the level of cytokeratin oncomarkers (UBC II, TPA, TPS) in the serum, urine, and washings can be, along with cystoscopy, used in the early diagnosis of UBC. A combination of UBC II, TPA, and TPS contents allows speci- fication of the stage of UBC and the grade of tumor cells. The increased levels of TNF-α and IL-12 in patients with UBC confirm the development of a proinflammatory cytokine shift and activation of angiogenesis. The ratio of proangiogenic TNF-α to anti-angiogenic IL12 rises with UBC progression. This may be considered to cause increased vascular permeability and a proneness to bleedings from tumor tissues in patients with UBC. Tumor growth and UBC progression are accompanied by a pronounced increase in the serum levels of growth and angiogenetic factors (VEGF, TGF-α, b-FGF, and IGF-1) as compared to the normal values and to those seen in noncancer diseases. Angiogenetic and growth factors may be used in the early diagnostics of UBC and in the verification of the stage and malignancy of tumor growth.

Objective: to determine the rate of prostate cancer (PC) development after repeated transrectal saturation prostate biopsy (RTRSPB), to study the characteristics of diagnosed tumors, and to estimate their clinical significance from the data of radical retropubic prostatectomy (RRP).

Materials and methods. The results of RTRSPB were analyzed in 226 patients with a later evaluation of a tumor from the results of RRP. All the patients underwent at least 2 prostate biopsies (mean 2.4). The average number of biopsy cores was 26.7 (range 24—30). The average value of total prostate-specific antigen before saturation biopsy was 7.5 (range 7.5 to 28.6) ng/ml. The mean age of patients was 62 years (range 53 to 70).  

Results. PC was diagnosed in 14.6% of cases (33/226). An isolated lesion of the prostatic transition zone was in 12.1% of cases. If this zone had been excluded from the biopsy scheme, the detection rate of PC during saturation biopsy should be reduced by 13.8%. Better PC detectability during repeated saturation biopsy generally occurred due to the localized forms of the disease (93.3%). The agreement of Gleason tumor grading in the biopsy and prostatectomy specimens was noted in 66.7% of cases.

Conclusion. Saturation biopsy allows prediction of a pathological stage of PC, Gleason grade of a tumor and its site localization with a greater probability. Most tumors detectable by saturation biopsy were clinically significant, which makes it possible to recommend RTRSPB to some cohort of high PC-risk patients 

Background. The main goal of treatment in patients with prostate cancer (PC) is not only to achieve the maximum survival, but also to assure the high quality of life (QL). By taking into account the fact there are no specialized Russian adapted questionnaires to assess QL in PC, the authors have developed a test system to evaluate the specific changes in the QL of patients, which occurred before and during treatment of this disease.

Materials and methods. The «universal quality of life questionnaire for patients with prostate cancer» comprises 4 scales (sections): «Urination», «Intestinal function», «Sexual function», «Hormonal function». Each section includes subscales (subsections) which concretize the degree of dysfunction of the above systems and ascertain how these changes influence patients' social life. Unified variants of answers that provide a rather objective assessment of the degree of dysfunction of the above systems of an organism are given to all questions.  The authors examined 235 patients treated for PC at the Clinic of Urology, Military Medical Academy, of them 182 males had underwent radical retropubic prostatectomy (RRP) and 60 had received maximum androgenic blockade (surgical or medical). The validity of the questionnaire was assessed, by evaluating resistance and internal consistency.

Results. After various medical measures, QL in patients with PC became worse due to impaired urination, and sexual and hormonal dysfunctions. After RRP, the major impairments were urinary incontinence lowering their social disadjustment, as well as related troubles. The men who have undergone antiandrogenic deprivation suffer mainly from dysuria.  The Pearson's correlation coefficient was 0.7, which signifies its high reliability. To estimate validity, the authors calculated the Crohnbach coefficient that was >0.8, which is indicative of the high validity of the test.

Conclusion. The questionnaire presented by the authors is a reliable tool in assessing the QL in patients with PC and may be recommended for its wide use by oncourological specialists in clinical practice and researches in the out- and inpatient settings.

The authors describe a new technology for controlling blood loss during an oncourological operation, which allows expansion of indications for radical surgical treatment in elderly patients with severe comorbidity.

The prognostic value of the Fuhrman renal-cell carcinoma (RCC) gradation system has been supported by numerous studies. The high RCC  grade after Fuhrman is a sign of the high risk of recurrence even in patients with the early stages of the disease, in clear-cell tumor in par-  ticular. The anticancer vaccine Oncophage is recommended to prevent a recurrence and/or to increase a relapse-free period in patients with  early stages of RCC. While using this vaccine, one should follow the Fuhrman histological gradation system and use a coordinated multi-  disciplinary approach to treating this group of patients. This paper describes the Fuhrman histological gradation system, indications for the  use of Oncophage in patients with the early stages of ECC and a moderate risk of a recurrence. The role of urological surgeons, oncologists,  and pathomorphologists in the treatment of patients with early stages of ECC is also considered.