Objective: to estimate the incidence of local recurrences and distant metastases, and the long-term results of treatment for renal cancer (RC) in relation to the used treatment option and surgical access.

Subjects and methods. The results of treatment were analyzed in 392 patients with RC, by using the 1993-to-2000 materials of the municipal cancer dispensary and other Kazan therapeutic-and-prophylactic institutions.

Results. With a laparotomic access, there were no local recurrences in any patients whereas with a lumbar access, local recurrence rate was 25%, which is, in the authors' opinion, associated with the disintegration of Gerota's fascia and with the spread of cancer cells. With the application of lumbotomic and transabdominal accesses, the incidence of metachronous distant metastases was 38.9 and 15.1%, respectively. With the laparatomic access, 3- and 5-year survival was also 10—20% higher than that with the lumbotomic access. Postoperative radiotherapy and/or hormonotherapy does not affect the incidence of local recurrences and distant metastases at all stages of the disease.

Conclusion. Midline laparotomy with hardware access correction with Sigal-Kabanov retractors (SKR-10) should be considered to be the access of choice in treating RC.

Introduction: Prompt surgical excision remains the standard of care for clinically localized enhancing renal tumors, for this reason the natural history of untreated renal cell carcinoma (RCC) has not been established. In order to increase our understanding of the natural history of RCC we reviewed our experience with the active surveillance of enhancing renal tumors.

Methods: We reviewed our renal cancer database for enhancing renal masses that were radiographically observed for a period of at least 12 months. Variables examined included patient age, gender, lesion size on presentation, radiographic tumor characteristics, duration of active surveillance, linear tumor growth rate, incidence, type of surgical intervention, and surgical pathology.

Results: 109 patients with 124 sporadic enhancing renal tumors were identified undergoing a period of active surveillance of at least 12 months. Mean patient age was 69.8 years (median 73, range 35—87). Mean duration of active surveillance was 33.4 months (median 26, range 12—156). Multifocal disease was present in 9% (10/109) patients on presentation. Tumor size on presentation was a mean of 2.61 cm (median 2.0, range 0.4—12.0). Overall mean tumor growth rate was 0.28 cm/yr (median 0.21, range -1.4—2.47). Observed linear growth rates were independent of patient age, gender, tumor size on presentation, and radiographic characteristics (solid versus cystic), p > 0.05. Of the patients initiating a period of active surveillance 36% (39/109) eventually underwent definitive therapy. Extirpative and ablative therapies were used in 72% (28/39) and 28% (11/39) of the patients undergoing surgical intervention, respectively. Malignant pathology was present in 90% (35/39) of the patients undergoing treatment. Of the malignant tumors evaluated, 68% were clear cell RCC.

Conclusions: Our current series reveals that the majority of small enhancing renal tumors show a slow interval growth and they are malignant. The investigation and development of clinical and radiographic predictors of future tumor growth would be of great benefit in order to avoid unnecessary intervention in selected patients.

The incidence of the relapse following radical nephrectomy for renal cancer is as high as 20—30%. The traditional predictors (including the histological type of a tumor) are insufficient to predict the likelihood of the relapse. The authors studied the expression of a number of molecular markers including thymidine phosphorylase (TP), Bcl-2, and Ki-67 and their prognostic value in patients with renal cancer (T1—2N0M0). The risk of progression significantly increased in higher grade of the tumor and in cases of TP hyperexpression. The favorable prognostic factors may include the absence of PT expression on the tumor cells.

The prognostic value of number and composition of stromal effector cells in specimens removed during radical surgical treatment for transitional cell bladder carcinoma (Ta-4N_xM₀) was studied. Higher 5-year survival and less risk of recurrence corresponded to the lower count of effector cells (p = 0.007): lymphocytes (p = 0.024 and p = 0.057) and segmented leukocytes (p = 0.037 and p = 0.042). In patients without progressive cancer, the independent predictors of 5-year survival were the degree of homogeneous mast cell distribution (p = 0.041) and the count stromal lymphocytes (p = 0.070) while in those with stage pTa-pT1, these were the number of segmented leukocytes (p = 0.009) and lymphocytes (p = 0.025) of the stroma (R² = 0.32; p = 0.008).

Objective: to assess the results of treatment and to identify the predictors of survival in patients with transitional cell carcinoma of the urinary bladder with regional lymph node metastasis.

Material and methods. A retrospective analysis of 56 patients with transitional cell carcinoma of the bladder (pT₁—4aN₁—2M_0—1,) who underwent radical cystectomy at the N.N. Blokhin Russian Cancer Center between 1980 and 2005 was performed. Their median age was 58.6 years; males and females were 85.7 and 14.3%, respectively. Studer`s (19.7%), Bricker`s (73.2%) procedures and ureterocutaneostomy (7.1%) were used for urinary divertion. Thirty-six (64.3%) of the 56 patients received additional treatment: neoadjuvant chemotherapy (CT) (n = 2 (3.6%)), adjuvant therapy (n = 32 (57.1%)); CT (n = 24 (42.8%)), and radiotherapy (n = 6 (10.7%)), chemoradiation therapy (n = 2 (3.6%)), and neo- and adjuvant CT (n = 2 (3.6%)). The median follow-up was 21.7 months (1-97.6 months).

Results. The effect of neoadjuvant CT was assessed as stabilization in all cases. Less than 15 lymph nodes were removed in 27 (48.2%), 15 lymph nodes or more were removed in 29 (51.8%) patients. The category pN+ was diagnosed in all cases: pN1 in 19 (33.9%), pN2 in 37 (66.1%). Involvement of nonregional (paraaortic) lymph nodes (pM+) was detected in 3 (5.4%) patients. Recurrences developed in 41 (71.9%) of the 56 patients on an average of 11.8 months after termination of treatment: localized regional and distant metastases in 3 (5.3%) and 35 (61.4%) patients, respectively; their combination in 3 (5.3%). In all 56 patients, overall, tumor-specific, and relapse-free 5-year survival was 32.1, 34.0, and 17.9%, respectively. Univariate analysis indicated that a history of superficial carcinoma (p = 0.036), as well as nonregional lymphogenic metastases (p = 0.036), and additional treatment (p = 0.020) were significant predictors. There was a trend for better survival in patients with pT < 3a (p = 0.056), after removal of more than 15 lymph nodes (p = 0.084), Bricker's operation (p = 0.055), and adjuvant therapy (p = 0.065).

Conclusion. Multimodal approach for transitional cell carcinoma of the urinary bladder with regional metastases improves tumor-specific 5-year survival as compared with that after radical cystectomy alone.

The total expenses on the early detection and further treatment of prostate cancer (PC) were analyzed in 1785 males aged 40 to 70 years, examined at the Russian Radiology Research Center, for prostate pathology-unassociated diseases in 2000—2005. A control group comprised 734 patients referred to urologist of the Russian Radiology Research Center Polyclinic during the same period. In the study group, the cost of treatment per patient with detected PC was 60,150 rbl (including that of screening) while in the control group, it was 150,376 rbl. The expected economic effect of introduction of a PC screening program at the federal level may be as many as 8,970,066,799.48 rbl.

The study covered 44 patients with localized and locally advanced prostate cancer (PC), who were followed up for at least 18 months after brachytherapy. A significant reduction in the level of prostatic specific antigen (PSA) in the blood of patients was observed 3 months after brachytherapy and tended to decrease further during a 12-month follow-up. It is the time after brachytherapy that may be considered as a criterion for a primary tumor response to the therapy. There were individual differences in the velocity and decrease rate of PSA levels during the therapy: in 30 (68.2%) patients, PSA values were in the range of 0.01—0.98 ng/ml (mean 0.39±0.31 ng/ml) while in 14 (31.8%) patients, those were 1.10—6.20 ng/ml (3.02±1.79 ng/ml). A certain correlation was found between the parameters of PSA (baseline PSA level, time course of changes, and kinetics of PSA levels) and the outcome of the disease. A more objective evaluation of the efficiency may be made after increasing the time of a follow-up and the number of patients after brachytherapy.

The clinical, pathomorphological, and immunohistochemical (p53, MIB-1, bcl-2, and cathepsin D) parameters were retrospectively analyzed to determine the molecular markers associated with the progression of a mature teratoma (MT) of the testis is presented.

Subjects and methods. Sixty-nine patients with pure primary MT of the testis were retrospectively selected. In all 69 cases, archival tumor blocks were accessible to histological re-evaluation. Fifty 55 (80%) patients with an early-stage tumorous process, including 44 patients with Stages I and 11 with IIA/B stage, had undergone radical orchiectomy, followed by retroperitoneal lymphadenectomy (RPLAE). Fourteen (20%) patients with a disseminated tumor received induction multidrug therapy (MDT), followed by residual tumor resection.

Results. The detection rates of metastases to the retroperitoneal lymph nodes were 14 and 73% in Stages I and IIA/B, retrospectively. The morphological diagnosis of pure MT was verified in all cases. However, 22 (79%) out of 28 patients with testicular metastases were found to have scars and calcification of the parenchyma; 6 patients had microscopic foci of a germ-cell tumor. In all, metastases were detected in 41% of patients. The mean follow-up was 92 (range 8—252) months. No recurrence developed in patients with Stage I; 5 patients with disseminated tumor had recurrences after RPLAE and 5 (7.3%) patients died from progressive cancer. The expression of p53, MIB-1, and cathepsin D in MT was low with an insignificant difference in different stages of the disease.

Conclusion. The molecular markers are of no clinical value in estimating the metastatic potential of MT. Additional serial paraffin sections should be made in all cases of pure MT. RPLAE should be performed when scar tissue or germ-cell tumor elements are found in the testis; a follow-up is indicated in other cases. If it is impossible to make additional serial paraffin sections, nerve-sparing RPLAE is the method of choice.

The authors have followed up five 16—18-year-old patients with transitional-cell urinary bladder carcinoma (UBC). They analyze rare cases of two 16-year-old youths diagnosed as having UBC of stages T₃ and T_2bN₀M₀. After complex treatment (urinary bladder resection, radio- and chemotherapy), one of them is a more than 10-year survivor with the tumor not being recurrent and metastazing; the other is a 9-month survivor. An 18-year-old woman at gestational weeks 27 who had concomitant congenital heart disease and transitional-cell UBC (T₁N₀M₀) complicated by profuse intravesicular hemorrhage, urinary bladder tamponade, and anemia was emergently hospitalized. She underwent transurethral bladder tumor resection. At gestational week 40, a healthy girl weighing 3.2 kg was vaginally delivered.

Hospital-acquired (nosocomial, intrahospital) infections are a principal cause of severe complications and death in cancer diseases in the postoperative period. A current infection-controlling system that notifies all cases of nosocomial infections in the patients of the hospital, including those with urinary tract cancer, has been in existence in Moscow City Cancer Hospital Sixty-Two since 2001. The paper presents the data of the authors' own follow-ups (in 2005—2006), which reflect the incidence of postoperative nosocomial urinary tract infections (PNUTI) in urological cancer patients depending on the site of a tumor, the scope of surgical intervention, the etiological agents of PNUTI, and their susceptibility to antibiotics. By using the results of the study, the authors have developed and proposed algorithms of efficient antibiotic therapy for PNUTI in patients with cancer of the kidney, urinary bladder, and prostate.