ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThere are limited independent predictors of survival in patients with renal cell carcinoma. Factors related to the tumor, host and treatment may help us to predict prognosis to a certain extent. Prognostic indicators would enable selection of patients who can benefit from adjuvant therapy and thus should be enrolled in clinical trials. This review highlights developments in the identification of current prognosticators for patients with renal cell carcinoma.Recent findingsTumor stage, grade and patient-performance status are the known prognostic indicators in renal cell carcinoma. Besides these parameters, many molecular and cytogenetic markers were evaluated recently. Unfortunately, none of these parameters appear to be a better predictive prognostic factor than the usual staging and grading. Therefore, efforts to identify new markers for tumor proliferation and progression are still ongoing. It was recently reported that low carbonic anhydrase 9 staining may be an independent poor prognostic factor in patients with renal cell carcinoma. Moreover, there is increasing interest in prognostic indices and predictive algorithms for survival. Staging systems that combine the pathological features with additional prognostic variables have been constructed to predict outcome. The UCLA Integrated Staging System seems to be superior to staging alone in differentiating patients' survival.SummaryAlthough the literature reviewed contains numerous promising clinical, histological, molecular and cytogenetic parameters, none of them has yet been shown to have an independent prognostic value

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewIn the past decade, minimally invasive therapy options for renal cell carcinoma have been devised in an attempt to minimize operative morbidity while achieving comparable oncologic and functional outcomes. Herein, we evaluate the new developments related to the modern surgical and energy ablative techniques for renal cell carcinoma.Recent findingsWhen compared with the open counterpart, laparoscopic radical and partial nephrectomies have equivalent operative time, decreased blood loss, superior recovery, and improved cosmesis. Nowadays, laparoscopic radical nephrectomy can be performed for pT2 tumors (up to 15 cm), and level I renal vein thrombus is not a formal contraindication for the laparoscopic procedure. Ongoing advances in laparoscopic techniques and operator skills have allowed the development of a reliable technique of laparoscopic partial nephrectomy, which includes the ability to achieve effective intracorporeal renal hypothermia. Cryoablation and radiofrequency ablation therapies have been performed through a laparoscopic or percutaneous approach, using a combination of fine probes and high-resolution imaging studies to precisely target the lesions and accurately monitor the freezing or heating ablation process. Noninvasive tumor ablation can now be achieved by extracorporeally induced high-intensity focused ultrasound.SummaryThese minimally invasive techniques represent the modern surgical approach for renal cell carcinoma, aiming to decrease patient morbidity. Laparoscopic radical and partial nephrectomy techniques duplicate the open approach. Results obtained with energy ablative techniques are encouraging. Based on the known slow growth rates of small renal cell carcinoma, one should be cautious when interpreting the short-term results of energy ablative therapies monitored by imaging only.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewAlthough pathological findings including tumour grade and tumour-node-metastasis stage provide prognostic information, the outcome for patients with renal cell carcinoma is occasionally unpredictable. Many studies have been undertaken to improve prediction of the prognosis of renal cell carcinoma, along with efforts to clarify the pathogenesis of renal cell carcinoma at the molecular level. This article reviews the advances in renal cell carcinoma research relevant to pathology published between 1 May 2002 and 30 April 2003.Recent findingsThe establishment of a strict tumour grading system or adding microscopic venous invasion or tumour necrosis is potentially useful for predicting patient outcomes. The contribution of the von Hippel-Lindau-related pathway in early carcinogenesis has been partly revealed with regard to angiogenesis and cell cycle control. Tumour development in renal cell carcinoma can be considered as accumulating heterogenous molecular events related to cytokine production, cell cycle control, anti-apoptotic signal machinery and angiogenesis.SummaryFinding the target genes related to the von Hippel-Lindau pathway may explain the resistance of chemotherapy, and also provide a clue to finding a novel therapeutic option. Molecular targeting therapy can be applicable after more general molecules leading to tumour development and the metastasis of renal cell carcinoma have been identified.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewIL-2 or IFN-α induce remissions and prolong life in patients carefully selected for a possibly toxic treatment. However, there is a need for better-tolerated and more effective therapies, especially in patients with co-morbidities and those resistant to systemic immunotherapy. Recent achievements in the treatment of advanced renal cell carcinoma highlight potentially significant improvements.Recent findingsCytoreductive surgery or radiation of metastases seems beneficial in well-selected patients, especially as immunotherapy is available. Immune cells within the tumour correlate with response and survival, indicating the importance of local immune modulation. Such modulation has allowed the introduction of well-tolerated treatments such as the inhalation of IL-2 to control lung metastases, which results in a significant survival benefit for high-risk patients, as suggested by a recent outcome study in 200 patients. Antibody-based tumour targeting against cG250, specifically expressed on renal cell carcinoma, seems to stabilize progressive metastatic disease and does not induce toxicity. Vaccination strategies are also well tolerated, but have not yet shown convincing results in advanced disease. Other approaches have not fulfilled expectations. Thalidomide has significant neurotoxicity and its efficacy was not confirmed in recent studies. Stem cell transplantation has significant toxicity, and cannot yet be recommended, but may have future potential.SummaryCytokine-based immunotherapy can now be considered standard in the treatment of metastatic renal cell carcinoma. There is good evidence that additional local procedures such as surgery, radiation or the inhalation of IL-2 improve response and survival in metastatic disease with moderate toxicity, resulting in a significant improvement for patients suitable for these approaches.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewRenal cell carcinoma represents the third most common cancer in men. Radical surgery remains the only curative approach, and the 5-year survival rate once the cancer has metastasized rarely exceeds 20% despite systemic therapy. It becomes evident that an improvement in outcome might only be achieved if (1) there is early diagnosis, (2) there is accurate prediction of progression and response, and (3) new treatment options reflecting the molecular pathogenesis and progression are developed.Recent findingsThe detection of circulating cancer cells by reverse transcriptase/polymerase chain reaction techniques for theMN/CAIXgene, the identification of specific genetic alterations in circulating tumor DNA, as well as the demonstration of somatic von Hippel-Lindau mutations and extracellular matrix proteins in urine of high-risk patients might be clinically useful in improving early diagnosis and treatment. The signal transducer and activator of transcription has been shown to significantly correlate with relapse patterns following radical surgery. Heterozygosity or homozygosity for class II haplotypes DQA1 and DQB1 accurately predicts response and survival following cytokine-based therapy and may be helpful in patient selection. In terms of treatment, the use of monoclonal antibody derivates against the epidermal growth factor receptor and the vascular endothelial growth factor receptor has shown promising clinical results. Antisense oligodeoxynucleotide therapy has shown significant therapeutic effects in in-vitro and in-vivo studies. Recent developments in the clinical application of proteasome inhibitors have opened the door to exciting, highly specific and effective molecular treatment options for metastatic renal cell carcinoma.SummaryRecent developments in research on renal cell carcinoma have identified various clinically useful diagnostic and therapeutic options reflecting the molecular basis of the pathogenesis and progression of the disease.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThe combination of several recent molecular technologies, including comparative genomic hybridization, fluorescence in-situ hybridization and complementary DNA and tissue microarrays, has advanced our understanding of renal cancer. However, a great deal of information regarding the genetics of renal neoplasms has also emerged from the extensive cytogenetic investigations in the past decade.Recent findingsThe correlation between cytogenetic or molecular genetic abnormalities and histomorphology is most consistent in clear cell and papillary types of renal cell carcinoma. However, gene expression profile studies have brought new insights into the classification of renal tumors, and may provide new markers that identify patients with a poor prognosis as well as identifying potential therapeutic targets.SummaryThe integration of expression profile data and clinical parameters could serve to enhance the diagnosis and prognosis of renal cell carcinoma. The identification and evaluation of new molecular parameters will be necessities in cancer research and cancer treatment.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewTo review recent developments in the diagnosis and treatment of penile cancer, we reviewed the medical literature from 1 May 2002 to 1 June 2003 on the incidence, aetiology, staging, diagnosis and treatment of penile cancer by a Medline search.Recent findingsThe diagnostic tools and treatment modalities for penile cancer are still controversial. Recently developed diagnostic and therapeutic modalities should help urologists in the management of the disease.SummaryOur review of the recent literature provides an update on diagnostic and therapeutic opinion on penile cancer.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewTo review current developments in the management of patients with testicular cancer, with special emphasis on risk factors for the primary tumour and treatment options for clinical stage I testicular germ cell tumours.Recent findingsThe management of patients with testicular cancer has substantially improved over the past 25 years. Current concepts for treating localized and regional disease have been influenced by effective systematic chemotherapy. At present, cure rates approach nearly 100% for low-stage disease and more than 80% for advanced disease.SummaryRetroperitoneal lymph node dissection is still favoured as the therapy of choice for clinical stage I non-seminomatous germ cell tumours in many centres, but as risk factors for the primary tumour have become better understood, surveillance and risk-adapted therapy, including surveillance for low-risk patients and adjuvant chemotherapy for the high-risk group, is now being considered a therapeutic option particularly in European centres. Adjuvant radiotherapy is still the gold standard for the treatment of patients with clinical stage I seminoma, but the relapse rate of 19% and a 5-year overall survival of 97.7% make surveillance a possible therapeutic option. The results of phase II and III trials should soon provide additional information on carboplatin for single-agent adjuvant chemotherapy.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewRadical cystectomy and urinary diversion is the accepted standard of care for invasive bladder cancer, with orthotopic neobladders as the preferred method of bladder substitution in male and female patients. Last year's studies and reports on this subject are summarized and reviewed.Recent findingsToday, most patients considered candidates for radical cystectomy, independent of sex, are potential candidates for orthotopic bladder substitution. It has been shown that orthotopic bladder replacement is well tolerated and feasible even in selected patients with locally advanced tumors with or without positive nodes. The complication rates for orthotopic bladder substitutes are similar to, or lower than, the morbidity rates after conduit formation or continent cutaneous diversion. It has been shown that an afferent tubular segment without any antireflux flap-valve-type implantation techniques protects the upper urinary tract adequately for more than a decade. The true impact of the chosen type of urinary diversion on distress symptoms, quality of life and patients' well-being among survivors of bladder cancer remains controversial and requires further clinical investigation.SummaryThe excellent functional outcome and voiding pattern with orthotopic bladder substitution, even in the long-term, argues in favor of this technique as the preferred method for lower urinary tract reconstruction following radical cystectomy for invasive bladder cancer.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID