[Pronostic value of ureteral location of upper tract urinary carcinoma]. / Impact pronostique de la localisation urétérale dans les tumeurs de la voie excrétrice supérieure.

OBJECTIVES: The aim of this study was to evaluate the prognostic significance of the ureteral location of the upper tract urinary carcinoma (UTUC). PATIENTS AND METHODS: Between January 1998 and December 2007, 161 patients with UTUC were operated in our center. Tumors were located on renal pelvis in 51% of cases, on the ureter in 34% of cases and in both locations in 15% of cases. Nephroureterectomy was performed in 79.5% of cases (128/161) whereas a conservative treatment was performed in 20.5% of cases (33/161). RESULTS: In our series, 29.8% of patients had primary bladder cancer and 14.3% had synchronous bladder tumor. At a median follow-up of 42.5 months, 38.6% of patients developed bladder recurrence and 4.8% developed controlateral upper tract tumor. In multivariate analysis, ureteral location and existence of synchronous bladder tumor were independent prognostic factors of bladder recurrence (P=0.009 and P=0.025, respectively). Multivariate analysis retained T-stage and ureteral location as independent prognostic factors in both overall and disease-free survival (P=0.002 and P=0.0008 respectively for ureteral location). CONCLUSION: Ureteral location was an independent prognostic factor of bladder recurrence and was associated with a poorer prognosis.

Hedgehog pathway activation in human transitional cell carcinoma of the bladder.

BACKGROUND: The Hedgehog (Hh) signalling pathway functions as an organiser in embryonic development. Recent studies have shown constitutive activation of this pathway in various malignancies, but its role in bladder cancer remains poorly studied. METHODS: Expression levels of 31 genes and 9 microRNAs (miRNAs) involved in the Hh pathway were determined by quantitative real-time RT-PCR in 71 bladder tumour samples (21 muscle-invasive (MIBC) and 50 non-muscle-invasive (NMIBC) bladder cancers), as well as in 6 bladder cancer cell lines. RESULTS: The SHH ligand gene and Gli-inducible target genes (FOXM1, IGF2, OSF2, H19, and SPP1) were overexpressed in tumour samples as compared with normal bladder tissue. SHH overexpression was found in 96% of NMIBC and 52% of MIBC samples, as well as in two bladder cancer cell lines. Altered expression of miRNAs supported their oncogene or tumour-suppressor gene status. In univariate analysis, high expression levels of PTCH2, miRNA-92A, miRNA-19A, and miRNA-20A were associated with poorer overall survival in MIBC (P=0.02, P=0.012, P=0.047, and P=0.036, respectively). CONCLUSION: We observed constitutive activation of the Hh pathway in most NMIBC and about 50% of MIBC. We also found that some protein-coding genes and miRNAs involved in the Hh pathway may have prognostic value at the individual level.

[Healing and targeted therapies: Management in perioperative period?]. / Cicatrisation et thérapies ciblées : quelles précautions en période périopératoire ?

INTRODUCTION: In the era of new-targeted therapies and neoadjuvant strategies, this article highlights the role of angiogenesis in the process of physiological wound healing with a review of literature about parietal complications under anti-angiogenic therapies. METHODS: Research on Medline was carried out using the terms renal cell carcinoma, angiogenesis, wound healing, targeted therapies, and complications. RESULTS: The frequency of these complications varies between 5 and 50% in recent series. These results depend on half-lives of each drug and perioperative management (before and after surgical procedure). CONCLUSION: In the absence of current recommendations, it is advised to stop bevacizumab at least five weeks before a surgical intervention and to take it back 4 weeks later. For the tyrosine kinase inhibitors, the treatment can be stopped 24-48 hours before the surgery and taken back 3-4 weeks later. Finally, for the mTOR inhibitors, it is advised to stop the treatment 7-10 days before and to take back it at least 3 weeks later.

[Spermatic cord sarcoma in adults: diagnosis and management]. / Les sarcomes du cordon spermatique de l'adulte : diagnostic et prise en charge.

PURPOSE: to clarify the patterns of diagnosis and management of adult spermatic cord sarcoma. PATIENTS AND METHODS: between 1996 and 2009, seven patients with spermatic cord sarcoma were treated at Cochin hospital. After updating the pathological diagnosis according to the new classification of sarcoma we found that all patients had well-differentiated or dedifferentiated liposarcoma. We analysed their clinical presentation, management and carcinological outcome. RESULTS: the patients' age ranged from 51 to 77 years, and their follow-up from 7 to 68 months. In five patients, the diagnosis of well-differentiated liposarcoma (lipoma-like) with some dedifferentiated sectors was made straightaway. In the two other patients, the initial diagnosis was that of leiomyosarcoma, which was reconsidered as dedifferentiated liposarcoma according to the cytogenetical and immunohistochemical techniques available since 2005. In 6/7 patients, a tumour resection with an orchiectomy at the same time (four patients) or secondarily (two patients) was performed. In one patient, only a tumour resection, without orchiectomy, was made. Multiple recurrences were observed in the two patients who were initially diagnosed as leiomyosarcoma. They needed multiple reintervention. One of them died after 68 months of evolution, the other one was treated with chemotherapy and died after 47 months of evolution. Four patients are out of recurrence. One patient was lost to follow-up. CONCLUSION: the diagnosis of liposarcoma must be considered in all adult patients aged of more than 50 with fatty-shaped or containing fibomuscular nodules paratesticular tumours. The surgeon and the pathologist must be well informed and an early and wide resection of fatty masses of the sperm cord with negative margins is advocated. The quality of resection is crucial but its appreciation and carrying out are difficult. The role of complementary treatments, especially radiotherapy, has to be determined.

[Hybrid renal tumors: a report of two patients]. / Tumeurs rénales hybrides: à propos de deux patients.

PURPOSE: Renal hybrid tumors (HT) are characterized by the association of both oncocytes- and chromophobe-cells within the same tumor. They have been reported in patients with Birt-Hogg-Dube (BHD) syndrome. The aim of this report was to describe two cases of HT and summarize recent literature. PATIENT AND METHOD: Case study was summarized from the patient's medical chart. Review of literature was performed using the National Center for Biotechnology Information (NCBI) database. RESULTS: Two patients were diagnosed with multiple but small tumors of the kidney, and were treated with partial nephrectomy. Pathological analysis of these tumors showed oncocytoma-like and chromophobe-like cells intermixed in the same stroma. CONCLUSIONS: HT may constitute a spectrum of tumors between renal oncocytoma and chromophobe renal cell carcinoma. From a pragmatic management perspective, it would be appropriate to consider such tumors as chromophobe carcinoma. In case of HT, a genetic study for BHD syndrome can be proposed to family relatives.

[Prostate cancer: medicoeconomic aspects]. / Cancer de la prostate: aspects médicoéconomiques.

Prostate cancer is the first cancer in men. Its incidence is constantly increasing. The significant evolution of diagnostic and therapeutic means during the two last decades contrasts with the scarcity of medicoeconomic studies. The aim of this review is to present a synthesis of the different studies published and to respond to questions about the economic aspects of this disease, with the evaluation of its direct and indirect costs. The cost-effectiveness and the benefits of the prevention and the screening are still being studied. The costs of the surgery and the radiotherapy are roughly similar. The new surgical techniques, especially the laparoscopic and the robotic surgeries, are not necessarily associated with higher costs, in condition of a high-volume laparoscopic surgery program and a faster discharge. The indirect costs of prostate cancer concern the loss of economic production associated with the disease and death and are more difficult to determine.

[Primary metastatic urethral melanoma: a case study]. / Mélanome primitif de l'urètre découvert au stade métastatique: à propos d'un cas.

PURPOSE: Primary urethral melanoma is a rare pathology for which treatment strategies are controversial. The aim of this work was to report a case of metastatic primary urethral melanoma, and to discuss recent data available from literature. MATERIAL AND METHOD: Case study was summarized from the patient's medical chart. Review of literature was performed using the National Center for Biotechnology Information (NCBI) database. RESULTS: We reported the case of an 89-year-old woman who died from a primary metastatic melanoma of the urethra. This pathology encounters for less than 1% of melanomas and has an adverse prognosis. In case of metastasis, specific survival is only of a few months. When localized to the urethra, treatment relies on radical urethrectomy, followed by adjuvant chemo- and immunotherapy. CONCLUSIONS: The modalities of treatment of primary urethral melanoma rely only on reported case studies. When diagnosed at the metastatic stage, reported specific survival does not exceed a few months.

[Analysis of anatomopathological results of radical prostatectomy specimen of patients who answer to criteria for active surveillance of prostate cancer]. / Analyse des résultats anatomopathologiques des pièces de prostatectomie radicale des patients répondant aux critères de surveillance active du cancer de prostate.

OBJECTIVE: To analyze pathological data of the radical prostatectomy specimen in patients operated for clinically-localized prostate cancer and who meet strict criteria for active surveillance. PATIENTS AND METHODS: The data of patients who underwent a radical prostatectomy by a single surgeon between 2002 and 2007 were reviewed. We only included the patients that met the usual criteria for active surveillance: clinical stage T1-2a tumor, PSA< or =10 ng/mL, biopsy Gleason sum inferior or equal to 6 with no pattern of grade 4 or 5, cancer involvement inferior or equal to two biopsy cores, inferior to 50% of malignant tissue in each positive biopsy core and a PSA density inferior or equal to 0.15 ng/ml/cc. RESULTS: Two hundred and seventy-three patients were operated, including 25 (9.2%) who met all the criteria for active surveillance. Mean age was 61 years (55-68). The mean preoperative PSA was 6.6 ng/mL (2.5-10). Clinical stage of the tumor was T1c in 84% of patients and T2a in 16%. Biopsy Gleason score was 3+3 in 92%, 2+3 in 4% and 2+2 in 4%. Pathological study of the surgical specimen showed that 28% of the tumors were pT2a, 8% pT2b, 40% pT2c and 20% pT3a. One tumor was pT0. The pathological Gleason score was 3+3 in 68% of patients and 3+4 in 28%. Surgical specimen showed a higher Gleason score in 44% of cases, but there were no cases of predominant grade 4. After a mean follow-up of 19.2 months, there was no clinical or biological recurrence. CONCLUSION: In our experience, 20% of patients who meet the criteria for active surveillance show an extracapsular extent of the tumor on pathological analysis. Active surveillance is still under evaluation. Its main risk is to underestimate the aggressiveness of the tumor at the time of diagnosis.

[Preoperative factors of misdiagnosis of renal angiomyolipoma]. / Facteurs associés à l'échec du diagnostic préopératoire des angiomyolipomes rénaux.

OBJECTIVES: To explain the high incidence of misdiagnosis of angiomyolipoma (AML) prior to surgery. MATERIALS AND METHODS: Between 1989 and 2007, 2,657 patients were operated for a renal tumor at Dupuytren hospital in Limoges and at Cochin hospital in Paris. In 85 cases (3.2%), tumors were AMLs on pathology. The group of patients in which the diagnosis was done preoperatively was compared to the one in which the diagnosis was missed. RESULTS: Mean age of patients was 57-years-old and the sex-ratio was five women for one man. The mean size of AMLs was 5.4 cm. The patients were symptomatic in 46% of cases (39/85). The diagnosis of AML was ignored preoperatively in 62 patients (73%). In multivariate analysis, the small size of the AML, low proportion of fat and male sex were significantly associated with misdiagnosis of AML (p<0.001, p<0.018 and p<0.008, respectively). CONCLUSIONS: The incidence of misdiagnosis of AML preoperatively is high. The diagnosis seems particularly difficult when the tumor is small or contains a small proportion of fat. In addition, this study highlights that the diagnosis of AML is frequently ignored in men. The increased resolution of CTscan and the use of preoperative biopsies for tumors less than 4 cm could be helpful to decrease the incidence of useless surgery of AMLs.

[Use of double J ureteral stent as an alternative to prevent ureteroileal anastomosis stricture in orthotopic bladder substitution]. / Etude comparative du drainage urétéral par sonde double J ou sonde urétérale après cystectomie-entéroplastie.

OBJECTIVE: The aim of the study was to compare ureteroileal anastomosis strictures rates in patients receiving either double J stent or open-ended ureteral stent, after bladder replacement for cancer. METHODS: Medical charts from 75 patients who underwent cystectomy and Z pouch bladder substitution for bladder cancer, between 2001 and 2005, were retrospectively reviewed. Ureteroileal anastomosis was direct, spatulated end-to-side fashioned in all patients. Double J stents were used in 39 patients (group A) and open-ended ureteral stent were used in 36 patients (group B). Mean hospital stay, early and late complications were also observed. RESULTS: Seventeen anastomotic strictures have been documented during the follow-up: 5.2% in group A versus 18.3% in group B (p=0.012). Mean catheterization period was six weeks in group A and 12 days in group B. No significant differences were found in mean hospital stay, early and late complications. CONCLUSION: The use of internal double J ureteral stent is now a feasible option and can decrease the rate of anastomotic stricture. The fact that the double J stent is removed after the anastomosis healing period may be a possible explanation.

[Testicular implants, patient's and partner's satisfaction: a questionnaire-based study of men after orchidectomy]. / Prothèses testiculaires après orchidectomie: enquête de satisfaction auprès des patients et de leurs partenaires.

OBJECTIVE: To assess the satisfaction of men and of their partner towards their testicular implants after undergoing orchidectomy. MATERIALS AND METHODS: Hundred and twenty-four consecutive patients, who had undergone orchidectomy, and their partner were sent an anonymous questionnaire. The follow-up after the implantation was at least one year. The testicular implants used were all Perthèse. RESULTS: Seventy-two patients answered to the questionnaire, among whom 63 had a testicular implant. Fifty-eight partners answered. From the patients with implant, 5% thought their body image was worse than before the operation and 80% thought their sexual activity was unchanged. Ninety-six percent thought the implantation was worthwhile and would do it again if they had to do the choice again. The reasons for dissatisfaction were: for the shape (n=8), for the size (n=3), for the position (n=2) and one patient thought the implant was too cold. Forty percent of the partners did not care about the implants and 58% thought the implant was essential. The dissatisfaction rate for the partners was 26% and reasons for were: for the shape (n=5), for the size (n=2), and one partner thought the implant was too cold. From the patients without implant, only one is thinking about having one. CONCLUSION: Testicular implants are well accepted, but some reasons of dissatisfaction appeared in our study. It was the first evaluation of the partner's satisfaction.

[PTa bladder tumours: prognostic factors of recurrence and progression]. / Tumeurs de vessie pTa: facteurs de récidive et de progression.

OBJECTIVE: The aim of this work has been to study the prognostic factors of recurrence and progression of stage pTa bladder tumours. PATIENTS AND METHODS: The case files of 193 patients, consecutively undergoing transurethral resection for primary pTa bladder tumour between 1980 and 2003, were retrospectively reviewed. Recurrence, progression and specific survival rates were studied. Prognostic factors associated with this type of tumour were then investigated. RESULTS: After a mean follow-up of 58 months, the recurrence rate was 56.5% and the rate of progression to stage T1 was 9.3%. The 10-year specific survival was 95.8%, but the 10-year recurrence-free survival rate was only 22.5%. Two risk factors for recurrence were identified on univariate analysis: haematuria at the time of diagnosis (p=0.009) and tumour size (p=0.01). Two factors were associated with a risk of progression: tumour size (p=0.03) and relapse during the first year after initial resection (p=0.003). None of these factors were independent prognostic factors on multivariate analysis. CONCLUSION: pTa bladder tumours present a high risk of recurrence. However, with attentive follow-up, the risk of progression is low and their 10-year specific survival rate is greater than 95 %. Tumour size at the initial diagnosis and early relapse increase the risk of progression to more aggressive disease.

[Conformal radiotherapy to 76Gy in localized prostate cancer. Therapeutic modalities and preliminary results]. / Radiothérapie conformationnelle à 76Gy des cancers localisés de la prostate. Modalités thérapeutiques et résultats préliminaires.

PURPOSE: To describe therapeutic modalities for localized prostate cancer treated by conformal radiation to 76Gy with or without androgen ablation. To evaluate the preliminary results in terms of survival, biological control and toxicity. PATIENTS AND METHOD: Between January 1998 and June 2001, 321 patients with localized prostate cancer were irradiated at institut Curie. Tumors were stratified into the three Memorial Sloan-Kettering Cancer Center prognostic groups (1998) for analysis: favorable risk group (FG) 23%, intermediate risk group (IG) 36.5%, unfavorable risk group (UG) 40.5%. Androgen deprivation, mainly neoadjuvant, less or equal to one year was prescribed to 93.8% of patients (72.6% less or equal to six months). Planning target volume prescription doses were: prostate: 76Gy, seminal vesicles: 56 to 76Gy, and pelvic lymph nodes: 44Gy to 16.8% of patients. RESULTS: The five-year actuarial overall survival was 94% (95% IC: 90-97%). The median post-therapeutic follow-up was 36 months (nine to 60 months). The 48-month actuarial rates of biochemical control for the three prognostic groups were statistically different according to both the American Society for Therapeutic Radiology and Oncology consensus (ASTRO 1997) and the Fox Chase Cancer Center definitions of biochemical failure (FCCC 2000) with respectively 87 and 94% for FG, 78 and 84% for IG, 54 and 58% for UG (P<10(-6) and P<10(-8)). At time of our analysis, late post-treatment rectal and bladder bleedings were 17,4 and 13,6%, respectively. According to a 1-4 scale adapted from M.D. Anderson Cancer Center criteria: rectal bleedings were grade 1 (9.6%), grade 2 (6.2%) and grade 3 (1.6%). Bladder bleedings were grade 2 (13%) and grade 3 (0.6%). Analysis of rectal bleeding risk factors showed significant correlations with pelvic lymph nodes irradiation for grade 2 and 3, (P=0.02), and for all grades, a correlation with smaller rectal wall volumes (P=0.03), and greater percentages of rectal wall irradiated to higher doses: 65, 70, 72 and 75Gy (P=0.02, P=0.01, P=0.0007 and P=0.003, respectively). CONCLUSIONS: These results are comparable to those previously reported with the same follow-up. Impact of dose escalation with short androgen deprivation on local control, survival and complications needs longer follow-up and further analysis.

Risk factors for adult renal cell carcinoma.

This study confirmed several independent risk and protective factors for RCC identified in the authors' previous study. Protective factors such as oral contraceptive use and moderate alcohol consumption were identified only in women. Tobacco consumption and severe obesity were the main independent risk factors. There were other modifiable risk markers, however, such as occupational exposure, thiazidic drug intake, and urinary tract infections. The associations between risk factors and RCC were weak, even for tobacco, for which the association was weaker than that for lung cancer. The identified risks involve a large proportion of the population, however, and the risk attributable to these types of exposure is high. The authors' recommendations for the prevention of RCC are therefore similar to those for the prevention of cardiovascular disease and cancer, and should be disseminated to the general population. The high-risk groups identified are too large for a specific early-screening program for RCC, but such screening might be appropriate if restricted to selected age groups.

Intermittent androgen suppression in patients with prostate cancer.

OBJECTIVES: To evaluate intermittent androgen suppression (IAS) in patients with prostate cancer and to try to define predictive factors for biochemical progression. PATIENTS AND METHODS: From 1989 to 2001, 146 patients received IAS as a primary treatment for localized, advanced or metastatic prostate cancer (72 men) or as a treatment for prostate-specific antigen (PSA) recurrence after radical prostatectomy (RP) and/or radiation therapy (74 men). Androgen-deprivation treatment (ADT) was continued up to 6 months after PSA became undetectable or a nadir PSA level was reached. ADT was then re-instituted when the PSA level was> 4 ng/mL for patients who had RP or> 10 ng/mL for the others. RESULTS: After a mean (range) follow-up of 45.6 (12-196.9) months, 24 patients had biochemical progression. These patients were younger than those with no biochemical progression (67 vs 72 years, P = 0.004) and had a statistically higher Gleason score (7.21 vs 6.52, P = 0.01) and PSA level (111.1 vs 32.1 ng/mL, P = 0.05), and a shorter first phase without treatment (7.6 vs 11.2 months, P = 0.05). Overall 5-year metastatic disease free survival of 91.3%. The overall 5-year biochemical recurrence-free survival was 68%. Using multivariate analysis, a Gleason score of >or= 8 (P = 0.021), first-phase duration with no treatment of < 1 year (P = 0.044), positive lymph nodes or metastatic disease at the time of starting IAS (P = 0.023) and age < 70 years (P = 0.037) were the strongest predictors of biochemical progression. CONCLUSION: IAS appeared to be a feasible treatment; the best candidates being those aged> 70 years with localized prostate cancer and a Gleason score of

Predictive factors of radiation therapy for patients with prostate specific antigen recurrence after radical prostatectomy.

OBJECTIVE: To assess the efficacy of salvage/adjuvant radiation therapy (RT) for patients with prostate-specific antigen (PSA) recurrence after radical prostatectomy (RP). PATIENTS AND METHODS: Between 1997 and 2001, 52 patients were treated in our institution with RT for PSA recurrence after RP. The mean (range) delay between RP and RT was 30.5 (0.16-105.6) months. Eighteen patients received no hormonal therapy before RT. The failure of RT was defined as three consecutive increases in PSA levels with intervals of > or = 6 weeks. RESULTS: Within a mean (range) follow-up of 27.7 (6-69) months, 18 patients presented with biochemical progression. The 3-year biochemical progression-free survival was 51%. Using univariate analysis, an age < 65 years (P = 0.0262), a Gleason score on the RP specimen of > or = 8 (P = 0.0024), stage pT3 (P = 0.02), a detectable nadir PSA after RT (P < 0.001) and the absence of hormonal therapy (P = 0.0359) were associated with a lower biochemical progression-free survival. However, only the Gleason score (P = 0.0395) and nadir serum PSA after RT (P = 0.028) remained independent predictive factors on multivariate analysis. CONCLUSION: Half of the present patients treated with RT for an isolated high serum PSA level after RP were free of biochemical relapse at 3 years of follow-up. RT may be proposed to selected patients with mild morbidity. However, definitive evidence of the beneficial effect of adjuvant RT for patients with PSA recurrence after RP awaits the conclusion of randomized clinical trials.

Local immunostimulation induced by intravesical administration of autologous interferon-gamma-activated macrophages in patients with superficial bladder cancer.

We conducted a phase I/II clinical trial of the safety and efficacy of intravesical administration of autologous IFN-gamma-activated macrophages (MAK) in patients with superficial bladder cancer. Monocyte-derived MAK cells were prepared in vitro and patients received six instillations of 1.4 x 10(8) to 2.5 x 10(8) cells, once a week, for five consecutive weeks. Treatment was well tolerated, with seven grade 1 and five Grade 2 protocol-related adverse effects. Nine out of 17 included patients had no recurrences during the year following the first instillation of MAK. The aim of the present study was to search for immune parameters related to local immunostimulation induced by MAK. Monitoring of the patients showed that urinary IL-8, GM-CSF and, to a lesser extent, IL-18 were increased following MAK instillations, with inter-individual differences. The urinary IL-8 level was about 10-fold higher than that observed for other cytokines, and its biological activity was reflected by a concomitant increase of urinary elastase, indicating neutrophil activation and degranulation. We also showed that nine out of 12 patients investigated presented an increase of urinary neopterin, a marker of IFN-gamma-activated macrophages, 7 days after MAK instillation, while serum neopterin levels were almost stable. These results are in line with persistence of activated macrophages in the bladder wall after infusions. Moreover, there was evidence of macrophages in urine smears 2 months after the sixth MAK instillation, and the score of macrophages correlated with the quantity of neutrophils in the urine. Overall, this study provides evidence of a local immunostimulation induced by this novel and safe immunotherapeutic approach of MAK instillations in patients with superficial bladder cancer.

[Chromophobe cell renal cancer, a distinct entity. Report of a series of 35 cases]. / Cancer du rein à cellules chromophobes, une entité à part entière. A propos d'une série de 35 cas.

OBJECTIVE: To describe the clinical and histological characteristics and natural history of clear cell renal carcinoma. PATIENTS AND METHODS: The case files of 35 patients (22 men and 13 women, with a mean age of 58 +/- 13.8 years) operated for clear cell renal carcinoma were reviewed. The circumstances of diagnosis and the histological features of the tumour were analysed. The outcome of the patients was studied with a mean follow-up of 70 +/- 20.2 months. RESULTS: The diagnosis was incidental in 66% of cases. The macroscopic appearance of the tumour was characteristic: homogeneous and beige or white colour. On light microscopy, tumours were composed of variable proportions of clear cells and eosinophilic cells. The were classified as 15 predominantly eosinophilic tumours (43%), 9 predominantly clear cell tumours (26%) and 11 tumours composed of equal number of clear cells and eosinophilic cells (31%). Nuclei were irregular and indented. Hale stain was positive in every case. The majority of tumours were confined to the kidney (T1: 65% and T2: 29%) with a low nuclear grade (91% of grades 1 and 2). No patient developed local recurrence or metastasis during follow-up. The overall 5-year survival rate was 92%. No death related to the disease was reported. CONCLUSION: The histological diagnosis of clear cell renal cancer is now easy and can be suggested even on macroscopic examination of the operative specimen. This tumour appears to have a good prognosis, as it is usually confined to the kidney with a low nuclear grade.