SUMMARYThe mechanism of anti-tumour activity by BCG is not known clearly. However, many studies suggest that immunological response is related to effectiveness of intravesical instillation of BCG in the therapy for super®cial bladder carcinoma. Peripheral blood mononuclear cells (PBMC), urine and serum were obtained from patients with super®cial carcinoma at various times during the course of BCG instillation. Urine of patients showed increased levels of IL-1b, IL-2, IL-6, tumour necrosis factor-alpha (TNF-a), interferon-gamma (IFN-g) and macrophage colony-stimulating factor (M-CSF) after BCG instillation. Levels of IL-2 and IFN-g in the serum also increased after BCG instillation, but IL-1b, IL-6, TNF-a and M-CSF were not detectable. Maximal levels of IL-2 and IFN-g in the urine or serum were shown after the fourth instillation. BCG-induced killer cell activity in PBMC increased signi®cantly after the third BCG instillation. These results suggest that BCG instillation involved not only local immunological efforts but also systemic immune responses. Tumour-free patients produced higher BCG-induced killer cell activity than tumour recurrence patients. BCG-induced killer cell activity may be useful for monitoring the effectiveness of intravesical BCG instillation.

Purpose: The expression of matrix metalloproteinase-7 (MMP-7) correlates with the malignant potential of various tumors and patient survival.We investigated the clinical and prognostic significance of MMP-7 expression in cancer cells and endothelial cells in human renal cell carcinoma (RCC). Experimental Design: We reviewed tissue samples of 156 patients with RCC who had undergone radical operation. MMP-7 expression was examined by immunohistochemistry. Sections containing MMP-7-positive vessels were also stained for CD34. The density of MMP-7-positive vessels was determined by a computer-aided image analysis system. Multivariate analysis was done to assess relevant variables for invasion, metastasis, and cause-specific survival.Results: The proportion of MMP-7-expressing tumor cells were significantly higher (P < 0.001) than that of normal cells. MMP-7-positive vessels were considered blood vessels based on staining for CD34, and their density was increased in tumor areas. The proportion of MMP-7-expressing cancer cells and density of MMP-7-positive vessels correlated with grade, pathologic tumor stage, and metastasis. Multivariate analysis showed that MMP-7 expression on cancer cells correlated with pathologic tumor stage only, whereas MMP-7-positive vessel density correlated with metastasis only. The elevated status of MMP-7 in cancer tissues was an independent predictor for cause-specific survival (odds ratio, 8.61; P = 0.040) by multivariate analysis. Conclusions: Our results showed that MMP-7 influences tumor progression by regulating invasion and angiogenesis. Multivariate analysis showed that MMP-7 status of cancer tissues was strong predictor of poor prognosis. Our results suggest that MMP-7 targeting treatment may be a potential target against RCC. Systemic dissemination of cancer cells influences prognosis inthe majority of malignancies. Many factors are associated with this process, and cancer cell invasion into surrounding tissue is one of the early and crucial steps. In addition, the formation of new capillaries (neoangiogenesis) is also an important process in tumor growth and metastasis in solid tumors (1, 2). Degradation of the extracellular matrix and destruction of the basement membrane by cancer cells are important processes for direct invasion. Likewise, degradation of extracellular matrix of endothelial cells is one of the initial steps in neoangiogenesis. Thus, these processes are important for tumor progression and prognosis, and full understanding is essential in the planning of treatment and observation strategy.Matrix metalloproteinases (MMP) are zinc-dependent proteolytic enzymes capable of cleaving extracellular matrix components. Several investigators have paid special attention to the pathologic significance of MMPs in cancer cells, and it is a well-known fact that MMPs are overexpressed in a variety of cancers and play important roles in cancer invasion and metastasis (3 -5). In addition to cancer cells, several investigators found that some MMPs are secreted by endotheli...

Objective To determine the clinical usefulness of Bosniak's classi®cation of cystic renal masses, the differentiation of which remains dif®cult despite signi®cant advances in diagnostic imaging. Patients and methods The computed tomography (CT) ®ndings of all histopathologically examined cystic renal masses diagnosed at our institution were analysed retrospectively; 35 patients with cystic renal masses were treated between 1986 and 1998. Tissues surgically removed were examined pathologically and the ®nal diagnosis compared with the preoperative CT category of Bosniak's classi®cation. Results The histopathological examined showed cystic renal cell carcinoma in 21 patients, a benign renal cyst in 12, haemangiosarcoma in one and transitional cell carcinoma in one. Most of the 35 masses (26, 74%) were found incidentally during evaluation for an unrelated disease or a routine health check. All 11 masses of Bosniak category I were benign and one category II mass was malignant. All 10 masses of category III and 12 of category IV were malignant. Conclusions Bosniak's classi®cation is useful for differentiating category I, III and IV cystic renal masses.There were too few samples to allow meaningful conclusions to be drawn for category II renal masses. It is critical to differentiate between complicated cysts of category II and III because of the major implications for prognosis and clinical management.

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