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Introduction: When checking tumour growth, a number of observations indicate that the immune system plays a significant role in patients with renal cell carcinoma (RCC). Infiltration by lymphocytes (tumour infiltrating lymphocytes, TILs) is more prevalent in RCC than any other tumours. T lymphocytes are the dominant population of TIL cells. Views concerning the role of T lymphocytic subpopulations, B lymphocytes and NK cells in an anti-tumour response are not established. Aim: The aim is to determine the phenotype and activation of T and B lymphocytic subpopulations and NK cells and to compare their representation in tumour stroma and peripheral blood lymphocytes (PBL) in patients with RCC. Material and methods: Samples of peripheral blood taken from the cubital and renal veins and tumour stroma cells were obtained from 44 patients in the course of their surgeries carried out due to primary RCC. TILs were isolated from mechanically disintegrated tumour tissue. Immunophenotype multiparametric analysis of PBL and TILs was carried out. Their surface and activation characteristics were determined by means of flow cytometer. Results: CD3+ T lymphocytes (69.7 %) were the main population of TILs. The number of CD3+/CD8+ T lymphocytes was significantly higher in TILs, 42.6 % (p< 0.01), while CD4+ T lymphocytes were the majority population in peripheral blood, 41.35 % (p < 0.001). The representation of CD3+/69+ T lymphocytes was significantly higher in TILs, 32.9 %, compared to PBL (p<0.001). On the contrary, the numbers of CD3+/CD25+, CD8+/57+ and CD4+/RA+ (naive CD4+ T lymphocytes) were higher in PBL (p<0.001). The differences in representation of (CD3-/16+56+) NK cells and CD3+/DR+ T cells in TILs and PBL were not significant. Conclusion: The above-mentioned results prove that the characteristics and intensity of anti-tumour responses are different in compared compartments (tumour/PBL). CD3+/CD8+ T lymphocytes are the dominant lymphocytic population of TILs. The knowledge of the phenotype and functions of effector cells, which are responsible for anti-tumour response, are the basic precondition for understanding the anti-tumour immune response and the cause of its failure.

E 5 9What ' s known on the subject? and What does the study add? Surgical treatment of renal cell carcinoma (RCC) with tumour thrombus extending into the right atrium remains, despite its complexity and specifi c technical aspects, the only radical therapeutic option.This single-centre study, unique in size for this rare condition, reports early and late results over a period of 18 years. All patients were operated on using a standardised protocol with use of cardiopulmonary bypass and deep hypothermic circulatory arrest. Overall and cancer-specifi c cumulative survival was better than in other reports. OBJECTIVE• To evaluate the long-term results of radical surgical management of renal cell carcinoma (RCC) with tumour thrombus extension (TTE) level IV into the right atrium (RCC/TTE IV) in a large singleinstitution series. PATIENTS AND METHODS• Radical complex urological and cardio-surgical procedure was performed over a period of 18 years (1993 -2010) on 21 patients with RCC/TTE IV. A radical nephrectomy was performed followed by sternotomy, institution of cardiopulmonary bypass and extraction of the intracardiac tumour thrombus under direct visual control during deep hypothermic circulatory arrest (DHCA).• Perioperative and postoperative variables, and long-term overall and cancer-specifi c survival using the Kaplan -Meier method were analysed. RESULTS• In all patients, precise removal of tumour thrombus was accomplished in a bloodless fi eld during DHCA.• The mean ( SD ) duration of circulatory arrest was 16 (6) min at a mean hypothermia of 20 (3) ° C. In-hospital mortality was 9.5% (two patients).• The median survival (including in-hospital mortality) was 25 months.• In Kaplan -Meier analysis, 2-and 5-year overall cumulative survival rate was 57 (95% confi dence interval, CI 36 -78)% and 37 (95% CI 15 -58)%, respectively.• Cancer-specifi c cumulative survival was 68 (95% CI 49 -89)% at 2 years and 51 (95% CI 28 -74)% at 5 years. CONCLUSIONS• Late outcome after radical surgical treatment in patients with RCC and TTE reaching up to the right atrium justifi es this extensive procedure.• Cardiopulmonary bypass with DHCA allows safe and precise extirpation of all intracaval and intracardiac tumour mass.