Background. The prognosis of patients with locally confined renal cell carcinoma is variable. To improve the prognostic knowledge and select patients at high risk, additional prognostic parameters are needed. Methods. The significance with respect to survival and tumor recurrence of “classic” and “new” prognostic parameters has been examined by following 41 patients with locally confined renal cell carcinoma after nephrectomy (mean follow‐up, 5,2 years). The significance of histologic grade, tumor stage, Ki‐67 index, proliferating cell nuclear antigen index, 3H‐thymidine labeling index, tumor ploidy status, and tumor growth after xenotrans‐plantation into nude mice (GAX range) was tested using the Kaplan‐Meier plots by the log rank test or Tarone's test and also by the Cox multiple hazard regression analysis. Results. Tumor stage (P < 0.0025), histologic grade (P < 0.005), Ki‐67 index (P < 0.006), and GAX range (P < 0.00004) were found to be significant prognostic parameters for survival and tumor recurrence using single‐factor analysis. Applying the multivariate analysis, the combination of the “new” factors, GAX range and Ki‐67 index, resulted in even a higher prognostic relevance than the combination of the “classic” prognostic factors, tumor stage and histologic grade. The calculated prognostic index based on the results of the Cox analysis, which, except for stage and grade, included the Ki‐67 index, was shown to be highly correlated with survival (P = 0.00002) and tumor recurrence (P = 0.0004). Its prognostic validity was studied with the receiver operating characteristicss procedure and was found to be considerably superior to that of the two conventional prognosticators. Conclusions. The additional determination of the Ki‐67 labeling index increases the prognostic assessment of patients with locally confined renal cell carcinoma. Cancer 1995; 76:296–306.

Introduction: The role of positron emission tomography (PET) with 2-[¹⁸F]fluoro-2-deoxy-D-glucose ([¹⁸F]FDG) is currently under evaluation in urologic oncology. The aim of the present study was to investigate the use of [¹⁸F]FDG positron emission tomography ([¹⁸F]FDG-PET) in the detection and treatment control of malignant germ cell tumors compared to computed tomography (CT). Materials and Methods: Thirty-two PET studies and CT scans were carried out in 23 patients with histologically proven germ cell tumors (10 seminomas, 12 non-seminomatous germ cell tumors (NSGCT), 1 unclassified serologic recurrent disease) Lugano stage I–III. The scans were done either after initial diagnosis (n = 21) and/or within 3–45 days after chemotherapy was completed (n = 11). PET and CT were validated either by histology (n = 7) or clinical follow-up of 6–11 months after the last PET study has been performed (n = 16). Sensitivity, specificity, accuracy, positive and negative predictive values were determined for PET and CT. Differences between PET and CT for parameters of diagnostic value were evaluated by χ² test. Results: Although not statistically significant, the sensitivity, accuracy and negative predictive value were higher for PET than for CT with respect to the detection of metastatic infradiaphragmatic and supradiaphragmatic lesions after initial diagnosis. The specificity and positive predictive value of PET and CT were comparable. After chemotherapy, PET was found to be significantly superior in specificity and accuracy compared to CT with respect to infradiaphragmatic lesions (p < 0.05). False-positive PET findings in supradiaphragmatic lesions after chemotherapy occurred in the case of inflammatory processes and resulted in a loss of specificity and accuracy compared to CT (p < 0.05). Conclusions: These preliminary results demonstrate [¹⁸F]FDG-PET to be a useful diagnostic tool for the initial staging and treatment control in patients with germ cell tumors. Possible advantages compared to CT, however, are as yet not clearly defined. The possibility of false-positive PET findings due to reactive supradiaphragmatic inflammatory processes early after chemotherapy have to be considered.

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