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Background. The prognostic value of flow cytometric analysis of DNA content is contradictory in renal cell carcinoma (RCC). Methods. Flow cytometric analysis was performed on 72 patients with RCC, and the relationship between the DNA content and pathologic or clinical features was investigated. Results. Aneuploidy was observed in 36 (50%) of these patients. Two tissue samples from primary tumors of 12 patients were analyzed, and heterogeneity was found in 7 (58%) of these patients. The incidence of aneuploidy was significantly higher in high‐grade than in low‐grade tumors (P = 0.0328). All five tumors with a maximum diameter of 2.5 cm or smaller (T1N0M0) were diploid, and a trend for more aneuploid tumors among high‐stage diseases was observed. The survival rate of patients with diploid tumors was not significantly different from that of those with aneuploid tumors in the low‐ or high‐stage group. Conclusions. DNA ploidy assessed with one sample is not a prognostic factor, and heterogeneity between different samples of a given tumor indicates that one sample is not enough for DNA flow cytometry in RCC. Cancer 1993; 72:1319–23.

A retrospective analysis based on Robson’s tumor stage classification was performed on 56 patients with renal cell carcinoma who had undergone radical nephrectomy through a lumbar flank approach and 35 who had through a transperitoneal approach. The 5-year survival rates of patients with nephrectomy through the lumbar approach for Robson’s stage 1, stage 2 and stage 3 were, respectively, 93.1, 70.4 and 60.0%. In comparison, the respective 5-year survival rates of patients with nephrectomy through the transperitoneal approach for Robson’s stage 1 stage 2 and stage 3 were 90.5, 72.2 and 25.0%. As a result, there was no significant difference in survival rates between the two surgical procedures for any of the three Robson’s stages. It is further suggested that the lumbar flank approach for radical nephrectomy does not result in poorer prognosis than does the transperitoneal approach, though transperitoneal and thoracoabdominal approaches have been generally recommended.

Fourteen patients with metastatic renal cell carcinoma (RCC) were treated by systemic administration of autologous lymphokine-activated killer (LAK) cells and interleukin-2 (IL-2). Pulmonary metastases alone were found in 9 cases, pulmonary and mediastinal nodal metastases in 3, and pulmonary and bone metastases in 2. LAK cells, generated by incubation in 2 units/ml of IL 2 for 3-4 days, were intravenously administered once or twice a week. In addition, beginning on the day of the first LAK cell infusion, 1000 units of IL 2 diluted in normal saline were intravenously infused once or twice a day with occasional supplementation of 1000 units of IL-2 on each day of LAK cell infusion. The total number of LAK cells and total amount of IL-2 administered per patient in this study ranged from 0.8 x 10(10) to 6.9 x 10(10) cells and from 3.3 x 10(4) to 21.4 x 10(4) units, respectively. As toxic effects caused by the infusion of LAK cells, headache, shaking chills, fever and leukocytosis were found in all 14 cases. Side effects possibly induced by IL-2 infusion were tolerable fever, fluid retention (body weight gain of 2-3 kg) and eosinophilia. No objective regression of mediastinal nodal or bone metastases was observed. In regard to lung metastases, however, partial and minor responses were observed in 3 and 2 cases, respectively. One of the 3 patients with a partial response was clinically free of disease after undergoing a thoracotomy for resection of residual lesions, but a brain metastasis was detected 10 months after the thoracotomy. The remaining 2 patients are being closely followed up at present. In 3 of 11 patients who showed a minor response, no change or progressive disease, brain metastases were observed during or after the immunotherapy. Furthermore, we examined the possibility of selection of suitable candidates for this therapy on the basis of the degree of in vitro LAK activity against autologous cultured tumor cells in 6 patients, but there was no significant correlation between in vitro autologous tumor cell lysis by LAK cells and the clinical response to immunotherapy. In conclusion, although a complete response could not be obtained, it can be said that this immunotherapy may be effective against RCC, in particular lung metastases, since a partial response was achieved in 3 of 14 patients. However, it should be taken into consideration that this immunotherapeutic approach may have a risk of increasing the frequency of brain metastases.