RENAL CELL CARCINOMA Factors of importance for follow-up and survival

........................................................................................................... 6 ABBREVIATIONS.................................................................................................. 7 ORIGINAL PAPERS .............................................................................................. 9 INTRODUCTION .................................................................................................. 10 EPIDEMIOLOGY................................................................................................... 10 ETIOLOGY AND ORIGIN ........................................................................................ 11 Familial clear cell carcinoma................................................................................11 Hereditary papillary renal carcinoma (HPRC) ......................................................11 The hereditary leiomyomatosis ............................................................................11 The BirtHogg-Dube cancer syndrome ...............................................................12 HISTOLOGICAL SUBTYPES ................................................................................... 12 NUCLEAR GRADE ................................................................................................ 13 SYMPTOMS AND DIAGNOSIS................................................................................. 13 INCIDENTAL TUMOURS......................................................................................... 14 PROGNOSTIC FACTORS ....................................................................................... 14 TNM staging system .................................................................................... 14 Tumour size. ........................................................................................................17 T3 and adrenal gland status. ...............................................................................17 Lymph nodes .......................................................................................................18 Prognostic models ....................................................................................... 19 SURGICAL TREATMENT AND SURVIVAL ................................................................. 22 Open radical nephrectomy (ORN) ............................................................... 22 Laparoscopic radical nephrectomy (LRN) ................................................... 22 Nephron-sparing surgery (NSS) .................................................................. 23 Minimally invasive NSS................................................................................ 23 MANAGEMENT OF METASTATIC RCC.................................................................... 23 The role of surgery....................................................................................... 23 The role of immunotherapy .......................................................................... 24 Targeted therapy.......................................................................................... 24 AIMS OF THIS STUDY ........................................................................................ 25 MATERIAL AND METHODS ............................................................................... 26 STUDY PERIOD ................................................................................................... 26 SURGERY........................................................................................................... 26 FOLLOW-UP........................................................................................................ 26 NUCLEAR GRADING ............................................................................................ 27 TISSUE AND BLOOD SAMPLE COLLECTION............................................................. 27 FLOW CYTOMETRIC STUDY .................................................................................. 27 LABORATORY ..................................................................................................... 28 STATISTICAL ANALYSIS ....................................................................................... 28