Pathologic study and prognostic factors in 28 patients with ovarian immature teratoma

28 patients with ovarian immature teratoma were studied pathologically. Neoplasms with other germ cell elements were excluded. The ages ranged from 11 to 38. 71% were women under 25 years. Each primary tumor and metastatic lesion was graded histologically according to the criteria of Norris. Of these 28 cases, 11 were grade I; 11 grade II; and 6 grade III. The study showed that the stage of primary tumor is closely related to the prognosis. The likelihood of recurrence and metastasis could be determined by the grade of the primary tumor. The recurrence rate of grade I, II, and III were 0%, 44% and 100%, respectively. It also showed that the addition of hysterectomy and contralateral adnexectomy for grades II and III lesions did not improve the survival. One patient had been operated for 3 times to remove recurrences in the abdominal cavity and liver in a period of 25 months. The first and second recurrent tumors were grade III, but the third one was grade II showing that the immature teratoma tends to mature, but this conversion needs time. The authors support the opinion that repeated operations to remove the recurrences may improve the survival.     

Multiple primary malignant neoplasm in patients with laryngeal carcinoma

BACKGROUND AND OBJECTIVES: The aim of this study was to study the incidence, localization, and nature of second primary tumors arising in patients with primary laryngeal carcinoma and their correlation with the site, staging, and grade of differentiation. METHODS: Between 1979 and 1996, 877 patients underwent laryngeal surgery (850 male and 27 female; age range = 30.5-76 years). The second primary tumor was multicentric in 7 cases (14%), systemic in 16 cases (33. 3%), and "coincidental" in 25 cases (52%). In 3 cases the tumors were simultaneous, in 7 cases they were synchronous, and in 38 cases they were metachronous. In the 48 patients with multiple primary malignant neoplasm, the index tumor was glottic in 38 cases and supraglottic in the remaining 10, but the incidence of second tumors in these two groups was virtually matching, respectively: 38/709 (5. 3%) and 10/168 (5.9%). RESULTS: This study did not identify any correlation between the second primary tumor and the extension of the first neoplasm (T) and the presence of laterocervical lymph node metastases (N). Our data showed a higher incidence of second tumor in patients having G1 carcinomas compared with the other series with G2 and G3 carcinomas. As far as survival rates are concerned, a significant reduction was observed in patients developing a second primary tumor, regardless of whether the index tumor was glottic or supraglottic. CONCLUSIONS: The incidence of new tumors in patients with laryngeal carcinoma is not linked to the site, size, staging, or grade of differentiation of the index tumor.     

High expression of L-type amino acid transporter 1 in infiltrating glioma cells

L-type amino acid transporter 1 (LAT1), a neutral amino acid transport agent, is essential for the transport of large neutral amino acids. LAT1 also corresponds to tumor-associated gene-1 (TA1), an oncofetal antigen that is expressed primarily in fetal tissues and cancer cells such as glioma cells. We have investigated the expression of the transporter in the human primary glioma tissue from 68 patients. Among these patients, we could see the border zone between tumors and normal bain tissues in 10 patients. By WHO criteria, two of the specimens were diagnosed as grade 2, three as grade 3, and five as grade 4 [glioblastoma multiforme (GBM)]. In 9 of 10 cases, we could identify the infiltrating glioma cells associated with stronger immunoreactivity for LAT1. These tumor cells aggregated around the neurons in the border zone and were often found in the perivascular space. In one GBM case, the tumors seemed to develop expansively and separated from the normal brain with a border of arachnoid membrane. The expression of LAT1 was always higher in infiltrating glioma cells than in cells located in the center of the tumor. These findings suggest that LAT1 is one of the molecular targets for glioma therapy.     

Carcinomatous meningitis in a case of anaplastic meningioma

Summary Twelve adult patients in the records of 38 patients with histologically verified supratentorial low grade glioma showed recurrence at the Gifu University Hospital between 1980 and 1992. A mean period to recurrence from the initial surgery and postoperative radiation was 38 months. Six of these patients underwent intraoperative radiation therapy. The other six patients received chemotherapy with conventional cytoreductive surgery in three cases and additional external irradiation in three cases. The 2-year survival rate of the former patients was 83.8% and significantly higher than that of the latter ones, 16.7% (p < 0.05). Most cases showing recurrence of supratentorial low grade glioma were occurred locally, and dissemination or remote metastasis of the lesion were rare. The results revealed that the local control is important for recurrent tumors of supratentorial low grade gliomas. The effectiveness of the intraoperative radiation therapy as the second operation for the recurrent supratentorial benign glioma is discussed.     

Expression of cell cycle regulator p27Kip1 is correlated with survival of patients with astrocytoma.

p27Kip1 is a cyclin-dependent kinase inhibitor that negatively regulates cell proliferation by mediating cell cycle arrest in G1. This study was undertaken to assess the prognostic value of p27Kip1 for astrocytomas. Tissue samples from 130 astrocytomas (WHO grade 1, 5 cases; grade 2, 23 cases; grade 3, 64 cases; grade 4, 38 cases), including 92 primary and 38 recurrent tumors, were examined immunohistochemically for Ki-67 and p27Kip1 expression. Patient charts were reviewed for clinical presentation, and survival was followed. The p27Kip1 labeling index (LI) ranged from 2.3 to 98.4%, with a mean value of 47.5% (+/-23.4%). The p27Kip1 LI decreased with increasing tumor grade but did not correlate with other parameters. There was no correlation between Ki-67 LI and p27Kip1 LI. For patients with primary astrocytomas, the 50% survival times of those with low p27Kip1 LI (<50%) and those with high p27Kip1 LI (> or =50%) were 17.1 and 69.6 months, respectively. For patients with high-grade tumors, the 50% survival times were 13.1 months for those with low p27Kip1 LI and 33.7 months for those with high LI. On multivariate analysis, p27Kip1 was one of the most significant prognostic factors, indicating that low p27Kip1 LI was associated with poor prognosis (primary, risk ratio = 2.5, P = 0.0023; high-grade, risk ratio = 2.2; P = 0.0139). The expression of p27Kip1 was inversely related to tumor grade and positively related to favorable outcome of patients with astrocytoma, suggesting that p27Kip1 may be a candidate for prognostic factor for this tumor.     

中人氟安植入剂在乳腺癌手术中的应用

目的探讨间质化疗植入剂中人氟安在乳腺癌手术中的应用。方法对212例乳腺癌患者应用中人氟安植入剂作为间质化疗,其中保乳患者174例,改良根治术患者38例。结果随访3至95个月,保乳手术后局部复发2例,局部复发率为1.1%(2/174);乳腺癌根治术后局部复发1例,局部复发率为2.6%(1/38)。6例(2.8%)患者出现植入区域皮肤红肿,多在7～10d内红肿消退;伤口感染、药物颗粒溢出1例(0.5%),经换药清理后二期缝合,伤口愈合。结论中人氟安植入剂作为间质化疗用以处理可能残存的肿瘤细胞,对预防复发具有一定作用。临床应用中,应注意该药物的剂量和植入方法。     

Multivariate analysis for clinical prognostic factors in 163 patients with soft tissue sarcoma

Clinical and histologic findings in 163 patients with localized soft tissue sarcoma (STS) in the extremities and trunk were reviewed. There were 91 male patients and 72 female patients ranging in age from 2 to 84 years (median, 46 years). The histologic status of the tumors was as follows: low grade, 29 cases; intermediate grade, 52 cases; and high grade, 82 cases. The primary tumors were treated by intralesional excision (two cases), marginal (88), wide local (52), or amputation (21). Subsequent adjuvant therapy was given to 61 patients; 17 had radiotherapy (RT), 27 had chemotherapy (CH), and 17 had combined RT and CH. The overall survival (P less than 0.1) and disease-free survival (P less than 0.001) were better in the group that received multimodal treatment (radical surgery and adjuvant chemotherapy with or without radiotherapy) than in the group treated only by surgery. This suggests the favorable role of adjuvant therapy. The univariate and the Cox multivariate analysis for prognosis revealed that sex, tumor-related symptoms, tumor size, tumor depth, and histologic grade were the significant factors. Among the treatment schemes, adjuvant chemotherapy was the only one that affected survival, especially for the intermediate-grade tumors. Initial surgical treatment (marginal versus wide local excision) significantly contributed to the local control of the primary tumors.     

Malignant gliomas of the cerebellum: An analytic review

Using an analytical review, the demographic data on malignant cerebellar gliomas such as length of survival, and those factors associated with prolonged survival were examined. Seventy-one cases of malignant cerebellar glioma reported since 1975 were combined and reviewed with the seven cases treated at our institution since that time. Thirty-seven patients (47%) had grade III tumors and 41 (53%) had grade IV tumors. Fifty-nine percent of the tumors were located in the hemispheres and 41% were found in the vermis. Median survival for patients with grade III anaplastic astrocytomas was 32 months compared to 11 months for those with grade IV glioblastomas multiforme (P = 0.0257). For the entire cohort, patients with grade III tumors, those who had a surgical resection, and those that had received radiation therapy for treatment of their tumor had prolonged survival on multivariable analysis. Radiation therapy was associated with extended survival for patients with grade III tumors by uni- and multivariate analysis. For grade IV tumors, univariate analysis revealed prolonged survival for those patients who had surgical resection compared to those who had biopsy alone (P=0.0036) and for those who received external beam radiation therapy (P=0.0001). Patients with malignant gliomas of the cerebellum had length of survival comparable to their supratentorial counterparts. Prompt diagnosis and treatment may explain the similarity in survival found between supra- and infratentorial malignant gliomas despite an expected shorter survival because of treatment limitations. Surgical resection followed by radiation therapy is recommended for patients with malignant gliomas of the cerebellum.     

Quantitation of androgen receptor gene expression in sporadic breast tumors by real-time RT-PCR: evidence that MYC is an AR-regulated gene

Little is known of the function and clinical significance of the androgen receptor (AR) in human breast cancer. Paradoxically, synthetic progestins, such as medroxyprogesterone acetate, are used for second line hormone therapy of breast cancer following tamoxifen failure. A sensitive and accurate assay for AR expression in breast tumors is thus required. Here we have developed and validated a real-time RT-PCR assay to quantify AR gene expression at the mRNA level in a series of 131 patients with unilateral invasive primary breast tumors. AR expression varied widely in tumor tissues (by at least 3 orders of magnitude), being underexpressed in 24/131 (18.3%) and overexpressed in 45/131 (34.4%) relative to normal breast tissues. We observed links (or trends) between AR status and age, menopausal status, Scarff-Bloom-Richardson histopathological grade, lymph node status and estrogen receptor alpha and progesterone receptor status. High AR mRNA levels were negatively linked to MYC gene overexpression (P = 8 x 10(-6)), confirming previous in vitro studies. Our results also suggest a role of the ARA70 gene (which encodes a major AR co-activator) in the AR pathway dysregulation observed in breast cancer. This simple, rapid and semi-automated method will be useful for screening cancer patients for altered AR expression and for predicting the response to androgen therapy in AR-related cancer patients.     

Histologic grade and karyotype of immature teratoma of the ovary

Seven cases of ovarian "pure" immature teratoma were encountered in patients 10 to 38 years of age, six cases being in Stage Ia and one case in Stage IIc. The primary tumors and recurrent growth observed in one case were histologically graded from 0 to 3 according to the criteria of Norris et al. Karyotypes of the tumors and the patients were determined using culture and banding techniques. The only nonsurviving case was in Stage IIc. Four primary tumors belonging to grades 0, 1, and 2 showed a normal 46,XX female karyotype and the patients are alive and healthy. Three grade 3 tumors showed various types of karyotype abnormalities (48,XX,+14,+21; 47,XX,+20; 47,XXX). One patient died, one is alive after experiencing a recurrent tumor, and one has only been followed for 22 months. All seven patients had a normal 46,XX female chromosome constitution. Evidence to date indicates that karyotype of ovarian immature teratoma is either normal female 46,XX or a slight deviation from normal. It is postulated that in ovarian immature teratoma normal 46,XX karyotype is an indicator of favorable prognosis, whereas deviations in karyotype suggest a possibility of poor prognosis.     

电化学治疗癌性疼痛的临床应用

目的:分析2003年1月-2010年1月电化学治疗的癌性疼痛61例疗效,探讨治疗癌痛的一种有效新方法。方法:本组病例中有头颈部、胸部、消化系、妇科、骨及软组织恶性肿瘤,肿瘤分期均为4期。疼痛级别VAS分级:1级4例,2级20例,3级37例。常规麻醉下,疼痛的瘤体内设置正负电极,1-2cm相间,治疗电量每1立方厘米100库仑。全部病例治疗过程平稳,无并发症发生。结果:全部病人疼痛缓解,有效率100%。疼痛效果评估:完全缓解(CR)56例,部分缓解(PR)5例;疗效维持最短7天,最长者超过1年。治疗后均停止用吗啡、杜冷丁等镇痛药。结论:对于适应电化学治疗的癌痛患者,进行电化学治疗,方法简便、不出血、痛苦小,不仅能缓解癌痛,还能有效治疗原发肿瘤以及复发癌和转移癌,是一种有效的新方法,值得推广应用。     

电化学治疗癌性疼痛的临床应用

目的：分析2003年1月-2010年1月电化学治疗的癌性疼痛61例疗效,探讨治疗癌痛的一种有效新方法。方法：本组病例中有头颈部、胸部、消化系、妇科、骨及软组织恶性肿瘤,肿瘤分期均为4期。疼痛级别VAS分级：1级4例,2级20例,3级37例。常规麻醉下,疼痛的瘤体内设置正负电极,1-2cm相间,治疗电量每1立方厘米100库仑。全部病例治疗过程平稳,无并发症发生。结果：全部病人疼痛缓解,有效率100%。疼痛效果评估：完全缓解（CR）56例,部分缓解（PR）5例;疗效维持最短7天,最长者超过1年。治疗后均停止用吗啡、杜冷丁等镇痛药。结论：对于适应电化学治疗的癌痛患者,进行电化学治疗,方法简便、不出血、痛苦小,不仅能缓解癌痛,还能有效治疗原发肿瘤以及复发癌和转移癌,是一种有效的新方法,值得推广应用。     

Stage IE primary malignant lymphomas of the uterine cervix

The experience of the authors with primary non-Hodgkin's lymphoma of the uterine cervix from 1980 to 1986 included five Ann Arbor Stage IE cases successfully managed by meticulous staging and radiation therapy. The clinicopathologic features of the patients are described and compared with 38 previously reported Stage IE cases. When all 43 patients were evaluated, the median age was 40 years of age (range, 20 to 80 years of age) and 77% were premenopausal. Most patients (74%) reported abnormal vaginal bleeding, although approximately 20% were asymptomatic. The primary cervical tumors were typically of large size, with half exceeding 4 cm in diameter. Using the International Federation of Gynecology and Obstetrics (FIGO) system for staging cervical cancer, stage distribution was 44% Stage I, 42% Stage II, 12% Stage III, and 2% Stage IV. Histologically, approximately 70% were of the diffuse, large cell type (Working Formulation). External beam radiation therapy supplemented by brachytherapy or hysterectomy was used for 76% of the patients reviewed. There was only one treatment failure among the 28 patients whose treatment included radiation and whose cases were followed for at least 2 years. This experience and a review of the literature indicate that most cases of primary lymphoma of the uterine cervix are Ann Arbor Stage IE, and can be cured with traditional combinations of surgery and radiation therapy after careful evaluation.     

In situ expression of interleukin-4 (IL-4) receptors in human brain tumors and cytotoxicity of a recombinant IL-4 cytotoxin in primary glioblastoma cell cultures.

We have reported that human malignant glioma cell lines express high levels of plasma membrane interleukin-4 receptors (IL-4R). We have also reported that biopsy/surgical samples or primary explant cell cultures from brain tumors express mRNA and protein for the IL-4Ralpha chain, a primary IL-4-binding protein. However, whether IL-4R are expressed in brain tumors in situ has not been resolved. In addition, expression of IL-4R on the cell surface of various normal brain tissues is not known. We examined the expression of IL-4R by using a monoclonal antibody to the IL-4Ralpha chain (also known as IL-4R beta) in surgical/biopsy samples of brain tumor tissues by immunohistochemistry. Our data indicate that 15 of 18 glioblastoma multiforme (GBMs) tumors obtained from two different institutions and 12 other brain tumor samples are moderately to intensely positive for IL-4Ralpha. In contrast, although IL-4Ralpha mRNA was expressed, no IL-4R protein was detectable in two adult and one pediatric brain tissue specimens. In addition, a commercially available human neural tissue grid containing fixed tissues from various areas of brain showed no positive staining for the IL-4Ralpha chain. IL-4Ralpha expression was also demonstrated on astrocytoma grades I, II, and III. Because IL-4 cytotoxin comprised of a circularly permutated IL-4 and a mutated form of Pseudomonas exotoxin [IL4(38-37)-PE38KDEL] is cytotoxic to IL-4R-expressing cells, we tested whether primary GBM explant cell cultures are sensitive to IL-4 cytotoxin. Our data indicate that 13 of 15 GBM cell cultures were 25-74 times more sensitive to IL-4 cytotoxin compared with normal human astrocytes or the NT2 neuronal cell line. These observations indicate that human brain tumors in situ overexpress IL-4R compared with normal brain tissues, thus confirming our previous conclusions that IL-4R in brain tumors may serve as an attractive target for anticancer therapy.     

Cytofluorometric DNA ploidy analysis in giant cell tumor of bone: histologic and prognostic value.

DNA ploidy analysis by DNA cytofluorometry was performed on 41 tumors obtained from 37 patients with primary giant cell tumor of bone (GCT). Histologically, 26 of the tumors from primary or recurrent lesions were evaluated as grade I, and 13 tumors as grade II. Among the 33 primary GCT patients, 4 patients had local recurrence or pulmonary metastasis. The DNA ploidy pattern and the percentage of hyperdiploid cells showing a greater DNA content than diploid cells, were obtained from DNA cytofluorometry. All of the 33 primary tumors were diploid. Of 6 recurrent tumors, 4 were diploid and 2 were euploid-polyploid. One of the two pulmonary metastatic tumors was diploid, but another that demonstrated a malignant transformation to malignant fibrous histiocytoma was aneuploid. The percentage of hyperdiploid cells was significantly different between primary and recurrent tumors (P = 0.0188) and between grade I and grade II tumors (P = 0.0052), while there was no difference between primary tumors in the cases that recurred or metastasized and those that did not. Thus, these data indicate that cell proliferative activity is closely correlated with biological aggressiveness and histological grading, although DNA ploidy is not useful for predicting prognosis.     

Mutations of PTEN/MMAC1 in primary prostate cancers from Chinese patients.

PTEN/MMAC1 is a putative tumor suppressor gene located on 10q23, one of the most frequently deleted chromosomal regions in human prostate cancer. Although mutations of PTEN have often been detected in metastases of prostate cancer, localized tumors have shown lower rates of mutation, which have varied from 0 to 20% among different studies. It is unknown whether the rate of PTEN mutations is different in prostate cancer from Asian men compared with Western men. To further clarify the role of PTEN in prostate cancer and to examine the gene for mutations in Asian men, we analyzed 32 cases of primary prostate cancers from Chinese patients, each of whom was not diagnosed by screening with serum prostate-specific antigen, for PTEN mutations using the methods of tissue microdissection, single-strand conformational polymorphism, and direct DNA sequencing. Seventy % of the tumors were Gleason scores 8-10, whereas the remainder were Gleason score 7. Six metastases of prostate cancer from American patients were also analyzed. Five of 32 (16%) primary prostate cancers from Chinese men and two of six metastases from American men showed mutations in a total of 10 codons of PTEN, which involved exons 1, 2, 5, 8, and 9. Two of the mutations were truncation type, whereas the rest were missense mutations. The mutation frequency in these cases from Asian patients was higher than that in our previous study of cases in radical prostatectomy specimens from American men, in which the 40 primary tumors were lower grade and had been detected by serum prostate-specific antigen test. We conclude that mutation of PTEN occurs more often in primary prostate cancers of Chinese men, whose tumors are high grade and reflective of an unscreened population.     

Characteristics of and therapeutic options for contralateral axillary lymph node metastasis in breast cancer

Aim

Contralateral axillary metastasis (CAM) from breast cancer is uncommon. This papers aims to identify the features of our patients with CAM, as well as clarify management options.

Methods

We reviewed all of our breast cancer patients during the period from 2004 to 2009. All patients with a proven pathological diagnosis of CAM were included. Patients were evaluated for demographics, tumor features and management modalities.

Results

A total of 21 patients were included, forming 1.9% of our breast cancer population. The median age was 51 years (range 29-71). Twelve patients had large central or diffuse tumors. Most of the tumors were of invasive ductal type (95%), of high grade (81%) and with lymphovascular invasion (81%). The majority of cases were locally advanced (stage III: 90%). Hormonal receptor positivity and HER-2 overexpression were seen in 48% and 42% of cases, respectively. Those pathological features were significantly worse than those of patients without CAM. Ten patients had synchronous and 11 patients had metachronous CAM. Treatment modalities included axillary dissection, chemotherapy and hormonal therapy. Four patients died from metastatic disease and 5 patients are still alive without evidence of metastasis.

Conclusion

CAM is associated with tumors with aggressive pathological features. Hormonal therapy is associated with an excellent response in patients whose tumors are hormone-receptor positive. Axillary dissection is indicated in patients with early-stage tumors, when there is no response to systemic therapy, or for palliation. It is associated with excellent local control.     

表浅性膀胱癌预后与癌肿数目、病理分级的关系

目的探讨表浅性膀胱癌肿块数目、病理分级与患者预后的关系。方法对122例表浅性膀胱癌进行回顾性分析。结果122例中,40例术后复发,术后5年内的复发率为32.79%。初诊时肿瘤为多发者即3个及3个以上肿瘤、G3级的肿瘤术后复发的平均时间、5年内的复发率分别高于单发或双发者、G1或G2级的肿瘤。结论膀胱癌肿瘤数目、细胞分级是影响表浅性膀胱癌预后的重要因素,多发肿瘤、G3级肿瘤可能在较短时间内复发,及时行膀胱切除更为妥当。     

A prospective feasibility study of respiratory-gated proton beam therapy for liver tumors

PurposeTo evaluate the feasibility of a respiratory-gated proton beam therapy for liver tumors.Methods and materialsFifteen patients were enrolled in a prospective institutional review board-approved protocol. Eligibility criteria included Childs-Pugh A/B cirrhosis, unresectable biopsy- proven hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), or metastatic disease (solid tumors only), 1-3 lesions, and tumor size of ≤ 6 cm. Patients received 15 fractions to a total dose of 45-75 GyE [gray equivalent] using respiratory-gated proton beam therapy. Gating was performed with an external respiratory position monitoring based system.ResultsOf the 15 patients enrolled in this clinical trial, 11 had HCC, 3 had ICC, and 1 had metastasis from another primary. Ten patients had a single lesion, 3 patients had 2 lesions, and 2 patients had 3 lesions. Toxicities were grade 3 bilirubinemia-2, grade 3 gastrointestinal bleed-1, and grade 5 stomach perforation-1. One patient had a marginal recurrence, 3 had hepatic recurrences elsewhere in the liver, and 2 had extrahepatic recurrence. With a median follow-up for survivors of 69 months, 1-, 2-, and 3-year overall survivals are 53%, 40%, and 33%, respectively. Progression-free survivals are 40%, 33%, and 27% at 1, 2, and 3 years, respectively.ConclusionsRespiratory-gated proton beam therapy for liver tumors is feasible. Phase 2 studies for primary liver tumors and metastatic tumors are underway.     

Loss of 14q31-q32.2 in renal cell carcinoma is associated with high malignancy grade and poor survival

The present study was undertaken to further approach the importance of 14q deletions in renal cell carcinoma (RCC) development. The initial screening using 2 RFLP markers from distal 14q identified loss of heterozygosity (LOH) in 17 of 45 informative cases (38%). In addition, in 37 patients with primary RCCs, it was shown that cases with LOH at D14S1 had significantly shorter survival as compared to cases with-out LOH (p<0.005). Subsequently, 19 primary tumors and 6 metastases were genotyped for 20 polymorphic markers and the findings were evaluated in relation to the clinical characteristics of the primary tumor and the survival during follow-up. Overall LOH was identified in 11 of the primary tumors (58%) and 4 of the metastases (66%). In metastases as well as in primary tumors the highest frequency of LOH was detected with markers from the distal part of the chromosome i.e., 14q32. Five minimal regions of overlapping deletions were identified, three of which (II, IV and V) were defined from the primary RCCs. From centromere to telomere these include region I proximal of D14S259, region II between D14S255 and D14S588, region III in the D14S61-D14S617 interval, region IV between D14S617 and D14S260, and region V telomeric of D14S1007. For the primary tumors, losses in regions IV and V were each significantly associated with high tumor grade (i.e., grade 3; p<0.05). Furthermore, LOH within region IV was also associated with a significantly shorter survival (p=0.02). In conclusion, the high frequency of distal 14q LOH supports the relevance of this alteration for the development of RCC.