PROGNOSIS IN CARCINOMAS OF THE RENAL PELVIS AND URETER: THE ROLE OF CLINICAL SIGNS, EXPRESSION OF PROTEIN KI-67 AND CELLULAR INFILTRATION OF STROMA

THE AIM of the investigation was to analyze clinical manifestations of carcinoma of the renal pelvis and ureter, its classical morphological signs, to give quantitative assessment of expression of protein Ki67 and cell infiltration of carcinoma stroma, and to reveal indicators allowing to refer the patients to groups of high and low risk of progressing and recurrences of carcinoma. PATIENTS AND METHODS. A retrospective investigation of findings of the original examination and fiveyear dispensary followup was carried out after operative treatment of 37 patients with transitional cell carcinoma of the renal pelvis and ureter. In addition to a standard clinical examination and general morphological analysis the content of cellseffectors of stromas of carcinomas were studied in the ablated tumor tissues and Ki67 proliferation index was calculated. The data obtained were compared with recurrent growths into the urenary bladder and five year survival of the patients. RESULTS. Fiveyear survival without progressing carcinoma was lower in patients with coexisting benign prostate hyperplasia (p=0.038), left side position of the tumor (p=0.043), late consultation with a doctor for symptoms of the disease (p=0.035), B(III) blood group (p=0.005), leukocytosis with formula shift to the left (p=0.001), low level of prothrombin (p=0.022), high creatinin level (p=0.024), low specific weight of urine (p=0.30), great depth of invasion (p=0.003), low degree of differentiation (p=0.002), recurring course (p=0.042), short «light» gap without recurrences (p=0.023), high index of proliferation of Ki67 (r=0.48; p=0.003), and more pronounced infiltration of stroma tumor by macrophages (r=0.28; p=0.015) and eosinophilic leukocytes (t=3.76; p=0.001). The regression analysis more exactly demonstrated the probability of recurrent carcinoma into the bladder by revealing low degree of differentiation (p=0.0001) and high values of Ki67 index (p=0.0005). For prognosis of five year survival without progression according to the results of multifactorial analysis (R2  = 0.81; F=40.93; p<0.0001) the most valuable signs proved to be Gcategory, index Ki67 and degree of stroma infiltration by macrophages. CONCLUSION. The combined assessment of clinical, traditional morphological and additional morphometrical and immunohistochemical indices in patients with carcinomas of the renal pelvis and ureter allows to make more exact prognosis of risk of recurrences and progressing of carcinoma.

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