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Objective To develop an algorithm to predict progression to relapse or metastases after radical or partial nephrectomy for Chinese patients with localized clear cell RCC (ccRCC), so as to guide the postoperative treatment. Methods The clinical and pathological features and prognosis of 1,034 localized ccRCC patients between January 2006 and December 2013 in the second hospital of Tianjin Medical University was analyzed retrospectively. Univariate comparisons of survival analysis used the Kaplan-Meier method. COX regression model method was used in the multivariate analysis. Harrell’s concordance index was used to assess the prognostic accuracy of the new model. Results The median follow-up was 39 months (range 4-109 months). Relapse or metastases occurred in 129 patients. The relapse-free survival (RFS) rates after 1 year, 3 years, 5 years, 7 years were 94.8%, 88.6%, 83.4% and 80.4% respectively. In these 1,034 ccRCC patients, 130 patients underwent partial nephrectomy and 904 patients underwent radical nephrectomy. There was no difference in RFS rates between group of partial nephrectomy and group of radical nephrectomy (P=0.061). Multivariate analysis showed that the features of age, tumor size, symptoms at presentation, preoperative platelet count, tumor stage [2010], Fuhrman grade, histologic tumor necrosis were independent predictors associated with RFS for ccRCC patients. A scoring algorithm to predict progression to relapse or metastases after patients underwent partial or radical nephrectomy for ccRCC was developed using the regression coefficients from the multivariate analysis. In this model, the score was calculated as 2 (for pT1b), 3 (for pT2), 4 (for pT3 and pT4), 1 (for age ≥58), 1 (for tumor size ≥5.5 cm), 1 (for symptoms at presentation), 2 (for platelet count ≥400×109/L), 1 (for grade 3), 3 (for grade 4), 1 (for histologic tumor necrosis) and 0 otherwise. The risk of progression to relapse or metastases was divided into three groups: low-risk group (score 0-3), intermediate-risk group (score 4-7) and high-risk group (score ≥8). The estimated 5-year RFS rates were 96.9%, 72.7% and 13.1% respectively in these three groups (P

Epithelial–mesenchymal transition (EMT) has been linked to cancer stem-like (CD44+) cell in the prostate cancer (PCa) metastasis. However, the molecular mechanism remains elusive. Here, we found EMT contributed to metastasis in PCa patients failed in androgen deprivation therapy (ADT). Castration TRAMP model also proved PCa treated with ADT promoted EMT with increased CD44+ stem-like cells. Switched CD44+ cell to EMT cell is a key step for luminal PCa cell metastasis. Our results also suggested ADT might go through promoting TGFβ1-CD44 signaling to enhance swift to EMT. Targeting CD44 with salinomycin and siRNA could inhibit cell transition and decrease PCa invasion. Together, cancer stem-like (CD44+) cells could be the initiator cells of EMT modulated by TGFβ1-CD44 signaling. Combined therapy of ADT with anti-CD44 may become a new potential therapeutic approach to battle later stage PCa.