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Objective: To report our data of patients with clinical stage T(1-3)N(1-2)M(0) renal cell carcinoma (RCC) and explore the biological behavior of this malignancy., Methods: A total of 531 patients with no distant metastatic RCC underwent open radical nephrectomy at our institution between 1988 and 2008, among whom 42 patients with histological nodal metastases had successful surgical tumor resection. The clinical data and outcomes of the 42 patients were analyzed., Results: Of those 42 patients, 19.0% had T1, 21.4% had T2, and 59.5% had T3 stage tumors; 42.9% had N1 and 57.1% had N2 stage tumors. Tumor recurred in 30 (71.4%) patients after the surgery, and death occurred in 26 (61.9%) cases at the last follow-up; among the recurrent cases, 83.3% (25/30) had multiple metastases at the initial recurrence. The median cancer-specific survival (CSS) and disease-free survival (DFS) was 23 and 11 months in these cases, respectively. Multivariate analysis demonstrated that Fuhrman grade (P=0.005), N stage (P=0.014) and T stage (P=0.037) were the independent predictors of CSS; Eastern Cooperative Oncology Group (ECOG) performance status (PS) (P=0.002), tumor size (P=0.007), Fuhrman grade (P=0.009) and N stage (P=0.019) were the independent predictors of DFS., Conclusion: Patients with T(1-3)N(1-2)M(0) RCC have poor prognosis. N stage is an independent predictor of both CSS and DFS, suggesting that extended lymph node dissection should be performed when suspicious enlarged nodal disease is found during surgery.

Objective: To construct human renal cell carcinoma patient-specific full-length antibody library using mammalian cell surface display technique., Methods: Peripheral blood mononuclear cells (PBMC) were isolated from patients with renal cell carcinoma. The repertoires of kappa light chain (LCkappa) and heavy chain variable region (VH) of antibody were amplified by RT-PCR. The LCkappa and VH libraries were inserted into the vector pDGB-HC-TM separately, and the ligated libraries were transformed into competent E.coli TOPO10 to construct the renal cell carcinoma patient-specific antibody heavy and light chain libraries. 293T cells were co-transfected with the libraries and the full-length human antibodies expressed on the surface of 293T cells were analyzed by flow cytometry., Results: The libraries of renal cell carcinoma-specific antibody kappa light chain (LCkappa) and heavy chain (IgG1) were constructed. The expression of the full-length human antibodies on the surface of 293T cell was confirmed by flow cytometry. The libraries showed an expressible combinatory diversity of 7.5x10(10)., Conclusion: The expressible antibody library provides a useful platform for screening of renal cell carcinoma-specific antibodies.

Objective: To investigate the expression of human telomerase reverse transcriptase (hTERT) in renal cell carcinoma (RCC) and its clinical significance., Methods: The expression levels of hTERT mRNA and protein were detected using RT-RCR and Western blotting in 45 RCC tissues, 45 adjacent tissues and 786-0 cell line, and the associations of hTERT expression with the tumor size, clinical stage, pathological type and grade were evaluated., Results: hTERT mRNA and protein was expressed at significantly higher levels in RCC tissues than in the adjacent tissues (P=0.000), and no correlation of hTERT expression was found with the tumor size, clinical stage, pathological type or grade., Conclusion: hTERT might serve as a diagnostic and prognostic marker for RCC, and also shed light on the new clues for gene therapy of RCC.

Objective: To study the role of programmed cell death 5 (PDCD5) protein in the oncogenesis and development of renal clear cell carcinoma and its association with the prognosis of the malignancy., Methods: PDCD5 expression was assayed immunohistochemically in 46 cases of human renal clear cell carcinoma, and the patients' survival was followed up., Results: PDCD5 staining in the adjacent normal tissue of the tumor was significantly stronger than that in the tumor tissue, and PDCD5 expression was significantly correlated with the tumor grade, stage and prognosis. The tumors of high grade with strong invasive ability had much less PDCD5 expression and lighter staining. The three- or five-year survival rates of patients positive for PDCD5 expression was much higher than that of patients negative for PDCD5 expression., Conclusion: PDCD5 is a potent inhibitor of malignant transformation of renal clear cell carcinoma and may serve as a major predictor for evaluating the malignant potential and prognosis of the tumor.

Objective: To detect the expression of apoptosis gene PDCD5 in tissues of normal human kidney, renal clear cell carcinoma, normal bladder and bladder carcinoma, and explore the role of PDCD5 gene in renal clear cell carcinoma and bladder carcinoma., Methods: Indirect immunohistochemistry was employed to detect PDCD5 expression in 63 kidney specimens and 42 bladder specimens. Positive expression rates and intensity of PDCD5 protein expression in the kidney tissue were investigated microscopically and by computerized image analysis. Positive expression rate in the bladder tissue was investigated by microscopic observation., Results: The results of immunohistochemical staining showed PDCD5 protein overexpression in the renal tubule of normal human kidney tissues and downregulation with the stage increase of renal clear cell carcinoma. PDCD5 protein expression showed statistical significance in tissues of normal kidney and renal clear cell carcinoma in all stages. No obvious PDCD5 expression was detected in the tissues of normal human bladder and bladder carcinoma., Conclusion: PDCD5 is an important apoptosis-regulating factor in the occurrence of renal clear cell carcinoma, and its expression is extremely low in tissues of normal human bladder and bladder carcinoma.

Objective: To explore the expression of hypoxia inducible factor-1alpha (HIF-1alpha) and vascular endothelial growth factor (VEGF) in renal cell carcinoma (RCC) and their relationship., Methods: The expression of HIF-1alphaand VEGF was examined in 42 patients with renal cell carcinoma by SABC methods of immunohistochemistry., Results: The positivity rate of HIF-1alpha was 57.1% in the RCC tissues, and there was no expression in the tissue adjacent to the tumor and normal tissues. The positivity rate of VEGF was 61.9% in the tumor tissues, with significant difference from the control tissues (P<0.05). The expression levels of HIF-1alpha and VEGF were significantly higher in metastatic RCC than in non-metastatic RCC (P<0.01) tissues, and there was a significant correlation between HIF-1alpha and VEGF expressions (Kappa=0.41, P<0.01)., Conclusions: HIF-1alpha is highly expressed in renal cell carcinoma tissues in close correlation with VEGF. HIF-1alpha and VEGF may serve as important indicators to evaluate the biological behaviors of RCC such as metastasis and prognosis. HIF-1alpha is an important regulator of VEGF.

Objective: To evaluate the clinical effects of nephron-sparing surgery in patients with early-stage small renal cell carcinoma., Methods: Nephron-sparing surgery was performed in 21 patients with renal cell carcinoma including 1 with solitary kidney, 3 with unilateral tumor and contralateral renal compromise, and 17 with unilateral tumor and normal contralateral kidney. The diameter of the tumors ranged from 1.5 to 6.0 cm, with a mean of 2.8 cm. The tumor diameter in 17 patients with normal contralateral kidney was less than 4 cm (mean 2.5 cm) and the average diameter in 4 patients with contralateral renal compromise was 4.2 cm. Sixteen cases were in stage T(1), 4 in stage T(2), and 1 in stage T(3). Of the 21 patients, 4 underwent tumor enucleation, 10 polar nephrectomy and 7 wedge resection., Results: All patients were followed up for an average of 40.8 months (7 to 66 months). One patient suffered a right lung and mediastinum metastasis 3 years after the surgery later and 1 with chronic glomerulonephritis required dialysis 27 months after the operation. No surgical complication or local recurrence were found in other patients., Conclusion: As a safe and effective therapy for early-stage small renal cell carcinoma, nephron-sparing surgery can be considered as the gold-standard therapy for patients with lesions less than 4 cm in T(1) and T(2) stages of localized unilateral tumor with normal contralateral kidney.

Objective: To investigate the relation of dendritic cell (DC) infiltration to the prognosis and lymph node metastasis of renal cell carcinoma., Method: The tissue specimens were obtained from 69 patients with renal cell carcinomas, who were treated surgically from 1994 to 2000 in our hospital and followed up for over 2 years. ABC immunohistochemical method using S-100 protein antibody was employed to examine the tumor tissues and the DCs was counted., Results: The patients showing no signs of tumor recurrence within 2 years postoperatively had significantly greater number of S-100(+) DCs in the tumor tissues than that of patients with recurrence in 2 years (61.3 +/- 14.7/mm(2) vs 31.4 +/- 11.6/mm(2)). The number of S-100(+) DCs of the group with lymph node metastasis was much lower than that of the group without the metastasis (28.8 +/- 10.4/mm(2) vs 62.6 +/- 13.5/mm(2))., Conclusion: The density of DC infiltration is closely related to the prognosis and lymph node metastasis, which may be used as a good indicator for prognostic assessment of renal cell carcinoma.