UroToday - Renal cell carcinoma (RCC) has long been recognized to be an immunologically relevant tumor in part due to the histologic observation that immune cells are frequently found to infiltrate resected primary tumors. The question remains whether these cells represent friend (the host immune system attacking the primary tumor) or foe (dysfunctional immune cells that in some way facilitate tumor growth and progression). Previous studies have suggested that immune cell infiltration of the primary tumor is associated with a worsened prognosis in RCC but this remains controversial. Here Webster and colleagues out of the Mayo Clinic examine mononuclear cell infiltration in nephrectomy specimens as a predictor of prognosis in clear cell RCC.

The authors examined histologic specimens from 306 patients with clear cell RCC. Mononuclear cell infiltration was noted to be absent in 54%, focal in 23%, moderate in 17%, and marked in 6%. In both univariate and multivariate analysis, patients with mononuclear cell infiltration had a significantly increased risk of dying from RCC (RR 1.61, p=0.028). Furthermore, patients with mononuclear cell infiltration were more likely to have increased tumor size, more advanced tumor stage, higher grade tumors, anemia, elevated ESR, and the presence of coagulative necrosis. In a subset analysis of 268 patients with localized RCC, mononuclear cell infiltration was associated with an increased risk of cancer progression (RR 2.68, p

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