New aspects on the identification of genetic alterations and prognostically important biological parameters in renal cell cancer

The observation of extremely variable clinical courses for patients with re nal cell carcinomas of an identical pathological stage as well as a compara ble histological differentiation resp. growth pattern strongly indicates th e existence of tumors harboring different biological aggressiveness. Curren tly available histopathological classification systems do not predict the b iological behaviour of renal cell cancer as sufficiently as the establishme nt of a therapeutical strategy adjusted to the individual patient would req uire. The need for a more refined characterization of the biological potent ial of the indidual tumor results from the introduction of modified operati ve strategies as organ-preserving surgery, for example, as well as from the recently suggested application of an adjuvant systemic therapy adapted to the individual risk for tumor recurrence resp, the development of progressi ve disease. Therefore, the clinically orientated basic scientist and the ba sic scientifically orientated clinician intensively try to determine progno stically important biological Variables which would allow to better predict the biological aggressiveness of a single tumor in addition to "classical" prognostic parameters (T-stage, histological grading, growth patterns). In this context, several biological parameters including the identification o f alterations on the DNA-, RNA- and protein level have been discussed as po ssible biological prognostic markers for renal cell cancer. The present rev iew tries to reflect currently available biological characteristics of RCC which might gain clinical importance with regard to an individualized thera py in the near future.