الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
RCC is considered a tumor of unpredicted clinical behavior. Its incidence is increasing all around the world. Approximately one third of RCC patients present initially with metastasis or develop metastasis later in the course of the disease. Moreover 30% of patients who underwent radical nephrectomy develop recurrence. Median 5 year survival for patients with metastatic RCC is of 5% to 30%. A major problem in the management of RCC patients is to predict its malignant potential. A variety of prognostic factors such as stage, grade and performance status of the patient, have been proposed as prognostically useful parameters but have only achieved limited clinical application. The poor outlook of RCC and the lack of conclusive prognostic factors make it important to search for new prognostic factors and therapeutic modalities for this aggressive tumor.
It has been recently suggested that the quantitative levels of EphA2 expressed by cancer cells might provide useful prognostic information for the metastatic potential of RCC and the clinical course of the patients. There is also Ki 67 that is a well-known proliferative marker and correlated with poor clinicopathological features of RCC and poor outcome of the patient. In a trial to elucidate new predictive factors for RCC, the present work studied the immunohistochemical expression of EphA2 and Ki 67 in relation to each other and to other clinicopathological variables of prognostic significance in RCC. These variables included tumor-related factors as stage, grade, size and histologic type as well as the sinus invasion, capsular invasion and vascular invasion of the tumor, and patients-related factors included age, sex and outcome of the patients.
The present study comprised 50 cases of RCC. Clinical and radiological data of the cases were collected from the Pathology and urology departments, Faculty of Medicine, Alexandria University. The mean age of the patients was 55.8 years with male to female ratio of 1.7:1. The 50 cases were classified according to the WHO 2016 and AJCC/UICC 2017 classifications, and CCRCC was the most frequent type encountered, 35 cases (70%). PRCC comprised 7 cases (14%). Four cases were type I PRCC (57.1%) and 3 cases were type II PRCC (42.9%). chromophobe RCC comprised 5 cases (10%), clear cell papillary RCC comprised 2 cases (4%) and collecting duct carcinoma one case (2%). 45 cases were graded according to ISUP/WHO 2016 grading system into Grade 1 in 3 cases (6.7%), Grade 2 in 15 cases (33.3%), Grade 3 in 19 cases (42.2%), and Grade 4 in 8 cases (17.8%). This grading system is not applicable on the 5 cases of chromophobe RCC.
Using the available radiological and pathological data, the 50 cases were subsequently staged according to TNM staging system 2017, into 20 cases (40%) of stage Ι, 16 cases (32%) of stage Π, 14 cases (28%) of stage Ш RCC.
In the present study, the IHC expression of Ephrin A2 was assessed semiquantitatively and expressed in terms of staining intensity. EphA2 expression was detected in 82% of RCC cases with variable intensity of staining. A significant positive correlation was found in the present study between EphA2 expression and RCC grade and stage. Expression of EphA2 was also found to increase with increasing the size of RCC. And this relation was statistically significant. Similarly, the relationship between EphA2 expression and outcome of the patient was significant. It increases with worse outcome. Regarding sinus, capsular and vascular invasion of RCC, EphA2