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Objective:To investigate the long-term survival and safety in patients with muscle-invasive bladder cancer (MIBC) who experienced a noninvasive down-staging (≤pT 1)after transurethral resection of bladder tumor (TURBT) plus systemic chemotherapy and received bladder-sparing treatment. Methods:The records of patients with MIBC who underwent maximal TURBT plus systemic chemotherapy-guided bladder-sparing treatment were reviewed retrospectively from Dec 2013 to Dec 2020. Eventually, 22 patients who achieved noninvasive down-staging underwent conservative management. The total patient cohort contained 10 males and 12 females. A majority of patients had single lesion and stage T2 disease. The median age of the patients was 66 years and the median tumor size was 3.0 cm. All patients underwent maximal TURBT to resect all visible diseases and followed by 3-4 cycles platinum-based systemic chemotherapy. After achieving noninvasive down-staging, 14 patients received concurrent chemoradiotherapy, and the other 8 patients underwent surveillance. Overactive bladder symptom score (OABSS) was used to assess the bladder function after treatment.Results:Twelve patients achieved pT 0 and 10 patients were down-staged to cT a-T 1. At a median follow-up of 36.7 months, 90.9%(20/22) patients retained their bladder function successfully. Among the 14 patients who received concurrent chemoradiotherapy, 4 had grade 3 or 4 adverse events. Among the 8 patients who underwent surveillance, 3 had grade 3 or 4 adverse events after systemic chemotherapy.Nine patients experienced tumor recurrence in the bladder, and 2 patients died of bladder cancer. Seven (31.8%) patients experienced Ⅲ/Ⅳ grade complications. The 5-year recurrence-free survival (RFS) and overall survival (OS) in patients achieved pT0 were 66.7% and 100.0%, respectively. The 5-year RFS and OS in patients achieved cTa-T1 were 40% and 72%, respectively. The OABSS score of 20 patients who retained their bladder successfully was (1.00±1.03). Conclusions:MIBC patients who achieved noninvasive down-staging might be candidates for the bladder-sparing treatment with maximum TURBT followed by systemic chemotherapy.The patients who achieved pT 0 might have better prognosis with functional bladder.
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Purpose@#Reduced quality of life after cystectomy has made bladder preservation a popular research topic for muscle-invasive bladder cancer (MIBC). Previous research has indicated significant tumor downstaging after neoadjuvant chemotherapy (NAC). However, maximal transurethral resection of bladder tumor (TURBT) was performed before NAC to define the pathology, impacting the real evaluation of NAC. This research aimed to assess real NAC efficacy without interference from TURBT and apply combined modality therapies guided by NAC efficacy. @*Materials and Methods@#Patients with cT2-4aN0M0 MIBC were confirmed by cystoscopic biopsy and imaging. NAC efficacy was assessed by imaging, urine cytology, and cystoscopy with multidisciplinary team discussion. Definite responders (≤ T1) underwent TURBT plus concurrent chemoradiotherapy. Incomplete responders underwent radical cystectomy or partial cystectomy if feasible. The primary endpoint was the bladder preservation rate. @*Results@#Fifty-nine patients were enrolled, and the median age was 63 years. Patients with cT3-4 accounted for 75%. The median number of NAC cycles was three. Definite responders were 52.5%. The complete response (CR) was 10.2%, and 59.3% of patients received bladder-sparing treatments. With a median follow-up of 44.6 months, the 3-year overall survival (OS) was 72.8%. Three-year OS and relapse-free survival were 88.4% and 60.0% in the bladder-sparing group but only 74.3% and 37.5% in the cystectomy group. The evaluations of preserved bladder function were satisfactory. @*Conclusion@#After stratifying MIBC patients by NAC efficacy, definite responders achieved a satisfactory bladder-sparing rate, prognosis, and bladder function. The CR rate reflected the real NAC efficacy for MIBC. This therapy is worth verifying through multicenter research.
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Renal cell carcinoma is a common malignant tumor of the urinary system. The immune microenvironment to which neutrophils belong has a dual role of suppressing and promoting the development of renal cell carcinoma. The cancer-promoting effects through mechanisms such as mediating inflammation, expressing chemokines, and generating neutrophil extracelluar traps have become research hotspots. Targeted drugs and immune checkpoint inhibitors are used as systemic treatments for patients with advanced renal cell carcinoma. Their efficacy and prognosis are related to neutrophil activity. The neutrophil infiltration in tumor and peripheral blood neutrophil level increase suggest the poor prognosis of patients with renal cell carcinoma. The phenotype and function of neutrophils can be affected by inflammation associated with renal cell carcinoma, and the high expression of CXC chemokines leads to poor prognosis. In addition, the neutrophil extracellular traps can capture tumour cells in the peripheral blood and assist their survival and migration.
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Repeat prostate biopsy is of great significance for missed diagnosis of prostate cancer. We make a review on the independent risk factors, route selection and new techniques to improve clinicans’ cognition of prostate biopsy indications. MpMRI targeted biopsy is recommended for patients who are eligibile for repeat biopsy for higher detection rate of clinically significant prostate cancer and lower rate of non-clinically significant prostate cancer.
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Bladder cancer is the most common malignant tumor in urinary system. Immunotherapy, as a new treatment modality, has recently achieved great success in urothelial cancer. As a hotspot of immunotherapy, oncolytic virus can promote anti-tumor response by specifically destroying tumor cells and activating specific anti-tumor immune response. At present, oncolytic virus has made a great breakthrough in the treatment of bladder cancer, especially in the treatment of NMIBC. Oncolytic viruses, including adenovirus, coxsackie virus, vaccinia virus and herpes simplex virus, have shown good safety and effectiveness in a number of clinical trials for bladder cancer treated by intravesical instillation. Especially when recombinant adenovirus interferon α is used in the phase Ⅲ clinical trial of bladder cancer, up to 53% of the patients have achieved complete response at the third months, but there was no grade Ⅳ/Ⅴ adverse reaction. In this paper, the latest progress of research on oncolytic virus in the treatment of bladder cancer was reviewed.
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At present, the application of artificial intelligence in the diagnosis of renal cell carcinoma (RCC) is still at an early stage. There were more reports of imaging diagnosis than pathology. Studies of imaging diagnosis mainly focused on using artificial intelligence to identify benign and malignant renal tumors and predict pathological types of RCC by computed tomography. However, there were no reports of artificial intelligence in diagnosing RCC by magnetic resonance imaging. Studies of pathological diagnosis were mainly about the classification of the nucleus. In the future, artificial intelligence has great development potential in the diagnosis of RCC, and further research is needed.
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Bladder cancer is one of the tenth most common malignant tumors in Chinese men.Almost 20％ to 30％ patients are diagnosed as the muscle-invasive bladder cancer (MIBC) at the first diagnosis.In the past,radical cystectomy (RC) was the first-line treatment with MIBC.The current researches'results show that,neoadjuvant chemotherapy combined with RC can improve the tumor complete response rate and prolong the overall survival of patients with MIBC,comparing with the RC alone.It has become the recommended standard first line treatment for MIBC,which has the possiblity of preserving bladder.Lots of researches indicate that the application of cisplatin-based neoadjuvant chemotherapy in patients with MIBC is becoming more and more popular.However,there is still the possibility of ineffectiveness or tumor progression.Therefore,discussions about the sensitivity of neoadjuvant chemotherapy have always been a hot spot in urological tumor research.In order to provide guidance and help for clinical work,the article reviews the sensitivity of neoadjuvant chemotherapy of bladder urothelial carcinoma.
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Bladder cancer is one of the tenth most common malignant tumors in Chinese men. Almost 20% to 30% patients are diagnosed as the muscle-invasive bladder cancer (MIBC) at the first diagnosis.In the past, radical cystectomy (RC) was the first-line treatment with MIBC.The current researches' results show that, neoadjuvant chemotherapy combined with RC can improve the tumor complete response rate and prolong the overall survival of patients with MIBC, comparing with the RC alone. It has become the recommended standard first line treatment for MIBC, which has the possiblity of preserving bladder. Lots of researches indicate that the application of cisplatin-based neoadjuvant chemotherapy in patients with MIBC is becoming more and more popular. However, there is still the possibility of ineffectiveness or tumor progression. Therefore, discussions about the sensitivity of neoadjuvant chemotherapy have always been a hot spot in urological tumor research. In order to provide guidance and help for clinical work, the article reviews the sensitivity of neoadjuvant chemotherapy of bladder urothelial carcinoma.
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Objective To improve the accuracy of preoperative diagnosis of renal vein tumor thrombus in renal cell carcinoma (RCC),the clinical characteristics of RCC with misdiagnosis of renal vein tumor thrombus (RVTT) were analyzed.Methods Clinical data of 128 patients with RCC accompanied with RVTT from January 2000 to September 2015 were studied retrospectively.According to whether RVTT failed to be detected preoperatively,all patients were divided into 39 cases of misdiagnosis group and 89 cases of no misdiagnosis group.Forty cases of RCC with pathologically confirmed no RVTT were selected as no tumor thrombus group from January 2015 to June 2015.Misdiagnosis group included 29 males and 10 females,with age of (61.4 ± 11.1) years old,body mass index of (26.74 ±3.12) kg/m2,KPS ＜80 in 2 cases,paraneoplastic syndrome and Mayo grade 0 in 1 case.No misdiagnosis group consisted of 74 males and 15 females,with age of (60.2 ± 9.7) years old,body mass index of (25.12 ± 1.93) kg/m2,KPS ＜ 80 in 5 cases,paraneoplastic syndrome and Mayo grade 0 in 7 cases.No tumor thrombus group comprised of 31 males and 9 females,with age of (59.5 ± 10.7) years old,body mass index of (24.48 ± 2.56) kg/m2,KPS ＜ 80 in 3 cases,and paraneoplastic syndrome in 3 cases.There was no significant difference in general clinical data between misdiagnosis group and no misdiagnosis group,and misdiagnosis group and no tumor thrombus group (P ＞ 0.05).The tumor location,tumor diameter and imaging data were compared between misdiagnosis group and no misdiagnosis group,and misdiagnosis group and no tumor thrombus group.Results There was no significant difference in term of tumor locating in the middle pole [56.4％ (22/39) vs.38.2％ (34/89)],tumor with collateral vessels [33.3％ (13/39) vs.31.5％ (28/89)] and renal vein contrast agents filling defect [42.9％ (9/21) vs.61.8％ (21/34)] between misdiagnosis group and no misdiagnosis group (P ＞ 0.05).The proportion of renal tumor locating in the middle pole,tumor with collateral vessels and renal vein contrast agents filling defect in misdiagnosis group was significantly higher than that of no tumor thrombus group [30.0％ (12/40),P =0.018;10.0％ (4/40),P =0.012;16.7％ (4/24),P =0.002].Conclusions RVTT is vulnerable of misdianosis in RCC.It should be alert to the possibility of complicating tumor thrombus in the presence of renal tumor locating in the middle pole,renal tumor with collateral vessels and renal vein contrast agents filling defect.The clinical understanding of these features should be improved.
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Objective To investigate the dose of docetaxel appropriate for patients with metastatic castration-resistant prostate cancer and its affects to the prognosis.Methods A retrospective analysis was performed on the clinical data of 75 patients with metastatic castration-resistant prostate cancer admitted from March 2010 to July 2016 who received docetaxel combined with prednisone chemotherapy.The patients were divided into the low-dose group (n =43,docetaxel ＜ 65 mg/m2),the middle-dose group (n =21,docetaxel 65-70 mg/m2) and the high-dose group (n =11,docetaxel ＞ 70 mg/m2).The median age in the low-dose group,middle-dose group and high-dose group was 67 (53-80),66 (56-78) and 61 (47-76) years old,respectively.Among 75 patients with bone metastasis,2 patients had no evidence of bone metastasis in the low-dose group.The lymph node metastasis was found in 26,13 and 6 cases in each group,respectively.And visceral and other metastasis were founded in 11,4 and 2 cases,respectively.The Gleason score in the low-dose group was≤7 points in 15 cases,≥8 points in 22 cases and no score in 6 cases.The Gleason score inthe middle-dose group was ≤7 points in 4 cases,≥8 points in 13 cases and no score in 4 cases.The Gleason score in the high-dose group was ≤7 points in 3 cases,≥8 points in 5 cases and no score in 3 cases.The number of patients with pain in the low-dose group,middle-dose group and high-dose group was 36,12 and 9,respectively,there were no significant differences in the above indicators (P ＞ 0.05),except age,which showed relatively more aged patients in the low-dose group,(P =0.045).Kaplan-Meier method was used to compare the overall survival (OS),progression-free survival (PFS) and the incidence of ≥CTCAE-4 grade 3 adverse reactions between the two groups.The Cox regression model was adopted to analyzed the factors that might affect patient prognosis,including the effective time of first-line endocrine therapy,hemoglobin level,ECOG score,pain score,number of cycles of chemotherapy,age,dose of docetaxel and alkaline phosphatase (ALP).Kaplan-Meier method was used to analyze the effect of dose of docetaxel on the prognosis,and log-rank method was used to test the significance of the results.Results The median OS was respectively 24.1,18.5 and 23.5 months in the low-dose group,middle-dose group and high-dose group,respectively.The median PFS was 5.3 months in all three groups,which didn't show statistically significant differences.The incidence of grade 3/4 adverse reactions in the low-dose group,middle-dose group and high-dose group was 15 cases (34.9％),8 cases (38.1％) and 5 cases (45.5％) respectively.It showed an increasing trend,but no statistically significant difference.The single factors related to OS mainly include the effective time of first-line endocrine therapy,hemoglobin level,ECOG score,pain score,number of cycles of chemotherapy,there was no significant correlation with age,docetaxel dose,ALP and PSA value.Conclusions It is common to receive lower doses of docetaxel in clinical practice for patients with metastatic castration-resistant prostate cancer in China.The efficacy of low-dose docetaxel is similar to that of high doses (standard dosage).There was no significant correlation between the OS and the actual dose of docetaxel in the tolerable range.
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Objective@#To analyze the efficacy and its impacting factors of pelvic confined muscle invasive bladder cancer (MIBC) treated with radiotherapy, also including the preservation of functional bladders and the treatment related late toxicity.@*Methods@#Forty-five MIBC patients who received radiotherapy from March 1999 to October 2016 in our hospital were analyzed.41 of the patients were transitional cell carcinomas. The radiation volume included the bladder±pelvic lymph node with or without local tumor boost, with a median bladder dose of 45 Gy and median tumor dose of 56 Gy.24 patients received concurrent chemoradiotherapy.14 patients received neoadjuvant chemotherapy, and 29 underwent transurethral resection of bladder tumors before radiotherapy.@*Results@#The median follow-up duration was 28 months (range, 4–101 months). The 3-year overall survival were 51%.Concurrent chemoradiotherapy had a better survival than that of radiation alone, with 3-year overall survival of 64% and 30%(P=0.001). The effect of neoadjuvant chemotherapy on 3-year overall survival was not obvious, 59% and 47%(P=0.540) with or without neoadjuvant chemotherapy. The 3-year overall survival were 58% and 43%(P=0.160), respectively for patients with or without the transurethral resection of bladder tumors. The 3-year overall survival were 20% and 79%(P=0.001) for patients with or without relapse. Nine patients recurred locally and fourteen patients developed metastases. The highest bowel toxicity of more than 3 months after radiotherapy was grade 2 in 2 patients. Late grade 2 urinary toxicity occurred in 4 patients, grade 3 in 2 patients. All other patients preserved their functional bladders except 7 patients who had an uncontrolled bladder tumors or radiation induced severe injury of bladder function.@*Conclusions@#A better survival could be obtained for localized muscle invasive bladder cancer treated with concurrent chemoradiotherapy. Most of the patients can preserve their functional bladders after radiotherapy, and the late toxicity is acceptable.
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Objective To evaluate the efficacy and safety of the modified docetaxel plus prednisone scheme for the metastatic castration resistant prostate cancer patients who got poor tolerance to chemotherapy.Method The clinical data of 50 metastatic castration resistant prostate cancer who received docetaxel + prednisone chemotherapy from March 2010 to October 2015 were analyzed retrospectively.23 cases received the modified DP regimen (modified group),27 cases received the standard DP regimen (standard group).The median age of the modified group and the standard group were 69 years (47-80 years) and 63 years (52-77 years) (P =0.005).There were 19 and 24 cases with pain in modified group and standard group respectively;10 and 19 cases with lymph node metastasis respectively;3 and 4 cases of visceral metastasis respectively;all of the 50 patients were complicated with bone metastasis.For the pathological Gleason score,there were 7 cases scored ≤7 points,13 cases scored ≥ 8 points and 3 cases unscored in the modified group;7 cases scored ≤7 points,15 cases scored ≥8 points and 5 cases unscored in standard group.There was no significant difference of the pain,metastasis,and Gleason score between the two groups (P ＞ 0.05).Progression free survival (PFS),overall survival (OS)and adverse events were analyzed using Kaplan-Meier curves,and the differences were assessed using the log-rank test.Results In the modified group and standard group,the median follow-up times were 11.0 months and 14.0 months respectively,the median chemotherapy cycles were 4.5 cycles and 5.0 cycles respectively;OS were 18.0 months and 27.5 months respectively (P =0.746).The PFS of the two groups were 6.0 months and 5.2 months,respectively (P =0.822).The PSA response were 13 cases and 17 cases in the modified group and standard group respectively (P =0.615),and the pain response were 8 cases and 7 cases (P =0.927),grade 3 to 4 adverse events were 3 cases and 14 cases (P =0.003).The main adverse events were blood toxicity,neutrophils,gastrointestinal reaction,edema,fatigue and oral mucositis etc.Conclusions Compared with the standard DP scheme,the modified DP scheme had no significant difference in OS,PFS,pain response rate and PSA response rate,while the incidence of grade 3 to 4 adverse events was significantly reduced.Modified DP scheme may be a better choice for patients with metastatic castration resistant prostate cancer who get poor tolerance to chemotherapy.
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Objective To exploie the choices and timing of different treatment regimens of prostate cancer.Methods The complete clinical data of one case of localized high-risk prostate cancer was reported.The patient,aged 69 years old,was admitted to hospital with urinary frequency and dysuria for 2 years.Serum total PSA was 36.8ng/ml and prostate biopsy dignosed as prostate cancer.The Gleason score was 4 + 3,and the clinical stage was T2b N0M0.Results The patient underwent radical prostatectomy,salvage radiotherapy + androgen deprivation therapy,abiraterone,enzalutamide,Radium-223,docetaxel + prednisone chemotherapy and mitoxantrone + prednisone chemotherapy,which included almost all of the current domestic treatment regimens.The patient lived for 57 months from the initiation of treatment.Conclusions For the patients with high-risk prostate cancer,especially for elderly patients,they should firstly be recommended the treatment of radical radiotherapy + 2-3 years of androgen deprivation therapy.For young patients,radical prostatectomy + extended pelvic lymph node dissection as part of multi-modal therapies is considered to be a positive choice.However,for the patients with risk factors or recurrence after radical prostatectomy,the postoperative radiotherapy should be performed in order to reduce biochemical recurrence and improve local control.Currently,the order of choice of abiraterone,enzalutamide or docetaxel + prednisone chemotherapy,is based on the patient's situation,past history of treatment,symptoms,side effects as well as other related clinical features.
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Objective To observe the effect of intravesical chemotherapy in papillary urothelial neoplasm of low malignant potential (PUNLMP) urinary bladder after transurethral resection of bladder tumor (TUR-Bt). Methods 44 cases of PUNLMP confirmed by pathological examination from Jan 2004 to Dec 2013 were retrospectively analyzed. Clinical manifestation: 24 asymptomatic, 19 gross hematuria and 1 abdominal discomfort. All cases were treated by TUR-Bt and immediately administered by intravesical instillation of 40 mg HCPT once, then 32 cases (A group) underwent additional intravesical instillation of HCPT once, and 12 cases (B group) underwent instillation qw for 8 times. Results PUNLMP cases accouted for 2.28 %(44/1 926) of bladder neoplasms admitted during the same period. There were 32 males and 12 females. 39 patients had multiple tumors, and 5 had single. All of cases were followed up with the medial follow-up time of 82 months (16-136 months), only one case in B group recurred after 14 months, and postoperatively without pathological progression. The difference of recurrence rates between two groups had no statistical significance (P=0.273). Conclusions PUNLMP has low incidence rate and is more common among middle-aging males. Doctors should consider PUNLMP when patients with bladder neoplasm are asymptomatically detected. Immediate instillation combined with additional one postoperatively could reduce the recurrence rate of PUNLMP obviously with satisfying prognosis. However, maintenance instillation does not enhance effect.
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Objective To investigate the incidence of renal dysfunction among patients received radical nephrectomy during 5-year follow-up and to discover the risk factors for chronic kidney dysfunction (CKD).Methods Data of 339 patients who underwent radical nephrectomy for renal cell carcinoma between Jan.2006 to Dec.2007 were investigated,and those who suffered renal dysfuntion before surgery or lost follow-up were excluded.Finally,148 patients were enrolled in this retrospective study.GFR after surgery were replaced by eGFR which were calculated with the abbreviated equation of MDRD.It will be defined as CKD when eGFR was less than 60 ml/(min · 1.73 m2).Postoperative occurence rate of CKD was estimated using the Kaplan-Meier methods.Rank sum test and chi-square test were used for the univariate analysis in term of CKD between groups.Multivariate Logistic regression analysis was used to judge the independent risk factors for CKD.Results Patients were followed up for 42-60 months.CKD occurred in 58 cases,and the 5 year cumulative incidence of CKD was 42.7％.As many as 17.4％ of the patients with a normal eGFR during the first 3 months follow-up would progress to CKD 5 years later.Clinical characteristics,including age at surgery,weight,body mass index,hypertension,preoperative total GFR and contralateral GFR,complications,size of tumor,pathologic type,eGFR calculated shortly after operation,were significantly different between the CKD group and the normal group (P＜0.05).Multivariate Logistic regression analysis shows that age at surgery (P =0.016,OR =1.106),size of tumor (P =0.048,OR =0.680) and eGFR calculated within one week postoperatively (P=0.002,OR=0.874) were the independent risk factors for postoperative CKD.Conclusions The incidence of CKD after radical nephrectomy in patients with renal cell carcinoma is not uncommon.The of age at surgery,size of tumor and eGFR value calculated within one week postroperatively have a close relation with the incidence of postoperative CKD.
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Objective To investigate the creatinine level of wound drainage and the changes of serum creatinine after radical nephrectomy or partial nephrectomy in patients with renal cell carcinoma,to explore the feasibility of testing creatinine level to predict urine leakage after surgery and to compare the influence on rcnal function after different kinds of operations.Methods 65 patients data were analyzed,in which 31 patients had undergone partial nephrectomy and 34 had radical nephrectomy for renal cell carcinoma from March 2012 to July 2012.The level of creatinine in serum and wound drainage were detected within 24 hours after surgery.Also,the serum creatinine were redetected 3 months later.Results The creatinine level of wound drainage were significantly lower than that in serum in both groups [(99.94±21.10) μmol/L vs (114.61± 25.09) μmol/L,P =0.000].Urine leakage was observed in only one patient (2.9 ％) after partial nephrectomy,which his level of creatinine in serum and wound drainage was 107 μmol/L and 686μmol/L,respectively.The other 30 patients' creatinine level of wound drainage were also significantly lower than serum after partial nephrectomy [(92.90±26.21) μmol/L vs (99.83±28.77) μmol/L,P =0.021).Although the level of creatinine in the wound drainage was not significantly different between these two groups (P =0.239),the serum creatinine was statistical lower in partial nephrectomy group than that of radical nephrectomy group (P =0.035).Also,after three months,the partial nephrectomy group had a lower level of serum creatinine [(81.43±12.82) μmol/L vs (106.53±21.73) μmol/1,P =0.001].Conclusion Partial nephrectomy has advantages in protecting renal function when compared with radical nephrectomy.The level of creatinine in wound drainage is significantly lower than serum.The level of creatinine in wound drainage is a predictive indicator for diagnosing urine leakage.
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Objective To investigate the copy number changes on chromosome 3q26. 1 in urothelial carcinoma of the bladder, and to explore its potential clinical significance. Methods The microarray-based comparative genomic hybridization (Array-CGH) approach was used to analyze the genome-wide copy number changes of 35 tumor tissue samples of bladder cancer. To confirm the loss of a small fragment in 3q26. 1 detected by Array-CGH, real-time fluorescent quantitative polymerase chain reaction (real-time PCR) was performed with 57 frozen tumor tissue samples and 34 formalinfixed paraffin-embedded (FFPE) tumor tissue samples. The urine sediment cells collected from 15 healthy volunteers and 29 bladder cancer patients were checked as above. Results The Array-CGH data showed that the copy number loss of a small fragment in 3q26. 1 was detected in 77.1% (27/35)of the tumor tissue samples investigated. Real-time PCR analysis validated this loss of a small fragment of 3q26.1 with high frequencies in both 57 frozen tumor samples and 34 FFPE tumor samples.The percentage of samples exhibiting loss was 78.9% (45/57) and 100. 0% (34/34) respectively.Furthermore, the relative copy number of the 3q26.1 small fragment was significantly lower in the urinary sediment cells of the patients (median=0. 0020), comparing with that of healthy controls (median=0. 0030) (P＜0.01). Conclusions Loss of the small fragment in 3q26.1 could be a characteristic genetic change of urothelial carcinoma of the bladder. It may serve as a potential molecular marker for bladder cancer.
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Objective To discuss the characteristics of renal cell carcinoma with regional lymph node metastasis at diagnosis. Methods The data of 19 patients diagnosed with renal cell carcinoma with regional lymph node metastases at diagnosis from January 2004 to December 2008 were reviewed.The median age was 57 years (29-77).The study group included 15 males and four females.The primary tumor was located in the left kidney in 12 patients and fight in seven patients.The median maximam diameter of retroperitoneal lymph nodes was 2.8 cm(1.5-5.0).The lymph nodes in four patients were not detected by the preoperative image examination,but were confirmed by intraoperative exploration.Eleven cases had enlarged retroperitoneal lymph nodes resected and eight had regional lymph nodes dissected. Results The patients with regional lymph node metastases at diagnosis of renal celI carcinoma accounted for 1.6% (19/1213) of the total renal cell carcinoma cases.With a median follow-up of 34 months,six patients were survival without progression,and seven were survival with progression.giving a 5-year survival rate of 68.4%.The survival and recurrence rates after surgery were not significantly different by Fisher test(P=0.644 and 0.319 respectively) between the patients who underwent retroperitoneal regional lymph node dissection and those who underwent enlarged lymph node resection. Condmiom Renal cell carcinoma with regional lymph node metastasis at diagnosis is uncommon.Some patients may achieve long-term tumor-free survival through regional lymph node dissection or enlarged Iymph nodes resection.
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Objective To evaluate the safety and efficacy of sorafenib for patients with advanced stage renal cell carcinoma.Methods The clinical data of 85 patients with advanced renal cell carcinoma were reviewed.These patients were treated by sorafenib 400 mg Bid,dose escalation of sorafenib(400 mg Bid 1-4 weeks;600 mg Bid 5-8 weeks;800 mg Bid since then) or sorafenib 400 mg Bid+NF-α,respectively,until intolerance or disease progression occurred.The primary end points were objective response,disease control rate and adverse effects rate.Results The data of 80 patients can be evaluated.The median follow-up duration was 72 weeks (4-108 weeks).One patient (1.2%) reached complete remission(CR),17 cases(21.2%) reached partial remission(PR),50 cases (62.5%) maintained stable disease (SD),and 12 cases (15%) progressed.The objective response (CR+PR) was 22.5%,disease control rate (CR+PR-SD)was 85.0%.By May 2009,only 18 patients died,progression free survival and overall survival were not available.The common side effects included hand-foot skin reaction (55.0%),mucosa hemorrhage (52.5%),diarrhea(40.0%),lassitude (35.0%),anorexia(22.5%),mucosa ulcer(20.0%),hypertension(15.0%) and baldness(15.0%)etc.Most of these side effects could be released by symptomatic treatment.Conclusion Sorafenib has good short term effect for patients with advanced renal cell carcinoma and is well tolerated.
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Objective To study the character of multiple primary malignant neoplasms (MPMN) in patients with bladder cancer.Methods From 1958 to 1998,patients with bladder cancer associated MPMN were studied retrospectively.Results MPMN was found in 49(5.7%,49/847) patients with bladder cancer,including 32 male and 17 female.All the bladder cancer were urothelial carcinoma,47 cases of non muscleinvasive urothelial carcinoma and 2 muscle-invasive.47 cases were double-primary cancer patients,and 2 triple-primary.Non-bladder primary malignancies were found in digestive system(36.7%),respiratory system (20.4%),genital system(20.4%),and other system(20.4%).Lung cancer was the second primary cancer in 7 cases(14.3%,7/49).The MPMN were diagnosed at the same time in 5 cases,and the others one after another.Bladder cancer was the first primary cancer in 25 cases,and 24 as the second primary.The mean age when the first cancer was diagnosed was 51y.It was 86.2 months between the first cancer and the second for the mean time.90% cancer was in clinical stage Ⅰor stage Ⅱ.The median survival time was 39 months after the second primary malignant,and 104 months after the first primary malignant.Conclusion The most pathology type of the bladder cancer in MPMN is non muscle-invasive urothelial carcinoma. Non-bladder primary malignancies are found more common in digestive system,the following are respiratory system and genital system.When lung cancer is the second primary malignant,it should be discriminated from metastasis of bladder cancer.90% cancer is in early clinical stage.They will have a good prognosis if diagnosed early and treated properly.