ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
Objective:To discuss the surgical techniques and clinical value of pure laparoscopic radical nephroureterectomy without changing patient’s position in the treatment of upper tract urothelial carcinoma(UTUC).Methods:The clinical data of 28 patients, who underwent pure laparoscopic radical nephroureterectomy with single patient’s position in the treatment of UTUC , were collected and analyzed, including 16 males and 12 females, with the median age of (68.3±9.7)(45-80)years.There were 20 renal pelvic carcinoma and 8 ureteral carcinoma with preoperative clinical TNM stage of T l-T 3N 0M 0. Among them, 9 tumors were located in right side, while 19 in left side. With the patient in a contralateral oblique position at 50°-70°. , an additional instrument hole is added at the midpoint between the umbilicus and pubic symphysis, besides the classical four holes. Nephrectomy was carried out routinely after the pneumoperitoneum was built, and then the ureter was dissected all the way down to bladder wall. The bladder was closed with 3-0 absorbable barbed suture following the bladder cuff being incised.The specimen were retrieved through the extended incision of the lower abdomen trocar or through vagina if suitable. There was no need to change patient’s positioning during operation. Results:All surgical procedures were successfully performed without conversion to open surgery. There was no serious bleeding or other operation related complications. The mean operative time was (136.3±48.7)(70-270)min, while the estimated blood loss was (46.3±38.3)(10-200)ml. The mean postoperative drainage volume (287.3±196.6)(30-910)ml, while the mean postoperative drainage time was 3.2(1-5)d. Their intestinal function recovered 1.5(1-4) d postoperatively. Their average postoperative hospital stay was(6.1±1.7)(3-12)d.Pathological results showed urothelial carcinoma in all cases, including 21 high grade and 7 low grade. Lymphovascular invasion was found in 7 cases of high-grade urothelial carcinoma. All the surgical margins were negative. The median follow-up was(9.2±4.8)(1-12)months, and there was neither tumor recurrence nor distant metastasis.Conclusions:Compared with the traditional operation method, single posture pure transperitoneal laparoscopic radical nephroureterectomy have the advantages of standardized operation method, simple procedure, less trauma, less bleeding and quick postoperative recovery. It is a safe and effective minimally invasive technology for the treatment of UTUC.
ABSTRACT
The incidence and mortality of prostate cancer have steadily increased. As such, the prevention and treatment of prostate cancer are important. Standardized drug therapy in patients with castration-resistant prostate cancer (CRPC) is crucial for improving survival and quality of life. Here, we review the current situation and latest research progress in drug therapy for CRPC.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
Objective To investigate the tubulocystic carcinoma (TC) of kidney in diagnosis and differential diagnosis,clinical and pathological features.Methods A case of TC was performed with HE and immunohistochemical staining,with review of the related literature.Results A man of 43 years old,who was found an occupying in the upper pole of the right kidney by B ultrasound,was performed ill-circumscribed of the right kidney.A gray solid ill-circumscribed mass was found within the renal parenchyma,which was sized of 1.5 cm × 1.5 cm × 1.0 cm.Microscopically,the tumor showed an invasive growth,and that it was composed of small tubular and vesicular structure closely spaced with slender fibrosis mesenchymal.The epithelial cells lining the tubules and cysts were flattened,cuboidal and hobnail cells,with abundant eosinophilic cytoplasm and obvious nucleolus of Fuhrman grade 3.The tumor showed positive of cytokeratin,CD10+++ and P504S+++,with low Ki-67 labeling index.Postoperative follow-up of 6 months,the patient showed no tumor recurrence and metastasis.Conclusions TC is a special subtype of renal cell carcinoma,with a tubular and cystic structure,high nuclear grade and rare mitotic.The differential diagnosis mainly includes other renal cystic lesions.The biological behavior of TC is indolent with less recurrence and distant metastasis.
ABSTRACT
Objective To investigate The effect of Heat shock protein 70(HSP70) antisense oligonucleotides (ASO)to bladder carcinoma in mouse loaded with tumor.Methods The 40 mice loaded with tumor subcutaneously were established by cultured BIU-87 cells,and divided into 4 groups randomly when the subcutaneous neoplasms grew to about 100 mm3,namely,HSP70 mRNA ASO plus mitomycin C(MMC)group;HSP70 mRNA ASO group;MMC and blank control.HSP70 mRNA ASO were injected into neoplasms,10mmg/kg weight,twice every week,and MMC 0.1mg/kg weight,twice every week,and the above schemes were replaced with normal saline to blank.The neoplasms were peeled off,photograghed and weighed in 30 days.HSP70 expressions were examined with reverse transcription polymerase chain reaction (RT-PCR),mierovaseular density(MVD)was evaluated by immunohis to chemical staining and the tumor cells apoptosis was detected by terrainal deoxynucleotidyl transferase(TdT)-mediated dUTP-biotin nick end labeling technique (TUNEL).Results The tumor inhibition rate in ASO+MMC surpassed 50%.more than ASO or MMC respectively,and the differences were significantly(P＜0.05).The ASO and MMC exceeded blank group respectively(P＜0.05).The ASO was the same as the MMC(P＞0.05).The apoptotic index(AI)in ASO+MMC surpassed the other three groups (P＜0.05).The difference between ASO and MMC was not significant (P＞0.05),while the A1 of ASO or MMC was more than blank respectively(P＜0.05).The results of MVD were in accordance with the above results.Conclusion The injection of HSP70 mRNA ASO in tumor locally can inhibit neoplasm growth,and this effect might correlate with the inhibition of apoptosis and microvascular forming resulting from the ASO.
ABSTRACT
Objective To investigate the effect of cyclooxygenase-2(COX-2) inhibitor celecoxib on bladder cancer xenografts in nude mice and apoptosis of tumor cells in the xenografts. Methods Models of bladder cancer xenograft in nude mice was used to observe the effect of celecoxib on the animals and the xenografts.TUNEL was used to assess apoptotic index of tumor cells in the xenografts. Results Celecoxib could effectively inhibit the growth of xenografts(P0.05). Conclusions Celecoxib maybe inhibit the growth of bladder cancer via inducing apoptosis of tumor cells and perhaps will become a choice of chemoprevention and adjuvant therapy of bladder cancer.
ABSTRACT
Objective To investigate the expression of HSP 70 mRNA in transitional cell carcinoma of bladder and association of HSP 70 mRNA with cell apoptosis. Methods In situ hybridization histochemistry(ISHH) was applied to detect HSP 70 mRNA expression in 60 patients with transitional cell carcinoma of bladder,and cell apoptosis was evaluated by means of terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end labeling technique(TUNEL). Results Of 60 cases of bladder transitional cell carcinoma,HSP 70 mRNA expression was 56.7%(34/60),and it increased with grade and stage progressing( P
ABSTRACT
Objective To study endostatin expression in tumor tissues and serum levels of bladder cancer patients. Methods Expression of endostatin in 45 cases of bladder cancer and 12 subjects with normal bladder tissues was examined immunohistochemically.Serum levels of endostatin in 58 patients with bladder cancers and 43 healthy controls were analyzed by competitive enzyme immunoassay. Results Positive expression of endostatin was found in 61.5% patients with superficial bladder cancer,90.6% with invasive bladder cancer and 33.3% in normal bladder tissues.Serum level of endostatin was significantly higher in patients with bladder cancer than that in healthy controls (P