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Objective:To investigate the association between bone lesions distribution and survival outcome and prognostic risk stratification in renal cell carcinoma bone metastasis (RCC-BM).Methods:The data of 122 RCC-BM patients admitted to Peking University People's Hospital between January 2009 and December 2019 were retrospectively reviewed. There were 100 males and 22 females, with a baseline age of (59.87±11.33) years old. According to the Memorial Sloan-Kettering Cancer Center (MSKCC)/Motzer score, patients were stratified into different risk groups using profiles at first bone metastasis diagnosis, with 20 (16.4%), 74 (60.6%) and 28 (23.0%) patients in favorable, intermediate and poor group, respectively. The spatial distribution of bone metastasis was investigated at the first bone metastasis diagnosis. The overall distribution patterns were as follows: locoregional group (lesions only involved thoracic and/or lumbar vertebrates) in 26 cases (21.3%), stochastic group (bone lesions randomly distributed) in 69 cases (56.6%), extensive group (with concomitant visceral metastasis) in 27 cases (22.1%). Metastatic site involvement was as follows: spine in 48 cases(39.3%), pelvis in 43 cases (35.2%), upper extremities in 22 cases (18.0%), and lower extremities in 20 cases (16.4%). Half (61 cases) of the enrolled patients had synchronous bone metastasis as their first bone metastases were diagnosed simultaneously with their renal tumors. Of all the patients, 99 (81.1%) accepted radical nephrectomy, 6 (4.9%) accepted partial nephrectomy, and the other 17 patients (13.9%) accepted the treatment of ablation or embolization. Eighty-two patients (67.2%) received definitive treatment for bone metastatic lesions, respectively. Forty patients (32.8%) accepted the palliative tumor reduction therapy. Thirty-two patients (26.2%) received tyrosine kinase inhibitor (TKI) or immune checkpoint inhibitor (ICI) medication, and 12 patients (9.8%) received local radiotherapy. Distribution variation and therapeutic strategies throughout the disease course until the last follow-up were recorded. Univariate analysis (chi-squared test, Mantel-Haenszel test), Kaplan-Meier survival analysis, and multivariate ordinal logistic regression were performed for the possible association.Results:Patients from the locoregional group (30.8%, 8/26) were prone to have higher risk stratification at first diagnosis than patients in the stochastic and extensive groups ( 20.8%, 20/96, P=0.107) as the marginal difference was found. At first bone metastasis diagnosis, RCC-BM patients with spinal involvement were more likely to have higher MSKCC risk stratification than those without spinal involvement [20.3%(15/48) vs. 17.6%(13/74), P<0.05]. Multivariate ordinal logistic regression showed that after adjusting for general data, bone metastasis sites, and concomitant visceral metastasis, RCC-BM patients with spinal involvement at first bone metastasis diagnosis were 3.3 times (95% CI 1.195-9.091, P<0.05)more likely to fall into the higher MSKCC risk group than those without spinal involvement.In those 93 cases with follow-up records, 20 (21.5%), 53 (57.0%), and 20 (21.5%) cases were in the locoregional group, stochastic group, and extensive group, respectively. The median overall survival time (mOS) of patients with pelvic involvement (36 cases) throughout the disease course was 32.0 months (95% CI 6.0-58.0), which was shorter than that of patients without pelvic involvement (57 cases, mOS 49.0 months, 95% CI 20.4-77.5, P<0.05). Conclusions:Spinal involvement (especially limited to thoracic and/or lumbar vertebrates) at first bone metastasis diagnosis and pelvic involvement throughout the disease course were associated with poor prognosis.
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Objective To evaluate the health-related quality of life (HRQOL) for prostate cancer patients receiving androgen deprivation therapy (ADT).Methods We studied 200 patients with prostate cancer who were treated with primary ADT in Peking University People's Hospital from June 2014 to June 2015.The patients'average age was 73.9 years.The mean PSA level was 21.57 ng/ml when they were diagnosed with prostate cancer.Of these 200 patients,79％ (158/200) were localized and seclected ADT therapy due to age,body condition,basic diseases or individual will.21％ (42/200) were locally advanced or metastasic,which accord with the indication of ADT therapy.The scales,including the MOS item short from health survey (SF-36),Functional Assessment of Cancer Therapy-General module (FACT-G),Functional Assessment of Cancer Therapy-Prostate instrument (FACT-P),Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were used to evaluate their HRQOL.Results According to results of SF36,the physical health component score and mental health component score was 67.41 ± 16.39 and 64.81 ± 17.51,respectively.They indicated that the overall quality of life of these patients was at an acceptable level.And the average score of all domains exceeded 60 except general health domain,which the score was only 40.03 ± 21.89.When it comes to FACT-P,the sum score,emotional well-being score and prostate cancer component score were 8.15 ± 3.72,12.30 ± 4.04 and 77.41 ± 9.95,respectively,which were less than half of their respective top score.However the physical well-being score was 20.41 ±4.29,which was a relatively satisfactory value.In addition,61％ (121/200) patient selected not at all in item I am able to have and keep an erection.The score of SDS and SAS was 46.76 ± 8.29 and 43.25 ±9.69,respectively.And there were 23.0％ (46/200) and 21.5％ (43/200) patiens exhibited depression and anxiety,respectively.Conclusion In the present study,the prostate cancer patients receiving ADT showed acceptable HRQOL,but some patients sufferd from depression,anxiety and erectile dysfunction.
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Objective To explore the expression of sex determining region Y-box 18 (SOX18) in prostate cancer(PCa) and its role on prostate cancer cells.Methods The expression of SOX18 in 98 PCa tissues and 81 adjacent non-tumor tissues was detected by immunohistochemistry.The expression of SOX18 mRNA and protein in PCa cell lines were detected by q-PCR and Western blotting analysis,respectively.After knocking down SOX18 with si-RNA,the proliferation,migration and invasion of PCa cells were analyzed by CCK8,Transwell and Matrigel assays in vitro.Results The rate of high SOX18 expression in prostate cancer tissues was 73.5％ (72/98),which was higher than that in adjacent normal tissues (43.2％,35/81) (P ＜ 0.01).In addition,the rates of high SOX18 expression in clinical stage Ⅲ-Ⅳ [83.7 ％ (36/43) vs.65.5 ％ (36/55),x2 =4.131,P =0.042],pathological grading G3-4 [88.6％ (39/ 44) vs.61.7％ (33/54),x2 =9.424,P =0.002] and Gleason scores ≥ 8 [85.0％ (34/40) vs.65.0％ (38/58),x2 =4.610,P =0.032] groups were higher than those in clinical stage Ⅲ-Ⅳ,pathological grading G1-2 and Gleason scores ≤7 groups.However,there were no differences in the rate of high SOX18 expression in different age groups [77.3％ (38/54) vs.70.4％ (34/44),x2 =0.539,P =0.441].Knockdown of SOX18 notably suppressed the proliferation,migration and invasion of prostate cancer cells.Conclusions SOX18 is over-expressed in prostate cancer,and could promote the proliferation,migration and invasion ability of prostate cancer cells.
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Objective: To evaluate the development, safety and efficacy of percutaneous nephrolithotomy(PNL) for management of upper urinary tract calculi in pediatric patients.Methods: In the study, 77 pediatric patients undergoing 87 PNLs through mini or standard tract for upper urinary tract calculi between January 2005 and December 2016 in Peking University People''s hospital were reviewed, including 69 renal calculi, 6 upper ureteral calculi, 12 renal and upper ureteral calculi, 35 single calculi, 43 multiple calculi and 9 staghorn calculi.The development and efficacy of PNL in pediatric patients were studied by analyzing the characteristics and clinical indexes, and by reviewing the associated literature.The Clavien classification system was used to evaluate the complications after PNL.Results: A total of 87 PNLs were performed in 77 pediatric patients.Eighty-one upper urinary tract calculi were managed through a single tract(93.1%), 5 pediatric patients were managed through 2 tracts(5.7%), and 1 pe-diatric patient was managed through 3 tracts(1.2%).The mean operating time was (77.0±29.8) min.The stone-free rate after one session was 100% for single calculi and 71.2% for multiple or staghorn calculi, 5(5.8%) children underwent auxiliary procedure to remove the residual calculi and the final stone-free rate of PNL was 88.5%.One of the main complications of pediatric PNL was fever.Sixteen(18.4%) had moderate fever(38-39 ℃), 5(5.7%) had high fever(39-40 ℃) and there were no severe complications of infection, such as sepsis or septic shock.The mean hemoglobin loss was (10.3±16.1) g/L and the serum creatinine rise was (7.0±13.3) μmol/L.One(1.2%) pediatric patient suffered ureteroscopic lithotripsy because of the obstruction by the residual stone in ureter.No injury of organs or retroperitoneal urinary extravasation occurred.General assessment of the complications showed Clavien grade Ⅰ complications in 14 (16.1%) pediatric patients, grade Ⅱ in 7(8.0%) children and grade Ⅲ in 1(1.2%) children.There was no grade Ⅳ or Ⅴ complications.The overall complication rate was 25.3%.Conclusion: PNL for management of upper urinary tract calculi in pediatric patients is effective.Complications after PNL, as assessed with Clavien classification system, are mild and PNL in pediatric patients is safe.
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Objective:To investigate the association between metabolic factors,such as obesity,blood pressure,blood glucose,serum lipid profile,and the histopathological characteristics of renal cell carci-noma.Methods:The medical records of 382 consecutive renal cell carcinoma patients who underwent radical or partial nephrectomy at Peking University People’s Hospital from January 2009 to January 2015 were retrospectively reviewed.Metabolic factors were collected from the records,including weight,body mass index,waist circumstance,blood pressure,fasting blood glucose,serum total triglyceride,serum total cholesterol,serum low-density lipoprotein-cholesterol and serum high-density lipoprotein-cholesterol. The patients were divided into different groups according to tumor grade,stage and diameter.Statistics analysis,such as t test,Mann-Whitney U test and Logistic analysis,were performed to investigate the as-sociation between metabolic factors and grade,stage and tumor diameter of renal cell carcinoma.Re-sults:A total of 80 (20.94%)of the tumors were classified as high grade disease,63 (16.49%)were classified as advanced disease and 153 (40.05%)tumor diameter more than 4 cm.The patients in high grade group were found to have lower high-density lipoprotein-cholesterol level than in low grade group (P =0.015),body mass index,total cholesterol and high-density lipoprotein-cholesterol were found to be lower in advanced disease than in localized disease (P =0.022,P =0.005 and P =0.006,respec-tively),and low-density lipoprotein-cholesterol was found to be lower in larger tumors (P =0.030). Other factors were comparable between the different groups.The results of Logistic analyses showed that, body mass index (OR =0.906,95%CI:0.852 -0.986,P =0.023)and total cholesterol (OR =0.660,95%CI:0.492 -0.884,P =0.005)were associated with the tumor stage,high-density lipopro-tein-cholesterol level was significantly associated with tumor grade (OR =0.293,95% CI:0.108 -0.797,P =0.016)and stage (OR =0.204,95%CI:0.065 -0.635,P =0.006),and low-density lipoprotein-cholesterol level was significantly associated with tumor diameter (OR =0.756,95% CI:0.586 -0.975,P =0.031).Conclusion:The results of our study indicate that metabolic factors,espe-cially obesity and serum lipid profile,are closely related with the histopathological characteristics of renal cell carcinoma.
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Objective To investigate the pathogenesis,clinical characteristics,diagnosis and treatment of Ceftriaxone-associated urinary tract and biliary pseudolithiasis in children.Methods A 6-year-old boy was treated in our hospital in March 2011.The initial diagnosis was acute suppurative tonsillitis.Ceftriaxone was administered intravenously at a dose of 3 g/d [ 117 mg/( kg · d) ]for three days.After that the boy complained of bilateral abdominal pain and nausea.Abdominal sonogram obtained after cessation of ceftriaxone treatment revealed urinary tract and gallbladder stone and hydronephrosis.After cessation of ceftriaxone treatment and intubation tube into the ureters by cystoscope,symptoms gradually disappeared and renal function recovered.Results After cessation of ceftriaxone treatment,symptoms gradually disappeared,with urinary tract CT scan normal after 10 days.Urinary tract and gallbladder sonograms were found to be normal 22 days after diagnosis without specific treatment.Followed up for 1 month,no recurrence of stone was observed.Conclusions Ceftriaxone-associated urinary tract and biliary pseudolithiasis in children is rare.These complications generally resolve spontaneously with cessation of the ceftriaxone therapy.Physicians should be aware of these complications so as to avoid unnecessary therapeutic procedures.