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The 2023 American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO-GU) reported several advancements in the field of urothelial carcinoma. Multiple new treatment options for non-muscle invasive bladder cancer (NMIBC) were introduced, providing more choices for bladder preservation in BCG-resistant/failed NMIBC cases. In muscle invasive bladder cancer (MIBC) perioperative treatment, the updated 3-year follow-up data from the CheckMate 274 study demonstrated a clear advantage in disease-free survival for the nivolumab monotherapy adjuvant treatment group. For metastatic urothelial carcinoma (mUC), the final overall survival (OS) report from the IMvigor130 study was published, prompting further considerations for future first-line treatment options in mUC. Additionally, the conference highlighted research progress in upper tract urothelial carcinoma (UTUC).
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Objective:To evaluate the clinical value of Xing's ureteroileal anastomosis technique in radical cystectomy.Methods:The data of 38 patients who underwent radical cystectomy with Xing's ureteroileal anastomosis technique at Cancer Hospital, Chinese Academy of Medical Sciences and Beijing Chaoyang Hospital from July 2013 to June 2021 were retrospectively reviewed. There were 30 males and 8 females. The mean age was 61.6±15.1 years old. The mean body mass index (BMI) was 25.1±2.7 kg/m 2. The American Society of Anesthesiology (ASA) graded 25 cases as grade 1, 10 cases as grade 2 and 3 cases as grade 3. There were 35 cases with stage cT 2N 0M 0 and 3 cases with cT 3N 0M 0. All patients underwent radical cystectomy and ileal conduit, and the ureteroileal anastomosis was performed using the Xing's ureteroileal anastomosis technique. Afferent loop entry was divided equally into two lumens. After 1.5 cm-long lengthwise incisions, each ureter was directly and end-to-end anastomosed to the aforementioned lumens. Postoperative information was recorded, including ureteric stricture, ureteric reflux, hydronephrosis, anastomotic leakage, renal calculus, urinary tract infection, and pyelonephritis. Results:Ureteroileal anastomosis was performed successfully in 38 cases with 76 units. The median follow-up time was 35.6 (17.0, 46.3) months. Three patients developed unilateral anastomotic stenosis after operation. Five patients had unilateral ureteral reflux. Two patients had unilateral hydronephrosis. No anastomotic leakage, urinary tract infection, or pyelonephritis occurred after the operation. Renal calculus appeared in 3 cases, all on the left unit.Conclusions:Xing's ureteroileal anastomosis technique is a simple method with few postoperative and good functional outcomes.
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Objective:To investigate the clinical effect and demonstrate the techniques of single position laparoscopic nephroureterectomy.Methods:The clinical data of 84 upper urinary tract urothelial carcinoma patients admitted to the Cancer Hospital Chinese Academy of Medical Sciences from September 2018 to July 2022 were retrospectively analyzed, including 39 males and 45 females, with a median age of (64.9±9.3)years and mean BMI of(24.7±3.4)kg/m 2. The tumor was located on the left side in 47 cases and the right side in 37 cases. All 84 patients received single position laparoscopic nephroureterectomy. According to different treatment methods, they were divided into two groups, including 67 cases undergoing nephrectomy first, and then bladder cuff excision was performed along ureter(traditional group), 17 cases undergoing bladder cuff excision before clamping the ureter below the tumor, and then nephrectomy was performed along the ureter to the head side (modified group). There was no statistically significant in the comparison of age [(65.5±9.4)years vs.(62.7±8.9)years], BMI[(24.9±3.5)kg/m 2vs.(23.9±3.3)kg/m 2], left/right side tumor of(38/29 cases vs. 9/8 cases), tumor location (in renal pelvis or calyx or upper/middle/lower ureter being 46/9/12 cases vs. 13/2/2 cases)and tumor stage(T 1-2/T 3-4: 54/13 cases vs. 15/2 cases) between traditional group and modified group ( P>0.05). The operation time, estimate blood loss, postoperative intestinal function recovery time and postoperative drainage time were recorded and compared. Results:All 84 cases were successfully completed without conversion to open surgery. The mean operation time was (160.4±50.1)min, the mean estimated blood loss was(59.4±24.4)ml, the median postoperative intestinal function recovery time was 1(1, 2)d and the mean postoperative drainage time was (4.8±1.9)d(No drainage tube was placed in 4 patients). No Clavien Dindo >grade 3 complications occured. There was no significant difference in the comparison of operation time [(159.2±52.9)min vs. (164.7±38.1)min], estimate blood loss [(60.5±26.2)ml vs. (55.0±17.5)ml], postoperative intestinal function recovery time [1(1-2)d vs. 2(1-2)d] and drainage removal time [(4.8±1.8)d vs. (5.2±2.0)d] between traditional group and modified group ( P>0.05). The postoperative pathology of 84 cases was urothelial carcinoma, and the pathological results of the resection margin were negative. The median follow-up of 84 upper tract urothelial carcinoma patients was 13(3, 28)months. Five patients were lost to follow-up. In traditional group, 5 patients had bladder tumor recurrence, and 5 patients had distant metastasis. In modified group, no bladder tumor recurrence occurred and 1 patient had distant metastasis. Conclusions:Laparoscopic nephroureterectomy in single position is a safe and effective minimally invasive technique for the treatment of upper urinary tract urothelial carcinoma. Treatment of the bladder cuff excision firstly is more in line with the principle of tumor-free and increase surgical space.
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Prostate cancer is one of the most common malignancies in older men. Prostate cancer patients with distant metastasis often have a poor prognosis, and more than half of Chinese prostate cancer patients have developed distant metastasis at the time of initial diagnosis. In recent years, with the disclosure of the results of a number of global multi-center clinical trials, combination therapy and precision therapy have become two major themes in the treatment of metastatic prostate cancer (mPCa). The American Society of Clinical Oncology Genitourinary (ASCO-GU) Cancers Symposium is a grand meeting of the urologic oncology community. Several research advances reported at the meeting will help to update the treatment strategy of mPCa. This article interprets and comments on a number of milestone studies on mPCa treatment at the ASCO-GU 2022 annual meeting, with a view to providing help for the clinical treatment decisions of mPCa patients.
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Objective:To investigate the trend of prostate cancer incidence in Chinese tumor registration areas between 1988 and 2015.Methods:Collect the data including number of males, prostate cancer incidence rate and age-standardized incidence rate by world standard population(ASIRW) in Chinese tumor registration areas between 1988 and 2015. Calculate the average annual increase rate, and evaluate the trend of changes in the incidence of prostate cancer in China.Results:From 1988 to 2015, the number of male population covered by Chinese tumor registration areas increased from 10.41 million to 162.76 million, an average annual increase of 10.72%.The incidence of prostate cancer increased from 1.71 per 100 000 to 10.39 per 100 000, with an annual percentage change of 6.91%. The ASIRW increased from 1.82 per 100 000 to 6.05 per 100 000, with an average annual increase of 4.55%. In 1988—1997, 1998, 1999—2008, 2009—2010, and 2011—2015, the average annual increase rate of the male population covered by Chinese tumor registration areas was 0.99%, 36.73%, 7.92%, 37.55%, and 20.88% respectively. The average annual increase rate of prostate cancer incidence was 8.43%, -0.75%, 12.08%, -9.74%, 3.01%, and the average annual increase rate of ASIRW was 5.94%, -6.01%, 8.88%, -7.04%, 0.78%, respectively.Conclusions:The incidence of prostate cancer in Chinese tumor registration areas increased gradually during the early era of epidemiological investigation, followed by a rapid increase and a subsequent mild increase. With the rapid changes in the national cancer registration area and the population covered, the incidence of prostate cancer has declined in a short period of time.
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Objective:To explore risk factors for positive surgical margin (PSM) after laparoscopic radical prostatectomy (LRP) in high risk prostate cancer (PCa) patients with and without neoadjuvant hormornal therapy (NHT).Methods:The clinicopathological data of 202 high risk patients who underwent LRP from January 2012 to July 2020 was retrospectively analyzed. There were 111 cases performed in Beijing Chaoyang Hospital and 91 cases in National Cancer Center. Mean age was(67.7±6.5)years, mean BMI was (25.65±3.21)kg/m 2. Median highest preoperative PSA was 20.97(11.00, 34.40)ng/ml, median preoperative prostate volume was 32.88(23.33, 46.20)ml. Among all 202 high risk PCa patients, 97 did not receive NHT(non-NHT group) and 105 received NHT(NHT group). There were significant statistical difference in term of highest PSA, preoperative prostate volume between NHT and non-NHT groups ( P<0.05), while there was no significant difference in term of age or BMI between the two groups. Among NHT patients, 80 cases accepted complete androgen blockade therapy with median course of 3 months; 3 cases accepted simple castration therapy with median course of 3 months; 22 cases accepted simple anti-androgen therapy with median course of 1 month. Risk factors for PSM after LRP in NHT and non-NHT groups were respectively explored, including age, BMI, hypertension, diabetes, history of pelvic surgery, highest PSA before puncture, ISUP before puncture, preoperative prostate volume, ISUP after LRP, postoperative pathological stage T, pathological lymph node involvement, vessel carcinoma embolus, etc. Results:PSM rate was 50.5%(49/97) and 24.8% (26/105) in non-NHT and NHT, respectively. The apex was the most common location of PSM in non-NHT group(35.1%, 34/97), while the fundus was the most common location of PSM in NHT group(14.3%, 15/105). Multiple logistic regression revealed that postoperative pathological stage T was the only independent factors affecting the PSM for high risk patients without NHT ( OR=3.814, 95% CI 1.302-11.173, P=0.015), while postoperative pathological stage T, pathological lymph node involvement, and vessel carcinoma embolus were independent risk factors affecting PSM for high risk patients with NHT ( OR=18.434, 95% CI 4.976-68.297, P<0.001; OR=7.181, 95% CI 2.089-24.689, P =0.002; OR=3.545, 95% CI 1.109-11.327, P=0.033). Conclusions:Postoperative pathological stage T was independent risk factors affecting PSM for all high risk PCa patients no matter with or without NHT, while pathological lymph node involvement, and vessel carcinoma embolus were also independent risk factors affecting PSM for high risk PCa patients with NHT.
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The guideline content of non-muscle invasive bladder cancer(NMIBC) by European Association of Urology has been updated in 2020, mainly included: ①Histological variant classification information of urothelial carcinoma has been added; ②The classification of BCG therapy failure has been revised; ③Immune checkpoint inhibitors has been approved for the treatment of BCG unresponsive high risk NMIBC. This paper is to introduce and summarize the main points of the updated guideline.
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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.
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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 status and trends of prostate cancer mortality in China.Methods Prostate cancer data between 1998 and 2008 from the National Cancer Registration Center were collected,including the mortality of prostate cancer,the cumulative probability of dying from prostate cancer of males aged 0-74,composition and age-specific mortality.Comparing and analysing the status and trends of the mortality between urban and rural men.Results In 2008,the mortality of prostate cancer of chinese men was 4.07/100 000,the world's population age-standardized mortality rate was 2.44/100 000.The mortality cumulative risk of males aged 0-74 was 0.18％,accounting for 1.78％ of the mortality of men's malignant tumors.The mortality of urban males was about 2.7 times of that in rural areas.The results of age-specific mortality showed that the mortality of chinese males over the age of 70 ranked lth in the males genitourinary tumor.The average annual growth rate during 1998-2008 was 8.44％.The growth mortality rate of urban men with prostate cancer was higher than in rural areas,it was 2.49/100 000 and 0.96/100 000,but the average annual growth rate was lower than rural males,it was 7.86％ and 8.28％.The proportion of high age group was increased significantly in the age composition of the mortality over time.Conclusions In recent years,the mortality of prostate cancer has showed a obvious growth trend in China.Prostate cancer impacts Chinese men's health seriously.