Preoperative Lymphocyte-to-monocyte Ratio Predicts Prognosis in Patients with Stage T1 Non-muscle Invasive Bladder Cancer / 中国医学科学院学报

Objective To investigate the clinical value of preoperative lymphocyte-to-monocyte ratio(LMR)in evaluating the prognosis of patients with stage T1 non-muscle invasive bladder cancer(NMIBC).Methods A total of 215 patients with stage T1 NMIBC who underwent transurethral resection of bladder tumor were enrolled.Clinical data were collected.Patients were followed up and their disease-free survival(DFS)and overall survival(OS)were recorded.The receiver operating characteristic(ROC)curve of preoperative LMR in detecting patient prognosis was used to determine the optimal cut-off value for LMR.Patients were divided into low LMR group(LMR <3.86,=77)and high LMR group(LMR ≥ 3.86,=138).Kaplan-Meier survival curves were explored to compare cumulative DFS and OS rates in patients with different LMR levels,and COX proportional hazards regression model was used to analyze factors associated with DFS and OS.Results All these 215 patients with T1 stage NMIBC were followed up for 2-92 months,and the DFS rate was 59.07% and OS rate was 65.12%.Kaplan-Meier curves showed that the cumulative DFS rate(=4.784,=0.029)and cumulative OS rate(=7.146, =0.008)in the low LMR group were significantly lower than those in the high LMR group.Tumor size ≥ 3 cm(=1.398,95% :1.042-1.875,=0.025),pathological grade G3(=1.266,95% :1.026-1.563,=0.028),and LMR ≥ 3.86(=2.347,95% :1.080-5.101,=0.031)were independent factors associated with DFS in patients with stage T NMIBC.In addition,tumor size ≥ 3 cm(=1.228,95% :1.015-1.484,=0.034),pathological grade G3(=1.366,95% :1.017-1.834,=0.038),and LMR<3.86(=2.008,95% :1.052-3.832,=0.035)were independent factors associated with OS in patients with T1 stage NMIBC. Conclusion Preoperative LMR is an independent factor associated with patients' prognosis in T1 stage NIMBC.Patients with low LMR tend to have higher risk of NMIBC progression and death.

Diagnosis and treatment of micro-paragangliomas in urinary bladdler / 基础医学与临床

Objective To develope the diagnostic criteria and surgical methods to treat micro-paraganagliomas (<1 cm) of urinary bladder ( PUB) , we now report a case series study including 5 individual cases .Methods Clinical data of 5 patients with micro-PUBs who underwent surgical treatment were obtained and analyzed retrospectively . Two male patients and three female patients were included in our study with the mean age of 51 ( range from 41 to 65 years) .4 patients were reported as symptomatic due to hypercatecholaminemia , while the other was free of symptoms.24-hour urine catecholamine ( CA) examination was utilized to qualitatively diagnose PUB , positive in 75%patients.Ultrasonography(USG), CT, MRI, 111In-DTPA-Octreotide scintigraphy (OctreoScan) and 131 I-MIBG scintigraphy were used to locate the tumor , positive in 80%, 20%, 75%, 25%and 33%patients respectively .What's more, all 5 patients underwent transurethral resection of tumor .Overfilling of bladder and puncture following ultra-sonography guidance were performed to locate the tumors , when tumors were absent in surgical vision .Results All tumors were located and resected completely with no open conversions .It took 0.5 to 26 minutes to locate the tumor and another 3 to 10 minutes to resect the tumors .All lesions were diagnosed by histopathological confirma-tion, especially by immunohistochemical staining.Blood pressure return to normal level after the procedures.No local recurrence or distal metastasis were observed by performing 24-hour urine CA test , USG, cystoscopy and MRI within adequate follow-up.The mean follow-up duration was 38.6 months, ranging from 6 to 120 months.Conclu-sions USG and MRI examination were considered better in detecting micro PUB than CT-scan.Overfilling of blad-der and puncture following USG guidance may support more accurate tumor location intraoperatively if the tumors were not found in transurethral resection procedures .

Simultaneous renal clear cell carcinoma and gastrointestinal stromal tumor in one case

Renal cell carcinoma is a tumor in kidney, while gastrointestinal stromal tumors are localized in the stomach and small intestine. They seldom occur simultaneously in sporadic case, both of which were suspective to sunitinib, a tyrosine kinases [RTKs] inhibitor. Our current case is novel in that concurrent RTK-related tumors are involved in one case. One possible explanation is the presence of some activating mutations

Application of adrenocorticotropic hormone receptor determination and ultrastructural observation of tumor cells in the subtyping of adrenocortical neoplasms / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the values of adrenocorticotropic hormone receptor (ACTH-R) determination and ultrastructural observation of tumor cells in the subtyping of adrenocortical neoplasms (ANs).</p><p><b>METHODS</b>The expression of ACTH-R in 87 AN tissues were determined with Polymer immunohistochemical staining, with 10 normal adrenal tissues as the controls. The ultrastructure of the tumor cells was observed using electron microscopy.</p><p><b>RESULTS</b>The positive expression rate of ACTH-R was (80.1 +/- 8.2)%, (53.2 +/- 10.3)%, (63.2 +/- 10.1)%, (83.3 +/- 6.5)%, and (70.1 +/- 7.3)% in the sub-CPA group, CPA group, APA group, NFA group, and NC group, respectively. ACTH-R expression was significantly higher in NFA and sub-CPA groups than in NC group (P = 0.001, P = 0.000), APA group (P = 0.000, P = 0.000), and CPA group (P = 0.000, P = 0.000), and was also significantly different between NC group and APA group (P = 0.039) and between APA group and CPA group (P = 0.037). However, no significant difference was found between NFA group and sub-CPA group (P = 0.325). As shown by the electron microscopy, ANs had some partially similar microscopic features, while different AN subtypes showed differences in the type and amount of secretory granules.</p><p><b>CONCLUSION</b>ACTH-R determination and ultrastructural observation of tumor cells may be helpful for subtyping ANs.</p>

Expressions of receptor tyrosine kinases mRNA and protein in carcinoma of bladder / 中国医学科学院学报

<p><b>OBJECTIVE</b>To detect the expressions of receptor tyrosine kinases (RTKs) mRNA and protein and to explore potentially promising tumor markers and conceivable drug target in bladder cancer.</p><p><b>METHODS</b>The expressions of RTKs mRNA and protein in tissue from invasive urothelial carcinoma of the bladder were examined by real-time quantitative PCR array and cytokine antibody array, with normal bladder tissue as control. The Results were analyzed using bioinformatic approaches.</p><p><b>RESULTS</b>The expressions of TGFA, STAB1, SERPINE1, ANGPT2, SPINK5, ANGPTL1, PROK1, MDK, CXCL9, GRN, RUNX1, VEGFA, and TGFB1 were obviously upregulated in bladder cancer tissue, while those of EDIL3, PTN, CCL2, PDGFD, FGF13, KITLG, FGF2, SERPINF1, and TNF were downregulated. ALK, Btk, EphB2, ErbB4, PDGFR-α, ROS, Tie-2, Tyk2, and VEGFR3 were over-expressed in bladder cancer, while FRK, Fyn, IGF-IR, Insulin R, Itk, JAK1, JAK3, and LCK were low-expressed.</p><p><b>CONCLUSION</b>Vascular endothelial growth factor/platelet-derived growth factor-targeted therapies may play an active role in treating carcinoma of bladder.</p>

Diagnosis and treatment of primary adult renal sarcoma / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the clinical characteristics of primary adult renal sarcoma.</p><p><b>METHODS</b>A total of 1654 cases with adult renal tumors were treated during 1985 to 2009 in Peking Union Medical College Hospital. Of all, 17 cases were diagnosed as primary renal sarcoma and underwent radical nephrectomy. The clinical features of 17 such patients were retrospectively analyzed.</p><p><b>RESULTS</b>The first symptom of 10 (59%) cases in all renal sarcomas was abdominal mass. The pathological diagnosis was leiomyosarcoma (7 cases), rhabdomyosarcoma (2 cases), malignant fibrous histiocytoma (2 cases), low-differentiated sarcoma (2 cases), chromophobe renal cell carcinoma coexisting with liposarcoma (1 case), fibrosarcoma (1 case), embryonic sarcoma (1 case) and leiomyosarcoma (1 case). One patient died of tumor thrombus of the inferior vena cava during surgery. Finally, 15 cases were regularly followed up for 4 to 60 months. Till now, 1 had tumor-free survival for 9 months, and the other 14 cases died 2-38 months after the operation with a median survival time of 18 (range, 5-60) months. The median survival time of leiomyosarcoma group was 28 (range, 11-60) months, and 2 cases of malignant fibrous histiocytoma died 4 and 8 months after the operation respectively.</p><p><b>CONCLUSIONS</b>The primary renal sarcoma has the clinical symptom similar with advanced renal cell carcinoma and has poor prognosis. Leiomyosarcoma might have relative good prognosis.</p>

decade of clinical experience with extra-adrenal paragangliomas of retroperitoneum: report of 67 cases and a literature review

The purpose was to highlight the diagnosis and treatment of extra-adrenal para-gangliomas, which often causes catecholamine hypersecretion and hypertension. 67 cases of extra-adrenal paraganglioma of retroperitoneum proven pathologically from 1999 to 2009 were reviewed and studied after operation. Endocrine secretion examinations, B-US, CT, MRI, 131-MIBG, octreotide and hands microcirculation inspection were used to diagnose the disease. All patients underwent successful surgical resection of the tumors, which proved to be paragangliomas. They were from 3 cm to 25 cm in size. Almost all of them were diffusely positive for cgA, syn, NSE and s-100 by immunohitochemical staining. There were nine cases assayed malignant paraganglioma by the follow-up. 131-MIBG and octreotide have high sensitivity and accuracy in diagosing extra-adrenal paraganglioma. Surgical treatment should be carried out on the basis of correct drug preparation of a-receptor blocker, such as prazosin and phenoxybenzamine. Complete surgical excision is the treatment of choice for extra-adrenal paragangliomas as well as recurrent or metastatic disease, which could be resected laparoscopically. Intimate lifelong follow-up is necessary and important

Differential diagnosis and laparoscopic treatment of adrenal pheochromocytoma and ganglioneuroma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Adrenal ganglioneuroma is a rare adrenal pathogenic disease with difficult differential diagnosis from adrenal pheochromocytoma. Currently, very limited literature is available to allow a differential diagnosis of these two conditions from each other. This study aimed to evaluate the clinical profile, differential diagnosis and surgical treatments of both conditions.</p><p><b>METHODS</b>Clinical characteristics of 36 patients with adrenal pheocheomocytoma and 18 patients with adrenal ganglioneuroma were analyzed. Data from CT scans and surgical treatments from 1999 to 2007 were collected. Endocrine hormone tests and (131)I-metaiodobenzylguanidine (MIBG) were performed. Neither (131)I-MIBG nor endocrine hormone tests were available in 9 cases of asymptomatic adrenal ganglioneuroma with tumor size less than 4 cm and there were negative findings from contrast enhanced CT scans. The level of urine catecholamine of patients was compared by one-way analysis of variance.</p><p><b>RESULTS</b>Te mean age of patients in the adrenal ganglioneuroma group was 41.2 years (16 - 67 year) and in the adrenal pheochromocytoma patients 38 years (17 - 74 year). Contrast enhanced CT showed that the foci were intensified in 5 cases (27.8%) of adrenal ganglioneuroma and there were obvious contrast indications in 30 (83.3%) of the pheochromocytoma. Catecholamine levels in a 24-hour urine sample were normal in 4 patients with adrenal ganglioneuroma and increased in 36 (100%) cases with adrenal pheochromocytoma. (131)I-MIBG nuclear scan showed negative results in 4 patients (100%) with adrenal ganglioneuroma and positive results in 25 (96.2%) with adrenal pheochromocytom. Laparoscopy for adrenal tumors was performed through a transperitoneal or retroperitoneal approach during a follow-up period of (43 +/- 6) months, and all cases survived well.</p><p><b>CONCLUSIONS</b>CT, urinary catecholamine and (131)I-MIBG are standard and efficient tools for differential diagnosis of adrenal ganglioneuroma from pheochromocytoma. Laparoscopic surgery can be performed through a transperitoneal or retroperitoneal approach depending on the finding of CT scans. Open surgery is necessary for patients with blood loss of more than 800 ml and violent fluctuation of intraoperative blood pressure.</p>

Serum osteoprotegerin as a novel marker of bone metastasis in prostate cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the diagnostic usefulness of serum osteoprotegerin (OPG) in prostate cancer bone metastasis.</p><p><b>METHODS</b>Serum osteoprotegerin were measured by ELISA assay in 30 healthy men, 30 patients with benign prostatic hyperplasia, 66 patients with prostate cancer including 36 without bone metastasis (30 with localized cancer, 6 with lymph node metastasis) and 30 with bone metastasis. The results associated with clinical data were calculated statistically.</p><p><b>RESULTS</b>Serum osteoprotegerin were significantly increased in patients with bone metastasis compared with others (P<0.001). OPG level had a positive correlation with either prostate specific antigen (PSA) or Alkaline phosphatase (ALP) level (r=0.427, 0.277; P<0.001); and a positive correlation with either Gleason score or grade (r=0.427, 0.277; P<0.001). ROC analysis proved that OPG had better diagnostic accuracy than ALP for detecting bone metastasis in prostate cancer.</p><p><b>CONCLUSION</b>Serum osteoprotegerin could be used as a marker for diagnosis of bone metastasis in prostate cancer.</p>

Expression of HGF and its receptor c-Met in renal cell carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the clinical significance of expression of hepatic growth factor (HGF) and its receptor c-Met in renal cell cancer (RCC).</p><p><b>METHODS</b>Twenty-six patients with RCC and 10 benign renal tumor patients were examined. The expression of HGF and c-Met mRNA was detected using Northern blot. GAPDH was used as the internal control.</p><p><b>RESULTS</b>Twenty-one out of 26 patients with RCC had positive gene expression of HGF and c-Met with the positive rate of 80.8%. According to the tumor TNM staging, the more advanced the cancer had a stronger expression of HGF and c-Met, the expression of c-Met was higher than that of HGF in the RCC. Whereas in the control group with benign tumor, the expression of c-Met was rather mild.</p><p><b>CONCLUSION</b>The result suggests that HGF and its receptor c-Met may play an important role in the development and progression of renal cancer, which may also imply a potential clinical significance in diagnosing and assessing prognosis of RCC.</p>

Immunotherapy of metastatic renal cell carcinoma: report of 28 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the efficacy of IL-2, IFN and Furtulon in patients with metastatic renal cell carcinoma.</p><p><b>METHODS</b>During the induction phase of the treatment of 28 patients, which lasted 3 months, IL-2 and IFN were administered subcutaneously three times a week at doses of 5 - 20 MU/m(2) and 6 - 9 MU/m(2), Furtulon was administered at doses of 800 - 1,200 mg daily by oral during 28 days a month.</p><p><b>RESULTS</b>The response rate was 46.4%, including 4 complete response (CR), 9 presented with partial response (PR).</p><p><b>CONCLUSION</b>The three-drugs combination described in this study demonstrates activity. Based on the present data, combined biochemotherapy may be a promising new approach to the therapy of the metastatic renal cell carcinoma.</p>

Clinical significance of RANTES and MIP-1 alpha in acute rejection episode in kidney transplantation / 中国医学科学院学报

<p><b>OBJECTIVE</b>To discuss the correlation between acute rejection episodes and expression of regulated upon activation normal T cell expressed and secreted (RANTES) and macrophage inflammatory protein-1 alpha (MIP-1 alpha) gene following kidney transplantation.</p><p><b>METHODS</b>A total of 76 kidney biopsies (episode biopsy) were performed on both 57 patients with allograft dysfunction following transplantation and 19 patients without rejection, and the latter were served as controls. All acute rejections were confirmed by histological examination. The expressions of RANTES and MIP-1 alpha mRNA in all samples were assayed by reverse transcription polymerase chain reaction.</p><p><b>RESULTS</b>Thirty-eight (66.7%) of 57 cases with acute rejection had strong expression of RANTES, and 41 (72%) had expression of MIP-1 alpha. Only four (21%) of 19 controls had mild expression of RANTES, and 5 (26%) had expression of MIP-1 alpha, which evoked a statistical significance (P < 0.001) when compared with those with acute rejections.</p><p><b>CONCLUSIONS</b>The expressions of chemokines RANTES and MIP-1 alpha are important in the process of immune reaction in the rejection of transplanted kidney, which may imply a potential way for early diagnosis and treatment of acute rejection after further research.</p>