Diagnosis and treatment of malignant mesothelioma of the tunica vaginalis testis: a series of 7 cases / 中华外科杂志

Objective: To investigate the clinical features, diagnosis, prognosis of malignant mesothelioma of the tunica vaginalis testis (MMTVT). Methods: The clinicopathological data of 7 patients with MMTVT who treated at Sun Yat-sen University Cancer Center between January 2010 and October 2022 were retrospectively reviewed. Cases were first diagnosed at (M (IQR)) 49 (23) years old (range: 27 to 64 years old). The main clinical manifestations were scrotal enlargement (7 cases) and hydrocele (2 cases). Results: Three patients underwent radical orchiectomy as initial treatment, 2 cases underwent hydrocelectomy due to diagnosis of hydrocele, followed by radical orchiectomy at Sun Yat-sen University Cancer Center, and 2 cases underwent transscrotal orchiectomy. Common tumor markers of testicular cancer were not significantly elevated in MMTVT. The expression of tumor PD-L1 was positive in 2 out of the 3 cases. One patient received adjuvant chemotherapy and 2 patients received first-line chemotherapy after tumor recurrence. Chemotherapy regimens used include cisplatin+pemetrexed. Up to October 2022, 3 cases relapsed, of which 2 cases died. The median overall survival was 35 months (range: 4 to 87 months) and the median progression-free survival was 6 months (range: 2 to 87 months). Conclusions: MMTVT at early stage should be treated with early radical orchiectomy and followed up closely after surgery. The cisplatin+pemetrexed regimen is a common option for the treatment of metastatic MMTVT, while whether immune checkpoint inhibitors could serve as a second-line treatment option deserves further research.

Efficacy of partial nephrectomy in patients with localized renal carcinoma: a 20-year experience of 2 046 patients in a single center / 中华外科杂志

Objectives: To analyze the long-term survival of patients with localized renal cell carcinoma after partical nephrectomy. Methods: The clinicopathological records and survival follow-up data of 2 046 patients with localized renal cell carcinoma, who were treated with partial nephrectomy from August 2001 to February 2021 in the Department of Urology, Sun Yat-sen University Cancer Center, were retrospectively analyzed. There were 1 402 males and 644 females, aged (M(IQR)) 51 (19) years (range: 6 to 86 years). The primary end point of this study was cancer-specific survival. Survival curves were estimated using the Kaplan-Meier method, and the difference test was performed by Log-rank test. Univariate and multivariate Cox analysis were fitted to determine factors associated with cancer-specific survival. Results: The follow-up time was 49.2 (48.0) months (range: 1 to 229 months), with 1 974 patients surviving and 72 dying. The median cancer-specific survival time has not yet been reached. The 5- and 10-year cancer specific survival rates were 97.0% and 91.2%, respectively. The 10-year cancer-specific survival rates for stage pT1a (n=1 447), pT1b (n=523) and pT2 (n=58) were 95.3%, 81.8%, and 81.7%, respectively. The 10-year cancer-specific survival rates of patients with nuclear grade 1 (n=226), 2 (n=1 244) and 3 to 4 (n=278) were 96.6%, 89.4%, and 85.5%, respectively. There were no significant differences in 5-year cancer-specific survival rates among patients underwent open, laparoscopic, or robotic surgery (96.7% vs. 97.1% vs. 97.5%, P=0.600). Multivariate analysis showed that age≥50 years (HR=3.93, 95%CI: 1.82 to 8.47, P<0.01), T stage (T1b vs. T1a: HR=3.31, 95%CI: 1.83 to 5.99, P<0.01; T2+T3 vs. T1a: HR=2.88, 95%CI: 1.00 to 8.28, P=0.049) and nuclear grade (G3 to 4 vs. G1: HR=2.81, 95%CI: 1.01 to 7.82, P=0.048) were independent prognostic factors of localized renal cell carcinoma after partial nephrectomy. Conclusions: The long-term cancer-specific survival rates of patients with localized renal cancer after partial nephrectomy are satisfactory. The type of operation (open, laparoscopic, or robotic) has no significant effect on survival. However, patients with older age, higher nuclear grade, and higher T stage have a lower cancer-specific survival rate. Grasping surgical indications, attaching importance to preoperative evaluation, perioperative management, and postoperative follow-up, could benefit achieving satisfactory long-term survival.

Incidence and Prognosis of Infections in the Elderly and Non-elderly Residents in a Community of Beijing / 中国医学科学院学报

To compare the incidence and prognosis of infections between elderly and non-elderly residents in a community of Beijing. Adult inpatients during the study period(from July 1,2012 to June 30,2014)living in Yuetan Subdistrict of Beijing were screened for infections,and patients with infections were included into the analysis. A total of 19 472 patients were screened,and infections were found in 3449 patients(17.7%).The incidence was significantly higher in the elderly than that in the non-elderly patients(21.5%10.5%,=362.202,<0.001).Lower respiratory tract was the most commonly affected site,followed by genitourinary system.The mortalsity rate of the elderly patients with infections was significantly higher than that of the non-elderly patients with infections(13.6%3.4%,=56.829,<0.001)and increased with age.Logistic regression analysis found that older age,emergency surgery,comorbid cancer,chronic cardiac insufficiency,higher Charlson comorbidity index,intra-abdominal infection,gastrointestinal infection,bloodstream infection,lower respiratory infection,and hospital-acquired infection were independent risk factors of death for the elderly patients. The incidence of infections in the elderly patients living in Yuetan Subdistrict of Beijing is much higher than that of the non-elderly patients,and elderly infected patients had longer hospital length of stays and higher mortality rates than non-elderly infected patients.

Independent external verification of the nomograms for predicting lymph node metastasis in penile cancer / 中华男科学杂志

<p><b>Objective</b>To evaluate the two newly established nomograms for predicting lymph node metastasis in penile cancer based on the clinical data on a large cohort of patients.</p><p><b>METHODS</b>We retrospectively studied the clinical data on 93 patients with penile cancer treated in the Center for Tumor Prevention and Treatment. Using the two recently established nomograms (Bhagat nomogram and Zhu nomogram), we predicted lymph node metastasis in the patients, analyzed the differences between prediction and the results of postoperative pathology, and compared the accuracy of prediction between the two nomograms with the receiver operating characteristic (ROC) curve and the area under the curve (AUC).</p><p><b>RESULTS</b>The median age of the patients was 55 (27－82) years. Positive lymph nodes were found in 31 cases (33.3%) postoperatively and in 9 (21.9%) of the 41 clinically negative cases. The AUC of the Bhagat nomogram was 0.739 and that of Zhu nomogram was 0.808, both of which were similar to the prediction accuracy of internal verification and manifested a medium predictive ability.</p><p><b>CONCLUSIONS</b>The newly established Bhagat and Zhu nomograms can be used for predicting lymph node metastasis in penile cancer, but with a low precision, and therefore cannot be relied exclusively for the option of inguinal lymphadenectomy.</p>

Solanine inhibits prostate cancer Du145 xenograft growth in nude mice by inducing cell cycle arrest in G1/S phase / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of solanine on the growth of human prostate cancer cell xenograft in nude mice.</p><p><b>METHODS</b>Human prostate cancer Du145 cells were injected into the subcutaneous layers on the back of nude mice. After a week, the mice bearing subcutaneous tumor graft were randomly divided into solanine treatment group and saline control group for treatment for 3 weeks. The tumor grafts were then harvested to evaluate the inhibition rate. The mRNA and protein expressions of cell cycle-related genes in the tumors were detected by qRT-PCR and Western blotting, respectively, and tumor cell apoptosis was detected using TUNEL method.</p><p><b>RESULTS</b>The tumor growth rate in solanine-treated group was significantly slower than that in the control group (P<0.01). The mRNA and protein expressions of C-myc, cyclin D1, cyclin E1, CDK2, CDK4 and CDK6 were significantly inhibited by solanine. Solanine significantly up-regulated p21 mRNA and protein expression in the tumors and induced a higher apoptosis rate of the tumor cells than saline (P<0.01).</p><p><b>CONCLUSION</b>The tumor-inhibition effect of solanine is probably mediated by regulating the expressions of genes related with G1/S cell cycle arrest and cell apoptosis.</p>

Efficacy of periprostatic nerve block anesthesia for pain control in transrectal ultrasound- guided systematic prostate biopsy / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the efficacy of periprostatic nerve block anesthesia (PPNB) for pain relief in transrectal ultrasound-guided systematic prostate biopsy (PBx).</p><p><b>METHODS</b>We reviewed the data of patients undergoing initial PBx at our center from November, 2013 to January, 2015. Only the patients with 12-core systemic PBx were included and 111 patients were eligible for this study, among whom 52 patients received PPNB and 59 did not. PPNB was achieved by an injection of 5 mL of 1% lidocaine at the angle between the seminal vesicle and base of the prostate on each side before biopsy. The DRE pain score, probe insert pain score, and biopsy pain score were assessed by visual analogue scale (VAS) immediately after the biopsy. The complications were recorded and evaluated immediately after and at 7 days after the biopsy.</p><p><b>RESULTS</b>The mean age, prostate volume, total prostate specific antigen (tPSA), free PSA (fPSA), and abnormal DRE were comparable between the 2 groups (P>0.05). Immediately after the biopsy, no difference was found between the 2 groups in DRE pain score (1.40±0.98 vs 1.39±0.91, P=0.102) or probe insert pain score (2.07±0.96 vs 2.03±0.90, P=0.960), but the biopsy pain score was significantly lower in PPNB group than in no PPNB group (2.54±1.42 vs 3.07±1.43, P=0.033). The incidence of the procedure-related complications was similar between the 2 groups (P>0.05).</p><p><b>CONCLUSION</b>PPNB can significantly lower the biopsy pain score in PBx without increasing the incidence of complications.</p>

Radical cystectomy for bladder cancer: oncologic outcome in 271 Chinese patients / 癌症

Few large scale studies have reported the oncologic outcome of radical cystectomy for treating bladder cancer in China; hence, we lack long-term prognostic information. The aim of the current study was to determine the survival rate and prognostic factors of patients who underwent radical cystectomy for bladder cancer in a Chinese medical center. We retrospectively analyzed clinicopathologic data from 271 bladder cancer patients who underwent radical cystectomy between 2000 and 2011. Univariate and multivariate analyses were conducted to identify independent prognostic predictors for this cohort. Median follow-up was 31.7 months (range, 0.2-139.1 months). Thirty-day mortality was (1.4%). The 5-year recurrence-free survival, cancer-specific survival (CSS), and overall survival rates were 61.6%, 72.9%, and 68.0%, respectively. The 5-year CSS rates of patients with T1-T4 disease were 90.7%, 85.0%, 51.0%, and 18.0%, respectively. Patients with organ-confined disease had a higher 5-year CSS rate than those with extravesical disease (81.4% vs. 34.9%, P < 0.001). For the 38 patients (14%) with lymph node involvement, the 5-year CSS rate was 27.7%-significantly lower than that of patients without lymph node metastasis (P < 0.001). The 5-year CSS rate was much higher in patients with low grade tumor than in those with high grade tumor (98.1% vs. 68.1%, P < 0.001). Multivariate Cox regression showed that patient age (hazard ratio, 2.045; P = 0.013) and T category (hazard ratio, 2.213; P < 0.001) were independent predictors for CSS. These results suggest that radical cystectomy is a safe and effective method for treating bladder cancer in Chinese patients. Old age and high T category were associated with poor prognosis in bladder cancer patients who underwent radical cystectomy.

Efficacy analysis of three therapeutic modes on clinical stage Ia nonseminomatous germ cell testicular tumors / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the oncologic outcomes of surveillance, retroperitoneal lymph node dissection (RPLND) and primary chemotherapy in patients with clinical stage Ia nonseminomatous germ cell testicular tumors (CS Ia NSGCT) and to analyze risk factors for relapse.</p><p><b>METHODS</b>Patients with CS Ia NSGCT were retrospectively reviewed. Totally 72 patients were enrolled and grouped according to three different treatment after orchiectomy, among them 33 cases in surveillance group, 24 cases in RPLND group and 15 cases in primary chemotherapy group. Disease progressive free survival and disease specific survival were compared using Kaplan-Meier analysis. Cox regression analysis was used to confirm variables those were associated with disease progression.</p><p><b>RESULTS</b>All 72 patients were followed-up at mean 62 months (12 - 175 months), 6 patients had evidence of relapse. Both the 5-year disease specific survival and 5-year overall survival rate were 100%. For surveillance, chemotherapy and RPLND, cumulative 5-year PFS rates were 84.0%, 93.3% and 100%, respectively. Relapse rate was higher in surveillance group than in RPLND group (17.8% vs. 0, χ² = 3.99, P = 0.04). Patients with the history of cryptorchidism also have higher relapse rate than without (37.5% vs. 4.7%, χ² = 10.02, P = 0.01). In the surveillance cohort, relapse rates were significantly higher in patients with a predominant component of embryonal carcinoma (3/6 vs. 7.4%, χ² = 6.93, P = 0.04) and for those over 13 years of age (23.1% vs. 5.3%, χ² = 4.33, P = 0.04). On multivariate analysis, treatment mode of patients (OR = 0.08, 95% CI: 0.06-0.36, P = 0.03) and patients with a history of cryptorchidism (OR = 25.3, 95% CI: 6.57-78.42, P = 0.04) were independent predictors of relapse.</p><p><b>CONCLUSIONS</b>Surveillance, RPLND and adjuvant chemotherapy could be reliable strategies in compliant stage Ia nonseminoma patients and achieve satisfactory overall survival. Relapse rate is relatively higher for patients with surveillance. Those who are older or have a history of cryptorchidism experience a higher risk of relapse.</p>

Prognostic significance of the 2004 WHO classification compared with the 1973 WHO classification for organ-confined invasive bladder cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the 2004 and 1973 WHO classifications for predicting tumor recurrence for organ-confined (T stage ≤ pT2b) invasive urothelial carcinoma of the bladder treated with radical cystectomy.</p><p><b>METHODS</b>From February 2000 to August 2011, the 173 consecutive cases of organ-confined invasive urothelial carcinoma of the bladder were treated with radical cystectomy. The data of clinical and follow-up information was collected. The Kaplan-Meier plots with Log-rank test were used to estimate recurrence-free survival (RFS). Univariate and multivariate analysis using the Cox proportional hazard regression model were performed to evaluate the impact of any clinicopathological prognostic factors (tumor grade, tumor stage, lymph node status, lymphovascular invasion, preoperative hydronephrosis, and non-pure urothelial carcinoma) on RFS.</p><p><b>RESULTS</b>The 5-year RFS was 84.7% for the entire cohort. Univariate and multivariate analysis demonstrated that when using the 2004 WHO classification, lymph node status (RR = 4.573, 95% CI: 1.469-14.237), tumor grade (RR = 9.993, 95% CI: 1.325-75.390) and preoperative hydronephrosis (RR = 3.207, 95% CI: 1.209-8.508) presented independent predictors for RFS; while using the 1973 WHO system, lymph node status (RR = 9.484, 95% CI: 3.450-26.074) and lymphovascular invasion (RR = 3.009, 95% CI: 1.062-8.526) were independent predictors.</p><p><b>CONCLUSIONS</b>The 2004 WHO classification, as an independent factor, is superior to the 1973 classification for predicting RFS in patients with organ-confined invasive bladder cancer treated with radical cystectomy. However, a further perspective study is needed to validate its role in prognosis.</p>

Retroperitoneal schwannoma mimicking metastatic seminoma: case report and literature review / 癌症

If a testicular cancer patient has a mass in the retroperitoneum, a metastasis is often the first suspicion, probably leading to improper diagnosis and overtreatment. Here we report a case of retroperitoneal schwannoma mimicking metastatic seminoma. A 29-year-old man, who had a history of seminoma, presented with a single retroperitoneal mass suspected to be a metastasis. Because the patient refused radiotherapy, 3 cycles of cisplatin, etoposide, and bleomycin were offered. Post-chemotherapy computed tomography scan revealed persistence of the retroperitoneal mass, with no change in tumor size or characteristics. Subsequently, retroperitoneal lymph node dissection was performed. The dissected tissue contained negative lymph nodes but a single mass in the attached fat. Pathology revealed retroperitoneal schwannoma, which was confirmed by immunohistochemistry. Thus, clinicians should be aware of retroperitoneal schwannoma and its distinction from metastatic seminoma to avoid misdiagnosis and ensure proper treatment.

Complications of radical nephrectomy for renal cell carcinoma: a retrospective study comparing transperitoneal and retroperitoneal approaches using a standardized reporting methodology in two Chinese centers / 癌症

The reporting of complications following transperitoneal and retroperitoneal open radical nephrectomy (RN) is nonstandardized. This study aimed to compare early complications between the two approaches using a standardized reporting methodology in a large contemporary cohort. Between 1996 and 2009, 558 patients underwent open RN for renal cell carcinoma (RCC) in our two centers (424 from Sun Yat-sen University Cancer Center and 134 from the First Affiliated Hospital of Sun Yat-sen University). Records were reviewed for clinicopathologic features and complications. Complications were graded using the Clavien system based on the severity of impact. One hundred and five patients (18.8%) had one or more early complications (168 complications overall). The overall rates of grades I to V complications were 5.6%, 10.8%, 2.2%, 0.4%, and 0.2%, respectively. Patients who underwent transperitoneal RN did not experience more overall or procedure-related complications than those who underwent retroperitoneal RN (P = 0.911 and P = 0.851, respectively). On subgroup analysis, neither grade I/II nor grades III-V complications were significantly different between the transperitonal RN and retroperitoneal RN groups. Multivariate analysis showed that for any grade of complication, age (P = 0.016) and estimated blood loss (P = 0.001) were significant predictors. We concluded that open RN is a safe procedure associated with low rates of serious morbidity and mortality. Compared with retroperitoneal RN, transperitoneal RN was not associated with more complications. Older patient and more blood loss at surgery were independent predictors for higher early postoperative complication rates.

Intraarterial chemotherapy with gemcitabine and cisplatin in locally advanced or recurrent penile squamous cell carcinoma / 癌症

The prognosis of locally advanced or recurrent squamous cell carcinoma (SCC) of the penis after conventional treatment is dismal. This study aimed to evaluate the therapeutic effects of intraarterial chemotherapy with gemcitabine and cisplatin on locally advanced or recurrent SCC of the penis. Between April 1999 and May 2011, we treated 5 patients with locally advanced penile SCC and 7 patients with recurrent disease with intraarterial chemotherapy. The response rate and toxicity data were analyzed, and survival rates were calculated. After 2 to 6 cycles of intraarterial chemotherapy with gemcitabine and cisplatin, 1 patients with locoregionally advanced disease achieved a complete response, and 4 achieved partial response. Of the 7 patients with recurrent disease, 2 achieved complete response, 3 achieved partial response, 3 had stable disease, and 1 developed progressive disease. An objective tumor response was therefore achieved in 10 of the 12 patients. The median overall survival for the patients was 24 months (range, 10-50 months). Three out of 10 patients who responded were long-term survivors after intraarterial chemotherapy. Intraarterial chemotherapy with gemcitabine and cisplatin may be effective and potentially curative in locoregionally advanced or recurrent penile SCC. The contribution of this therapy in the primary management of advanced or recurrent penile SCC should be prospectively investigated.

Effects of cholesterol depletion on the growth inhibition and apoptosis of human prostate cancer PC-3 cells / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the regulatory effect of cholesterol depletion on the proliferation inhibition and apoptosis of human prostate cancer PC-3 cells.</p><p><b>METHODS</b>We cultured PC-3 cells in cholesterol depletion media (CDM) or normal media (NM), and added to the media platelet-derived growth factor (PDGF) and epidermal growth factor (EGF), respectively. Then we observed cell morphology under the inverse microscope, detected cell growth inhibition by MTT assay, and analyzed cell apoptosis and cycle phase by flow cytometry.</p><p><b>RESULTS</b>After treated with CDM for 48 hours, the PC-3 cells obviously grew rounder and smaller, with more detached ones, and their proliferation remarkably inhibited in a dose-dependent manner, while their apoptosis rate not significantly increased, as compared with those treated with NM. After exposure to PDGF or EGF, the number of cells was increased in the NM group, but there were more detached and apoptotic cells in the CDM group than in the former (P < 0.05). Cell cycle analysis showed an increase in the number of G0/G1-phase cells and a decrease in that of S- and G2/M-phase cells in the CDM group compared with the NM group.</p><p><b>CONCLUSION</b>Cholesterol depletion could significantly inhibit the growth of PC-3 cells without obvious induction of their apoptosis, which is probably one of the self-regulating mechanisms of the cells avoiding apoptosis.</p>

Clipping the extremity of ureter prior to nephroureterectomy is effective in preventing subsequent bladder recurrence after upper urinary tract urothelial carcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Bladder recurrent disease is still a challenge in the treatment of upper tract urothelial carcinoma (UTUC). This controlled study aims to investigate the efficacy of early clipping of the distal ureter prior to nephroureterectomy (NU) to prevent bladder recurrence after UTUC.</p><p><b>METHODS</b>Patients with clinical diagnosis of UTUC were subjected to open trans-peritoneal NU and were randomly divided into two groups. One group received modified NU: clipping the distal ureter prior to NU; while the other group underwent traditional standard NU. Subsequent bladder recurrence was the primary endpoint.</p><p><b>RESULTS</b>From January 2007 to December 2009, 85 eligible cases were enrolled in this study. Modified NU and standard NU were performed on 42 and 43 patients, respectively. Operation time ((215.73 ± 21.26) minutes vs. (220.19 ± 15.35) minutes), blood loss ((105.15 ± 11.32) ml vs. (110.12 ± 9.07) ml), transfusion event (11.20% vs. 9.78%), and the in-patient time (10.0 days vs 9.5 days) were not significant between the two groups. After a median follow-up of 28 months (5 - 60), six (14.3%) cases who received modified NU had bladder recurrence, which was significantly lower compared with 15 (34.9%) patients from the group that underwent standard NU (P = 0.026). In univariate and multivariate analysis, tumor grade (HR 4.33, 95%CI 2.66 - 6.30, P = 0.01) and operation type (HR 2.35, 95%CI 1.53 - 3.48, P = 0.041) were independent risk factors for subsequent bladder recurrence after UTUC.</p><p><b>CONCLUSIONS</b>Clipping the distal ureter at the beginning of NU significantly reduces bladder recurrence after UTUC. It is reasonable to conclude that clipping the distal portion of ureter trans-peritoneal is an effective surgical procedure for the treatment of UTUC.</p>

Stage T1N0M0 renal cell carcinoma: the prognosis in Asian patients / 癌症

The prognostic features of T1N0M0 renal cell carcinoma (RCC) in Asian patients have not been well explored in large sample studies. In this study, we retrospectively analyzed the records of 713 patients undergoing nephrectomy for T1N0M0 RCC between 1991 and 2009 in three Asian hospitals. Univariate and multivariate analysis were performed to identify the independent predictive factors for T1N0M0 RCC prognosis among a series of clinicopathological parameters, including age, gender, tumor size, Fuhrman grade, and histological classification. Our results showed that 388 of 713 patients had tumors 4.0 cm or smaller (stage T1a) and 325 of 713 patients had tumors 4.0-7.0 cm in size (stage T1b). Five-year cancer-specific survival (CSS) and recurrence-free survival (RFS) rates for this group of patients were 96.0% and 93.5%, respectively. The patients with T1b RCC had a significantly lower 5-year CSS and RFS rates than did those with T1a RCC (CSS, 93.1% vs. 98.6%, P = 0.026; RFS, 90.0% vs. 96.5%, P < 0.001). Patients with low grade (grades I-II) tumors had a higher 5-year CSS (97.8% vs. 91.2%, P = 0.001) and RFS (95.5% vs. 85.5%, P < 0.001) rate than did those with high grade (grades I-II) tumors. More interestingly, when stratifying patients to T1a and T1b groups, the role of grade in distinguishing prognosis could be only observed in patients with T1b disease. Cox regression showed tumor size and Fuhrman grade were significant in predicting CSS and RFS. Our study suggests that the prognosis of patients with T1N0M0 RCC is excellent, and these results are comparable to previously reported studies in Western patients. Furthermore, our data indicates that patients with T1b disease and high Fuhrman grade have high risk of tumor recurrence and death, thus requiring more frequent follow-up.

Reassessment of the predictive role of perivesical fat invasion in invasive bladder cancer prognosis in 151 Chinese patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Perivesical fat invasion is considered as an important prognostic factor for bladder cancer. However, the predictive role of perivesical fat invasion in invasive bladder cancer prognosis has never been reported in Chinese patients. The aim of the study was to assess the predictive value of perivesical fat invasion for prognoses of T2 and T3 bladder cancer in Chinese patients.</p><p><b>METHODS</b>One hundred and fifty-one patients who underwent radical cystectomy for pT2-3N0M0 invasive bladder cancer from 2001 to 2007 were studied. Cancer-specific survival rate (CSS) and recurrence-free survival rate (RFS) were compared between the pT2 and pT3 patient groups. Other clinicopathological parameters were also retrospectively analyzed by univariate and multivariate analyses to identify the independent predictor for the prognoses of this cohort.</p><p><b>RESULTS</b>Average patient age at surgery was 58 years. Ninety (60.3%) patients had grade I and II disease. During follow-up (median 66 months), 27 patients (17.9%) had tumor recurrence and 18 (11.9%) died of bladder cancer. In the univariate analysis, the CSS and RFS curves between T2 and T3 patients showed no significant difference (P = 0.756 and 0.354, respectively). Multivariate Cox regression showed that histological classification and grade were independent predictors for CSS, while grade was the sole independent predictor for RFS.</p><p><b>CONCLUSIONS</b>For this group of Chinese patients, perivesical fat invasion did not demonstrate a statistically significant difference in prognosis between T2 and T3 patients. Nontransitional cell carcinoma (non-TCC) and high-grade patients had short CSS, and patients with high-grade tumor had higher recurrent risk.</p>

Clinical outcomes of nephron sparing surgery for T1 renal cell carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the safety and effect of nephron-sparing surgery (NSS) in treatment of T1a and T1b renal cell carcinoma.</p><p><b>METHODS</b>Retrospective analyzed the clinical data of 101 patients with T1 renal cell carcinoma underwent NSS from November 1999 to December 2009.Including 79 male and 22 female with the mean age of 52.3 years (ranged 28 to 79 years). Based on tumor pathologic diameter, 101 patients were divided into T1a group with 62 patient and T1b group with 39 cases. Demographic, intraoperative, postoperative and follow-up data were compared between the 2 groups.</p><p><b>RESULTS</b>The operation were performed successfully in all the 101 cases. The mean operation time was (151 ± 80) min in group T1a and (158 ± 50) min in group T1b with no statistical difference (P = 0.32). The mean blood loss was (322 ± 596) ml in group T1a and (308 ± 239) ml in group T1b (P = 0.45). Postoperative follow-up ranged from 8 to 102 months with a mean of 38.4 months. One patient in T1b group died of distant metastasis 36 months after operation. Others were no tumor recurred.</p><p><b>CONCLUSION</b>Nephron-sparing surgery is safe and effective for the treatment of T1a and T1b renal cell carcinoma.</p>

Oncological outcome of surgical treatment in 336 patients with renal cell carcinoma / 癌症

<p><b>BACKGROUND AND OBJECTIVE</b>The most effective therapy against renal cell carcinoma (RCC) is surgical treatment; however, there have been few large-scale studies that focused on the oncological outcome of this disease in China. The aim of the current study was to report the clinicopathological results and cancer-specific survival (CSS) rate in RCC patients after surgical treatment in our center.</p><p><b>METHODS</b>We retrospectively analyzed the clinicopathological data of 336 RCC patients who underwent radical or partial nephrectomy between 1999 and 2006. Of the 336 patients, 226 were male and 110 were female; the median age was 51 years. Univariate and multivariate analyses were conducted to identify the independent prognostic predictors for this cohort of RCC patients.</p><p><b>RESULTS</b>During follow-up, the overall 5-year CSS rate was 81.4%. The 5-year CSS rates for patients with stage-I, -II, -III, and -IV RCC were 94.7%, 88.9%, 68.8%, and 19.3%, respectively. The patients with T1N0M0 (T1) and T2N0M0 (T2) tumors had similar survival curves. For patients with T1 category tumor, the survival rate did not differ significantly between the radical nephrectomy and nephron-sparing surgery groups. For the 21 patients with metastasis confined to the local lymph nodes, the 5-year survival rate was 31.6% after radical nephrectomy and lymph node dissection. For the 15 patients with vena caval tumor thrombus, the 5-year survival rate was 52.5% after radical nephrectomy and tumor thrombus extirpation. Multivariate Cox regression showed that stage was an independent predictor for CSS (hazard ratio, 3.359; P < 0.001).</p><p><b>CONCLUSIONS</b>For localized RCC, the oncological outcome of this cohort is comparable to that reported in the Western literature. For some patients with locally advanced RCC, aggressive surgical treatment can lead to better long-term survival. However, the prognosis of the patients with metastasis still needs to be improved.</p>

Experience of the treatment for clinical Stage-1 seminoma over a period of 10 years / 癌症

<p><b>BACKGROUND AND OBJECTIVE</b>Patients with clinical stage I seminoma accounts for 70%-80% of patients with this disease. This study was to analyze the relationship between different therapeutic methods and the prognosis of this disease.</p><p><b>METHODS</b>The data of all patients with clinical Stage I seminoma treated by multi-disciplinary approach from 1999 to 2008 in Sun Yat-sen University Cancer Center were analyzed. The patients were divided into 3 groups based on the treatment they received after orchiectomy: 30 patients treated with chemotherapy, 8 with radiotherapy, and 20 under surveillance. The prognosis of different treatment groups was evaluated.</p><p><b>RESULTS</b>Among the 58 patients with stage I seminoma, 57 were followed up successfully. The median follow-up time was 50 months (range, 8-115 months). No relapse or metastasis was seen in the chemotherapy group. One patient relapsed in the radiotherapy group. Four patients had metastasis of retroperitoneal lymph node in the surveillance group. The disease-free survival was higher in the chemotherapy group than that in the surveillance group (P=0.005). There was no significant difference in the relapse-free survival between the surveillance group and the radiotherapy group (P=0.364).</p><p><b>CONCLUSIONS</b>Chemotherapy is a safe and effective treatment for patients with Stage-1 seminoma after radical orchidectomy.</p>

A case-control study of environmental and genetic factors and prostate cancer in Guangdong / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the etiologic relationship of prostate cancer and environmental and genetic polymorphism in southern China</p><p><b>METHODS</b>A hospital-based and 1:1 matched case-control study was conducted. A total of 142 matched pairs of subjects were investigated in this study. The blood samples were collected from 85 cases of prostate cancer and 82 controls of other diseases after informing consent. The CYP1A1, CYP17 and AR genes were analyzed by using the method of PCR, PCR-RFLP. The data were analyzed with conditional logistic regression model.</p><p><b>RESULTS</b>An increased risk of prostate cancer development was observed with the early first spermatorrhea (age < 18) (OR = 2.90, 95% CI: 1.76 - 4.80), early first sexual intercourse (age < or = 24) (OR = 2.38, 95% CI: 1.14 - 4.96), frequent sexual intercourse before 35 year old (OR = 1.80, 95% CI: 1.19 - 2.70), family history of cancer (OR = 2.70, 95% CI: 1.31 - 5.58), more intake of pork (OR =2.27, 95% CI: 1.38 - 3.70). Factors in lowing the risks were the fruit intake and drinking of green tea by OR value at 0.25 (95% CI: 0.08 - 0.75) and 0.52 (95% CI: 0.28 -0.96) respectively. CYP17 A1/A2 and CYP17 A2/A2 genotypes were related with a high risk of prostate cancer and OR values of 1.78 (95% CI: 0.70 - 4.53) and 2.57 (95% CI: 0.91 - 7.25) respectively. Study also showed that there was an interaction between CYP17 polymorphisms and early first spermatorrhea and family cancer history related to the risk of prostate cancer with OR value at 13.35 (95% CI: 1.58 - 113.00) and 4.01 (95% CI: 1.22 - 13.17) respectively.</p><p><b>CONCLUSION</b>Sexual intercourse, dietary intake and family cancer history should be related to prostate cancer occurrence. CYP17 polymorphism might be associated with a high risk of prostate cancer. It suggests that there are multiple environmental and genetic factors to the prostate cancer.</p>