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Objective To evaluate the effects of rigorous surveillance and retroperitoneal lymph node dissection (RPLND) in the treatment of low-risk patients with clinical stage Ⅰ nonseminomatous germ cell testicular tumors (NSGCT) after radical orchiectomy.Methods The data of 71 patients with clinical stage Ⅰ NSGCT were analyzed retrospectively in Hunan Provincial Tumor Hospital,Xiangya Third Hospital of Central South University and Hunan Provincial People's Hospital between Feb,2001 and Apr,2012.Excluding lymphatic and vascular invasion,percentage of embryonal carcinoma＞50％ and increasing tumour markers (AFP/β-HCG) following orchiectomy,46 low-risk patients out of 71 patients with clinical stage Ⅰ NSGCT were selected and divided into rigorous surveillance group (30 cases) and RPLND group (16 cases) according to different therapeutic methods after radical orchiectomy.Univariate analysis was used to confirm variables associated with disease progression,and the disease free survival rates (DFSR) were compared by using Kaplan-Meier analysis.Results Five cases were lost,and 41 cases were followed up for an average of 61 months (range,15-147 months),with 58 months in rigorous surveillance group (range,19-147months) and 65 months in RPLND group (range,15-144 months).The survival rate was 100％ in 2 groups.The DFSR was 89％ (24/27) and 86％ (12/14),respectively,and there was no significant difference between the 2 groups (x2 =0.08,P=0.78).The DFSR was 83％ in patients with small amout of embryonal (percentage of embryonal carcinoma ＜ 50％),and 92％ in patients without embryonal carcinoma,and there was no significant difference between the 2 groups (x2=1.07,P=0.30).Also there was no significant difference between the patients less than 15 years and patients more than 15 years (x2=1.59,P =0.21).Conclusions There is no significant difference in recurrence rate and DFSR between rigorous surveillance group and RPLND group.Low-risk patients with clinical stage Ⅰ NSGCT may achieve satisfactory prognosis with surveillance after radical orchiectomy.
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Objective To investigate the expression of survivin/Human leukocyte antigen class I ( HLA-Ⅰ) proteins and its physiological significance in clear cell renal cell carcinoma ( CCRCC ) . Methods Immunohistochemistry was used to analyze survivin/HLA-Ⅰ protein expression in 90 cases of CCRCC and 10 normal tissues to study relationships with clinical symptoms and disease prognosis . Resutl s The level of survivin protein expression was found to be significantly higher in CCRCC tissues 82.2%( 74/90) than in normal tissues( 0/10).However, the relative amount of HLA-Ⅰprotein in colorectal cancer tis-sue was also found to be significantly lower 67.8%(61/90) than in normal tissues 90%(9/10).Survivin expression was associated with tumor grade , stage,and lymph node metastasis ( P=0.000, P=0.016, and P=0.001, respectively ) .Conversely , lost HLA-Ⅰexpression did not have any associations with clinicopath-ological data (P>0.05).Survivin negative patients (25.0%, 4/16) had a higher tumor-free survival rate than patients (52.7%, 39/74)with survivin expression (P=0.037).Patients (27.6%, 8/29) with normal HLA-Ⅰlevels had a higher tumor-free survival rate than those ( 60.7%, 37/61) with reduced HLA-Ⅰlev-els (P=0.020).The univariate and multivariate analyses indicated that expression of survivin and HLA indi -vidually and in combination were independent predictors for CCRCC patient survival . Conclusions Over-expression of survivin but reduced HLA-Ⅰ expression is associated with CCRCC development and progres-sion.
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Objective To evaluate the prognostic factors affecting recurrence,progression,bladder preservation,metastasis and cancer specific survival in patients with primary superficial transitional cell carcinoma of bladder. Methods Using Kaplan Meier method,Log rank test and Cox proportional hazards model,the retrospective survival analysis was performed in 198 patients with primary superficial transitional cell carcinoma of bladder. Results The mean follow up period was 79.76 months.The recurrence rates at 3 ,5 ,10 year were (28.75?0.78)%,(35.70?0.16)%,and (42.83?0.00)%,respectively.The main variables affecting recurrence were the duration of symptoms,histological grades and intra operative blood transfusion.The progression rates at 3 ,5 ,10 year were(8.89?0.33)%,(15.16?0.16)%,and (23.88?0.00)%,respectively.The main variables affecting progression were intra operative blood transfusion,histological grades,the number of reexaminations and recurrence free period (RFP).The rates of bladder preservation at 3 ,5 ,10 year were(94.68?0.23)%,(93.87?0.00)%,(91.51?0.00)%,respectively. The main variable affecting bladder preservation was RFP. The metastasis rates at 3 ,5 ,10 year were (8.25?0.22)%,(11.24?0.00)%,(28.94?0.00)%,respectively.The main variables affecting metastasis were tumor multifocality, hydronephrosis,microscopic growth pattern and RFP. The cancer specific survival at 3 ,5 ,10 year were (95.02?0.00)%,(90.70?0.46)%,(77.14?1.06)%,respectively.The variables that could predict cancer specific survival were microscopic growth pattern and RFP. Conclusions By cancer specific survival analysis of the follow up data,we can well identify the main prognostic factors from numerous ones,and also can design the therapeutic and follow up strategies for primary superficial transitional cell carcinoma of bladder.
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0 05) The histological types in these two groups were not significantly different, except that there were more well differentiated adenocarcinoma in SSO group than that in APR group ( P 0 05). However,the 5 years survival rate (79% in SSO,67% in APR) was significantly different (P