The survival analysis of metastatic prostate cancer / 中华外科杂志

<p><b>OBJECTIVES</b>To analyze the clinical and pathological informations of metastatic prostate cancer patients to find the predictive factors of the survival.</p><p><b>METHODS</b>To filter 364 cases of metastatic prostate cancer in the 940 cases of prostate cancer that were treated in Cancer Hospital Fudan University in Shanghai from March 1998 to June 2009, the cases had hormonal therapy and full clinical and pathological records. All the 364 cases were followed up and the clinical and pathological informations were analyzed, to find the predictive factors that related to the prognosis. Statistic software SPSS 15.0 was used for analysis. Cumulative survival was analyzed by the method of Kaplan-Meier. Cox regression was used for univariate and multivariate analysis. Log-rank method was used for the significance test.</p><p><b>RESULTS</b>The last follow-up date was 30th June 2009 and the median follow-up time was 24 months. At the final follow-up, 240 cases were alive, 109 cases were dead and 15 cases were lost to follow up. The median survival time of metastatic prostate cancer was 64 months, and the one-year, two-year, three-year, four-year, five-year survival rate was 92%, 78%, 66%, 60%, 54%. The univariate analysis indicated that Gleason score (P = 0.033), clinical stage (P < 0.001), the effectiveness of hormonal therapy (P < 0.001), the prostate specific antigen (PSA) nadir during hormonal therapy (P < 0.001) and the time from the start of hormonal therapy to the PSA nadir (P = 0.002) were predictive factors for the survival time of metastatic prostate cancer. The multivariate analysis indicated that the PSA nadir during hormonal therapy (P < 0.001) and the time from the start of hormonal therapy to the PSA nadir (P < 0.001) were independent factors that predict the survival time of metastatic prostate cancer.</p><p><b>CONCLUSION</b>The PSA nadir during hormonal therapy and the time from the start of hormonal therapy to the PSA nadir are independent factors that predict the survival time of metastatic prostate cancer.</p>

The study of electrical acupuncture stimulation therapy combined with pelvic floor muscle therapy for postprostatectomy incontinence / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the effectiveness and significance of whether electrical acupuncture stimulation combining with pelvic floor muscle therapy (PFMT) can improve the recovery of urinary continence.</p><p><b>METHODS</b>A total of 109 patients took part in the study of novel combination treatment for urinary continence from September 2008 to September 2009. Patients were divided into study group (n = 40) and control group (n = 69). The patients in study group received electrical acupuncture stimulation therapy combined with PFMT one week after removal the catheter. The patients in control group performed PFMT as the only treatment for post prostatectomy incontinence. The patients were followed up closely, with their clinical characteristics recorded, questionnaires of ICI-Q-SF filled up, and all the data for statistical analysis collected.</p><p><b>RESULTS</b>There was a significant difference between the study group and the control group in the urinary control curve (P = 0.029). The difference of continence probability between these two groups became greater from 4 weeks after surgery, and the difference reached the peak at 6 weeks (P = 0.023). Then the difference became smaller, and there was no difference at 16 weeks after surgery. ICI-Q-SF questionnaires showed the same results.</p><p><b>CONCLUSION</b>Electrical acupuncture stimulation therapy combining with PFMT can improve the recovery of patients' urinary continence after radical prostatectomy.</p>

External validation of the Partin tables 2007 in Chinese prostate cancer patients / 中华外科杂志

<p><b>OBJECTIVE</b>To validate the 2007 Partin tables externally, which are based on the population of United States, using a cohort of Chinese prostate cancer patients.</p><p><b>METHODS</b>All of the patients enrolled and underwent radical prostatectomy between January 2006 and February 2010 were reviewed. The cases without preoperative hormone therapy and pelvic lymph node involvement according to radiologic tests were used for the external validation of the 2007 Partin tables. A comparative analysis of the clinical and pathological parameters of this Chinese cohort and Partin tables cohort was performed. Values of areas under the receiver operating characteristic (ROC) curve were used to assess predictive accuracy for the Chinese cohort.</p><p><b>RESULTS</b>The mean age of the whole cohort was 67 years. The serum prostate specific antigen level, Gleason score and clinical stage of this cohort were higher than the Partin tables cohort. The pathological outcomes analysis revealed that the rates of organ confined disease, capsular penetration, seminal vesicle involvement and lymph node involvement were 62.3%, 16.7%, 12.3% and 8.8%, respectively. The area under the ROC curve (AUC) for organ confined disease, capsular penetration, seminal vesicle involvement and lymph node involvement were 0.735, 0.653, 0.601 and 0.845.</p><p><b>CONCLUSIONS</b>The Partin tables discriminate well for Chinese patients at risk for positive lymph node. The discrimination of organ confined disease is also acceptable and the discrimination of capsular penetration and seminal vesicle involvement is more limited.</p>

The survival analysis of the advanced metastatic castration-resistant prostate cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze predictive factors of advanced metastatic castration-resistant prostate cancer.</p><p><b>METHODS</b>From December 1996 to March 2008, 250 cases of advanced metastatic prostate cancer progressed into the stage of hormonal independent prostate cancer. The last follow-up date was 31 March 2008 and the median follow-up time was 24 months. During the follow-up, 131 cases were alive, 105 cases were dead and 14 cases were lost to follow-up. Clinical and pathological information of the cases was analyzed to find the predictive factors that related to the prognosis.</p><p><b>RESULTS</b>The median survival time of advanced metastatic castration-resistant prostate cancer was 30 months, and the one-year, two-year, three-year survival rate was 79%, 59%, and 41%. The univariate analysis indicated that prostate specific antigen (PSA) at diagnosis, clinical stage, the PSA nadir during hormonal therapy, the time form the start of hormonal therapy to the PSA nadir, the time of response duration during hormonal therapy, PSA velocity (PSAV) and PSA doubling time (PSADT) at the emergency of castration-resistant prostate cancer, age and PSA at the diagnosis of castration-resistant prostate cancer were factors that predicted the survival time of advanced metastatic castration-resistant prostate cancer. The multivariate analysis indicated that the PSA nadir during hormonal therapy, the time form the start of hormonal therapy to the PSA nadir, PSAV at the emergency of castration-resistant prostate cancer, the time of response duration during hormonal therapy were independent factors that predicted the survival time of advanced metastatic castration-resistant prostate cancer.</p><p><b>CONCLUSION</b>The PSA nadir during hormonal therapy, the time form the start of hormonal therapy to the PSA nadir, PSAV at the emergency of castration-resistant prostate cancer and the time of response duration during hormonal therapy are independent factors that predict the survival time of advanced metastatic castration-resistant prostate cancer.</p>

Prevalence of incidental prostate cancer in patients undergoing radical cystoprostatectomy: data from China and other Asian countries / 亚洲男科学杂志(英文版)

The purpose of this study is to investigate the frequency of prostate cancer (Pca) discovered incidentally in radical cystoprostatectomy specimens in Asia and to determine the feasibility of prostate-sparing cystectomy (PSC) for Asian patients. Ninety-two male bladder cancer patients who underwent radical cystoprostatectomy at our center between January 2003 and January 2008 were included in this study. The mean age of patients was 67.1 years (range: 32-75 years). Prostate-specific antigen (PSA) levels and digital rectal examination (DRE) results before surgery were obtained retrospectively. Prostates of all patients were embedded and sectioned at 5-mm intervals. The same pathologist examined the prostatic tissues from radical cystoprostatectomy specimens. Finally, a structured literature review was performed using MEDLINE and PUBMED to estimate the occurrence of incidental Pca in Asia. Of the 92 patients, 3 (3.3%) were found to have Pca; in one out of three (33.3%) patients the disease was clinically significant due to a Gleason grade 4 carcinoma. Eight articles were included in our review. The overall incidence of Pca discovered incidentally in radical cystoprostatectomy specimens in Asia was 9.9% (64/642). When age was restricted to < 60 years, only 7 out of 222 (3.2%) patients were found to have synchronous Pca, and none of the cases was clinically significant. The occurrence of Pca in radical cystoprostatectomy specimens in Asia is much lower than that in Western countries. PSC might be feasible for Asian patients under a strict preoperative selection.

Repeat transurethral resection for non-muscle invasive bladder cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of repeat transurethral resection of tumor in patients with non-muscle invasive bladder cancer.</p><p><b>METHODS</b>From March 2004 to August 2008, 462 patients (350 males, 112 females, aged from 35 to 83 years old) with non-muscle invasive bladder cancer, were evaluated according to tumor stage, grade and muscle or no muscle tissue in initial transurethral resected sample. One hundred and twenty-five patients underwent repeat transurethral resection of bladder tumor within 4 to 6 weeks after initial resection. Of these 125 patients 49 were Ta, 76 were T1, 58 were low grade carcinoma, 67 were high grade carcinoma and 30 were not found presence of muscle tissue in initial resected sample in patients with T1 stage.</p><p><b>RESULTS</b>Of the 125 cases, 34.4% (43/125) had residual tumor and 65.6% (82/125) had no tumor on repeat transurethral resection. Of 43 cases with residual tumor 35 had non-muscle invasive tumor including 15 in Ta and 20 in T1. The patients with high grade carcinoma had more residual tumor than those with low grade carcinoma (P < 0.05). The patients with muscle tissue in initial transurethral resected sample had fewer residual tumor than those without (P < 0.05). Twelve cases (9.6%) were understated at initial resection. Six cases (4.8%) had bladder perforation and 7 (5.6%) had bleeding during repeat transurethral resection. All cases were followed up for 3 to 56 months (median 26 months), 37.2% (16/43) patients with residual tumor in repeat transurethral resection had recurrence while only 12.2% (10/82) without residual tumor in repeat transurethral resection did (P < 0.05).</p><p><b>CONCLUSIONS</b>Routine repeat transurethral resection is advised to non-muscle invasive bladder cancer patients with T1 tumor or high grade carcinoma or no muscle tissue in initial transurethral resected sample within 4 to 6 weeks after initial resection. Repeat transurethral resection could increases the stage accuracy.</p>

Regulatory dendritic cell therapy in organ transplantation / 上海第二医科大学学报

Dendritic cells (DCs) are uniquely well-equipped antigen (Ag)-presenting cells. This function of DCs, coupled with their remarkable plasticity, renders them attractive therapeutic targets for immune modulation. Recent data have demonstrated a promising role for pharmacologic treatment as a means of generating potent regulatory DCs. Herein, the evidence that the potential of regulatory DC the-rapy is considerable and that there are compelling reasons to evaluate it in the setting of organ transplantation in the near future are discussed in this paper.

Conversion from calcineurin inhibitor to sirolimus for renal function deterioration in kidney allograft recipients / 中华器官移植杂志

20% increase in serum creatinine over the last 6 months or progression to the range of 176-308?mol/L.Patients underwent abrupt cessation of cyelosporine and sirolimus maintenance at 1-2 rag/day after administration of 4-6 mg as first loading dose.Concomitant immunosuppression remained unchanged during conversion.Results Targeted sirolimus level was 4-8 ng/mL.Serum creatinine was dropped from pre-conversion level of(242.15?73.04)?mol/L to(188.32?58.96)?mol/L and (173.36?58.08)?mol/L at 3rd and 6th month respectively(P

Clinical efficacy of small dose of antithymocyte globulin and zenapax in kidney transplant recipients / 中华泌尿外科杂志

Objective To evaluate the effects of small dose of antithymocyte globulin(ATG)and zenapax in the induction therapy for kidney transplant recipients.Methods A series of 150 cadaver-donor kidney transplant recipients were randomly divided to 3 groups,ie,small dose of ATG group(total dose,2.1 -3.0 mg/kg;n=72),zenapax group(50mg,on the first and 14th d after operation;n=15)and controls without induction therapy(n=63).Follow-up was 6 months.The rates of acute rejection,delayed graft func- tion(DGF)and pulmonary infection were statistically compared among the 3 groups.Results During a 6-month period,in ATG,zenapax and control groups,acute rejection episodes occurred in 4 cases(5.5%), 1(6.7%)and 10(15.9%),respectively;DGF occurred in 3(4.2%),0 and 8(12.7%),respectively;pul- monary infection occurred in 4(5.1%),1(6.7%)and 3(4.8%),respectively;leucocytopenia occurred in 3(4.2%),1(6.7%)and 5(7.9%),respectively;thrombocytopenia occurred in 2(2.8%),1(6.7%)and 5(7.9%),respectively.Conclusions In the early stage of kidney transplantation,small dose of ATG and zenapax can be the optimal choice for induction therapy.