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Objective:To explore the risk factors of bladder recurrence in patients with upper urinary tract urothelial carcinoma (upper tract urothelial carcinoma, UTUC).Methods:We retrospectively analyzed the data of 815 patients underwent radical nephroureterectomy for upper tract urothelial carcinoma between June 2009 to June 2019.There were 519 males and 340 females, aged from 26-93 years old(average 66.5±9.6 years old). 396 patients were renal pelvic caicinoma.463 patients were ureteral caicinoma.675 patients were accompanied with hydronephrosis.664 patients were accompanied with preoperative gross hematuria. Preoperative diagnostic ureteroscopy was performed in 323 cases.283 patients had the history of smoking.48 patients were con-comitant with bladder carcinoma at the first diagnosis. Univariate analysis and logistic multivariate regression analysis were used to investigate the risk factors for bladder recurrence after UTUC radical surgery.Results:Among the 859 patients, 407 (47.4%) had low-stage tumor (T is/T a/T 1), 452 (52.6%) had high-stage tumor (T 2-T 4), 110 (12.8%) had low-stage tumor (G 1/G 2), and 749 (87.2%) had high-stage tumor (G 3). 126 (17.2%) of 859 patients had relapse during the follow-up period, the average follow-up time was 17 months, the median recurrence time was 12 months, 101(80.1%) of the relapse occurred within 2 years after operation. In univariate analysis, lower tumor stage ( P=0.047), higher tumor grade ( P=0.043), preoperative hematuria symptom ( P=0.023) and preoperative diagnostic ureteroscopy ( P=0.002) were closely related to bladder recurrence. Taking the above factors into the logistic multivariate regression analysis showed that tumor staging T is/T s/T 1 ( B=0.476, P=0.019), tumor grade G 3( B=0.848, P=0.024), preoperative hematuria symptom ( B=0.521, P=0.048), preoperative diagnostic ureteroscopy( B=0.521, P=0.002) were independent risk factors of postoperative recurrence of bladder. Conclusion:lower tumor stage, higher tumor grade, preoperative hematuria symptom and preoperative diagnostic ureteroscopy are the independent risk factors of postoperative bladder recurrence in patients with UTUC. Routine intravesical chemotherapy should be performed in patients with UTUC with the above risk factors, and routine diagnostic ureteroscopy is not recommended.
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Objective:To investigate the 2 years’ efficacy of intravesical instillation of domestic BCG versus epirubicin in the prevention of recurrence of intermediate-risk or high-risk non-muscular invasive bladder cancer and predictive factors of BCG instillation.Methods:From July 2015 to June 2020, 18-75 years old patients with moderate to high-risk non muscle invasive bladder cancer (NMIBC) confirmed by pathological examination were involved. The ECOG score was 0-2. Exclusion criteria included ①immune deficiency or impairment (such as AIDS), using immunosuppressive drugs or radiotherapy, suspected allergic to BCG or epirubicin or excipients of the two drugs, fever or acute infectious diseases including active tuberculosis or receiving anti tuberculosis treatment, with severe chronic cardiovascular and cerebrovascular diseases or chronic kidney disease; ②combined with other urogenital system tumors or other organ tumors; ③combined with muscle invasive bladder urothelial carcinoma (≥T 2); ④undergoing chemotherapy, radiotherapy or immunotherapy within 4 weeks (immediate instillation after surgery not included); ⑤ pregnant or lactating women; ⑥ comfirmed or suspected bladder perforation; ⑦gross hematuria; ⑧cystitis with severe bladder irritation that may affect the evaluation; ⑨participat in other clinical trials within 3 months; ⑩alcohol or drug addiction; ?any risk factors that may increasing the risk of patients. Epirubicin 50 mg was irrigated immediately after the operation(TURBT or laser resection). The patients were randomly divided into BCG15 group, BCG19 group and epirubicin group by the ratio of 2∶2∶1, and the patients were maintained intravescical instillation for 1 year. The recurrence and adverse events of the three groups were compared. Univariate and multivariate analysis was performed to predict the risk factors of BCG irrigated therapy failure. Result:By June 15, 2020, the median follow-up duration was 22.1 months(12.1, 32.3), and there was no statistical difference between the groups ( P=0.9024). There were 274 patients enrolled in BCG19 group, 277 patients enrolled in BCG15 group and 130 patients enrolled in the epirubicin group. The drop-off rate was 16.6%(113 cases)and made no difference between groups( P=0.6222). There were no significant difference in age, gender, BMI, or ECOG score( P>0.05). During the follow-up, 116 cases was detected recurrence or progression. The recurrence rate of the three groups was 14.2% and 14.8% in BCG19 group and BCG15 group, and 27.7% in the epirubicin group. There was no difference in recurrence rate between BCG19 and BCG15 group( P=0.9464). The recurrence rate of BCG19 group was lower than that of the epirubicin group ( P=0.0017). The recurrence rate of BCG15 group was lower than that of the epirubicin group ( P=0.0020). There was no difference in the cumulative recurrence free survival rate between BCG19 and BCG15 group (95% CI0.57-1.46, P=0.7173). The cumulative recurrence free survival rate of BCG 19 group was better than that of the epirubicin group( HR=0.439, 95% CI0.26-0.74, P=0.0006), and the cumulative recurrence free survival rate of BCG15 group was better than that of the epirubicin group ( HR=0.448, 95% CI0.29-0.80, P=0.0021). The total incidence of adverse events in 19 BCG19, BCG15 and epirubicin group were 74.5%, 72.6% and 69.8% respectively. There was no difference in the incidence of adverse events between BCG19 and BCG15 group( P=0.6153). The incidence of adverse events in epirubicin group was lower than that of BCG19( P=0.0051) and BCG15( P=0.0167) groups.There was no significant difference in the incidence of serious adverse events (SAE) among the three groups ( P=0.5064). Log rank test univariate analysis and Cox risk regression model multivariate analysis showed that the history of bladder cancer recurrence( HR=6.397, 95% CI1.95-20.94, P=0.0001)was independent risk factor for BCG irrigation failure. Conclusions:The 2 years’ efficacy of intravesical instillation of domestic BCG is better than than of epirubicin with good tolerance and safety. There is no difference between BCG19 and BCG15 group. BCG doesn’t increase SAE compared with epirubicin. Recurrence status was an independent prognostic factor regarding recurrence-free survival.
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Cisplatin-based chemotherapy is not effective in patients with advanced urothelial carcinoma. Recently, the application of immunological checkpoint inhibitors has brought new insight to resolve this problem. Since May 2016, five drugs, including Atezolizumab, Pembrolizumab, Nivolumab, Avelumab, and Durvalumab, targeting the PD-1/PD-L1 pathway have been approved by the FDA for the treatment of cisplatin-ineligible patients with advanced urothelial carcinoma, of which Pembrolizumab and Atezolizumab are the first-line drugs in the above treatments. The clinical efficacy and safety of these drugs are similar in different trials, but only Pembrolizumab is supported by a current level I evidence from a large randomized phase clinical trials. The results show that in the case of cisplatin ineligibility, Pembrolizumab is more effective than the traditional salvage chemotherapy in overall survival rate. Pembrolizuma is most effective in the treatment of cisplatin-ineligible patients with advanced urothelial carcinoma, while Pembrolizumab and Atezolizumab have similar efficacy in clinical applications of patients with cisplatin ineffective.
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Objective To investigate the efficacy and safety of intravesical instillation of BCG vaccine in the prevention of early recurrence of middle and high risk non-muscle invasive bladder cancer.Methods From July 2015,patients with non-muscle invasive bladder cancer aged 18-75 years with informed consent were screened and underwent transurethral resection of bladder tumor (TURBT).Immediately intravesical instillation of epirubicin 50 mg was given postoperatively.After pathology was comfirmed,patients was enrolled in group 1 (BCG15) or group 2 (BCG 19) or the control group (epirubicin 18) randomly with SAS 9.3 software.Data of follow-up and Adverse event was collected and analyzed.Results By May 31,2019,531 patients were enrolled in the study.The drop-off rate was 20.1％.167 patients (143 males and 24 females)in group 1,172 patients (141 males and 31 females)in group2 and 84(75 males and 9 females) in the control group with follow-up data were analyzed.There were no significant differences in age,gender,BMI,ECOG score,risk stratification between the three groups (P =0.8641,P =0.2906,P =0.9384,P =0.6126).The median follow-up time makes no statistical difference between the groups (P =0.9251),12.0 (6.0,22.5) months,13.0 (6.0,22.3) months,and 13.0 (7.0,22.3) months.The median recurrence time of the three groups was 4.0 (3.0,6.0) months,4.5 (3.0,9.8) months,4.5 (3.0,8.8) months.There was no statistical difference between the three groups (P =0.2852).Risk stratification in the patients got no significant difference between the three groups (P ＞ 0.05).The 1-year recurrence-free survival rates were 80.0％ in the group 1 and 88.3％ in the group 2 and 73.7％ in the control group.The group 2 was superior to the group 1 and the control group (P =0.0281,P =0.0031).There was no significant difference between group 1 and control group (P =0.2951).There was no significant difference in the cumulative recurrence-free survival between the experimental group 1 and the experimental group 2,(95％ CI 0.80-2.43,P =0.2433).The cumulative recurrence-free survival in the group 1 and the group 2 was better than the control group (95 ％ CI 0.31-0.92,P =0.0266;95 ％ CI 0.20-0.65,P =0.0008).All the cases underwent instillation were analyzed for adverse events.The incidence of overall AE(adverse events) in group 1 was 68.5％ (152/222),the incidence of grade Ⅰ-Ⅱ AE was 53.2％ (118/222),the incidence of grade Ⅲ-Ⅳ AE was 15.3％ (32/222).The incidence of overall AE in the group 2 was 71.8％ (160/223),the incidence of grade Ⅰ-Ⅱ AE was 60.1％ (134/223),and the incidence of grade Ⅲ-Ⅳ AE was 11.7％ (26/223).The overall AE rate in the control group was 53.2％ (59/111),of which the incidence of grade Ⅰ-Ⅱ AE was 42.4％ (47/111),and the incidence of grade Ⅲ-Ⅳ AE was 10.8％ (12/111).There was no difference in the incidence of overall AE between the group 1 and the group 2 (P =0.4497).The incidence of AE in the two experimental groups was higher than that in the control group (P =0.0062,P =0.0008).There was no difference in the incidence of grade Ⅲ-Ⅳ AE between the three groups (P =0.3902).Conclusions BCG(19 instillation schedule) has a better effect on preventing recurrence after 1 year of bladder surgery,which is superior to epirubicin group.The long-term efficacy of BCG in preventing recurrence and the efficacy of different schedules need to be further followed up.The lower urinary tract symptoms,which are mainly urinary frequency,are one of the causes of case fallout and should be fouced in future.Compared with epirubicin,BCG perfusion does not increase the incidence of grade Ⅲ-Ⅳ adverse reactions,and is safe to use.
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Objective To investigate the risk factors which can lead to chronic kidney disease (CKD) after radical nephroureterectomy and guide adjuvant chemotherapy for the patients with upper tract urothelial carcinoma (UTUC).Methods 239 patients with UTUC,who were treated at our hospital from October 2010 to February 2015 was analyzed retrospectively.Serum creatinine levels were measured preoperatively and 1 month (range:21days to 35 days) after radical nephroureterectomy.129 males and 110 females patients were enrolled.Ages were from 41 to 94,and mean age was 66 years.All patients underwent radical surgery.The pathological stages included Ta/T1/T2/T3/T4,and grades included G1/G2/G3.We calculated GFR using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in consideration of age,sex,and serum creatinine level.The new-onset CKD after RNU was defined as when the calculated CKD-EPI GFR decreased to less than 60 ml/(min · 1.73 m2).These patients were divided into 2 groups which depended on whether they got CKD after RNU.Cohorts were stratified by gender,age,smoking,BMI,hypertension,diabetes mellitus (DM),tumor location,tumor size,multifocality,pathologic stage,grade,hydronephrosis and preoperative CKD-EPI GFR.The chi-square test was used to examine the relationship among the various cohorts and the CKD after RNU.The Kaplan-Meier method was adopted to identify the relationship between Overall survival (OS).Cancer-specific survival (CSS) and CKD.Univariate and multivariate analyses were performed to study the relationship between clinical factors and CKD after RNU using the Cox proportional hazards regression model and chi-square test.Results In our study,the median follow-up time was 41.3 (range from 2-82) months for 239 patients.Median CKD-EPI GFR for all patients before and after surgery was 71.4 (65.2-108.7) ml/(min · 1.73 m2) and 54.7 (37.6-93.8) ml/(min · 1.73 m2),meanwhile 105 cases became new-onset CKD.There was no significant difference in overall or cancer specific survival between CKD + and CKD-(P =0.137,P =0.190).However age (HR =1.825,95％ CI 1.203-2.768,P =0.017),hydronephrosis (HR =0.243,95 ％ CI 0.106-0.613,P =0.034) and preoperative CKD-EPI GFR (HR =0.237,95 ％ CI 0.109-0.524,P =0.021) were significantly correlative with postoperative new-onset CKD.Conclusion Age,absence of hydronephrosis and preoperative CKD-EPI GFR were independent risk factors predicting new-onset CKD.They can be the predictor of new-onset CKD.
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Objective To investigate the risk factors which can lead to chronic kidney disease (CKD) after radical nephroureterectomy and guide adjuvant chemotherapy for the patients with upper tract urothelial carcinoma (UTUC).Methods 239 patients with UTUC,who were treated at our hospital from October 2010 to February 2015 was analyzed retrospectively.Serum creatinine levels were measured preoperatively and 1 month (range:21days to 35 days) after radical nephroureterectomy.129 males and 110 females patients were enrolled.Ages were from 41 to 94,and mean age was 66 years.All patients underwent radical surgery.The pathological stages included Ta/T1/T2/T3/T4,and grades included G1/G2/G3.We calculated GFR using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in consideration of age,sex,and serum creatinine level.The new-onset CKD after RNU was defined as when the calculated CKD-EPI GFR decreased to less than 60 ml/(min · 1.73 m2).These patients were divided into 2 groups which depended on whether they got CKD after RNU.Cohorts were stratified by gender,age,smoking,BMI,hypertension,diabetes mellitus (DM),tumor location,tumor size,multifocality,pathologic stage,grade,hydronephrosis and preoperative CKD-EPI GFR.The chi-square test was used to examine the relationship among the various cohorts and the CKD after RNU.The Kaplan-Meier method was adopted to identify the relationship between Overall survival (OS).Cancer-specific survival (CSS) and CKD.Univariate and multivariate analyses were performed to study the relationship between clinical factors and CKD after RNU using the Cox proportional hazards regression model and chi-square test.Results In our study,the median follow-up time was 41.3 (range from 2-82) months for 239 patients.Median CKD-EPI GFR for all patients before and after surgery was 71.4 (65.2-108.7) ml/(min · 1.73 m2) and 54.7 (37.6-93.8) ml/(min · 1.73 m2),meanwhile 105 cases became new-onset CKD.There was no significant difference in overall or cancer specific survival between CKD + and CKD-(P =0.137,P =0.190).However age (HR =1.825,95％ CI 1.203-2.768,P =0.017),hydronephrosis (HR =0.243,95 ％ CI 0.106-0.613,P =0.034) and preoperative CKD-EPI GFR (HR =0.237,95 ％ CI 0.109-0.524,P =0.021) were significantly correlative with postoperative new-onset CKD.Conclusion Age,absence of hydronephrosis and preoperative CKD-EPI GFR were independent risk factors predicting new-onset CKD.They can be the predictor of new-onset CKD.
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Objective To evaluate the clinical value of multiple bladder biopsies in the diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC) during transurethral resection of bladder tumor(TURBT).Methods The data of 408 NMIBC patients from January 2009 to December 2013 was analyzed retrospectively.There were 302 males and 106 females.The mean age of these 408 patients was 65 years old from 33 to 86 years.Bladder multipoint biopsies were performed in 216 patients (biopsy group),and were not performed in the other 192 patients (control group).The multipoint biopsies were taken from right and left bladder walls,anterior and posterior walls,dome,trigone,prostatic urethra and abnormal mucosa.There were 127 males and 89 females in the biopsy group,with a mean age of 64 years old (from 18 to 87 years).In the control group,118 males and 74 females aged between 15 and 92 years have an average age of 66 years old.There was no statistically significant difference in regard to gender and age between the two groups.The positive rate of biopsy and whether the diagnosis and treatment plan changed in the study group were recorded and the recurrence and progression rates were compared between study and control groups.Results Of these 216 multiple mucosa biopsies,the total abnormal detection rate was 48.1％ (104/216).There were urothelial carcinoma in 12.5％ (39/216),carcinoma in situ in 5.6％ (12/216),dysplasia in 9.7％ (21/216),cystitis in 20.4％.The final diagnosis were changed in fifteen patients (6.9％) due to the biopsy results,and 38 patients(17.6％) treatment plans were changed.The 1-,3-,and 5-year recurrence-free survival rates (RFS) of biopsy group and control groups were 96.3％ vs.85.4％(x2 =14.955,P=0.000),85.2％ vs.69.8％ (x2 =13.183,P =0.000) and 69.9％ vs.64.1％ (x2 =1.574,P =0.245);progression-free survival(PFS) were 99.1％ vs.96.3％ (x2 =8.253,P =0.006),94.0％ vs.87.0％ (x2 =5.901,P=0.017) and90.3％ vs.85.4％ (x2 =2.273,P=0.169).The 1-and 3-year RFS and PFS of biopsy group were higher than control group.There was no significant difference in the 5-year RFS and PFS between the two groups.Conclusions Multiple bladder biopsies could be helpful for pathological diagnosis and the post-TUR treatment of NMIBC.Furthermore,it may reduce the early recurrence and progression rates of NMIBC,but have no effect on long-term prognosis.
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Objective To assess the value of preoperative neutrophil-lymphocyte ratio ( NLR) for predict the prognosis in patients with high grade T1 bladder.Methods From January 2004 to December 2014, the data of 307 patients diagnosed as bladder cancer of Stage 1 and high grade after undergoing TURBT were analyzed, including gender, age, smoking status, tumor number and size, hydronephrosis, intravesical instillations and preoperative blood transfusion of 307 patients diagnosed as bladder cancer of stage 1 and high grade after undergoing TURBT were analyzed retrospectively.All patients were primary urothelial carcinoma.According to preoperative NLR,patients were divided into the low NLR group( NLR≤2.42,n=197) and the high NLR group(NLR >2.42,n =110).Recurrence-free survival (RFS) and progression-free survival ( PFS) were calculated according to the Kaplan-Meier model and compared by the log-rank model.Cox regression models were used for multivariate analyses of the association between NLR and bladder cancer, then the prognostic factors affecting RFS and PFS were evaluated.Result of these 307 patients, the low NLR group accounted for 64.2%(197/307), and the high NLR group accounted for 35. 8%(110/307).The mean follow-up period was 71(range, 1-123)months.The recurrence rate in the low NLR group and the high NLR group recurrence rate were 19.2%( 38/197 ) and 34.5%( 38/110 ) respectively, RFS were 73.0(range, 2-123)months and 67.5(range, 1-122)months respectively.The progression rates were 4.1%(8/197) and 10.9%(12/110) respectively.The recurrence and progression rates in the high NLR group is higher than those in the low NLR group(P2.42(P=0.007,HR=1.912)and hydronephrosis (P<0.01, HR =2.485 ) are associated with higher risk of recurrence.Conclusion Elevated preoperative NLR is an independent predictor of RFS and PFS in patients with high grade T1 bladder cancer.
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Objective This study is to investigate the expressions of MACC1 and c-Met genes in prostate cancer tis?sues and to explore the relationship between these gene expressions with the development, invasion and metastasis of pros?tate cancer. Methods The expressions of MACC1 and c-Met genes were examined in 30 cases of benign prostatic hyperpla?sia and 67 cases of prostate cancer using citron acid-microwave-SP immunohistochemical method and analysed with their clinical pathological features. Results Expressions of MACC1 and c-Met in prostate tissues show statistical difference ac?cording to Gleason score, PSA level, pathological stages and whether bone metastasis occurs after radical surgery ( P<0.05 or P < 0.01), but their expressions in prostate tissue show no significant difference among different sex, age and whether smoking or not. Expression of MACC1 in prostate tissue of stageⅢandⅣcancer is significantly higher than that in benign prostatic hyperplasia (BPH) tissues (P<0.05) while the expression of c-Met only shows statistical difference in prostate tis?sue of stage Ⅳcancer compared with that in BPH (P < 0.05). There is a positive correlation between the expression of MACC1 with expression of c-Met in prostate cancer tissues (P<0.01). Kaplan-Meier curves revealed that the survival rates was lower and survival time of bone-free metastasis were shorter in patients with high MACC1 and c-Met expressions in prostate tissue than those with low expressions of MACC1 and c-Met in prostate tissue. Conclusion Expression of MACC1 and c-Met is closely related to the development, invasion and metastasis of prostate cancer, so MACC 1 and c-Met may be used as promising diagnostic and prognostic markers for prostate tumor, and as new therapeutic targets for prostate cancer.
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Objective To evaluate the relationship between the CCNE1 or RIP2, identified at a single nucleotide poly?morphism, and the risk, clinic stage and pathological grade of bladder cancer. Methods Peripheral venous blood samples were obtained from 176 patients with bladder cancer and 210 controls without cancer. DNA was extracted. Polymerase chain reaction (PCR) method was used to detect CCNE1 (rs8102137) and RIP2 (rs42490) polymorphism. According to the postoper?ative pathological results, patients with bladder cancer were determined the grading and staging. The genotype differences of medium gene and the distribution gene were analyzed and compared in bladder cancer group and control group. The relation?ship of CCNE1 (rs8102137) and RIP2 (rs42490) genotypes and clinical data of patients with bladder cancer was analyzed, and the relationship of them with the genetic susceptibility to bladder cancer was also analyzed. Results The genotype dis?tribution was with good group representative in control group. The frequency of CCNE1(rs8102137) variant allele was signifi?cantly higher in bladder cancer group (40.91%) than that of control group (30.95%,OR=1.54,95%CI:1.02-2.45, P<0.05). The frequency of RIP2 (rs42490) variant allele was significantly higher in bladder cancer group (72.73%) than that of control group (62.38%, OR=1.61, 95%CI:1.04-2.48, P<0.05). There were no significant differences in gene polymorphisms of CC?NE1(rs8102137) and RIP2 (rs42490) between different pathological grades and different clinical stages of bladder cancer. Conclusion The CCNE1 (rs8102137) and RIP2 (rs42490) polymorphism have interaction in occurrence of bladder cancer process. There is higher risk of bladder cancer in individuals carrying mutant alleles than that of individuals carrying wild type.
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<p><b>OBJECTIVE</b>To evaluate the value of taking surgical margin specimens during transurethral resection of bladder tumor(TURBT) in the diagnosis and treatment of non-muscle invasive bladder cancer.</p><p><b>METHODS</b>The data of 356 patients with non-muscle invasive bladder cancer from June 2009 to January 2014 were analyzed retrospectively. A standardized protocol were performed during TURBT in 176 patients(surgical margin group), by taking surgical margin specimens from tumor base and 'normal'-appearing margin sites. The other 180 cases merely received general TURBT (general group). To observe the positive rate of surgical margin specimens and whether the diagnosis and treatment plan changed in the surgical margin group. Using Chi-square test to compare the recurrence and progression rates between surgical margin and general groups. To compare their recurrence-free survival time by Mann-Whitney U test. Results Of these 176 surgical margin specimens, the positive rate was 19. 3% (34/176),which consists of tumor base 11. 9% (21/176) and tumor normal-appearing margin 7. 4% (13/176). Following with urothelial carcinoma Ta stage in 1. 7% (3/176), T1 stage in 5. 7% (10/176), T2 stage in 8. 0% (14/176), carcinoma in situ (Tis) in 4. 0% (7/176). Among these 176 patients final diagnosis were changed in 10. 8% (19/176) patients due to the specimens results, and 18. 2% (32/176) patients altered their treatment plans. All 356 patients with a mean follow-up of 36. 8 months (6 to 60 months). Two groups of patients(surgical margin group vs. general group) recurrence rates respectively were 22. 2% (39/176) vs. 35. 6% (64/180), recurrence-free survival time were 33. 0 months vs. 23. 5 months and progression rates were 5. 7% (10/176) vs. 10. 6% (19/180). Compared with general group, patients who were taken additional surgical margin specimens showed significantly lower recurrence rate (χ2 = 7. 677, P = 0. 007) and longer recurrence-free survival time (U = 12 605,P = 0. 001). While the progression rate showed no statistical difference between them (χ2 = 2. 825, P = 0. 121).</p><p><b>CONCLUSION</b>Taking additional surgical margin specimens during transurethral resection of bladder tumor is helpful for pathological diagnosis and the planning of further treatment.</p>
Subject(s)
Humans , Carcinoma, Transitional Cell , Diagnosis , General Surgery , Cystectomy , Disease Progression , Neoplasm Recurrence, Local , Retrospective Studies , Specimen Handling , Statistics, Nonparametric , Urinary Bladder Neoplasms , Diagnosis , General SurgeryABSTRACT
Objective To explore the correlation and role of E2F3 gene,miR-17-5p and miR-20a in the cell lines of transitional cell carcinoma of bladder. Methods The plasmids of pcDNA3.1-HA-E2F3 and pAAV-siRNA-E2F3 were used to overexpress and knockdown E2F3.The mimics of miR-17-5p,miR-20a and their anti-miRNA oligonucleotides were used to overexpress and screen miR-17-5p and miR-20a.The expression levels of E2F3 gene,miR-17-5p and miR-20a were detected by quantitative real-time PCR,and E2F3 protein were detected by Western blot. Results When E2F3 was overexpressed,the 2- △△Ct of miR-17-5p and miR-20a were 2.26 ± 0.30 and 4.04 ± 0.51,it was statistically significant to compared with control (P ＜ 0.05) ; when E2F3 was knockdown,the 2 △△Ct of miR-17-5p and miR-20a were 0.49 ± 0.02and 0.65 ± 0.04 (P ＜ 0.05) ; when miR-17-5p and miR-20a were overexpressed simultaneously,the level of E2F3 mRNA was significantly decreased,the average E2F3 protein gray scale was 55.31 ± 7.89,the control was 103.67 ± 13.61 (P ＜ 0.05 ) ; when miR-17-5p and miR-20a were knockdown simultaneously,the E2F3 mRNA was significantly increased,the E2F3 protein gray scale was 295.68 ± 19.25,the control was 103.67 ± 13.61 ( P ＜ 0.05 ). Conclusions miR-17-5p and miR-20a could be up-regulated by E2F3 gene,and the E2F3 gene could be down-regulated by miR-17-5p and miR-20a.The regulatory feedback loop of E2F3 gene,miR-17-5p and miR-20a exists in transitional cell carcinoma of bladder. The loop maybe plays a key role in the development of bladder cancer.
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Objective To investigate the surgical technique and clinical effectiveness of retroperitoneal laparoscopic nephroureterectomy with transurethral bladder-cuff excision and open nephroureterectomy in pelvis carcinoma. Methods We retrospectively analysed the records of all 62 patients who underwent retroperitoneal laparoscopic or open nephroureterectomy in Tianjin Dagang Hospital or the Second Affiliated Hospital of Tianjin Medical University from July 2001 to July 2009. Variables analyse were compared including operative time, blood loss, turning to open operation, complications, length of stay, tumor recurrence and metastasis. Groups were compared using Student's t-test, and a probability (P) value of less than 0.05 was taken to indicate statistical significance. Results The respective mean operative duration [(47.34±39.16) vs (118.17±44.65) ml], length of hospital stay [(9.15±2.19) vs (11.64±3.71) d], time to ambulation [(3.58±0.79) vs (5.67±1.24) d]and blood loss [(70.64±27.33) vs (118.17±44.65) ml]in retroperitoneal laparoscopic nephroureterectomy with transurethral bladder-cuff excision group was significantly reduce to open nephroureterectomy group (t = 3.3167, 2.0587, 8.0494, 5.1777, P ＜0.05). There was no significantly difference between two groups in complication of during operation and post operation [4.8 % (2/42) vs 5.0 %(1/20), 0 vs 0, respectively](P ＞0.05). 4 cases were failed and conversed to open surgery in retroperitoneal laparoscopic nephroureterectomy group. During the follow up period range from 8-48 months, there was no significantly difference between two groups in tumor recurrence and metastasis [4.8 % (2/42) vs 5.0 % (1/20),2.4 % (1/42) vs 5.0 % (1/20), respectively](P ＞0.05). Conclusion Retroperitoneal laparoscopy in upper urinary tract transitional carcinoma uses a small incision, incurs less blood loss, and allows for a more rapid recovery, suggesting it is a safe and effective method for treating patients with renal and pelvis cancer.
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Objective To review the clinical and pathologic features of xanthogranulomatous cystitis (XC). Methods The clinical and pathologic data of 3 patients (2 females and 1 male, mean age, 37.3 year, age range, 24-50 year) with XC were reported in combination with review of the relevant literature. All 3 cases had recurrences cystitis-like symptoms, 2 cases had lower abdominal pain.1 case found low abdominal palpable mass during physical examination. Ultra sonography and CT revealed solid mass at the dome of the bladder. Partial cystectomy was performed on 2 patients, the rest 1 was case treated as urachal carcinoma.Results Postoperative pathology confirmed XC. Pathological features were as follows: xanthoma cells (lipidladenmacrophages), multinucleated giant cells and cholesterol clefts. With 12-36 (mean 28) months follow-up, there was no recurrence and cystitis-like symptoms on these patients. Conclusions XC is a rare disease. XC is usually identified by pathology. The presence of a concomitant neoplasm should be considered when the diagnosis of XC is made.Surgical resection could be a curative treatment.
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Objective: To acquire the expression of E2F3 protein and mRNA in bladder transitional cell carcinoma (BTCC) tissue and normal bladder epithelial tissue, and the relationship between E2F3 expression and the biological behaviors of BTCC thereof. Methods: Immunohistochemistry was used to detect the expression of E2F3 in BTCC(n = 64) and normal bladder mucosa(n = 10). Immunohistochemistry result was analysed by Image-pro Plus software and the expression result was indicated by integrated optical density (IOD). The expression of E2F3 mRNA was investigated using RT-PCR analysis in fresh bladder tumor tissues and normal bladder mucosa. Results: The expression rate of E2F3 in BTCC (32.8%) was higher than that of normal bladder mucosa(P < 0.01). The expression rate of E2F3 was strongly correlated with the pathological grade and clinical stage (P < 0.05;P < 0.01). Immunohistochemistry result indicated that the IOD of E2F3 was significantly higher in BTCC than that of normal bladder mucosa (P < 0.01). The expression level of E2F3 was strongly correlated with pathological grade (P < 0.01). Conclusion: E2F3 was the diagnostic and prognostic index of BTCC, and provided theory basis about the gene target therapy in BTCC.
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Objective:To investigate the relationship between the expression of Fascin protein and vascular endothelial growth factor(VEGF)and the biological behavior of bladder transitional cell carcinoma(BTCC).Methods:The expressions of Fascin and VEGF were examined by SABC(StreptAvidin-Biotin Complex)immunohistochemistry in 56 paraffin-embedded tissue specimens and 10 control samples of normal bladder tissues.Results:The positive expression rates of Fascin and VEGF were 0 in normal bladder tissue.The positive expression rates of Fascin and VEGF were 73.21% and 60.71% in BTCC(P ＜ 0.01).The higher expressions of Fascin and VEGF were related to the tumor grade,clinical stage and recurrence(P ＜ 0.01).The expression of Fascin was closely correlated with that of VEGF in BTCC(r=0.476 9,P＜ 0.01).Conclusion:The expression of Fascin may be one of parameters for understanding the biological behavior of BTCC.Fascin protein and VEGF may enhance the influence of the development of BTCC together,which may also provide theoretical foundation of chemopreventive stategy for bladder cancer in the future.
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Objective: To construct siRNA plasmid expression vector in order to knockdown E2F-3 activity. Methods: Sixty-four base-pair oligos for hairpin RNA expression, which targeted E2F-3 gene, were chemically synthesized and annealed. The pRNAT-U6.1/Neo vector was linearized with Bam HI and HindⅢ. Finally, the annealed oligos were inserted into the lined pRNAT-U6.1/Neo to construct RNAi plasmid(pRNAT-U6.1-E2F-3/Neo). The reconstructed RNAi plasmids were i-dentified by electrophoresis after digestion with BamHI and Hind Ⅲ, and were confirmed by sequencing analysis. Results: The recombinant pRNAT-U6.1-E2F-3/Neo vector was identified by polymerase chain reaction, and confirmed by sequencing analysis. The results demonstrated that 64 bp had been inserted into the expected site. Furthermore, the insertion sequence was exactly correct and no mutation site was found. Conclusion: The pRNAT-U6.1-E2F-3/Neo RNAi system was constructed successfully. This will facilitate the study of E2F-3 in bladder cancer cell lines.
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Objective:To research the relationship of urinary cytology positive rate with the grade and stage of primary ureter uroepithelium cancer.Methods:A total of 104 cases of primary ureter uroepithelium cancer were recruited in this study.The urine of all paitents was collected for preoperative urinary cytology de-tection.The urinary cytology detection rates were compared among different grades and stages of primary ureter uroepithelium cancer.Results:The overall unnary cytology positive rate of primary ureter uroepithelium cancer was 34.26%.The overall urinary cytology positive rate was 43.59%in the advanced stage group and 11.54%in the low stage group,with a significant difference(X2=8.740, P=0.003).The difference in positive rate between the advanced stage group and the low stage group in the high grade with inferior segment group of primary ureter uroepithelium cancer was statistically significant(X2=10.628,P=0.001).The difference in positive rate between the advanced stage group and the low stage group in the high grade group of primary ureter uroepithelium cancer was statistically significant(X2=5.678,P=0.01 7).The difference in positive rate be-tween the high grade group and the low grade group in low stage group of primary ureter uroepithelium can-cer was statistically significant(X2=12.860,P=0.001).Conclusion:The unnary cytology positive rate of primary ureter uroepithelium cancer of high grade and low stage is higher.