ABSTRACT
At present, antibody-drug conjugate is the focus of the research and development of new anticancer drugs. Three antibody-drug conjugates have been approved for the treatment of urothelial carcinoma, including Enfortumab Vedotin (Nectin-4 antibody-MMAE conjugate), Sacitumab Govitecan (Trop-2 antibody-SN-38 conjugate), and Disitamab Vedotin (HER2 antibody-MMAE conjugate) significantly improved the prognosis in patients with advanced disease, revolutionizing the treatment landscape of urothelial carcinoma. In addition, a number of studies that focus on combination of antibody-drug conjugate with targeted therapy, immunocheckpoint inhibitors is also under way. This article reviews the recent clinical development of antibody-drug conjugate in the treatment of urothelial carcinoma in recent years.
ABSTRACT
Objective:To investigate the effect of ultrasound-guided early removal of indwelling catheter on recovery quality and catheter-related infection of patients with general anesthesia in post anesthesia recovery unit (PACU).Methods:From September 2019 to April 2020, 146 patients with gynecological benign diseases who underwent hysteroscopic surgery in the Department of Anesthesiology, Shenzhen Hospital of Southern Medical University were selected prospectively and randomly divided into two groups, with 4 cases excluded. The function of the bladder was evaluated by ultrasound in the anesthesia recovery room after operation. In the ultrasound group, 71 patients had no abnormality, and the catheter was removed after the residual urine of the bladder was drained. 71 patients in the control group were normal, and the catheter was removed 24 hours after operation. The residual urine volume, urine retention, incidence of restlessness, urinary tract infection rate, time to first walking and hospital stay were observed in the two groups after the first bladder emptying.Results:The incidence of agitation in PACU was 7.0%(5/71) in the ultrasound group and 22.5%(16/71) in the control group, with statistically significant difference ( P<0.01); the first postoperative walking time in the ultrasound group and the control group was statistically significant [(10.5±4.1)h vs (18.9±6.5)h, P<0.05]; the postoperative hospital stay in the ultrasound group and the control group was statistically significant [(3.2±1.3)d vs (5.1±2.5)d, P<0.05]. The incidence of urinary tract infection and urinary tract irritationin in ultrasound group was significantly lower than that in control group (1.4% vs 9.8%, 1.4% vs 14.0%, P<0.05). Conclusions:For uncomplicated patients after gynecological laparoscopic surgery, ultrasound evaluation of bladder function, extraction of residual urine immediately after the removal of catheter, is more conducive to the early recovery of patients than 24 hours after the removal of catheter.
ABSTRACT
Objective To investigate the efficacy and safety of radical nephrectomy associated with venous thrombectomy and the role of preoperative angioembolization.Methods From Sep 2006 to Dec 2014,the data from 15 cases with renal cell carcinoma and venous tumor thrombus were collected and analyzed retrospectively.The 15 patients included 8 men and 7 women,whose age ranged from 16 to 75 years.Before operation,all patients underwent imaging examinations which demonstrated the renal tumor and venous thrombus.The tumors size ranged from 5.4 to 14.5 cm.The levels of venous thrombus included 0 grade in 4 cases,Ⅰ grade in 2 cases,Ⅱ grade in 6 cases and Ⅲ grade in 3 cases.The 15 patients were divided into angioembolization group (n =5) and non-angioembolization group (n =10) according to the conduction of preoperative angioembolization.Results All cases successful accepted the nephrectomy.The venous thrombectomy were undergone in 14 cases except for one case due to the severe adhesion between renal vein and aorta.The average operative time was 243.3 ± 77.0 min.The mean blood loss was 1 373.3 ± 1 440.9 ml and the volume of blood transfusion was 533.3 ± 521.9 ml.The average time of postoperative hospital stay was 12.7 ± 5.2 days.Symptomatic tumor thrombus embolism didn't occur in all cases,perioperatively.There were no significant difference between these two groups in operative time,blood loss,blood transfusion volume and postoperative hospital stay (P ＞ 0.05).Eight cases were followed up with a period of 6 to 69 months.Four cases had disease-free survival during follow up.Two cases died at 30 and 55 months after surgery,respectively.One had tumor recurrence at 6 months after surgery.One patient accepted a 6-months target therapy (sunitinib) before surgery.However,his thrombus could not be removed during the operation.After the operation,he continued to choose the target drug therapy for 18 months.No progression for thrombosis or metastasis has been found.Conclusions Nephrectomy and venous thrombectomy could be safe and effective for renal cell carcinoma associated with venous thrombosis.Preoperative angioembolization could not reduce the perioperative risk such as blood loss.
ABSTRACT
ObjectiveTo evaluate the clinical effect of post bladder sparing surgery intra-arterial chemotherapy combined with intravesical chemotherapy for the treatment of T1G3 bladder urothelial carcinoma.MethodsSeventy-four T1G3 bladder cancer patients were enrolled in this study.After bladder sparing surgery,22 patients received intra-arterial chemotherapy combined with intravesical chemotherapy,while the other 52 patients were treated with intravesical chemotherapy only.There was no significant difference between the 2 groups in sex,age,the size and number of bladder tumor and newly diagnosed cases (P ＞0.05).Twenty-two patients were treated with intra-arterial chemotherapy of piarubicin or epirubicin (40 -60 mg)+ cisplatin (60 -80 mg) 2 or 3 weeks after bladder sparing surgery,3 times as a cycle,repeat every 4 - 6 weeks.All the patients received the same protocol of intravesical chemotherapy.With a median follow-up of 32 months,effects of combination therapy group were compared with intravesical chemotherapy group in the aspects of tumor-specific death rates,recurrent rate,progressive rate,recurrent interval and the adverse reactions.ResultsThe tumor-specific death rates of combination therapy group and intravesical chemotherapy group were 0％ (0/22) and 13.5％ (7/52),respectively.There was no difference between the 2 groups (P =0.096).The recurrent rates were 13.6％ (3/22) and 46.2％ ( 24/52 ) ； The progressive rates were 0％ (0/22) and 21.2％ (11/52).There were significant differences between the 2 groups in recurrent rate (P =0.000) and progressive rate (P =0.048 ).The recurrent intervals of the 2 groups were 15 months and 6.5 months.During the interval of intra-arterial chemotherapy cycle,12 patients suffered 1 -2 degree nausea and vomit,2 patients suffered hypoleukemia,2 patients suffered neutropenia,4 patients'liver function was impaired and 1 patient's renal function was impaired.All the adverse reactions were minimal and reversible.ConclusionsIntra-arterial chemotherapy combined with intravesical chemotherapy is effective in preventing T1 G3 bladder cancer from recurrence and metastasis after bladder sparing surgery.The adverse reactions of this protocol were minimal and reversible.
ABSTRACT
Objective To discuss the feasibility and safety of retroperitoneal laparoscopic nephrectomy for treatment of kidney tuberculosis. Methods From March 2005 to February 2009, 28 patients with kidney tuberculosis underwent retroperitoneal laparoscopic nephrectomy. The patients′ data were reviewed and analyzed. Results There were 18 men and tencwomen with an average age of 36 (26-51) in the cohort. Sixteen patients had lesions on the left kidney and 12 on right kidney. All patients had a normal renal function on the contra lateral side. The severely impaired renal function of the lesion side was confirmed before operation. Anti-tuberculosis chemotherapy was administered to patients for two weeks to six months in advance of the surgery. No active lesion of tuberculosis was found and ESR level was normal before operation. All the operations were successfully performed without switching to open surgery. The average operative time was 170 (121-258) minutes, blood loss was 110 (70-250) ml and average postoperative hospital stay was 5.7 (5-14) days. Peritoneum injury was seen in three patients and incision infection in two patients. No severe complications were observed. Anti-tuberculosis chemotherapy was continued for three months. Twenty-four patients were followed-up, and the average follow-up time was 12.5 (6-20) months. All patients recovered without any lesion remaining. Conclusions Retroperitoneal laparoscopic nephrectomy could be a safe and reliable method for the treatment of non-functioning kidney due to tuberculosis.
ABSTRACT
Objective To evaluate the feasibility of European Organization for Research and Treatment of Cancer (EORTC) risk tables in non-muscle invasive bladder cancer in Chinese patients.Methods A retrospective analysis was performed on the data from 185 patients with non-muscle invaaive urothelial bladder cancer from January 2003 to February 2009. Among the 185 patients, 128 patients were stage Ta compared with 57 patients who were stage T1. There were 87, 53 and 45 patients with grade G1, G2 and G3 respectively. Transurethral resection of the bladder tumor was performed on all the patients and all the patients received routine post-operative intravesical instillation. A telephone interview follow-up was conducted on all the patients, and the average follow-up period was 36 months. EORTC risk tables were used to calculate risk scores for recurrence and progression for each patient. The recurrence and progression rates of different risk groups were recorded and compared with the estimated rates by EORTC risk table. Statistical analysis was used for comparison. ResultsTotal 1-year recurrence rate and progression rate for these patients were 25.9% and 3.8% respectively. According to calculated values of the patients, the 1-year recurrence rates of Group 0, Group 1-4, Group 5-9, Group 10-17 were 10.4%(5/48), 21. 5%(14/65), 35. 2% (19/54), 55.6%(10/18), respectively. The 1-year progression rates of Group 0, Group 2-6, Group 7-13, Group 14-23 were 0% (0/43), 1.5% (1/67), 6. 7% (4/60), 13. 3% (2/15). There was no significant difference between the real rates and estimated rates of the EORTC risk tables (P＞0. 05). However,the 1-year recurrence and progression rates between the low risk group, the medium risk group and the high risk group showed significant differences respectively (P ＜ 0. 05 ). Conclusions The EORTC risk tables are feasible to evaluate the recurrence and progression risk of non-muscle invasive bladder cancer in the present cohort. Nevertheless, the long term value and feasibility need more research to confirm.
ABSTRACT
Objective To compare WHO 2004 and WHO 1973 pathological grading methods of non-muscle invasive urothelial neoplasms. Methods The clinical pathological features of 160 non-muscle invasive urothelial neoplasms patients, treated in our hospital from February, 1998 to Decem-ber, 2008, were re-graded according to WHO 2004 and WHO 1973 classification system. To evaluate recurrence and progression of all the patients during the follow up period, we used statistical method to analyses the differences between two classification system. Results There were 160 patients, ac-cording to WHO 1973 classification methods: 5 cases of papilloma, 52 cases of grade 1 tumors, 83 ca-ses of grade 2 and 20 cases of grade 3;By WHO 2004 classification method: 7 cases of papilloma, 31 cases of low-grade malignant potential of urothelial papilloma, 99 cases of low-grade papillary urotheli-al carcinoma and 23 cases of high-grade papillary urothelial carcinoma. There was no difference in re-currence among the grades of WHO 2004 and WHO 1973 pathological grading system (both P>0.05). Regarding the progress of non-muscle invasive papillary urothelial neoplasms, no significant difference was found among grades of WHO 1973 classification system(P>0.05)while difference exis-ted among grades of WHO 2004 pathological grading system (P<0.05), especially between papillary neoplasm of low malignant potential (PNLMP) and high grade papillary urothelial carcinomas(HG-PUC) (P<0.01). Moreover, HGPUC grade had more progression rate (30.4%) than G_3 grade (15.0%). Conclusions Compare to G_3 grade, HGPUC grade was more easily to make progress in pa-tients,due to this grade include more high malignant papillary urothelial carcinomas. Therefore, it is necessary for urologists to use a more rigorously follow up and therapy method in connection with HG-PUC grade of new classification system.
ABSTRACT
Objective To discuss the clinical application and significance of non-enhanced computed tomography axis rotating movie imaging technique in PCNL for complex renal calculi. Methods Thirty-one cases unilateral and 2 cases bilateral multiple and staghorn renal calculi with mild or mediurn hydronephrosis patients were performed bilateral kidneys non-enhanced CT scanning,three dimensional reconstruction and the axis rotating movie composition were carried on by computer software,PCNL accesses were designed and the residual stone were predicted referred to the access-calyces angle measured in axis rotating movie image,PCNL were performed after while.Comparing between preoperation accesses design and residual stone prediction with in-operation practice were carried out.Results The first PCNL access was constructed via posterior middle upper minor calyces in 22 renal units and via posterior middle lower minor calyces in 13 renal units,which was consistent with pre-operation design according to CT axis rotating movie image.The second PCNL accesses were constructed via lower calyx posterior upper minor calyces in 9 renal units and via lower calyx posterior lower minor calyces in 5 renal units,nephrolithotomy were performed in the same operation,clinical stone clearance rate was 80%(28/35),other 7 cases with residual stone were consistent with pre-operation prediction,No blood transfusion was necessary and no severe complication happened in all 33 cases.Conclusions Non-enhanced CT axis rotating movie imaging provided the detail three dimensional shape and spatial structure of complex renal calculi intuitively) that was benefit for designing appropriate PCNL accesses for complex renal calculi patients, guiding for searching stone fragments in operation, predicting residual stone, and ensuring operation safety.
ABSTRACT
Objective To evaluate the therapeutic methods for stones in congenital anomalous kidneys. Methods The clinical outcomes of 126 patients(75 males and 51 females: mean age 39 years, range 12-66 years)who underwent extracorporeal shock wave lithotripsy (ESWL, n= 37), minimally invasive percutaneous nephrolithotomy (MPCNL, n = 41) or open surgery (n = 48) were retrospectively reviewed. There were 40 horseshoe kidneys(31.8%), 51 duplex kidneys(40.5%), 35 malrotated kidneys(27.8%). Seventyl calculi were located in left kidneys(55.6%)and 56 in right kid-neys(44.4%). There were 96 single stones(76.2%)and 30 complex stones(23.8%). The greatest di-ameter of stone ranged from0.8 cm to 2.2 cm(mean 1.5 cm) in ESWL group, 1.0 cm to 4.0 cm (mean 2.5 cm) in MPCNL group and 1.5 cm to 3.8 cm(mean 2.7 cm) in open surgery group. The therapeutic effects of 3 methods were compared. Results The stone-free rate at 1 session was 78.4%(29/31) in ESWL group, 85.4%(35/41) in MPCNL group and 87.5%(42/48) in open sur-gery group. No significant difference was found among the 3 groups(x2 = 1.39,P=0.50). The inci-dence of complications was 13.5% in ESWL group, 9.7% in MPCNL group and 6.3% in open sur-gery group(x2=1.28, P=0.53). Only 1 case of malrotated kidney suffered massive hemorrhage and was cured by selective embolism of renal artery. No major complications occurred in the other pa-tients. Conclusions With rigorous indication, ESWL or MPCNL is as safe and effective as open sur-gery in the management of stones in congenital anomalous kidneys. It should be considered as the pri-mary therapy. But the treatment must be individualized in terms of the type anomalous kidney, stone characteristics and obstruction.
ABSTRACT
Objective To evaluate the construction of scFv-psm-ETA immunotoxin and to study its antitumor effect on human prostate cancer cells. Methods The genes encoding the heavy and light chain Fv regions of the monoclonal murine antibody Ed-5,which recognizes prostate specific membrane antigen on the surface of human prostate cell,were cloned by PCR technique and were used to generate single-chain immunotoxins containing Pseudomonas exotoxin A(ETA).The light and heavy chains were connected by a flexible linker to form a single-chain antigen-binding protein,which was in turn fused to truncated forms of ETA.The resulting plasmid,pSW200-psm,was transformed intoE.coli CC118 and the recombinant immunotoxins,scFv-psm-ETA,were expressed and purified to near homogeneity.The cell killing activity and in vivo antitumor activity of scFv-psm-ETA were tested using human prostate cancer cell line LNCaP. Results scFv-psm-ETA was shown to be cytotoxic specifically to 80% of LNCaP cells,which expressed the PSM on their surface at a dose up to 100 ng/ml.In athymic nude mice, administration of the scFv-psm-ETA inhibited the growth of human prostate cancer cells LNCaP.The size of the tumors was 153 mm3 and 272 mm3,respectively, in treatment group and control group (P
ABSTRACT
Objective To assess the safety and effectiveness of minimally invasive percutaneous nephrolithotomy(MPCNL) in treating renal stones in patients with congenital anomalous kidneys.MethodsFrom January 2000 to November 2007 a total of 41 patients with renal stones complicated with congenital anomalous kidneys,including 12 cases of horseshoe kidneys,19 cases of duplex kidneys,and 10 cases of malrotated kidneys were treated by MPCNL in our hospital.Of the 41 patients,4 had upper calyx calculi,6 had middle calyx calculi,7 had lower calyx calculi,3 had pelvic calculi,4 had the upper segment calculi in duplex kidney,12 had multiple calculi,and 5 had staghorn calculi.The largest diameter of the stones ranged from 1.0 to 4.0 cm(mean 2.5 cm).Ureteral calculi that were found in 13 of the patients were treated at one time.ResultsThe procedure were completed in all of the cases with the operation time ranged from 45 to 210 minutes(mean 95 minutes),and blood loss ranged from 30 to 150 ml(mean 80 ml).The overall stone-free rate at one session was 85.4%(35/41).One of the duplex kidney cases and two of the horseshoe kidney cases were cured by a second operation.And two of the duplex kidney cases and one of the malrotated kidney cases were treated by ESWL after the MPCNL.One patient,who had malrotated kidney,suffered massive hemorrhage(800 ml) during the MPCNL,and was cured by selective embolization of the renal artery.No severe complications occurred in the other patients.The cases were followed up for 5-12 months,during the Period no patient had recurrence.ConclusionsMPCNL is safe and reliable for the treatment of stones in patients with congenital anomalous kidneys.The treatment must be individualized in terms of the type of the renal abnormalities,and the size and location of the stones.
ABSTRACT
Objective To determine the effects of pub op rostatic ligament and puborectalis sling sparing on postoperative complicationgs after radical retropubic prostatectomy. Methods A total of 16 men(mean age 67,stage B 14 cases,stage C 2 cases) with clinically prostat e cancer were managed with radical retropubic prostatectomy.Puboprostatic ligame nt and puborectalis sling sparing technique were used in all patients. Results All patients recovered from the operation.During 1 to 4 y ears,follow-up,none had long term incontinence or dysuria.PSA declined to 0.00 ng/ml and stayed 0.00 ng/ml in 9 cases within follow-up period.PSA were bellow