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Objective:To investigate the clinical outcomes of neoadjuvant chemotherapy with Gemcitabine and Cisplatin (GC) for muscle-invasive bladder cancer (MIBC).Methods:Retrospective analysis of 67 MIBC patients admitted to Beijing Friendship Hospital, Capital Medical University from December 2010 to June 2020. Fifty-five MIBC patients (cT2-T4aN0M0) underwent GC plus radical cystectomy-pelvic lymph node dissection. Pathological responses, prognosis and chemotherapy toxicities were analyzed. The Chi-square test and Fisher′s exact probability method were used to compare the count data between groups. The overall survival (OS) and disease-free survival (DFS) were based on the Kaplan-Meier survival curve, and the Log-rank test was used to evaluate the difference between groups in the survival curve. Prognostic analysis adopts Cox proportional hazards regression model.Results:Fifty-five MIBC patients received GC plus radical cystectomy-pelvic lymph node dissection. The 81.8% patients ( n=45) received 2 cycles GC and 18.2% patients ( n=10) received 3 cycles. The complete pathological response (pT0N0M0) rate was 30.9% ( n=17) and partial response (pT 1/Tis/T aN 0M 0) rate was 10.9% ( n=6). Overall pathological response rate was 41.8%. The median follow-up was (47.0±37.7) months, 5-year OS were 82.2% and 22.1% (<pT 2 versus ≥pT 2, P<0.001), and DFS were 86.1% and 32.1% (<pT 2 versus ≥pT 2, P<0.001). Pathological response and positive lymph nodes were independent risk factors of overall survival and disease-free survival on multivariable analysis ( P<0.05). The most common chemotherapy toxicities were hematologic toxicities and gastrointestinal reactions, and none delayed surgery due to toxicities. Conclusion:Neoadjuvant GC plus radical cystectomy-pelvic lymph node dissection has a significant clinical benefit in MIBC patents and chemotherapy toxicities are well tolerated.
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Objective@#Assist in clinical decision making by building models to predict the probability of clinically significant prostate cancer (CSPCa) with prostate imaging reporting and data system version 2 (PI-RADs v2) 3 and avoid unnecessary biopsy.@*Methods@#It’s a retrospective study which maintained database of 218 consecutive men who received prostate biopsy and with PI-RADs v2 category 3 in Capital Medical University, Beijing Friendship Hospital between January 2012 to July 2018, the average age was 70.7 years, and the age range was 63-77 years. Among them, 137 patients with benign diseases, 30 patients with clinically insignificant prostate cancer (CIPCa), and 51 patients with CSPCa. Models were established based on clinical variables. The measurement data were expressed as the median (interquartile range) [M(P25, P75)], and the rank sum test was used for comparison between groups; the Chi-square test was used for comparison between the count data groups. The decision curve was used to determine the clinical net benefit unilateral factors generated by the application of the model, univariate and multivariate logistic regression analysis to determine the predictors of positive outcomes. The diagnostic performance of the predictive model was evaluated by the area under the curve (AUC) of receiver operating curve, which was used to assess the overestimation or underestimation of the model, and the decision curve was used to determine the clinical net gain from the application of the model.@*Results@#Detection of prostate caner (PCa) and CSPCa in the PI-RADs v2 cohort were 37.2% (81/218) and 23.4% (51/218). The median prostate specific antigen of CSPCa patients was 12.1 ng/ml, which was higher than CIPCa (9.5 ng/ml) and benign (10.5 ng/ml) patients. The median prostate volume of CSPCa patients was 41.2 ml, lower than CIPCa (45.8 ml) and benign (57.3 ml) patients. The median prostate special antigen density (PSAD) was 0.28 ng/ml2, higher than CIPCa (0.20 ng/ml2) and benign (0.15 ng/ml2) patients. The predictive power of the developed model, based on age, PSAD, lesion region and ADC value, showed a higher AUC than that of parameters alone. Internally validated calibration curves showed that the nomogram might overestimate the risk of PCa when the threshold was above 35%. As for CSPCa, the predicted risk was closer to actual probability when the threshold was above 60%. Decision curves showed that a better net benefit was met when the model was used to guide clinical practice.@*Conclusions@#The models based on age, PSAD, lesion region and ADC value showed internally validated high predictive value for both PCa and CSPCa. It could be used to improve the detection rate of CSPCa and avoid unnecessary biopsy.
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Objective Assist in clinical decision making by building models to predict the probability of clinically significant prostate cancer (CSPCa) with prostate imaging reporting and data system version 2 (PI-RADs v2) 3and avoid unnecessary biopsy.Methods It's a retrospective study which maintained database of 218 consecutive men who received prostate biopsy and with PI-RADs v2 category 3 in Capital Medical University,Beijing Friendship Hospital between January 2012 to July 2018,the average age was 70.7 years,and the age range was 63-77 years.Among them,137 patients with benign diseases,30 patients with clinically insignificant prostate cancer (CIPCa),and 51 patients with CSPCa.Models were established based on clinical variables.The measurement data were expressed as the median (interquartile range) [M(P25,P75)],and the rank sum test was used for comparison between groups;the Chi-square test was used for comparison between the count data groups.The decision curve was used to determine the clinical net benefit unilateral factors generated by the application of the model,univariate and multivariate logistic regression analysis to determine the predictors of positive outcomes.The diagnostic performance of the predictive model was evaluated by the area under the curve (AUC) of receiver operating curve,which was used to assess the overestimation or underestimation of the model,and the decision curve was used to determine the clinical net gain from the application of the model.Results Detection of prostate caner (PCa) and CSPCa in the PI-RADs v2 cohort were 37.2％ (81/218) and 23.4％ (51/218).The median prostate specific antigen of CSPCa patients was 12.1 ng/ml,which was higher than CIPCa (9.5 ng/ml) and benign (10.5 ng/ml) patients.The median prostate volume of CSPCa patients was 41.2 ml,lower than CIPCa (45.8 ml) and benign (57.3 ml) patients.The median prostate special antigen density (PSAD) was 0.28 ng/ml2,higher than CIPCa (0.20 ng/ml2) and benign (0.15 ng/ml2) patients.The predictive power of the developed model,based on age,PSAD,lesion region and ADC value,showed a higher AUC than that of parameters alone.Internally validated calibration curves showed that the nomogram might overestimate the risk of PCa when the threshold was above 35％.As for CSPCa,the predicted risk was closer to actual probability wben the threshold was above 60％.Decision curves showed that a better net benefit was met when the model was used to guide clinical practice.Conclusions The models based on age,PSAD,lesion region and ADC value showed internally validated high predictive value for both PCa and CSPCa.It could be used to improve the detection rate of CSPCa and avoid unnecessary biopsy.
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Objective To investigate the safety of gemcitabine combined with cisplatin (GC) / carboplatin (GCa) regimen in adjuvant chemotherapy for upper urinary tract urothelial carcinoma.Methods The clinical and follow-up data of 80 patientswho underwent GC or GCa chemotherapy withinfourcycles of upper tract urothelial carcinoma (UTUC) admitted to Beijing Friendship Hospital,Capital Medical University from June 2012 to January 2018 were analyzed retrospectively,including 39 males and 41 females,aged 36 to 81 years,with a median age of 64.0 years.According to the chemotherapy regimen,all patients were divided into GC group (n =54) and GCa group (n =26).The software of SPSS 22.0 was used to calculate the incidence of adverse reactions of chemotherapy.The independent risk factors for serious adverse reactions were analyzed.The incidence of serious adverse reactions and the safety of renal function in patients with renal insufficiency during chemotherapy were explored.Results For adverse reactions to chemotherapy,GC group had 20 patients (37.0％) with severe myelosuppression,9 patients (16.4％) with non-hematological toxicity,3 patients (5.6％) with delayed chemotherapy due to serious chemotherapy adverse reactions,and 12 patients (22.2％) withdrawn chemotherapy early due to inability to tolerate chemotherapy toxicity.In GCa group,12 patients (46.2％) had severe myelosuppression,5 patients(19.2％) had severe non-hematologic toxicity,6 patients(23.1％) had delayed chemotherapy due to serious chemotherapy adverse reactions,and 6 patients (23.1％) had withdrawn chemotherapy early due to inability to tolerate chemotherapy toxicity.Pre-chemotherapye GFR ＜ 60 ml ·(min · 1.73 m2)-1 (OR =5.074,95％ CI:1.222-21.068) was an independent risk factor for severe myelosuppression in GC group (P ＜ 0.05).There was no significant difference in severe adverse reactions between the two groups (P ＜ 0.05).For the renal function decline between the two groups,Cr and eGFR decreased to a certain extent in the two groups during chemotherapy (P ＜ 0.05),but there was no significant difference in the extent and degree during chemotherapy (P ＜ 0.05).Conclusions Both GC and GCa adjuvant chemotherapy have certain toxicity and side effects.The process of chemotherapy needs to be closely monitored and timely symptomatic treatment if needed.Most patients can eventually endure chemotherapy.For patients with renal insufficiency,under the precondition of strict monitoring and adequate hydration,GC and GCa regimens adjuvant chemotherapy within four cycles may be the same safe level ofchemotherapy.