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Objective@#To investigate the relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopathological characteristics of patients treated with radical prostatectomy.@*Methods@#The clinicopahtological data of patients evaluated with 68Ga-PSMA PET-CT preoperatively and treated with radical prostatectomy between May 2016 and August 2019 were retrospectively reviewed. 31 patients with a mean age (63.1±4.9) and baseline PSA (72.71±173.15)ng/ml were enrolled. Their BMI mean (24.6±3.0)kg/m2. Baseline testosterone of 14 patients was (4.72±1.64)ng/ml.Based on the Gleason scores related ISUP classification, all patients were classified into grade one in 5 cases, grade 2in 7 cases, grade 3 in 4 cases, grade 4 in 10 cases and grade 5 in 5 cases. The clinical classification included 6 cases in T2a stage, 2 cases in T2b stage, 17 cases in T2c stage, 1 case in T3a stage, 4 cases in T3b stage and 1 case in T4 stage. SUVmax was accessed by two independent professional nuclear medicine physicians. SUVmax was 12.49±9.38. SPSS 16.0 software was used to do statistic analysis.@*Results@#The post-operative pathological results showed the surgical margin positive in 19 cases, negative in 12 cases, vascular positive in 5 cases, negative in 20 case, positive nerve invasion in 20 cases and negative in 11 cases. 2 patients were low risk, 7 patients were medium risk and 22 patients were high risk according to D′Amico classification. Based on the basis of PSA(≤10 or>10) and Gleason score(≤6 or>6), 6 patients were in group with low PSA and low Gleason score, 5 patients were low PSA and high Gleason score, 9 patients were high PSA and low Gleason score, 11 patients were high PSA and high Gleason score. SUVmax had a significant positive relationship with pathological ISUP(r=0.434, P=0.015) and SUVmax in patients with positive intravascular tumor emboli was significantly higher than those with negative intravascular tumor emboli(14.78±10.68 vs. 8.17±2.81, P=0.005). No significant correlation was found between SUVmax and baseline PSA, testosterone, pathologic T stage, surgical margin, nerve invasion, pelvic lymph node status as well as risk stratification. SUVmax could distinguish pathologic ISUP grade 5 with a maximum AUC 0.747 (P=0.033) and the sensitivity was 88.9%. The specificity was 77.3% when SUVmax≥11.34. SUVmax in patients with upgrading ISUP was significantly higher than that in patients with downgrading ISUP (16.01±5.40 vs. 4.98±2.11, P=0.007).@*Conclusions@#SUVmax measured on preoperative 68Ga-PSMA PET-CT may have a clinical significance in predicting unfavorable pathological factors for patients treated with radical prostatectomy.
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Objective To investigate the relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopathological characteristics of patients treated with radical prostatectomy.Methods The clinicopahtological data of patients evaluated with 68Ga-PSMA PET-CT preoperatively and treated with radical prostatectomy between May 2016 and August 2019 were retrospectively reviewed.31 patients with a mean age (63.1 ± 4.9) and baseline PSA (72.71 ± 173.15) ng/ml were enrolled.Their BMI mean (24.6 ± 3.0) kg/m2.Baseline testosterone of 14 patients was (4.72 ± 1.64) ng/ml.Based on the Gleason scores related ISUP classification,all patients were classified into grade one in 5 cases,grade 2in 7 cases,grade 3 in 4 cases,grade 4 in 10 cases and grade 5 in 5 cases.The clinical classification included 6 cases in T2a stage,2 cases in T2b stage,17 cases in T2c stage,1 case in T3a stage,4 cases in T3b stage and 1 case in T4 stage.SUVmax was accessed by two independent professional nuclear medicine physicians.SUVmax was 12.49 ± 9.38.SPSS 16.0 software was used to do statistic analysis.Results The post-operative pathological results showed the surgical margin positive in 19 cases,negative in 12 cases,vascular positive in 5 cases,negative in 20 case,positive nerve invasion in 20 cases and negative in 11 cases.2 patients were low risk,7 patients were medium risk and 22 patients were high risk according to D'Amico classification.Based on the basis of PSA(≤ 10 or ＞ 10) and Gleason score (≤6 or ＞ 6),6 patients were in group with low PSA and low Gleason score,5 patients were low PSA and high Gleason score,9 patients were high PSA and low Gleason score,11 patients were high PSA and high Gleason score.SUVmax had a significant positive relationship with pathological ISUP (r =0.434,P =0.015) and SUVmax in patients with positive intravascular tumor emboli was significantly higher than those with negative intravascular tumor emboli (14.78 ± 10.68 vs.8.17 ± 2.81,P =0.005).No significant correlation was found between SUVmax and baseline PSA,testosterone,pathologic T stage,surgical margin,nerve invasion,pelvic lymph node status as well as risk stratification.SUVmax could distinguish pathologic ISUP grade 5 with a maximum AUC 0.747 (P =0.033) and the sensitivity was 88.9％.The specificity was 77.3％ when SUVmax ≥ 11.34.SUVmax in patients with upgrading ISUP was significantly higher than that in patients with downgrading ISUP (16.01 ± 5.40 vs.4.98 ± 2.11,P =0.007).Conclusions SUVmax measured on preoperative 68 Ga-PSMA PET-CT may have a clinical significance in predicting unfavorable pathological factors for patients treated with radical prostatectomy.
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Objective@#To discuss the application experience and predictive value of circulating tumor cells for urothelial carcinoma.@*Methods@#The clinical data of 96 patients with urothelial carcinoma treated by Beijing Cancer Hospital Urologic Department between September 2017 and September 2019 were analyzed retrospectively to evaluate relationship between the number of CTCs and pathological outcome. The mean age of the entire cohort was 62(40-87)years, with 74 males and 22 females. There were 13 cases of upper urinary tract tumors (pyelocarcinoma and ureteral carcinoma), 83 cases of bladder carcinoma, and 12 cases of lymph node metastasis. There were 77 cases of primary onset and 19 cases of recurrence. 68 cases in single focus group and 28 cases in multiple group. There were 29 cases in non infiltrative Ta stage, 42 cases in infiltrative lamina propria T1 stage, 16 cases in infiltrative muscle T2 stage, and 9 cases in extra-muscular≥T3 stage. At least 3ml of peripheral blood was collected after fasting for at least 8 hours, After cleavage and centrifugation, immunomagnetic beads were added, folate probe was added, and then amplification was carried out. Then the copy number of CTCs in each ml of blood was calculated. Logistic linear regression was used to analyze the risk factors of lymph node metastasis.@*Results@#The mean CNC of all patients was 12.3±7.3; the mean CNC of ≤62 years old group was 10.8±4.2; the mean CNC of >62 years old group was 13.7±9.2; the mean CNC of initial cases was 11.5±5.3; the mean CNC of recurrent cases was 15.5±12.2. Age (P=0.135) and frequency of onset (P=0.087) had no effect on the number of CTCs. The average CNC of single focus group was 10.5±5.2, multiple focus group was 16.5±9.7, Ta stage group was 8.2±2.3, T1 stage group was 12.0±4.4, T2 stage group was 16.4±6.8, and ≥T3 stage group was 19.5±16.6. The number of lesions (P<0.001) was significantly correlated with pathological T stage (P<0.001) and the number of CTCs. Univariate regression analysis showed that T stage (P<0.001) and the number of CTCs (P=0.02) might be correlated with lymph node metastasis; multivariate analysis showed that only T stage could be used as an independent predictor of lymph node metastasis (P=0.002).@*Conclusions@#CTCs can be used to predict lymph node metastasis of urothelial carcinoma.
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Objective To discuss the application experience and predictive value of circulating tumor cells for urothelial carcinoma.Methods The clinical data of 96 patients with urothelial carcinoma treated by Beijing Cancer Hospital Urologic Department between September 2017 and September 2019 were analyzed retrospectively to evaluate relationship between the number of CTCs and pathological outcome.The mean age of the entire cohort was 62(40-87)years,with 74 males and 22 females.There were 13 cases of upper urinary tract tumors (pyelocarcinoma and ureteral carcinoma),83 cases of bladder carcinoma,and 12 cases of lymph node metastasis.There were 77 cases of primary onset and 19 cases of recurrence.68 cases in single focus group and 28 cases in multiple group.There were 29 cases in non infiltrative Ta stage,42 cases in infiltrative lamina propria T1 stage,16 cases in infiltrative muscle T2 stage,and 9 cases in extramuscular≥T3 stage.At least 3ml of peripheral blood was collected after fasting for at least 8 hours,After cleavage and centrifugation,immunomagnetic beads were added,folate probe was added,and then amplification was carried out.Then the copy number of CTCs in each ml of blood was calculated.Logistic linear regression was used to analyze the risk factors of lymph node metastasis.Results The mean CNC of all patients was 12.3 ±7.3;the mean CNC of ≤62 years old group was 10.8 ±4.2;the mean CNC of ＞62 years old group was 13.7 ±9.2;the mean CNC of initial cases was 11.5 ±5.3;the mean CNC of recurrent cases was 15.5 ± 12.2.Age (P =0.135) and frequency of onset (P =0.087) had no effect on the number of CTCs.The average CNC of single focus group was 10.5 ± 5.2,multiple focus group was 16.5 ± 9.7,Ta stage group was 8.2 ±2.3,T1 stage group was 12.0 ±4.4,T2 stage group was 16.4 ±6.8,and ≥T3 stage group was 19.5 ± 16.6.The number of lesions (P ＜ 0.001) was significantly correlated with pathological T stage (P ＜ 0.001) and the number of CTCs.Univariate regression analysis showed that T stage (P ＜ 0.001) and the number of CTCs (P =0.02) might be correlated with lymph node metastasis;multivariate analysis showed that only T stage could be used as an independent predictor of lymph node metastasis (P =0.002).Conclusions CTCs can be used to predict lymph node metastasis of urothelial carcinoma.
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Objective To explore the application of nephron-sparing surgery in giant renal angiomyolipomas with the maximum diameter greater than 15 cm and its relevant surgical experience.Methods Between July 2014 to January 2017,5 patients with giant renal angiomyolipoma greater than 15 cm was admitted to our hospital for nephron-sparing surgery.The patients were all female ranging in age from 32-50 years (43.0 ± 7.1) years.According to the tumor imaging characteristics,we divided them into 3 different types including diffuse endogenous,exogenous and mixed type.All the tumors meet the criterion of exogenous type,ranging in diameter from 15.0-28.0 cm (20.4 ± 5.8) cm.4 patients harbored one single tumor and the other bilateral tumors.All the giant tumors located on the right side.Open transperitoneal nephron-sparing surgery was performed.Result During the operation,to find the joint site between the tumor and normal kidney is the key procedure in order to reserve more normal renal parenchyma.The operation time ranged from 105-175 min (125.4 ± 28.4) min,warm ischemia time 8-20 min (15.8 ±4.8) min,blood loss 50-400 ml (162.0 ± 141.5) ml.The average postoperative drainage volume ranged from 50-165 ml (99 ± 45) ml,the time of drainage tube removal 1-8 days (4.0 ± 2.6) days.The postoperative serum creatinine had no significant change compared to the value before operation (P =0.808).Postoperative hospital stay was 5-12 days (7.2 ± 2.9) days.Benign renal angiomyolipoma with negative margins was diagnosed as expected.No patient had a recurrence after a 1-32 months follow-up.Conclusion Nephron-sparing surgery could be used selectively in patients with giant renal angiomyolipoma greater than 15cm.For the tumors with the characteristic of exogenous type on imaging assessment before operation,open transperitoneal nephron-sparing surgery was an optional choice and could be implemented safely.
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Objective To evaluate the effect of local treatment for the prognosis of hormonesensitive metastatic prostate cancer.Methods A systematic review of the literature about local treatment for the prognosis of hormone-sensitive metastatic prostate cancer was performed,searching Medline,Embase,Cochrane Library,CBM,CNKI,VIP and Wan Fang database from January 2001 to October 2016.Two authors reviewed the records to identify comparative studies.A meta-analysis was conducted using Review Manager 5.0.Results Five studies were enrolled,including 29 354 patients.Meta-analysis showed that,compared with no local treatment,local treatment had a significant beneficial effect in 5-year overall survival rate (OR =0.18,95 ％ CI 0.15-0.22,P ＜ 0.01),5-year disease specific survival rate (OR =0.39,95 ％ CI 0.31-0.49,P＜0.01) as well as 3-year overall survival rate (OR =0.47,95％ CI 0.35-0.62,P＜0.01).Sub-group analysis showed that,compared with no local treatment,prostatectomy had a significant beneficial effect in 5-year overall survival rate (OR =0.17,95 ％ CI 0.12-0.25,P ＜ 0.01),5-year disease specific survival rate (OR =0.30,95％ CI 0.22-0.40,P ＜0.01) as well as 3-year overall survival rate (OR=0.25,95％CI 0.19-0.32,P ＜0.01),and external beam radiation therapy only had a significant beneficial effect in 3-year overall survival rate (OR =0.54,95％ CI 0.42-0.69,P ＜ 0.01).Conclusions Prostatectomy and external beam radiation therapy may have a survival benefit for hormone-sensitive metastatic prostate cancer.Prospective randomized controlled studies are necessary because of the limits of current studies.
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Objective To evaluate the effect of local treatment for the prognosis of hormonesensitive metastatic prostate cancer.Methods A systematic review of the literature about local treatment for the prognosis of hormone-sensitive metastatic prostate cancer was performed,searching Medline,Embase,Cochrane Library,CBM,CNKI,VIP and Wan Fang database from January 2001 to October 2016.Two authors reviewed the records to identify comparative studies.A meta-analysis was conducted using Review Manager 5.0.Results Five studies were enrolled,including 29 354 patients.Meta-analysis showed that,compared with no local treatment,local treatment had a significant beneficial effect in 5-year overall survival rate (OR =0.18,95 ％ CI 0.15-0.22,P ＜ 0.01),5-year disease specific survival rate (OR =0.39,95 ％ CI 0.31-0.49,P＜0.01) as well as 3-year overall survival rate (OR =0.47,95％ CI 0.35-0.62,P＜0.01).Sub-group analysis showed that,compared with no local treatment,prostatectomy had a significant beneficial effect in 5-year overall survival rate (OR =0.17,95 ％ CI 0.12-0.25,P ＜ 0.01),5-year disease specific survival rate (OR =0.30,95％ CI 0.22-0.40,P ＜0.01) as well as 3-year overall survival rate (OR=0.25,95％CI 0.19-0.32,P ＜0.01),and external beam radiation therapy only had a significant beneficial effect in 3-year overall survival rate (OR =0.54,95％ CI 0.42-0.69,P ＜ 0.01).Conclusions Prostatectomy and external beam radiation therapy may have a survival benefit for hormone-sensitive metastatic prostate cancer.Prospective randomized controlled studies are necessary because of the limits of current studies.
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Objective:To determine the value of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) scans in identify-ing the residual retroperitoneal tumor after chemotherapy of testis germ cell tumors. Methods:Sixteen testis germ cell tumor patients with metastasis of retroperitoneal lymph nodes who were treated in our hospital from February 2014 to December 2016 were select-ed for the study from February 2014 to December 2016. After 4-6 cycles of chemotherapy, their CT scans showed residual masses with diameters greater than 2 cm. The retroperitoneal lymph nodes were dissected after the 18F-FDG PET exam. The post-surgery pathology results were compared with the results of the 18F-FDG PET exam. Results:Residual tumors were found in 5 of 10 patients with 18F-FDG PET positive. Residual tumor was absent in 4 of 6 patients with 18F-FDG PET negative, while residual mature teratoma tumors were found in two patients. The accuracy rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the 18F-FDG PET exam were 56.25%(9/16), 71.42%(5/7), 44.44%(4/9), 50.00%(5/10), and 66.67%(4/6), respectively. Conclusion: 18F-FDG PET is highly sensitive. However, many factors influence the result of 18F-FDG PET. Mature teratoma leads to a false negative re-sult, whereas massive tissue inflammation leads to a false positive result. Therefore, more clinical examinations should be made.
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Objective To study the influence of overactive bladder (OAB) on the symptoms and quality of life (QoL) in patients after Transvaginal Tape-Obturator (TVT-O) treatment for stress urinary incontinence (SUI).Methods Eighty-two SUI women underwent TVT-O were included in this study.The perioperative ICI-Q-SF scores,including frequency of leakage,volume of leakage,and QOL scores,were collected to study the perioperative OAB prevalence and the influence of OAB on the improvement on the symptoms and QOL after TVT-O.Results The total efficacy of TVT-O was 95%.The average symptom and QOL scores in all patients decrease from (8.17±2.29)and (7.95±2.16)to (1.84±2.34)and(1.32±2.24)after TVT-O,P＜0.05.The prevalence of OAB decreased from 46% to 24% after TVT-O,P＜0.05.The average post-operation symptom and QOL scores of the pre-operation non-OAB group were (1.09±1.60)and(0.82±1.45),while those of the OAB group were (2.71±2.75) and (1.89±2.82),P＜0.05.The average post-operation symptom and QOL scores of the post-operation non-OAB group were (1.06±1.68) and (0.56±1.15),while those of the OAB group were (4.25±2.49) and (3.65±3.10),P＜0.05.Conclusions TVT-O is effective for female stress urinary incontinence and contributes to the significant improvement of symptoms and QOL in patients with OAB.The treatment will not raise the prevalence of OAB in itself.
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Objective To study the changes of the symptoms and quality of life (QOL) in patients after the Transvaginal tape-obturator (TVT-O) treatment and weather would this treatment lead to bladder outlet obstruction (BOO) and bladder function change. Methods A total of 82 stress urinary incontinence (SUI) women who had underwent TVT-O were included, age from 39-82 years, 3-60 months after operation. All patients were divided into 5 groups by the time post-operation. The ICI-Q-SF scores were collected to study the change of the symptoms and QOL of each group perioperation. Qmax, PVR, bladder weight, wall thickness of each group were collected to study whether would TVT-O lead to BOO and bladder function change. Results Forty-five (55%) patients were cured and 33(40 %) improved after TVT-O. Total cure rate was 95 %. There was a significant improvement of average symptom and QOL in all of the 5 groups (3-month, 6-month, 1-year, 2-year, above-2-year) (P＜0. 05). Qmax changed from (32. 17±10.74), (25.64±6.05), (25.68±11.36), (25.70±10. 28), (25.29±15. 10)ml/s pre-operation to (28.30±15.21), (25.64±10. 48), (24. 49±7.96),(25.43±11.92), (25. 92± 10. 17)ml/s post-operation in 5 groups(P＞0. 05). PVR changed from (0.04±0.20), (0. 00±0.00), (0. 17±0. 39), (2.70±6.01), (1. 96±5.10)ml pre-operation to (1. 79±6.16), (0.00±0.00), (12. 50±29.89), (5.00±15. 54), (33. 70±92.10)ml post-operation in 5 groups(P＞0.05). The bladder weight changed from (43. 62±7.81), (41. 57±8. 63), (46.11±8.12), (42. 50±3. 85), (44. 52±4. 38)g pre-operation to (45. 62±5.32), (47.21±5. 47),(44.89±4. 65), (45. 14±4. 13), (46. 70±5.84)g post-operation, which differed significantly in 6-month, 2-year, above-2-year groups (P＜0. 05). The bladder wall thickness changed from (2.23±0.51), (2.22±0.47), (2.04±0.38), (2. 19±0. 43), (2. 19±0. 38)mm pre-operation to (2.25±0. 40), (2. 18±0.47), (2. 07±0.47), (2.22±0. 47), (2. 20±0. 44)mm post-operation(P＞0. 05).Conclusions TVT-O has a high cure rate for SUI and there was a significant improvement of average symptom and QOL of all patients after the treatment. But TVT-O may lead to BOO and bladder function change since bladder weight increases significantly in some patients.