ABSTRACT
Bladder cancer(BC) ranks the first of genitourinary tumor in China and is one of the most common urological malignancies, in which 25%-30% of patients were diagnosed with muscle-invasive bladder cancer. Radical cystectomy combined with pelvic lymph node dissection is the standard procedure for treatment, which can effectively avoid tumor recurrence or distant metastasis as well as improve the prognosis of patients. However, some patients may not tolerate or refuse to undergo radical bladder surgery due to worry about high complication rate, high morbidity and poor postoperative quality of life. With the increasing understanding of bladder cancer heterogeneity and biological behavior, the treatment of bladder cancer has changed from a surgery-based treatment model to an individualized and comprehensive treatment model by multidisciplinary collaboration. The bladder-preserving treatment can achieve the same oncological prognosis as that of radical bladder surgery with a better quality of life of the patients, which has become a hot topic and focus of research in muscle-invasive bladder cancer treatment. This article reviewed the progress of research related to the comprehensive treatment of muscle-invasive bladder cancer with preservation of the bladder.
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Exosomes are widely distributed in various body fluids. They are extracellular vesicles with a diameter of 30-100nm that contain a variety of biologically active substances. They play an important role in a variety of biological processes such as tumor invasion, migration and immune escape. With the progress of research, exosomes derived from bladder cancer have shown great potential in the early diagnosis and treatment of bladder cancer. This article reviews the main biological characteristics of exosomes and their new developments in the diagnosis and treatment of bladder cancer.
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Objective To evaluate the accuracy of enhanced CT scan in clinical staging of colorectal cance by detecting the general sit-uation and T and N staging through plain scan combined with enhanced CT scan.Methods Totally 49 cases of colorectal cancer patients were enrolled in this study from May 2015 to October 2015,and it showed no distant metastasis of colorectal cancer in clinical examination. Evaluated the general situation (location,size,and pathologic type)and T and N staging of colorectal cancer through plain scan and enhanced CT scan and multiplanar restructuring.Compared the imaging staging with pathological staging,and respectively calculated the sensitivity,spe-cific degree and accuracy of T and N staging.Evaluated the accuracy of T and N staging with the consistency test,and the differences were statistically significant with P <0.05.Results The location and pathological type of tumor detected by CT scan were compared with the re-sults of operation,and the coincidence rate was 100%.The maximum diameter of the tumor was (2.26 ±1.40)cm from CT image and (2.37 ±1.38)cm from operation measure,and the data were highly correlated (r =0.906,P =0.000).The coincidence rate of T staging was 65.3%,and the consistency was good (k =0.467,P =0.000).The coincidence rate of N staging was 63.3%,and the consistency was good (k =0.440,P =0.000).Conclusion Enhanced CT scan can provide sufficient information for the preoperative evaluation of colorectal cancer,and it has important clinical application value.
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Objective To evaluate the clinical,pathological and imaging features of basal cell adenoma in the parotid. Methods The clinical,pathological and CT imaging data of 21 cases with parotid basal cell tumor confirmed by operation and pathology were retrospectively analyzed. Results All 21 patients(5 male,16 female ) had solitary BCA lesion,which located at the superficial lobe of parotid gland(n=17)and involved both the superficial and deep lobe(n=4). Twelve lesions were well-defined and cystic degeneration was displayed in 9 le-sions,3 lesions had punctate calcification at the edge of tumor. All lesions were significantly enhanced,the enhancement of BCA in the ve-nous phase was close to the arterial phase. Conclusion The CT features of BCA in parotid gland are characteristic,which is helpful to make qualitative diagnosis when in combination with clinical features.
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Objective To investigate the miss rate of adenoma with colonoscopy and assess the features and risk factors for missed diagnosis.Methods Patients with colorectal adenoma received a second colonoscopy within 120 days after adenoma was detected and removed on the initial colonoscopy.The findings of two colonoscopies were reviewed and analyzed.The features of adenoma (including size, location, shape, number and pathology) , clinical characteristics of patients (including age, sex, reasons of colonoscopy, history of diverticular disease, history of abdominal or pelvic surgery and colonoscopy with sedation) and endoscopists were recorded.Miss rate and features of different types of missed adenoma were analyzed.We also assessed the effects of adenoma features, patients' characteristics and endoscopists on missed diagnosis of adenoma.Results Adenoma missed diagnosis was found in 271 patients out of 809 recruited subjects (33% ).A total of 425 adenomas were missed out of 2134 (20% ) adenomas detected by repeated colonoscopy.A large diameter was associated with a decrease in the miss rate for adenoma (P < 0.01).Conversely , sessile or flat shape (P < 0.01) , locations at sigmoid, hepatic flexure, cecum and ascending colonic ( P < 0.05) were significantly associated with a higher miss rate of adenoma, as was the number of adenomas (P <0.01).A higher adenoma missed diagnosis rate was observed in beginner colonoscopists, as compared with experienced ones (P < 0.01).Conclusion A marked miss rate of adenoma exists on colonoscopy, which is significantly associated with the size, shape, location and number of adenomas and endoscopists.
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Objective To investigate the predictive value of rectal aberrant crypt foci(ACF)for colorectal cancer(CRC)and progressive adenomas, and to analyze its risk factors.Methods IndependentSample T test, One-Way ANOVA and Chi-square test were used to analyze the mean number and incidence of rectal ACF.Logistic regression analysis was used to assess the predictive value of rectal ACF for progressive adenomas and CRC, and to identify the independent risk factors of ACF.Results Large number of ACF, i.e.more than 5, was a significant risk factor for CRC and progressive adenomas.Age and smoking were both risk factors of ACF, while aspirin was a protective factor.Conclusion ACF of more than 5 is predictive of CRC and progressive adenomas.For prevention of CRC, great importance must be attached to risk factors of ACF.