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Neoadjuvant therapy leads to the eradication of micrometastasis, thereby providing survival benefit to patients with muscle-invasive bladder cancer (MIBC). In the recent years, multiple clinical trials have corroborated the safety and durability of immune checkpoint inhibitors in the treatment of MIBC. Notably, there is a significantly higher response rate (e.g. pathologic complete response) and comparable occurrence of adverse events in patients treated with neoadjuvant dual immunotherapy, immunotherapy combined with chemotherapy or targeted therapy as compared with that treated with neoadjuvant single-agent immunotherapy. With an overview of breakthroughs in the past years, we believe that immune combination therapy is of great promise and expected to revolutionize the landscape of neoadjuvant therapy of MIBC.
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Objective:To investigate the efficacy of tyrosine kinase inhibitors (TKI) in the treatment of metastatic renal cell carcinoma with rhabdoid differentiation(mRCC-R) or sarcomatoid differentiation(mRCC-S)and the survival of the patients.Methods:The clinicopathological and postoperative follow-up data of 5 patients with mRCC-R and 9 with mRCC-S confirmed by pathology from February 2016 to December 2018 in Tianjin Medical University Cancer Hospital were reviewed. There were 3 male and 2 female patients in mRCC-R group, with the average age of (60.2±7.1)years old. The clinic manifestation included back or abdominal pain in 2 cases, loss of appetite and weight in one case and founding during physical examination in 2 cases, with the average maximum diameter was (8.8±4.1)cm. The site of tumor included left kidney in 3 cases and right kidney in 2 cases. Lung metastasis was found in 4 cases. Lung and peritoneum metastasis was found in one case. There were 8 male and 1 female patients in mRCC-S group, with the average age of (58.0±8.0)years old. The clinic manifestation included back or abdominal pain in one case, loss of weight in one case, gross hematuria in one case and founding during physical examination in 6 cases. The average diameter of tumor was (8.9±3.5)cm. The site of tumor included left kidney in 4 cases and right kidney in 5 cases. Postoperative metastasis included lung in 3 cases, bone in one case, retroperitoneal lymph node in one case, brain in one case, lung associated with bone in one case. All of the patients were pathologically diagnosed with renal clear cell carcinoma. After metastasis, 5 cases of mRCC-R and 6 cases of mRCC-S were treated with Sorafenib, 2 cases of mRCC-S were treated with Sunitinib, and 1 case of mRCC-S was treated with Axitinib. The efficacy of TKI for the two specific pathological types and for single pathological type at the early postoperative period (within 3 months) and 3 months later was compared. Meanwhile, subgroup analysis was performed on the efficacy of TKI and survival of patients with same metastatic sites in the two groups.Results:The mean overall survival(OS) of mRCC-R and mRCC-S treated with TKI was (26.5±5.5)months and (20.7±4.7) months( P=0.329), and the mean progression-free survival (PFS) was (21.9±5.5) months and (6.3±2.1)months( P=0.013), respectively. Comparing the efficacy of using TKI in the early postoperative period and after 3 months, the mean OS was (27.5±6.5)months and (16.8±6.1)months ( P=0.619), and the mean PFS was (12.3±3.3)months and (3.3±1.7)months ( P=0.096), respectively. There was only 1 patient with mRCC-R who used TKI within 3 months after surgery, and the result was disease progressed and eventually died, OS was 3 months. Comparing the efficacy of TKI in mRCC-R and mRCC-S with lung metastasis alone, the mean OS was (33.3±2.2) months and (19.5±8.9)months ( P=0.118), and the mean PFS was (27.3±3.1) months and (7.8±4.2) months ( P=0.009), respectively. Patients with liver, bone or brain metastasis only occurred in mRCC-S, so it is unable to identify the efficacy of TKI in the two groups. Conclusions:The efficacy of TKI in the treatment of mRCC-R was better than mRCC-S, and there was statistically significant difference in PFS, especially in patients with lung metastasis alone in the two groups. There was no significant difference in the efficacy between patients with mRCC-R who took TKI in the early postoperative period (within 3 months)and those who took TKI after 3 months.
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<p><b>OBJECTIVE</b>To study the effect of platelet derived growth factor-B and its receptor expression on the proliferation of renal cell carcinoma ACHN cells in vitro and in vivo.</p><p><b>METHODS</b>PDGF-B gene was transfected into human renal carcinoma cell line ACHN cells, and the proliferation capability of ACHN cells transfected with or without PDGF-B was assessed by MTT assay. The effect of PDGF-B on the expression of p-PDGFR-β in endothelial cells and vascular smooth muscle cells (VSMC) was detected by Western blot. ACHN cells transfected with PDGF-B were injected into mice (untransfected ACHN as control) to induce tumor formation. Immunohistochemical staining was used to detect the expression of Ki-67 in tumor cells and the tumor volume was measured to compare the tumor growth in the two groups.</p><p><b>RESULTS</b>The PDGF-B expression of ACHN cells in transfected group was significantly increased than that in the untransfected group. MTT assay showed that the proliferation capability of ACHN cells in the transfected and untransfected groups had no significant differences at different time points (P>0.05). The expression of p-PDGFR-β in VSMC was significantly increased when cultured with PDGF-B overexpression culture medium. The mean tumor size of the PDGF-B group and control group was (0.305±0.108) cm(3) and (0.577±0.218) cm(3), respectively (P=0.007). Ki-67-positive tumor cells were (41.00±5.34)/HPF in the PDGF-B-transfected group and (55.80±2.95)/HPF in the untransfected group (P=0.001).</p><p><b>CONCLUSION</b>PDGF-B overexpression may up-regulate p-PDGFR-β expression of VSMC in renal cell carcinoma, and inhibit the tumor cell proliferation and tumor growth through paracrine signaling.</p>
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Animals , Humans , Mice , Carcinoma, Renal Cell , Metabolism , Pathology , Cell Line, Tumor , Cell Proliferation , Kidney Neoplasms , Metabolism , Pathology , Proto-Oncogene Proteins c-sis , Receptor, Platelet-Derived Growth Factor beta , Genetics , MetabolismABSTRACT
Objective To explore prognostic factors of renal cell carcinoma and investigate the association of neutrophil-to-lymphocyte ratio (NLR) with the prognosis of renal cell carcinoma (RCC) in patients who received nephrectomy treatment.Methods We retrospectively reviewed the records of 1325 patients with renal cell carcinoma who underwent nephrectomy between January,2008 and December,2012.We retrospectively analyzed the clinicopathologic characteristics of patients.The optimal cutoff value for NLR was determined using receiver operating characteristic curve (ROC) analysis.We defined them as high NLR group when NLR ≥ 2.7 and low NLR group when NLR ＜ 2.7.Overall survival (OS) and recurrence free survival (RFS) were estimated using the Kaplan-Meier method and compared using the logrank test.Multivariate models were used to analyze the association of NLR with clinicopathologic outcomes.Results By the end of the study, 1220 cases were followed up.The follow-up rate was 92.1％.Mean follow-up was 40 months (range 2 months to 87 months).The three-year and five-year overall survival rate were 91.3％ and 86.9％, respectively.Meanwhile the three-year and five-year recurrence free survival rate were 88.2％ and 85.8％ ,respectively.2.7 was selected as the optimal cutoff value to differentiate between low NLR and high NLR.A NLR ≥2.7 was significantly associated with worse 5-year overall survival and worse 5-year recurrence free survival than a NLR ＜2.7,91.4％ vs 87.3％ ,89.6％ vs 71.9％ (P ＜0.05).Age ＞65, presentation mode with symptom, higher tumor stage, higher Fuhrman grade,histologic subtype,neutrophil count ≥ 4.5, lymphocyte count ＜ 1.7, NLR ≥ 2.7 significantly correlated with poor OS on univariate analysis.Multivariate analysis revealed that higher tumor stage, preoperative NLR ≥ 2.7 at diagnosis were poor independent prognostic factors for OS of renal cell carcinoma.Conclusion High NLR was independent poor predictor of renal cell carcinoma.
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Objective:To evaluate the prognostic significance of standard pelvic lymphadenectomy on the disease-free survival (DFS) rate of bladder cancer patients undergoing radical cystectomy (RC) and to discuss the influencing factors of lymph node positivity and the relationship between positive lymph nodes and lymphadenectasis. Methods:This prospective analysis includes 120 cases of bladder cancer treated with pelvic lymphadenectomy and RC in Tianjin Medical University Cancer Institute and Hospital between 2008 and 2013. The cases were divided into two groups, namely, the standard pelvic lymphadenectomy group (Group A) and the nonstandard pelvic lymphadenectomy group (Group B). The relationships among positive lymph nodes, lymphadenectasis, tumor stage, and patho-logical grade were retrospectively analyzed. Results:The 1-, 3-, and 5-year overall survival rates of 120 patients were 84%, 69.9%, and 57.9%, respectively. Group A was significantly correlated with a better 3-year overall survival rate than Group B, i.e., 78.4%vs. 46.2%(P<0.05). Lymphadenectasis influenced the DFS rate of bladder cancer patients after RC with pelvic lymphadenectomy, i.e., 50.0%vs. 86.4%(χ2=9.303, P<0.05). Meanwhile, lymphadenectasis was positively correlated with lymph node positivity (P<0.001). Tumor stage, histological subtype (urothelial carcinoma and non-urothelial carcinoma), and age were the prognostic factors for bladder cancer (P<0.05). Conclusion:Intraoperative lymphadenectasis is the influencing factor of lymph node positivity. This study determined that standard pel-vic lymphadenectomy and lymphadenectasis may influence the DFS rate after RC and are the independent risk factors for the prognosis of bladder cancer. Creating evidence-based guidelines of standardized lymphadenectomy for further improvement of the surgical quali-ty and survival of bladder cancer patients is essential.
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Objective:To analyze the impact of endophytic extent of renal tumor on the perioperative outcomes after partial ne-phrectomy and evaluate the long-term therapeutic effect of early renal cancer. Methods:A retrospective review was performed for 157 patients who underwent partial nephrectomy of T1N0M0 kidney cancer in Tianjin Medical University Cancer Institute and Hospital be-tween January 2011 and December 2013. The patients were classified into two groups according to the distance of the tumor margin to the collective system or renal sinus fat:group A,0.05). The warm ischemia time and operation time were significantly longer in group A than in group B (P=0.001;P=0.033). Postoperative complications occurred in 10 patients. No local tu-mor recurrence or metastasis was observed in the patients during a median follow-up of 18 months. Conclusion:The distance between the tumor margin and the collective system reflects the complexity of partial nephrectomy, which is associated with the warm ischemia time and operation time. Partial nephrectomy is safe and effective. This procedure has low complications and good survival.
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Objective To explore the effects of chlorhexidine aeetate and trielosan on inhibition of microorganism adhesion on soft denture-lining materials. Methods Silicone rubber soft denture- lining material and resin soft denture-lining material were soaked in 0. 2% chlorhexidine acetate and 0. 1% trielosan for 5 minutes. Then the colony numbers of three different microorganisms (streptococcus mutans, actinomyces viscosus, candida albicans) adhering to soft denture-lining materials were counted. Results The colony numbers of candida albicans were (121.0±7. 0) × 105 cfu/ml in resin soft denture-lining material and (208. 8±8. 6) × 105cfu/ml in silicone rubber soft denture-lining material (P<0. 05). But there were no differences in colony numbers of streptococcus mutans and actinomyces viseosus. After soaked in chlorhexidine acetate and triclosan, the colony numbers of streptococcus mutans were significantly reduced to (87.1±4. 3)× 105cfu/ml, (61.6± 7.9) × 105cfu/ml, (42.1±8.2) × 105cfu/ml and (21.3±4.3)× 105cfu/ml, and the colony numbers of candida albicans were significantly reduced to (11.6±3.6) × 105cfu/ml, (11.1±3. 7) × 105cfu/ml, (41.6±3.0) × 105cfu/ml and (44. 6±4.1)× 105cfu/ml(all P<0. 01). However, chlorhexidine acetate and triclosan had no effects on actinomyces viscosus. There were no significant differences in the action effects between the two detergents (P>0. 05). Conclusions Chlorhexidine acetate and trielosan can effectively inhibit the adhesion of microorganism on denture-lining materials, which are useful in clinic.
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Objective To study aesthetic effect of removable cosmetic resin veneer on the correction of heavy maxillary lateral incisor crossbite. Methods Eighteen appropriate volunteers with maxillary lateral incisor crossbite were corrected by removable cosmetic resin veneer. The effect was evaluated by subjective and objective satisfactory degree. Results All 18 patients treated with this method were satisfied with the results. Conclusion The effect of the aesthetic restoration on individual anterior tooth crossbite in adults is acceptable.