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【Objective】 To systematically evaluate the efficacy and safety of targeted drugs in the treatment of metastatic non-clear cell renal cell carcinoma (nccRCC) and to provide guidance for clinical treatment. 【Methods】 All observational studies and randomized controlled trials (RCTs) of nccRCC treated with targeted drugs were retrieved from the PubMed, Embase, the Cochrane Library and Web of Science. Three independent investigators screened the literature, extracted data and evaluated the quality of literature. The RCTs were evaluated using the Cochrane Handbook. One research with insufficient outcome data (follow-up bias) was assessed as high risk, and the other studies showed low or uncertain risk. The non-RCTs were evaluated with the JBI Quality Assessment Tool, and all studies displayed a low risk of bias. The data were analyzed with Stata 17.0 software. 【Results】 A total of 16 studies involving 989 patients were included. Meta-analysis showed that the objective response rate (ORR) was 12.6% (95%CI:8.1%-17.9%), the total disease control rate (DCR) was 65.3% (95%CI:58.3%-72.1%), the total median progression-free survival (PFS) was 5.80 (95%CI:4.69-6.91) months, and the median overall survival (OS) was 15.93 (95%CI:12.17-19.68) months. In subgroup analysis, the total ORR of patients with metastatic nccRCC treated with sunitinib and cabozantinib were 11.7% (95%CI:6.5%-18.0%) and 17.2% (95%CI:8.4%-28.2%), respectively. The total ORR of patients with papillary renal cell carcinoma was 9.1% (95%CI:2.4%-18.9%). 【Conclusion】 Targeted drugs have a significant effect on patients with metastatic nccRCC, but adverse reactions may occur. Targeted drugs have poor effects on metastatic papillary renal cell carcinoma, and cabozantinib may have greater survival benefits.
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【Objective】 To analyze the correlation between the expressions of CD10,CA9 and CD133 and the prognosis of patients with metastatic renal clear cell carcinoma (mccRCC) treated with sorafenib or sunitinib. 【Methods】 A total of 80 mccRCC patients who received sorafenib or sunitinib as first-line therapy were retrospectively enrolled. Immunohistochemical staining (IHC) was performed for CD10,CA9 and CD133 in tumor tissue samples to analyze the correlation between the expression of each marker and clinicopathologic variables. Univariate and multivariate Cox proportional risk models were used to analyze prognostic factors of progression free survival (PFS) and overall survival (OS),and Kaplan-Meier survival analysis was performed for CA9 expression and PFS,OS in the treatment subgroups. 【Results】 Altogether 37 patients (46.25%) had PFS,and the median PFS (mPFS) was 24.9 months (95%CI:16.5-33.2 months),while 55 patients (68.75%) died and the median OS (mOS) was 44.2 months (95%CI:14.6-73.7). Low expression of CD10 was correlated with high Fuhrman grade (χ2=6.241,P=0.012),lymph node metastasis (χ2=5.952,P=0.015),and the number of metastatic organs ≥2 (χ2=8.205,P=0.004). Univariate analysis showed that Fuhrman grade,number of metastatic organs and lymph node metastasis were the prognostic factors of PFS (P<0.05),while the number of metastatic organs,lymph node metastasis and CA9 expression were the prognostic factors of OS (P<0.05). Multivariate analysis showed that Fuhrman grade was an independent factor of PFS (HR=2.457,95%CI:1.126-5.365,P=0.024),and the number of metastatic organs was an independent prognostic factor of OS (HR=1.857,95%CI:1.048-3.290,P=0.034). Survival analysis in subgroups showed that high CA9 expression in the sorafenib group was associated with longer OS (HR=0.401,95%CI:0.204-0.787,P=0.008). 【Conclusion】 Low expression of CA9 is an non-independent risk factor for OS,while CD10 and CD133 cannot be used as prognostic factors for mccRCC patients. Since mccRCC patients with low CA9 expression have less survival benefit from sorafenib and sunitinib,they can choose target therapy combined with immunotherapy or dual immunotherapy according to the guidelines to improve prognosis.
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Objective@#To investigate the pathological characteristics of bladder low malignant potential papillary urothelial tumors (PUNLMP) and the predic factors of recurrence and pathological progress.@*Methods@#We retrospectively analyzed 150 patients of bladder PUNLMP in the Department of Urology of Xijing Hospital from February 2009 to February 2019. Among the 150 patients, 118 patients were males and 32 patients were females. The average age was 57 years, ranging 20-93 years. There were 112 cases of single tumor and 38 cases of multiple tumor. All patients received transurethral resection of bladder tumor (TURBT) and 136 patients received bladder infusion chemotherapy, including 61 patients for pirarubicin, 58 patients for gemcitabine, 11 patients for epirubicin, and 11 patients for mitomycin. 14 patients did not receive bladder infusion chemotherapy. In this study, univariate and multivariate logistic regression analysis were used to investigate independent predictors of recurrence and pathological progression in patients of bladder PUNLMP who received TURBT.@*Results@#The average follow-up time was 25.6 months, ranging 5.5-122.7 months. Among the patients, 21 patients occurred recurrence. The recurrent duration ranged from 2.2 to 108.3 months (mean 23.1 months). 12 patients had pathological progression, including 9 patients for low-grade non-invasive papillary urothelial carcinoma, 1 patient for high-grade non-invasive papillary urothelial carcinoma, 1 patient for high-grade invasive urothelial carcinoma, 1 patient for squamous cell carcinoma. The progressive duration ranged from 2.2 to 56.3 months (mean 21.5 months). Among the 150 patients, 18 patients with inverted growth pattern did not recur. There were significant differences in the number of tumors and the tumor length between the recurrence and non-recurrence groups, same as the progression and non-progression groups. The univariate and multivariate logistic regression analysis results showed that the number of tumors was an independent predictor of tumor recurrence (OR=7.884, 95%CI 2.815-22.082, P<0.05)and progression(OR=6.107, 95%CI 1.659-22.473, P=0.006) in patients of bladder PUNLMP. Bladder infusion chemotherapy failed to reduce the risk of recurrence and progression.@*Conclusions@#About 14% (21/150) patients of bladder PUNLMP reoccurred after TURBT. About half of them had pathological progression, and most of them progressed to low-grade non-invasive papillary urothelial carcinoma. Multiple tumors was an independent risk factor for postoperative recurrence and progression. Bladder infusion chemotherapy did not reduce the risk of recurrence and progression in patients of bladder PUNLMP.
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Objective:To construct an effective survival nomogram for patients with clear cell renal cell carcinoma (ccRCC) using a large sample sized Chinese dataset, which can be used to predict individual 3- and 5-year overall survival (OS) precisely.Methods:The data of 672 ccRCC patients received operation diagnosed at Xijing Hospital from January 2012 to December 2016 were retrospectively analyzed. There were 467 males and 205 females. Their median age was 56 years old (ranging 23-83 years old). There were 327 patients with tumor on the left kidney and 345 patients with tumor on the right kidney. Clinical stageⅠ, Ⅱ, Ⅲ, Ⅳ were 584, 47, 19 and 22 cases, respectively. At the time of diagnosis, 504 patients were asymptomatic and 168 patients were symptomatic. Preoperative alkaline phosphatase was 80 (41-240) U/L. Preoperative serum albumin was 44.8 (30.5-59.8) g/L. Preoperative neutrophil absolute value/lymphocyte absolute value (NLR) was 2.25 (0.81-9.89). Preoperative platelet count was 205 (82-589)×10 9/L. Preoperative creatinine was 97 (55-230) μmol/L. Radical nephrectomy was performed in 420 (62.5%) patients and partial nephrectomy was performed in 252 patients. Cox multivariate analysis was used to determine the independent predictors of the postoperative OS. Then, the nomogram was constructed using R software, which integrates all independent predictors according to the coefficients in the multivariate analysis. Moreover, the performance of the nomogram was evaluated using the consistency index (C-index) and the calibration plots. Results:Cox multivariate analysis results showed that age at diagnosis ( P<0.001), clinical TNM stage ( P<0.001), preoperative NLR ( P=0.012), preoperative alkaline phosphatase ( P=0.002) and preoperative albumin ( P<0.001) were the independent predictors of postoperative OS in ccRCC patients. The nomogram established by integrating these five factors had a good discriminatory ability (C-index=0.819, 95% CI 0.813-0.825), and the calibration plots showed that excellent agreements between the nomogram prediction and the actual observation were achieved. Conclusions:Based on a large sample sized Chinese dataset, this study established an effective survival model for patients with ccRCC and good performance of the nomogram was demonstrated by internal validation. Our nomogram can help urologists to predict individual 3- and 5-year OS accurately for Chinese ccRCC patients.
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Objective:To investigate the prognostic factors of renal function after nephron sparing surgery (NSS) in renal tumor patients.Methods:The data of 115 patients who underwent NSS in our hospital from December 2016 to December 2018 were retrospectively analyzed. There were 75 males and 40 females, aged (49.50±12.94) years. The body mass index was (24.59±3.59) kg/m 2. The maximum diameter of the tumor was (3.66±1.32) cm. The R. E.N.A.L. score was (6.43±1.60). Laparoscopic partial nephrectomy was performed in 61 cases and robot-assisted laparoscopic partial nephrectomy was performed in 54 cases, and all of which were successfully completed. Operative time, WIT and postoperative pathological results were recorded. Blood creatinine value, GFR of affected kidney, GFR of healthy kidney, total GFR, GFR preserving rate (the ratio of postoperative GFR to preoperative GFR), functioning parenchymal volume (FPV) of the affected kidneys, and FPV preserving rate of the affected kidneys (the ratio of postoperative FPV and preoperative FPV) were recorded 6 months after surgery. FPV was measured by the ellipsoid approximation on CT images before and after surgery. Paired sample t test was used to compare GFR and FPV before and after surgery. Spearman rank correlation analysis was used to evaluate the correlation between the study factors and GFR preserving rate of the affected kidneys. Multivariate linear regression models were used to analyze independent predictors of renal function of the affected kidneys. Independent sample t test was used for comparison between group of WIT≤25 min and group of WIT>25 min. Results:All of the 115 patients in this study underwent successfully operations, with the median operation time of 135(75-245) min, and WIT(24.57±5.51) min. Postoperative GFR of the affected kidneys(35.50±7.81)ml/(min·1.73 m 2) was significantly different from preoperative GFR( P<0.001). The FPV preserving rate of the affected kidneys was (84.28±4.37)%, which was significantly lower than that preoperative FPV of the affected kidneys ( P<0.001). Spearman rank correlation analysis showed that there was a strong positive correlation between the FPV preserving rate of the affected kidneys and the GFR preserving rate of the affected kidneys ( r=0.802), WIT was negatively correlated with the GFR preserving rate of the affected kidneys ( r=-0.503). Multiple linear regression analysis showed that preoperative GFR of the affected kidneys ( b=-0.150, P=0.008), WIT ( b=-0.443, P<0.001) and the FPV preserving rate of the affected kidneys ( b=1.638, P<0.001) were independent predictors of the GFR preserving rate of the affected kidneys. WIT>25 min group had a significantly lower GFR preserving rate of the affected kidneys than WIT≤25 min group [(68.77±10.88)% vs.(79.34±8.88)%, P<0.001]. Conclusions:In the case of short WIT (<30 min), the reservation of normal renal tissue is the most important variable prognostic factor of renal function after NSS, and short WIT plays a secondary role. Under the premise of complete tumor resection, normal renal tissue should be reserved as much as possible and WIT should be controlled within 25 min.
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Objective To investigate the pathological characteristics of bladder low malignant potential papillary urothelial tumors (PUNLMP) and the predic factors of recurrence and pathological progress.Methods We retrospectively analyzed 150 patients of bladder PUNLMP in the Department of Urology of Xijing Hospital from February 2009 to February 2019.Among the 150 patients,118 patients were males and 32 patients were females.The average age was 57 years,ranging 20-93 years.There were 112 cases of single tumor and 38 cases of multiple tumor.All patients received transurethral resection of bladder tumor (TURBT) and 136 patients received bladder infusion chemotherapy,including 61 patients for pirarubicin,58 patients for gemcitabine,11 patients for epirubicin,and 11 patients for mitomycin.14 patients did not receive bladder infusion chemotherapy.In this study,univariate and multivariate logistic regression analysis were used to investigate independent predictors of recurrence and pathological progression in patients of bladder PUNLMP who received TURBT.Results The average follow-up time was 25.6 months,ranging 5.5-122.7 months.Among the patients,21 patients occurred recurrence.The recurrent duration ranged from 2.2 to 108.3 months (mean 23.1 months).12 patients had pathological progression,including 9 patients for low-grade non-invasive papillary urothelial carcinoma,1 patient for high-grade noninvasive papillary urothelial carcinoma,1 patient for high-grade invasive urothelial carcinoma,1 patient for squamous cell carcinoma.The progressive duration ranged from 2.2 to 56.3 months (mean 21.5 months).Among the 150 patients,18 patients with inverted growth pattern did not recur.There were significant differences in the number of tumors and the tumor length between the recurrence and non-recurrence groups,same as the progression and non-progression groups.The univariate and multivariate logistic regression analysis results showed that the number of tumors was an independent predictor of tumor recurrence (OR =7.884,95％ CI 2.815-22.082,P ＜ 0.05) and progression (OR =6.107,95％ CI 1.659-22.473,P =0.006) in patients of bladder PUNLMP.Bladder infusion chemotherapy failed to reduce the risk of recurrence and progression.Conclusions About 14％ (21/150) patients of bladder PUNLMP reoccurred after TURBT.About half of them had pathological progression,and most of them progressed to low-grade noninvasive papillary urothelial carcinoma.Multiple tumors was an independent risk factor for postoperative recurrence and progression.Bladder infusion chemotherapy did not reduce the risk of recurrence and progression in patients of bladder PUNLMP.
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Objective To evaluate the efficacy and adverse events of adjuvant targeted therapy for non-distant metastatic renal cell carcinoma (ndmRCC).Methods A comprehensive literature search was conducted in PubMed,SpringerLink,Web of Science,and the Cochrane Library.All clinical randomized controlled trials on adjuvant targeting therapy for ndmRCC were retrieved.Literature screening,data extraction and literature quality evaluation were conducted by three researchers independently,and metaanalysis was performed using Review Manager Version 5.3.Outcomes we were interested in included progression-free survival (PFS),overall survival (OS),and adverse events.Results A total of 4 RCTs with 5 studies and 4 944 ndmRCC patients were selected for meta-analysis.Targeted adjuvant therapy improved the PFS of ndmRCC patients.The hazard ratio (HR) was 0.92(95％ CI0.85-1.00,P =0.05) between the targeted therapy group and the placebo group.With the extension of follow-up,this effect was more significant,and the HR was 0.89 (95％ CI0.81-0.97,P =0.01).However,targeted adjuvant therapy did not extend the OS of ndmRCC patients,and the HR was 0.92(95％ CI0.81-1.05,P =0.22).Compared with the placebo,targeted adjuvant therapy increased the incidence of adverse events and the number of patients who had to discontinue because of adverse events was also increased.The odds ratios were 6.03 (95％ CI5.30-6.86,P ＜ 0.001) and 7.65 (95 ％ CI6.31-9.26,P ＜ 0.001),respectively.Conclusions Targeted adjuvant therapy can improve the PFS of ndmRCC patients after surgery,but it cannot improve the OS.At the same time,it increases the incidence of adverse events.
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Objective To explore the independent predictors for recurrence-free survival (RFS) in patients with papillary renal cell carcinoma (PRCC),and establish a nomogram to predict individual 2-year RFS.Methods The data of patients diagnosed in Xijing Hospital of the Air Force Medical University from June 2009 to May 2018 were retrospectively analyzed.A total of 71 patients with primary T1-4 N0M0 unilateral tumor were included in this study.The median age was 54 (range from 25 to 83) years.There were 51 males and 20 females.There were 27 cases of type Ⅰ,44 cases of type Ⅱ,36 cases of left tumor and 35 cases of right tumor.Patients with clinical Ⅰ,Ⅱ,Ⅲ,Ⅳ stage were 47 cases,12 cases,9 cases and 3 cases,respectively.Tumor necrosis occurred in 15 cases (21.1％).The average preoperative alkaline phosphatase (ALP) was 89.0(43.0-217.0) U/L,the average preoperative hemoglobin (Hb)was (132.5 ± 19.9) g/L,with 20 cases (28.2％) of Hb ＜ 120 g/L before surgery;the average of preoperative Hb was (132.5 ± 19.9) g/L,among which 20 cases (28.2％) had Hb ＜ 120 g/L before surgery;the average of preoperative neutrophils/lymphocytes (NLR) was 2.40 (1.03-6.77);radical nephrectomy was performed in 43 patients and nephrectomy was performed in 28 patients.The 1-,2-,and 3-year RFS were calculated using Kaplan-Meier method and the differences among different subgroups were assessed using Log-rank test.Univariate and multivariate Cox regression analysis were used to identify the independent predictors for RFS,and the nomogram was developed using R software according to the results of multivariate Cox regression analysis.Furthermore,the predictive ability of the nomogram was internally validated using the Bootstrap method by calculating the C-index and drawing the calibration plot.Results After a median follow-up of 41 (range from 25 to 83) months,16 (22.5 ％) recurrence occurred,including 4 local recurrence and 12 distant recurrence,and 11 (68.8％) patients relapsed within 2 years after surgery.The 1,2,and 3-year RFS were 88.6％,80.4％,and 78.7％,respectively.Clinical stage Ⅱ (HR=3.655,95％CI 1.036-12.890,P =0.044) and stage ≥Ⅲ(HR =3.654,95％CI 1.008-13.248,P =0.049),preoperative ALP ≥ 90U/L (HR =3.274,95％ CI 1.044-10.267,P =0.042),preoperative Hb ＜ 120 g/L (HR =4.771,95％ CI 1.553-14.660,P =0.006),and preoperative NLR ≥2.40(HR =4.701,95％ CI 1.238-17.849,P =0.023) were identified as independent risk factors for RFS.On internal validation,the nomogram which integrates the four predictors of clinical stage,preoperative ALP,preoperative HB and preoperative NLR,has a good predictive performance (C-index =0.829,95％CI0.819-0.839).Conclusions In the present study based on single center data,clinical stage Ⅱ and ≥ Ⅲ,preoperative ALP≥90 U/L,preoperative Hb ＜ 120 g/L and preoperative NLR ≥2.40 were independent predictors for postoperative RFS in patients with PRCC,and a new preoperative nomogram for predicting individual postoperative 2-year RFS was established,which would be helpful for urologists to develop more systematic treatment plans.
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Objective@#To investigate the independent predictors of inguinal lymph node metastasis (LLM) in patients with penile squamous cell carcinoma (SCCP), and to establish a nomogram for predicting individual LLM risk.@*Methods@#The data of patients with SCCP diagnosed at the department of urology, Xijing Hospital from July 2009 to June 2019 were analyzed retrospectively. A total of 101 patients were included in this study, with age of 55 (26-84) years. There were 25 (24.8%) and 76 (75.2%) patients with and without palpable inguinal lymph node enlargement, respectively. There were 47 cases (46.5%), 40 cases (39.6%) and 14 cases (13.9%) in T1, T2 and T3 stages, respectively; there were 67 cases (66.3%), 21 cases (20.8%) and 13 cases (12.9%) in Broder 1, 2 and 3, respectively. The average value (or median) of fibrinogen was 2.84 (1.72-5.00)g/L; alkaline phosphatase was 80(32±214)U, hemoglobin was 147(81-180)g, platelet count was (193.74±65.68×109/L, absolute value of neutrophils, monocytes and lymphocytes were 3.98(1.19-11.85)×109/L, 0.44(0.17-1.90)×109/L and 1.68(0.58-4.13)×109/L, respectively. The average (or median) value of PLR, NLR and LMR were 113.38(18.80-418.42), 2.42(0.59-10.22) and 3.84 (1.08-9.89), respectively. There were 26 cases (25.7%) with LLM and 75 cases (74.3%) without LLM. The independent predictors of LLM were identified by univariate and multivariate logistic regression analyses. The R software was used to establish the nomogram by integrating all independent predictors, and the bootstrap method was used to internally validated our nomogram, where the value of AUC (area under the ROC curve) was calculated and the calibration plot was drawn.@*Results@#Clinical inguinal lymph node status (P<0.006), T stage (P<0.021), Broder grade (P<0.017) and absolute neutrophil value (P<0.043) were independent predictors of LLM. The accuracy of our nomogram was 0.875 (AUC=0.875, 95%CI 0.859-0.891); Moreover, the risk of LLM predicted by nomogram was in good consistency with the actual LLM rate, and the errors of the nomogram-predicted LLM risks were all within 10%.@*Conclusions@#Clinical inguinal lymph node status, T stage, broder grade and absolute value of neutrophils were identified as independent predictors of LLM in patients with SCCP on the basis of single center data. A generic nomogram predicting LLM risk for Chinese patients was developed, which would be helpful to screen SCCP patients who need prophylactic inguinal lymph node dissection.
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Objective@#To explore the independent predictors for disease-specific survival (DSS) rate in patients with stage N1-3 testicular seminoma (TS), and establish a nomogram to predict individual 5-year DSS.@*Methods@#The data of N1-3 TS patients registered in the SEER database of National Cancer Institute (USA) from January 2004 to December 2015 were retrospectively analyzed. The 5-year overall survival (OS) rate and DSS rate were calculated using Kaplan-Meier method and the differences among different subgroups were assessed using log-rank test. Besides, the independent predictors of DSS were defined using multivariate Cox regression analysis, and nomogram was drawn using R software. Furthermore, the predictive performance of the nomogram was internally validated using the C-index and calibration plot.@*Results@#TNM stage ⅢA (HR=5.604, 95%CI: 1.252-25.083, P=0.024), ⅢB (HR=6.710, 95%CI: 1.923-23.410, P=0.003) and ⅢC (HR=13.189, 95%CI: 3.916-44.420, P<0.001), age at diagnosis ≥45 years old (HR=3.575, 95%CI: 2.014-6.344, P<0.001), and patients without spouse (HR=2.346, 95%CI: 1.406-3.914, P=0.001) were identified as independent risk factors for DSS. On internal validation, the predictive accuracy of our nomogram was 0.751 (C-index: 0.751, 95%CI: 0.694-0.808). Besides, the calibration plot showed that the predicted survival outcomes were highly consistent with the actual survival outcomes.@*Conclusion@#The study confirms that age at diagnosis ≥45 years old, TNM stage ≥ⅢA and patients without spouse are the independent risk factors for DSS in TS patients with stage N1-3, and the nomogram for predicting individual 5-year DSS is established.
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Objective@#To explore the independent predictors for recurrence-free survival (RFS) in patients with papillary renal cell carcinoma (PRCC), and establish a nomogram to predict individual 2-year RFS.@*Methods@#The data of patients diagnosed in Xijing Hospital of the Air Force Medical University from June 2009 to May 2018 were retrospectively analyzed. A total of 71 patients with primary T1-4N0M0 unilateral tumor were included in this study. The median age was 54 (range from 25 to 83) years. There were 51 males and 20 females. There were 27 cases of typeⅠ, 44 cases of type Ⅱ, 36 cases of left tumor and 35 cases of right tumor. Patients with clinical Ⅰ, Ⅱ, Ⅲ, Ⅳ stage were 47 cases, 12 cases, 9 cases and 3 cases, respectively. Tumor necrosis occurred in 15 cases (21.1%). The average preoperative alkaline phosphatase (ALP) was 89.0(43.0-217.0) U/L, the average preoperative hemoglobin (Hb) was (132.5±19.9) g/L, with 20 cases (28.2%) of Hb<120 g/L before surgery; the average of preoperative Hb was (132.5±19.9) g/L, among which 20 cases (28.2%) had Hb<120 g/L before surgery; the average of preoperative neutrophils/lymphocytes (NLR) was 2.40 (1.03-6.77); radical nephrectomy was performed in 43 patients and nephrectomy was performed in 28 patients. The 1-, 2-, and 3-year RFS were calculated using Kaplan-Meier method and the differences among different subgroups were assessed using Log-rank test. Univariate and multivariate Cox regression analysis were used to identify the independent predictors for RFS, and the nomogram was developed using R software according to the results of multivariate Cox regression analysis. Furthermore, the predictive ability of the nomogram was internally validated using the Bootstrap method by calculating the C-index and drawing the calibration plot.@*Results@#After a median follow-up of 41 ( range from 25 to 83) months, 16 (22.5%) recurrence occurred, including 4 local recurrence and 12 distant recurrence, and 11 (68.8%) patients relapsed within 2 years after surgery. The 1, 2, and 3-year RFS were 88.6%, 80.4%, and 78.7%, respectively. Clinical stage Ⅱ (HR=3.655, 95%CI 1.036-12.890, P=0.044) and stage ≥Ⅲ(HR=3.654, 95%CI 1.008-13.248, P=0.049), preoperative ALP≥90U/L(HR=3.274, 95%CI 1.044-10.267, P=0.042), preoperative Hb<120 g/L (HR=4.771, 95%CI 1.553-14.660, P=0.006), and preoperative NLR≥2.40(HR=4.701, 95%CI 1.238-17.849, P=0.023) were identified as independent risk factors for RFS. On internal validation, the nomogram which integrates the four predictors of clinical stage, preoperative ALP, preoperative HB and preoperative NLR, has a good predictive performance (C-index =0.829, 95%CI 0.819-0.839).@*Conclusions@#In the present study based on single center data, clinical stage Ⅱ and ≥Ⅲ, preoperative ALP≥90 U/L, preoperative Hb<120 g/L and preoperative NLR ≥2.40 were independent predictors for postoperative RFS in patients with PRCC, and a new preoperative nomogram for predicting individual postoperative 2-year RFS was established, which would be helpful for urologists to develop more systematic treatment plans.
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Objective To investigate the independent predictors of inguinal lymph node metastasis (LLM) in patients with penile squamous cell carcinoma (SCCP),and to establish a nomogram for predicting individual LLM risk.Methods The data of patients with SCCP diagnosed at the department of urology,Xijing Hospital from July 2009 to June 2019 were analyzed retrospectively.A total of 101 patients were included in this study,with age of 55 (26-84) years.There were 25 (24.8％) and 76 (75.2％) patients with and without palpable inguinal lymph node enlargement,respectively.There were 47 cases (46.5 ％),40 cases (39.6％) and 14 cases (13.9％) in T1,T2 and T3 stages,respectively;there were 67 cases (66.3％),21 cases (20.8％) and 13 cases (12.9％) in Broder 1,2 and 3,respectively.The average value (or median) of fibrinogen was 2.84 (1.72-5.00) g/L;alkaline phosphatase was 80 (32 ± 214) U,hemoglobin was 147 (81-180) g,platelet count was (193.74 ± 65.68 × 109/L,absolute value of neutrophils,monocytes and lymphocytes were 3.98(1.19-11.85) × 109/L,0.44(0.17-1.90) × 109/L and 1.68(0.58-4.13) × 109/L,respectively.The average (or median) value of PLR,NLR and LMR were 1 13.38 (18.80-418.42),2.42 (0.59-10.22) and 3.84 (1.08-9.89),respectively.There were 26 cases (25.7％) with LLM and 75 cases (74.3％) without LLM.The independent predictors of LLM were identified by univariate and multivariate logistic regression analyses.The R software was used to establish the nomogram by integrating all independent predictors,and the bootstrap method was used to internally validated our nomogram,where the value of AUC (area under the ROC curve) was calculated and the calibration plot was drawn.Results Clinical inguinal lymph node status (P ＜0.006),T stage (P ＜0.021),Broder grade (P ＜ 0.017) and absolute neutrophil value (P ＜ 0.043) were independent predictors of LLM.The accuracy of our nomogram was 0.875 (AUC =0.875,95％ CI 0.859-0.891);Moreover,the risk of LLM predicted by nomogram was in good consistency with the actual LLM rate,and the errors of the nomogram-predicted LLM risks were all within 10％.Conclusions Clinical inguinal lymph node status,T stage,broder grade and absolute value of neutrophils were identified as independent predictors of LLM in patients with SCCP on the basis of single center data.A generic nomogram predicting LLM risk for Chinese patients was developed,which would be helpful to screen SCCP patients who need prophylactic inguinal lymph node dissection.
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Objective To explore the independent predictors for disease-specific survival (DSS) rate in patients with stage N1-3 testicular seminoma (TS),and establish a nomogram to predict individual 5-year DSS.Methods The data of N1-3 TS patients registered in the SEER database of National Cancer Institute (USA) from January 2004 to December 2015 were retrospectively analyzed.The 5-year overall survival (OS) rate and DSS rate were calculated using Kaplan-Meier method and the differences among different subgroups were assessed using log-rank test.Besides,the independent predictors of DSS were defined using multivariate Cox regression analysis,and nomogram was drawn using R software.Furthermore,the predictive performance of the nomogram was internally validated using the C-index and calibration plot.Results TNM stage ⅢA (HR =5.604,95％ CI:1.252-25.083,P =0.024),ⅢB (HR =6.710,95％ CI:1.923-23.410,P =0.003) and ⅢC (HR =13.189,95％ CI:3.916-44.420,P ＜ 0.001),age at diagnosis ≥45 years old (HR =3.575,95％ CI:2.014-6.344,P ＜ 0.001),and patients without spouse (HR =2.346,95％ CI:1.406-3.914,P =0.001) were identified as independent risk factors for DSS.On internal validation,the predictive accuracy of our nomogram was 0.751 (C-index:0.751,95％ CI:0.694-0.808).Besides,the calibration plot showed that the predicted survival outcomes were highly consistent with the actual survival outcomes.Conclusion The study confirms that age at diagnosis ≥45 years old,TNM stage ≥ ⅢA and patients without spouse are the independent risk factors for DSS in TS patients with stage N1-3,and the nomogram for predicting individual 5-year DSS is established.