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Objective To compare the efficacy of extended pelvic lymph node dissection (ePLND) and standard pelvic lymph node dissection (sPLND) in open radical cystectomy.Methods We retrospectively analyzed the clinical data of 139 patients with bladder cancer cases in our hospital from January 2007 to January 2017,who underwent open radical cystectomy and pelvic lymph node dissection performed by the same group of surgeons.There were 117 males and 22 females,aged from 20 to 84 years old,with an average of (64.6 ± 11.7) years,91 patients were underwent ePLND group and 48 patients were underwent sPLND group.The preoperative anemia-free patients was compared between the ePLND group and the sPLND group [24 (50.0％)] vs.58 (54.9％),respectively],the patients with anemia were [24 (50.0％) vs.41 (45.1％)].The range of ePLND is:sway to the common iliac artery and the lower aortic (unreaching the inferior mesenteric artery);the lateral boundary to the reproductive femoral nerve;the distal end of the iliac artery at the groin level,the posterior border to the iliac vessels and closure,which contains the anterior tibial lymph nodes between the two sides.The range of sPLND is below the level of the common iliac artery bifurcation,and the rest of the range is the same as ePLND.The average operative time,average intraoperative blood loss,intraoperative blood transfusion,intraoperative and postoperative complications,postoperative eating time,postoperative activity time,postoperative exhaust time,postoperative hospital stay,mean gastric tube indwelling time,average pelvic drainage tube indwelling time,lymph nodes positive rate,lymph node density,and cancer-free survival were evaluated.Results All 139 patients underwent surgery successfully.The average operative time in the ePLND group and the sPLND group were [(351.2 ±79.5)min vs.(342.5 ± 69.3) min],average intraoperative blood loss [(314.6 ± 120.6) ml vs.(298.3 ± 126.3)ml],intraoperative blood transfusion [(702.9 ± 645.7) ml vs.(936.9 ± 818.1) ml],no intraoperative complications,postoperative complications [29 cases (31.9 ％) vs.18 cases (37.5 ％)],postoperative eating time [(5.4 ± 1.9) d vs.(4.8 ± 2.1) d],postoperative activity time [(2.1 ± 0.9) d vs.(1.9 ± 0.8) d],postoperative exhaust time [(3.8 ± 0.9) d vs.(3.6 ± 1.0) d],postoperative hospital stay [(14.9 ± 7.8) d vs.(15.5 ± 6.9) d],average gastric tube indwelling time [(4.8 ± 2.6) d vs.(4.53 ± 1.9) d],average pelvic drainage tube indwelling time [(11.1 ± 4.9) d vs.(10.9 ± 4.9) d],the difference was not statistically significant (P ＞ 0.05).A total of 2 359 lymph nodes were dissected from the two groups.The number of lymph nodes dissected in each of the ePLND group and the sPLND group was [(20.3 ± 3.8) vs.(10.6 ± 3.1),P ＜ 0.01],and the average number of positive lymph nodes was [(0.6 ± 1.3) vs.(0.3 ±1.0),P =0.034],the ratio of lymph node positive patients was [33 (36.3％) vs.9 (18.8％),P =0.026],and the lymph node density was [7.9％ (146/1848) vs.4.1％ (21/511)],the difference was statistically significant (P ＜ 0.05).In regard to prognosis,the disease-free survival rate (DFS) of ePLND group was 94.5％,91.0％,84.4％,81.1％,75.3％ at 1,2,3,4 and 5 years follow-up respectively.The other group was 70.5％,63.5％,57.8％,51.4％,41.1％ respectively.DFS of ePLND group tended to be higher than that of sPLND group in lymph node positive subgroups.The difference between the two groups was statistically significant (P ＜ 0.001).Conclusions In open radical cystectomy,ePLND and sPLND have similar surgical safety,but expanded lymph node dissection can improve disease-free survival in patients and improve the prognosis by increasing the detection range of positive lymph nodes.
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Objective: To analyze the clinical characteristics, pathological features and prognosis of 4167 patients with renal carcinoma. Methods: The clinical data of 4167 patients with renal carcinoma were retrospectively studied who were admitted and received renal cancer surgery in the First Medical Center of Chinese PLA General Hospital from Jan. 2008 to Sep. 2016. All the cases were followed up for 40(2-99) months. The general data, pathological features, tumor-node-metastasis (TNM) stage, tumor diameter, surgical and postoperative clinical indicators, postoperative metastasis of renal carcinoma, and postoperative mortality and survival of patients were analyzed. Results: The male-female ratio of the 4167 cases was 72.2%(3010 cases) and 27.8%(1157 cases) (2.6:1), age of ill onset was 0.3-86(52.4 ± 12.4) years old, high incidence age was 45-65 years old. Case load diagnosed with and without symptom was 20.7% (863 cases) and 79.3% (3304 cases), respectively. In pathological diagnosis, 3670 cases of suprarenal epithelioma accounted for 88.1% in all cases. Minimally invasive surgery was 3821 cases (91.7%), nephron sparing surgery (NSS) was 1698 cases (40.7%), radical nephrectomy (RN) was 2466 cases (59.2%), open surgery was 346 cases (8.3%), transperitoneal approach rate was 16.9% (705 cases) and retroperitoneal approach rate was 83.1% (3462 cases). The overall survival rate at 1, 3 and 5 year post-operation was 98.1%, 94.8% and 92.0%, respectively. Cancer specific survival rate (1, 3, 5 year) was 98.6%, 96.2% and 94.6%, respectively. Tumor-free survival rate was 96.4%, 92.8% and 90.7%, respectively. Conclusions: The high incidence age of renal cancer is about 50 years old, the prevalence rate of men is 2.6 times higher than that of women. The main pathological type of renal cancer is suprarenal epithelioma. The rate of asymptomatic consultation rate has increased significantly. Minimally invasive surgery is the main treatment method for kidney cancer. The 5-year overall survival rate of renal cell carcinoma has exceeded 91%, and the long-term prognosis is better.
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We compared the predictive ability of the 2014 and 2005 Gleason grading systems in 568 patients initially diagnosed with metastatic prostate cancer (PCA). Outcomes included the duration of castration-resistant prostate cancer-free survival (CFS) and overall survival (OS). Univariate analyses and log-rank tests were used to identify prognosis indicators and assess univariable differences in CFS and OS in Gleason score (GS) groups. Cox proportional hazards and area under the curves of receiver operator characteristics methods were used to evaluate the predictive efficacy of the 2005 and 2014 ISUP grading systems. Univariate analyses showed that the 2005 and 2014 grading systems were prognosticators for CFS and OS; both systems could distinguish the clinical outcome of patients with GS 6, GS 7, and GS 8-10. Using the 2014 criteria, no statistical differences in patient survival were observed between GS 3 + 4 and GS 4 + 3 or GS 8 and GS 9-10. The predictive ability of the 2014 and 2005 grading systems was comparable for CFS and OS (P = 0.321). However, the 2014 grading system did not exhibit superior predictive efficacy in patients initially diagnosed with PCA and bone metastasis; trials using larger cohorts are required to confirm its predictive value. To the best of our knowledge, ours is the first study to compare the 2005 and 2014 grading systems in initially diagnosed PCA with bone metastasis. At present, we recommend that both systems should be used to predict the prognosis of patients with metastatic PCA.