[Renal carcinoid tumor presenting as bladder tamponade: a case report and review of the Japanese cases].

A 65-year-old man presented with sudden onset of gross hematuria and urinary retention. Computed tomographic scan (CT) showed a cystic multilocular enhancing lesion (9 cm in diameter) at the left renal hilum causing thinning and lateral displacement of the left renal parenchyma. Left hydronephrosis and a renal calculi were observed. We performed radical nephrectomy suspecting a cystic renal cell carcinoma. Microscopic examination and immunohistochemical studies confirmed the diagnosis of the carcinoid tumor. The tumor cells were fully positive for neuron-specific enolase and keratin, and partially positive for chromogranin-A. One of the resected lymph nodes was positive for metastasis. Additional gastrointestinal tract examinations for carcinoid tumor were negative. However, he was concurrently diagnosed with poorly differentiated prostate cancer and hormonal therapy was started. He is free of recurrent carcinoid tumor nine months postoperatively. This case is the 31st report of renal carcinoid tumors in Japan.

[Cost-utility analysis of androgen ablation therapy in metastatic prostate cancer].

BACKGROUND: As Bayoumi, et al pointed out in their article (J. Natl. Cancer Inst. 2000, vol 92, p 1731), it is evident that treatment of prostate cancer with Luteinizing Hormone Releasing Hormone (LHRH) analogue costs more than treatment by bilateral orchiectomy. However, patients with metastatic prostate cancer are usually treated with LHRH analogue. Does this mean that urologist choose higher cost and less Quality-Adjusted Life Year (QALY) treatment? Therefore, we urologists should re-analyze their conclusion whether the treatment with LHRH analogue is really strictly dominated (high cost and low effect). MATERIAL AND METHOD: We performed a cost-utility analysis using the Markov model based on a formal meta-analysis and literature review, using the same assumptions as Bayoumi, et al, from the perspective of insurer. The base case was assumed to be a 65-year-old man with symptomatic metastatic prostate cancer. The model used time horizon of 10 years. Five androgen ablation therapies were evaluated as first-line therapy: diethylstilbestrol diphosphate (DES), orchiectomy, orchiectomy + nonsteroidal antiandrogen (NSAA), LHRH analogue and LHRH analogue + NSAA. Outcome measures were QALY, lifetime costs and incremental cost-effectiveness ratios. RESULTS: While DES was the least expensive therapy with the lowest QALY, LHRH analogue monotherapy was the second most expensive therapy with the longest QALY. Incremental cost-effectiveness ratios relative to DES of LHRH (yen 4,288,295/QALY) was cheaper than that of orchiectomy when quality of life (QOL) weight of orchiectomy was assumed to be 0.94 relative to that of LHRH analogue. Contrarily, LHRH analogue + NSAA is excluded with strict dominance and Orchiectomy + NSAA is excluded with extended dominance. CONCLUSION: Although LHRH analogue costs higher than orchiectomy, LHRH analogue can offer longer QALY than orchiectomy. Cost/QALY of LHRH analogue relative to DES is yen 4,288,295/QALY, which we considered to represent a good value. Choice of therapy depends on the patient's preference.

Predicting disease outcome of non-invasive transitional cell carcinoma of the urinary bladder using an artificial neural network model: results of patient follow-up for 15 years or longer.

BACKGROUND: Patients with non-invasive (Ta/T1) transitional cell carcinoma (TCC) of the urinary bladder are often observed without progression in the long-term follow-up period, although many of them experience recurrence of disease. It is difficult to accurately predict the disease outcome of each patient with Ta/T1 TCC using conventional prognostic criteria. In this study, we examined the usefulness of artificial neural networks (ANNs) to predict the long-term disease outcome of patients with TCC of the urinary bladder. METHODS: A retrospective, prognostic study of 90 patients with Ta/T1 TCC of the urinary bladder, diagnosed by transurethral resection of the bladder tumor between April 1981 and March 1985, and then followed up for 15 years or longer, was carried out. Data were analyzed using the Bayesian network tool of SPSS Neural Connection 2.1. The input neural data consisted of tumor stage, grade, tumor number, age, gender, tumor architecture and estimates of mean nuclear volume. The data set was randomly divided into 68 training and 22 testing examples for the prediction of disease progression and tumor recurrence within 15 years. RESULTS: During 15 years follow-up, tumor recurrence was noted in 42/90 (47%) Ta/T1 tumors. The ANN model could not predict tumor recurrence. Conversely, disease progression was noted in 17/90 (19%) Ta/T1 tumors, and, in the test set, 4/22 (18%) Ta/T1 tumors underwent disease progression. The sensitivity of the ANN model to predict progression was 100% (specificity 67%; positive predictive value 40%; negative predictive value 100%). Patients who were judged to have a favorable prognosis using ANN analysis did not progress within the 15-year follow-up period. CONCLUSION: The results of the ANN study indicate that long-term progression-free survival of patients with non-invasive TCC of the urinary bladder can be precisely predicted. A favorable prognosis using ANNs would be one of the exclusion criteria for immediate or future total cystectomy.