[Preoperative Lymphocyte-to-monocyte Ratio Predicts Prognosis in Patients with Stage T1 Non-muscle Invasive Bladder Cancer].

Objective To investigate the clinical value of preoperative lymphocyte-to-monocyte ratio(LMR)in evaluating the prognosis of patients with stage T1 non-muscle invasive bladder cancer(NMIBC).Methods A total of 215 patients with stage T1 NMIBC who underwent transurethral resection of bladder tumor were enrolled.Clinical data were collected.Patients were followed up and their disease-free survival(DFS)and overall survival(OS)were recorded.The receiver operating characteristic(ROC)curve of preoperative LMR in detecting patient prognosis was used to determine the optimal cut-off value for LMR.Patients were divided into low LMR group(LMR <3.86,n=77)and high LMR group(LMR ≥ 3.86,n=138).Kaplan-Meier survival curves were explored to compare cumulative DFS and OS rates in patients with different LMR levels,and COX proportional hazards regression model was used to analyze factors associated with DFS and OS.Results All these 215 patients with T1 stage NMIBC were followed up for 2-92 months,and the DFS rate was 59.07% and OS rate was 65.12%.Kaplan-Meier curves showed that the cumulative DFS rate(χ 2=4.784,P=0.029)and cumulative OS rate(χ 2=7.146, P=0.008)in the low LMR group were significantly lower than those in the high LMR group.Tumor size ≥ 3 cm(HR=1.398,95% CI:1.042-1.875,P=0.025),pathological grade G3(HR=1.266,95% CI:1.026-1.563,P=0.028),and LMR ≥ 3.86(HR=2.347,95% CI:1.080-5.101,P=0.031)were independent factors associated with DFS in patients with stage T1 NMIBC.In addition,tumor size ≥ 3 cm(HR=1.228,95% CI:1.015-1.484,P=0.034),pathological grade G3(HR=1.366,95% CI:1.017-1.834,P=0.038),and LMR<3.86(HR=2.008,95% CI:1.052-3.832,P=0.035)were independent factors associated with OS in patients with T1 stage NMIBC. Conclusion Preoperative LMR is an independent factor associated with patients' prognosis in T1 stage NIMBC.Patients with low LMR tend to have higher risk of NMIBC progression and death.

Clinicopathologic Comparison of Urothelial Bladder Carcinoma in Young and Elder Patients.

Bladder cancer (BC) is a common aggressive malignancy and Urothelial bladder cancer (UBC) consists of the majority of BC. There is uncertainty regarding the clinicopathologic characteristics of UBCs in younger patients. To investigate the clinicopathologic features of young patients with UBCs. A total of 2825 pathological records of UBC patients, including 42 young patients (≤ 30 years old) and 2783 elder patients (> 30 years old), were retrospectively studied. The stage distribution classified was statistically significant (Χ (2) = 12.25, P = 0.02) between young and old patients; superficial tumors was far more in young patients than in old patients. More young patients tended to be low- and moderate-grade UBCs (Χ (2) = 6.75, P = 0.009). Young patients with superficial UBCs also showed lower recurrence rate, compared to elder patients (Χ (2) = 5.77, P = 0.02). For 5-year survival rate, young patients (93.8%) showed better than elder patients (85.1%) (Χ (2) = 4.01, P = 0.045). Patients younger than 30 years old with UBCs had low-grade and low-stage tumors and exhibited better prognosis than elder patients.

Serum CA 19-9 as a good prognostic biomarker in patients with bladder cancer.

BACKGROUND: Bladder cancer (BC) is the second leading malignant tumors of the genitourinary system. CA 19-9 has served as a diagnostic and prognostic marker for pancreatic carcinoma for years. In recent year, although a few studies have evaluated the roles of CA 19-9 in BC, the results are conflicting and the number of the patients studied is very small. AIM: To investigate the potential of serum CA 19-9 to serve as a diagnostic and prognostic marker of BC in a larger number of patients. METHODS: A total of 272 (144 BC patients and 128 healthy subjects) were enrolled. Patients were followed-up routinely at 3-month intervals for 5 years. Serum CA 19-9 level was detected by ELISA. RESULTS: CA 19-9 level was much higher than that in healthy subjects (43.69 ± 6.92 U/ml vs. 12.31 ± 4.39 U/ml, p < 0.001). However, when the value of 37 U/ml of serum CA 19-9 was used as the cut-off value for BC the sensitivity of CA 19-9 for BC was dropped to 38.8%. CA 19-9 was much higher in muscle invasive tumor subgroup than that in superficial tumor subgroup (38.09 ± 7.14 U/ml vs. 20.71 ± 4.15 U/ml, p < 0.027). CA 19-9 level was comparable in both subgroups (29.78 ± 5.07 U/ml vs. 26.13 ± 5.97 U/ml, p = 0.565). BC patients with more than 5 years survival time had lower serum CA 19-9 level than the rest (15.86 U/ml vs 46.68 U/ml, p < 0.001). Survival rate (>5 years) of patients with lower CA 19-9 levels (<29 U/ml) was significantly increased in comparison to those with elevated serum CA 19-9 levels (>29 U/ml) (p < 0.001). CONCLUSIONS: serum CA 19-9 is not a good diagnostic maker, but a very powerful prognostic marker for BC. Such a study might be helpful for urologists to manage patients with BC.

Fluorescent "turn-on" detecting CN(-) by nucleophilic addition induced Schiff-base hydrolysis.

A new chemosensor Sz based on Schiff-base group as recognition site and naphthalene as the fluorescence signal group was designed and synthesised. It could fluorescent "turn-on" detect cyanide (CN(-)) via a novel mechanism of nucleophilic addition induced Schiff-base hydrolysis. Adding the CN(-) into the solution of Sz could induce Sz to emit blue fluorescence at 435 nm instantly. Moreover, Sz could also colorimetric detect CN(-). Upon the addition of CN(-), the Sz showed dramatic color change from yellow to colorless. These sensing procedures could not be interfered by other coexistent competitive anions such as F(-), AcO(-), H2PO4(-) and SCN(-). In addition, Sz showed high sensitivity for CN(-), the detection limits is 3.42×10(-8) M of CN(-), which is far lower than the WHO guideline of CN(-) in drinking water (less than 1.9×10(-6) M). The CN(-) test strips based on Sz could act as a convenient CN(-) test kits.

A highly selective fluorescent chemosensor for iron ion based on 1H-imidazo [4,5-b] phenazine derivative.

Two kinds of fluorescent sensors (S and S1) for Fe(3+) bearing 1H-Imidazo [4,5-b] phenazine derivatives have been designed and synthesized. Between the two sensors, S showed excellent fluorescent specific selectivity and high sensitivity for Fe(3+) in DMSO solution. The test strip based on S was fabricated, which could act as a convenient and efficient Fe(3+) test kit. The recognition mechanism of the sensor toward Fe(3+) was evaluated by MS, IR and XRD. The detection limit of the sensor S towards Fe(3+) is 4.8×10(-6)M. And other cations, including Hg(2+),Ag(+), Ca(2+), Cu(2+), Co(2+), Ni(2+), Cd(2+), Pb(2+), Zn(2+), Cr(3+), and Mg(2+) had no influence on the probing behavior.

[Clinical character of metanephric adenoma of the kidney: a case report].

To investigate the clinicopathological characteristics of metanephric adenoma (MA), we analyzed the clinical and pathological data of metanephric adenoma. A 39-year old woman with asymptomatic right kidney tumor for 4 years was admitted to the hospital. A tumor with the largest diameter of 28 mm in the right kidney was homogeneously enhanced on CT. The tumor was distinctly increased as compared with 4 years before. The diagnosis was right kidney tumor. Nephron-sparing surgery was given after general anaesthesia. And the relative literature was reviewed. The tumor was homogeneous, with integrity tegument, and a grey cutting surface. Histopathologically, the tumor cells formed an adenoid or papillary pattern and contained psammoma bodies. Immunohistologically, they were positive for AE1/AE3, vimentin and WT1, negative for CK7, EMA and RCC. Pathological diagnosis was metanephric adenoma. The follow-up data of 24 months were available and without recurrence. MA is peculiar. It is difficult to get the final diagnosis of MA only by imaging characters. Nephron-sparing surgery is eligible for the treatment of MA. Considering the uncertainty of the biological behavior and cellular origin of MA, a long-term active surveillance is necessary.

Simultaneous renal clear cell carcinoma and gastrointestinal stromal tumor in one case.

Renal cell carcinoma is a tumor in kidney, while gastrointestinal stromal tumors are localized in the stomach and small intestine. They seldom occur simultaneously in sporadic case, both of which were suspective to sunitinib, a tyrosine kinases (RTKs) inhibitor. Our current case is novel in that concurrent RTK-related tumors are involved in one case. One possible explanation is the presence of some activating mutations.

Evaluation of retroperitoneoscopic partial nephrectomy with in situ hypothermic perfusion.

BACKGROUND: The objective of this study was to evaluate the clinical application value of in situ hypothermic perfusion of kidneys during retroperitoneal laparoscopic partial nephrectomy (RLPN). METHODS: We used in situ hypothermic perfusion of kidneys during RLPN in 12 patients with renal tumour. Renal arterial-catheterisation for temporary balloon occlusion of renal artery was used Hypothermic ischaemia was achieved by continuous perfusion of Ringer's solution at 4°C through the renal artery.The collecting system was repaired by 4/0 Dixon and renal reconstruction was performed by 1/0 Dixon.We compared data between the RLPN group and open partial nephrectomy (OPN) group. RESULTS: All RLPN operations were successfully completed. Ten of their pathological results were renal cell carcinoma, while two were reninoma and harmatoma respectively. Entry to the collecting system in two patients was repaired intraoperatively. No additional vascular repair was done. There were no significant postoperative complications. The renal function of the kidney was well preserved postoperatively. Neither local recurrence nor distant metastasis was found during the follow-up. There was a statistically significant difference in mean operative time and mean hypothermic ischaemia time between two groups. No difference was noted in mean tumour diameter, intraoperative blood loss, and preoperative and postoperative creatinine clearance rate. CONCLUSIONS: The technique of incorporating hypothermic ischaemia via arterial perfusion into RLPN is feasible and safe, which expands the armamentarium of the urologist with the help of radiologists. It is of high clinical applied value, especially for the more complex nephron-sparing surgery.

[Expressions of receptor tyrosine kinases mRNA and protein in carcinoma of bladder].

OBJECTIVE: To detect the expressions of receptor tyrosine kinases (RTKs) mRNA and protein and to explore potentially promising tumor markers and conceivable drug target in bladder cancer. METHODS: The expressions of RTKs mRNA and protein in tissue from invasive urothelial carcinoma of the bladder were examined by real-time quantitative PCR array and cytokine antibody array, with normal bladder tissue as control. The Results were analyzed using bioinformatic approaches. RESULTS: The expressions of TGFA, STAB1, SERPINE1, ANGPT2, SPINK5, ANGPTL1, PROK1, MDK, CXCL9, GRN, RUNX1, VEGFA, and TGFB1 were obviously upregulated in bladder cancer tissue, while those of EDIL3, PTN, CCL2, PDGFD, FGF13, KITLG, FGF2, SERPINF1, and TNF were downregulated. ALK, Btk, EphB2, ErbB4, PDGFR-α, ROS, Tie-2, Tyk2, and VEGFR3 were over-expressed in bladder cancer, while FRK, Fyn, IGF-IR, Insulin R, Itk, JAK1, JAK3, and LCK were low-expressed. CONCLUSION: Vascular endothelial growth factor/platelet-derived growth factor-targeted therapies may play an active role in treating carcinoma of bladder.

[Application of adrenocorticotropic hormone receptor determination and ultrastructural observation of tumor cells in the subtyping of adrenocortical neoplasms].

OBJECTIVE: To explore the values of adrenocorticotropic hormone receptor (ACTH-R) determination and ultrastructural observation of tumor cells in the subtyping of adrenocortical neoplasms (ANs). METHODS: The expression of ACTH-R in 87 AN tissues were determined with Polymer immunohistochemical staining, with 10 normal adrenal tissues as the controls. The ultrastructure of the tumor cells was observed using electron microscopy. RESULTS: The positive expression rate of ACTH-R was (80.1 +/- 8.2)%, (53.2 +/- 10.3)%, (63.2 +/- 10.1)%, (83.3 +/- 6.5)%, and (70.1 +/- 7.3)% in the sub-CPA group, CPA group, APA group, NFA group, and NC group, respectively. ACTH-R expression was significantly higher in NFA and sub-CPA groups than in NC group (P = 0.001, P = 0.000), APA group (P = 0.000, P = 0.000), and CPA group (P = 0.000, P = 0.000), and was also significantly different between NC group and APA group (P = 0.039) and between APA group and CPA group (P = 0.037). However, no significant difference was found between NFA group and sub-CPA group (P = 0.325). As shown by the electron microscopy, ANs had some partially similar microscopic features, while different AN subtypes showed differences in the type and amount of secretory granules. CONCLUSION: ACTH-R determination and ultrastructural observation of tumor cells may be helpful for subtyping ANs.

Diagnosis and treatment of primary adult renal sarcoma.

OBJECTIVE: To investigate the clinical characteristics of primary adult renal sarcoma. METHODS: A total of 1654 cases with adult renal tumors were treated during 1985 to 2009 in Peking Union Medical College Hospital. Of all, 17 cases were diagnosed as primary renal sarcoma and underwent radical nephrectomy. The clinical features of 17 such patients were retrospectively analyzed. RESULTS: The first symptom of 10 (59%) cases in all renal sarcomas was abdominal mass. The pathological diagnosis was leiomyosarcoma (7 cases), rhabdomyosarcoma (2 cases), malignant fibrous histiocytoma (2 cases), low-differentiated sarcoma (2 cases), chromophobe renal cell carcinoma coexisting with liposarcoma (1 case), fibrosarcoma (1 case), embryonic sarcoma (1 case) and leiomyosarcoma (1 case). One patient died of tumor thrombus of the inferior vena cava during surgery. Finally, 15 cases were regularly followed up for 4 to 60 months. Till now, 1 had tumor-free survival for 9 months, and the other 14 cases died 2-38 months after the operation with a median survival time of 18 (range, 5-60) months. The median survival time of leiomyosarcoma group was 28 (range, 11-60) months, and 2 cases of malignant fibrous histiocytoma died 4 and 8 months after the operation respectively. CONCLUSIONS: The primary renal sarcoma has the clinical symptom similar with advanced renal cell carcinoma and has poor prognosis. Leiomyosarcoma might have relative good prognosis.

A decade of clinical experience with extra-adrenal paragangliomas of retroperitoneum: Report of 67 cases and a literature review.

OBJECT: The purpose was to highlight the diagnosis and treatment of extra-adrenal para-gangliomas, which often causes catecholamine hypersecretion and hypertension. METHODS: 67 cases of extra-adrenal paraganglioma of retroperitoneum proven pathologically from 1999 to 2009 were reviewed and studied after operation. Endocrine secretion examinations, B-US, CT, MRI, 131-MIBG, octreotide and hands microcirculation inspection were used to diagnose the disease. RESULTS: All patients underwent successful surgical resection of the tumors, which proved to be paragangliomas. They were from 3 cm to 25 cm in size. Almost all of them were diffusely positive for cgA, syn, NSE and s-100 by immunohitochemical staining. There were nine cases assayed malignant paraganglioma by the follow-up. CONCLUSIONS: 131-MIBG and octreotide have high sensitivity and accuracy in diagosing extra-adrenal paraganglioma. Surgical treatment should be carried out on the basis of correct drug preparation of α-receptor blocker, such as prazosin and phenoxybenzamine. Complete surgical excision is the treatment of choice for extra-adrenal paragangliomas as well as recurrent or metastatic disease, which could be resected laparoscopically. Intimate lifelong follow-up is necessary and important.

Differential diagnosis and laparoscopic treatment of adrenal pheochromocytoma and ganglioneuroma.

BACKGROUND: Adrenal ganglioneuroma is a rare adrenal pathogenic disease with difficult differential diagnosis from adrenal pheochromocytoma. Currently, very limited literature is available to allow a differential diagnosis of these two conditions from each other. This study aimed to evaluate the clinical profile, differential diagnosis and surgical treatments of both conditions. METHODS: Clinical characteristics of 36 patients with adrenal pheocheomocytoma and 18 patients with adrenal ganglioneuroma were analyzed. Data from CT scans and surgical treatments from 1999 to 2007 were collected. Endocrine hormone tests and (131)I-metaiodobenzylguanidine (MIBG) were performed. Neither (131)I-MIBG nor endocrine hormone tests were available in 9 cases of asymptomatic adrenal ganglioneuroma with tumor size less than 4 cm and there were negative findings from contrast enhanced CT scans. The level of urine catecholamine of patients was compared by one-way analysis of variance. RESULTS: Te mean age of patients in the adrenal ganglioneuroma group was 41.2 years (16 - 67 year) and in the adrenal pheochromocytoma patients 38 years (17 - 74 year). Contrast enhanced CT showed that the foci were intensified in 5 cases (27.8%) of adrenal ganglioneuroma and there were obvious contrast indications in 30 (83.3%) of the pheochromocytoma. Catecholamine levels in a 24-hour urine sample were normal in 4 patients with adrenal ganglioneuroma and increased in 36 (100%) cases with adrenal pheochromocytoma. (131)I-MIBG nuclear scan showed negative results in 4 patients (100%) with adrenal ganglioneuroma and positive results in 25 (96.2%) with adrenal pheochromocytom. Laparoscopy for adrenal tumors was performed through a transperitoneal or retroperitoneal approach during a follow-up period of (43 +/- 6) months, and all cases survived well. CONCLUSIONS: CT, urinary catecholamine and (131)I-MIBG are standard and efficient tools for differential diagnosis of adrenal ganglioneuroma from pheochromocytoma. Laparoscopic surgery can be performed through a transperitoneal or retroperitoneal approach depending on the finding of CT scans. Open surgery is necessary for patients with blood loss of more than 800 ml and violent fluctuation of intraoperative blood pressure.

[Effects of docetaxel and prednisone for hormone-refractory prostate cancer].

OBJECTIVE: To investigate the role and side effects of docetaxel and prednisone on treating hormone-refractory prostate cancer (HRPC). METHODS: Docetaxel (75 mg/m(2)) and prednisone (5 mg, bid) were given to 14 patients, whose age range from 51 to 78 years old, of hormone-refractory prostate cancer for 3 - 8 cycles. Three-week is a chemotherapy cycle. Comparing the prostate specific antigen (PSA), alkaline phosphatase (ALP), pain score, Karnofsky performance status, bone scan, lymph node size before and after chemotherapy. RESULTS: 100 - 140 milligram docetaxel were given for each cycle, 1-8 cycles were experienced. The responses of PSA: excellence-5 cases, utility-3 cases, uselessness-6 cases, PSA response ratio was 57.1%. Among 6 N(1) cases, lymph nodes diminished in 2 cases and enlarged in 1 case after chemotherapy. Bone scan has improved in 2 cases, and no differences in other cases. Pain scores were decreased from 0 to 6, and the average Karnofsky performance status was increased by 4%. The common adverse events were myelosuppression, alopecia, fatigue, nail changes, phlebitis. CONCLUSION: Docetaxel plus prednisone for the treatment of HRPC can delay the progression of the disease, decrease the PSA value, diminish the lymph node, ease the pain, improve the quality of live, and the tolerance is quite good.

[Serum osteoprotegerin as a novel marker of bone metastasis in prostate cancer].

OBJECTIVE: To evaluate the diagnostic usefulness of serum osteoprotegerin (OPG) in prostate cancer bone metastasis. METHODS: Serum osteoprotegerin were measured by ELISA assay in 30 healthy men, 30 patients with benign prostatic hyperplasia, 66 patients with prostate cancer including 36 without bone metastasis (30 with localized cancer, 6 with lymph node metastasis) and 30 with bone metastasis. The results associated with clinical data were calculated statistically. RESULTS: Serum osteoprotegerin were significantly increased in patients with bone metastasis compared with others (P<0.001). OPG level had a positive correlation with either prostate specific antigen (PSA) or Alkaline phosphatase (ALP) level (r=0.427, 0.277; P<0.001); and a positive correlation with either Gleason score or grade (r=0.427, 0.277; P<0.001). ROC analysis proved that OPG had better diagnostic accuracy than ALP for detecting bone metastasis in prostate cancer. CONCLUSION: Serum osteoprotegerin could be used as a marker for diagnosis of bone metastasis in prostate cancer.

[Characteristics of recurrence of T1G3 transitional cell carcinoma of bladder].

OBJECTIVE: To investigate the characteristics of recurrence of T1G3 transitional cell carcinoma (TCC) of bladder. METHODS: The clinical data of 72 patients with TCC of bladder of the stage T1, 37 being of the stage T1G3 and 35 being of the stage T1G1-2, who underwent the initial treatment by transurethral resection of bladder tumor plus post-operative bladder infusion were analyzed. RESULTS: The first, second, third, and fourth year recurrent rates of the T1G3 group were 29.7%, 40.5%, 18.9%, and 10.8% respectively, all significantly higher than those of the T1G2 group (14.3%, 34.3%, 31.4%, and 20.0% respectively, t = 1.994, P = 0.025). The rate of recurrence for only time was 10.8% in the T1G3 group (4/37), significantly lower than that of the T1G1-2 group (17/35, 48.6%, P < 0.01). The rate of recurrence for more than 3 times was 54.0% in the T1G3 group (20/37), significantly higher than that of the T1G1-2 group (6/35, 17.2%, P < 0.01). The rate of recurrent tumor at the pathological stage over T2 was 86.5% (32/37) in the T1G3 group, higher than that of the T1G1-2 group (42.8%, 15/35). The rate of partial or total cystectomy at the last recurrence in the T1G3 group was 94.6% (35/37), significantly higher than that of the T1G1-2 group (57.1%, 20/35, chi(2) = 14.00, P < 0.05). CONCLUSION: A kind of dangerous bladder cancer, TCC at the stage T1G3 is apt recur soon after the treatment with a high recurrent frequency. Most recurrent tumors evolve into invasive cancer.

[Surgical diagnosis and treatment of Castleman's disease].

OBJECTIVE: To investigate the clinical features and treatment of the surgical tumors associated with Castleman's disease. METHODS: The clinical data of 20 patients with Castleman's disease, 6 males and 14 females, aged 39 (15-70), with the tumor size ranging from 2 cm x 3 cm to 10 cm x 9 cm, and with the tumor located in the mediastinal cavity (n = 6), retroperitoneal area (n = 2), abdominal cavity (n = 1), adrenal area (n = 1), neck and armpit (n = 2), and multi-centers (n = 2), were analyzed. RESULTS: Nineteen of the 20 patients underwent surgical resection of the tumor or lymph node. All were diagnosed as Castleman's disease by pathological examination. Most of the tumor was benign. Three cases were diagnosed as with paraneoplastic pemphigus. CONCLUSION: Surgical resection of the tumor is the first choice for treatment of Castleman's disease.

[Expression of HGF and its receptor c-Met in renal cell carcinoma].

OBJECTIVE: To study the clinical significance of expression of hepatic growth factor (HGF) and its receptor c-Met in renal cell cancer (RCC). METHODS: Twenty-six patients with RCC and 10 benign renal tumor patients were examined. The expression of HGF and c-Met mRNA was detected using Northern blot. GAPDH was used as the internal control. RESULTS: Twenty-one out of 26 patients with RCC had positive gene expression of HGF and c-Met with the positive rate of 80.8%. According to the tumor TNM staging, the more advanced the cancer had a stronger expression of HGF and c-Met, the expression of c-Met was higher than that of HGF in the RCC. Whereas in the control group with benign tumor, the expression of c-Met was rather mild. CONCLUSION: The result suggests that HGF and its receptor c-Met may play an important role in the development and progression of renal cancer, which may also imply a potential clinical significance in diagnosing and assessing prognosis of RCC.