DDD score for renal tumor: An intuitive and comprehensive anatomical scoring system to access the outcomes of retroperitoneal laparoscopic partial nephrectomy.

OBJECTIVE: To present a DDD scoring system in assessing the complexity and outcomes of retroperitoneoscopic nephron-sparing surgery for kidney tumor. METHODS: We retrospectively evaluated 232 patients who underwent retroperitoneoscopic nephron-sparing surgery between January 2013 and September 2017 for a renal tumor. Both the DDD score and RENAL score were used to classify the tumors. The DDD score consisted of the maximal tumor diameter inside the kidney, the maximal tumor depth into the medulla or collecting system and the minimal distance from the tumor to the main renal vessels. RESULTS: The DDD scoring systems were significantly associated with warm ischemia time (P = 0.007) and estimated blood loss (P = 0.017). There was an insignificant positive correlation between the DDD score and the operative time (P = 0.051). Meanwhile, the RENAL score had a significant correlation with the decreasing value of the estimated glomerular filtration rate. Patients with high or moderate DDD scores had a 13.6-fold or 8.4-fold risk of overall complications than those with low DDD scores, respectively (all P < 0.05). As for RENAL score, patients with moderate scores had a 2.9-fold risk of overall complications compared with patients in the low scores group (P = 0.004). In the receiver operating characteristic curve analysis, the DDD score had the greatest area under the curve for overall complications (area under the curve 0.625, P = 0.009), which was more than the RENAL score (area under the curve 0.620, P = 0.013). CONCLUSIONS: The DDD score is an intuitive renal tumor scoring system that is more effective than the RENAL score in complexity assessment, and marginally better in prediction of the risk of overall complications of retroperitoneal laparoscopic nephron-sparing surgery.

Taxus chinensis ameliorates diabetic nephropathy through down-regulating TGF-ß1/Smad pathway.

Diabetic nephropathy (DN) is one of the common microvascular complications of diabetes mellitus. Renal fibrosis is closely related to the deterioration of renal function. The present study aimed to investigate protective effect of Taxus chinensis on high-fat diet/streptozotocin-induced DN in rats and explore the underlying mechanism of action. The rat DN model was established via feeding high fat diet for 4 weeks and subsequently injecting streptozotocin (30 mg·kg-1 body weight) intraperitoneally. The rats with blood glucose levels higher than 16.8 mmol·L-1 were selected for experiments. The DN rats were treated with Taxus chinensis orally (0.32, 0.64, and 1.28 g·kg-1) once a day for 8 weeks. Taxus chinensis significantly improved the renal damage, which was indicated by the decreases in 24-h urinary albumin excretion rate, blood serum creatinine, and blood urea nitrogen. Histopathological examination confirmed the protective effect of Taxus chinensis. The thickness of glomerular basement membrane was reduced, and proliferation of mesangial cells and podocytes cells and increase in mesangial matrix were attenuated. Further experiments showed that Taxus chinensis treatment down-regulated the expression of TGF-ß1 and α-SMA, inhibited phosphorylation of Smad2 and Smad3. These results demonstrated that Taxus chinensis alleviated renal injuries in DN rats, which may be associated with suppressing TGF-ß1/Smad signaling pathway.

Preoperative Plasma Fibrinogen Level Represents an Independent Prognostic Factor in a Chinese Cohort of Patients with Upper Tract Urothelial Carcinoma.

BACKGROUND: Increased plasma fibrinogen is thought to contribute to tumor progression and metastasis. The association of plasma fibrinogen with clinicopathological characteristics, and the optimal cutoff with an ideal predictive value has not been fully determined in patients with upper tract urothelial carcinoma (UTUC). We aimed to investigate the clinical significance of this parameter in a Chinese cohort of patients with UTUC. METHODS: A retrospective study was conducted to analyze the clinical data of 184 operable UTUC patients in a Chinese cohort with a high incidence of chronic kidney disease (CKD). An optimal cutoff was set for further analysis according to validated web-based software. The associations of plasma fibrinogen with clinicopathological characteristics and survival were assessed. Multivariate analyses were performed to determine the independent prognostic factors. RESULTS: Elevated plasma fibrinogen was significantly associated with tumor necrosis, lymph node involvement, and a higher preoperative CKD stage, pathological tumor stage and grade (all P < 0.05). Kaplan-Meier analysis showed that plasma fibrinogen ≥ 3.54 g/L predicted a poorer overall and cancer-specific survival than < 3.54 g/L (P < 0.001 for both). Multivariate analyses revealed that elevated preoperative plasma fibrinogen was an independent negative prognostic factor for overall survival (HR = 2.026; 95% CI: 1.226-3.349; P = 0.006) and cancer-specific survival (HR = 1.886; 95% CI: 1.019-3.490; P = 0.043). CONCLUSIONS: Increased plasma fibrinogen was an independent prognostic risk factor for poor outcomes in UTUC. This parameter may serve as an effective biomarker with easy accessibility for evaluating prognosis for patients with UTUC.

Prognostic Significance of Preoperative Albumin-Globulin Ratio in Patients with Upper Tract Urothelial Carcinoma.

BACKGROUND: Preoperative albumin-globulin ratio (AGR) reflects both malnutrition and systemic inflammation in cancer patients. In particular, systemic inflammation has been reported to contribute to tumor progression and poor oncological outcome in various malignancies. However, the prognostic value of preoperative AGR in upper tract urothelial carcinoma (UTUC) has not been examined. METHODS: We retrospectively reviewed medical data of 187 operable UTUC patients in a Chinese cohort with a high incidence of chronic kidney disease (CKD). AGR was calculated as [AGR = albumin/(serum total protein-albumin)]. The associations of preoperative AGR with clinicopathologic characteristics and prognosis were assessed. Multivariate analyses using Cox regression models were performed to determine the independent prognostic factors. RESULTS: The median (IQR) preoperative AGR was 1.50 (1.30-1.70), and the optimal cutoff value was determined to be 1.45 according to the receiver operating curve analysis. Low AGR was significantly associated with female gender, high CKD stage and tumor grade (P < 0.05). Eighty-three patients died before the follow-up endpoint. Kaplan-Meier analysis showed that an AGR < 1.45 predicted significantly poorer overall and cancer-specific survivals compared to an AGR ≥ 1.45 (P < 0.001 and P = 0.008, respectively). Multivariate analyses showed that an AGR < 1.45 was an independent risk factor for poorer overall and cancer-specific survivals (P = 0.002 and P = 0.015, respectively). CONCLUSIONS: Preoperative AGR can act as an effective biomarker with easy accessibility for evaluating the prognosis of patients with UTUC. AGR should be applied in UTUC patients for risk stratification and determination of optimal therapeutic regimens.

[Predictor analysis of PSA response of docetaxel combined with prednisone in the treatment of metastatic castration resistant prostate cancer].

OBJECTIVE: To investigate the factors that may predict the effectiveness of metastatic castration resistant prostate cancer (mCRPC) patients who received docetaxel plus prednisone treatment. METHODS: We retrospectively collected the clinical data of mCRPC patients who has received docetaxel chemotherapy in Peking University First Hospital between February 2010 and March 2015, and the clinical factors were analyzed using univariate analysis. RESULTS: A total of 60 cases of patients were treated, of whom 33 with complete clinical data were analyzed. PSA responsive was defined as PSA declining ≥50% of baseline and without progression according to RESCIST criteria. The median PSA at chemotherapy was 153.4 µg/L (6.6-9 952.0 µg/L), and a total of 20 cases (60.6%) were PSA responsive. Univariate analysis found that lower Gleason score (Gleason scores≤7) (25% vs.72%, P=0.034), the existence of positive Lymph node (78% vs. 40%, P=0.032), the existence of visceral metastasis (80% vs. 44%, P=0.041) and baseline blood HGB value≤120 g/L (30% vs. 74%, P=0.024) were associated with chemotherapy effectiveness. CONCLUSION: High Gleason score, lymph node metastasis, visceral metastasis and normal HGB level may predict PSA response after docetaxel-based chemotherapy.

[Risk factors for the development of postoperative paralytic ileus after radical cystectomy: a report of 740 cases].

OBJECTIVE: To identify the risk factors that would aid in the identification of patients at the greatest risk of developing postoperative paralytic ileus. METHODS: In the retrospective study, 749 patients who received radical cystectomy from January 2005 to August 2014 were reviewed, of whom, 9 who received orthotopic ileal neobladder were excluded. Of the 740 patients, 82 (11.1%) developed postoperative paralytic ileus. The correlation between the clinical characters and the occurrence of post-operative paralytic ileus was identified. RESULTS: The postoperative paralytic ileus was significantly correlated with the patient's age (68 vs. 67, P=0.025), body mass index (23.0 kg/m2 vs.24.1 kg/m2, P=0.008), different urinary diversion reconstruction methods [13.2% (66/500) for ileal conduit and 7.3%(16/240) for cutaneous ureterostomy, P=0.008] and pelvic lymph node dissection [12.2% (77/632) vs.4.6% (5/108), P=0.021].The postoperative paralytic ileus caused a prolonged hospital stay and delayed recovery (24 d vs. 17 d, P=0.000). There was no significant correlation between the postoperative paralytic ileus and the patients' gender, previous abdominal operations, preoperative hemoglobin and creatinine, American Society of Anesthesiologists score, operative time, estimated blood loss, transfusion requirement, laparoscopic and open surgery, ICU admission or tumor staging. On multivariate analysis, age (hazard ratio 1.185, 95% confidence interval 1.036-1.355, P=0.013), body mass index (hazard ratio 0.605, 95% confidence interval 0.427-0.857, P=0.005), different urinary diversion reconstruction methods (hazard ratio 2.422, 95% confidence interval 1.323-4.435, P=0.004) and pelvic lymph node dissection (hazard ratio 2.798, 95% confidence interval 1.069-7.322, P=0.036) were significantly correlated with the presence of the postoperative paralytic ileus. CONCLUSION: Increasing age, decreasing BMI, ileal conduiturinary diversion and pelvic lymph node dissection were significantly correlated with the presence of postoperative paralytic ileus in patients undergoing radical cystectomy.

Comparison of clinicopathologic characteristics of urothelial carcinoma between patients after renal transplantation and on dialysis.

BACKGROUND: Urothelial carcinoma (UC) is a common complication after renal replacement therapy (RRT) among Chinese end-stage renal disease (ESRD) patients. It is unclear whether there are any differences in the clinicopathologic characteristics of UC between renal transplantation (RT) and dialysis patients; such differences could impact RRT modality selection. METHODS: We retrospectively reviewed clinicopathologic data for 27 RT patients and 40 dialysis patients who were diagnosed with UC in our center to explore differences in the clinicopathologic characteristics of UC and prognoses between the two groups. RESULTS: The median follow-up period was 92 months (2-137) for the RT group and 71 months (18-155) for the dialysis group. The demographic and baseline data showed no significant differences between the two groups. Upper urinary tract UC (UUC) occurred more frequently in the RT group (22 UUCs in 39 UCs), whereas bladder UC (BUC) predominated in the dialysis group (33 BUCs in 49 UCs) (P=0.025). The pathologic grading in the RT group was significantly higher than that in the dialysis group (P=0.046 for WHO1973 grading, P=0.026 for WHO2004 grading), whereas the difference in tumor stage was not significant (P=0.089). The RT group manifested a higher recurrence rate than the dialysis group (P=0.024). However, the overall and cancer-specific survival rates between the two groups were not significantly different (P=0.239 and P=0.818, respectively). CONCLUSION: Certain traits of UC, including tumor site, pathologic grading, and recurrence-free survival, were notably different between RT and dialysis patients, but the overall and cancer-specific survival rates were similar.

[Retrospective analysis of primary renal sarcoma: 17 cases report].

OBJECTIVE: To investigate the clinical characteristics,prognosis, survival and diagnosis of primary renalsarcoma. METHODS: In the study,17 cases of renal sarcoma were reviewed and analyzed, the incidence, clinical manifestations, treatments and prognosis of renal sarcoma discussed and analyzed, and the correlated literature also reviewed. RESULTS: Radical nephrectomy was the main treatment for 16 cases, one case was punctured and pathologized. The distributions of pathology were leiomyosarcoma, malignant fibrous histiocytoma, rhabdomyosarcoma, synoviosarcoma, liposarcoma, and clear-cell sarcoma. Thirteen of the subjects were followed-up, and the time of survival varied from 7 to 132 months. CONCLUSION: Renal sarcomas are rare and highly malignant and the prognosis is poor. Early diagnosis and radical nephrectomy can prolong the patient's life.

[Analysis of clinical characteristics of renal oncocytoma: 26 cases report].

OBJECTIVES: To investigate the diagnosis, therapy and prognosis of renal oncocytoma. METHODS: The data of 26 patients of renal oncocytoma in the department of urology of the Peking University First Hospital from 1999 to 2010 were collected. Retrospective analysis of renal oncocytoma clinical characteristics of patients including pathological characteristics and long term follow-up, treatment methods, and prognosis was undergone. RESULTS: The mean age of these patients was (55 ± 14) years, mean tumor size was (4.1 ± 1.3) cm, corresponding to a mean tumor volume of (24.0 ± 21.1) cm(3). All of these cases were unilocular unilateral. All of these 26 patients received surgical treatment, 5 cases accepted partial nephrectomy while the other cases accepted radical nephrectomy. After a median follow-up time was (47 ± 34) months (range 4 - 144 months) for 25 patients who had been followed up, there was no disease recurrence, progression or death attributed to oncocytoma. CONCLUSIONS: Renal oncocytoma is an uncommon tumor. It exhibits numerous features which are characteristic but not necessarily unique.Preoperative renal mass biopsy is the only way for pre-nephrectomy histologic diagnosis of oncocytoma.

[Correlation of intravesical prostatic protrusion with clinical evaluation parameters in BPH patients].

OBJECTIVE: To investigate the correlation of the degrees of intravesical prostatic protrusion (IPP) measured by transabdominal ultrasound with the clinical evaluation parameters in BPH patients. METHODS: We measured the length of IPP in the mid-sagittal section by transabdominal ultrasound in 275 BPH outpatients with lower urinary tract symptoms, and analyzed the correlations of the degree of IPP with the age, prostatic volume (PV), international prostatic symptom score (IPSS), maximum uroflow rate (Qmax), and postvoid residual urine volume (PVR) of the patients. RESULTS: The degree of IPP was correlated positively with the age (r = 0.210, P < 0.01), PV (r = 0.534, P < 0.01) and PVR (r = 0.314, P < 0.01), but negatively with the Qmax (r = -0.364, P < 0.01) of the BPH patients. There was no significant correlation between the degree of IPP and IPSS (r = 0.064, P = 0.299). CONCLUSION: The degree of IPP may be associated with the age and prostatic volume of BPH patients. Transabdominal ultrasound measurement of IPP is a useful noninvasive method to assess the presence and severity of bladder outlet obstruction in BPH patients.