Prognostic value of CD166 expression in cancers of the digestive system: a systematic review and meta-analysis.

OBJECTIVE: Many studies have reported the prognostic predictive value of CD166 as a cancer stem cell marker in cancers of the digestive system; however, its predictive value remains controversial. Here, we investigate the correlation between CD166 positivity in digestive system cancers and clinicopathological features using meta-analysis. METHODS: A comprehensive search in PubMed and ISI Web of Science through March of 2013 was performed. Only articles containing CD166 antigen immunohistochemical staining in cancers of the digestive system were included,including pancreatic cancer, esophageal cancer, gastric cancer and colorectal cancer. Data comparing 3- and 5-year overall survival along with other clinicopathological features were collected. RESULTS: Nine studies with 2553 patients who met the inclusion criteria were included for the analysis. The median rate of CD166 immunohistochemical staining expression was 56% (25.4%-76.3%). In colorectal cancer specifically, the results of a fixed-effects model indicated that CD166-positive expression was an independent marker associated with a smaller tumor burden (T category; RR = 0.93, 95%, CI: 0.88-0.98) but worse spread to nearby lymph nodes (N category; RR = 1.17, 95% CI: 1.05-1.30). The 5-year overall survival rate was showed relationship with cytoplasmic positive staining of CD166 (RR = 1.47 95% 1.21-1.79), but no significant association was found in the pool or any other stratified analysis with 3- or 5- year overall survival rate. CONCLUSION: Based on the published studies, different cellular location of CD166 has distinct prognostic value and cytoplasmic positive expression is associated with worse prognosis outcome. Besides, our results also find CD166 expression indicate advanced T category and N-positive status in colorectal cancer specifically.

Whole exome sequencing identifies mutation of EDNRA involved in ACTH-independent macronodular adrenal hyperplasia.

ACTH independent macronodular adrenal hyperplasia (AIMAH) is a rare disorder characterized by bilateral macronodular hyperplasia of the adrenal glands and increased cortisol production with subclinical or overt Cushing's syndrome. Although the family clustering of AIMAH is infrequent, we have tried our best to find such a familial affected pedigree with complete clinical information and successfully collect adrenalectomy tissue samples from two members of this family. Using whole exome sequencing and several variant prioritization strategies based on disease network analysis, we identified Endothelin receptor type A (EDNRA) Ser420Thr mutation as a causative mutation of AIMAH. EDNRA is a member of G protein coupled receptor family and is involved in cardiovascular or polycystic kidney disease. Our findings indicate that the mutation of EDNRA at S420T site should be regard as a potential AIMAH causative variation in familial and sporadic affected patients.

[The influence of benign prostatic hyperplasia drugs on incidence and pathology grading of prostate cancer].

OBJECTIVE: To analyze the influence of benign prostatic hyperplasia (BPH) drugs on incidence and pathology grading of prostate cancer in China. METHODS: Retrospectively investigated the history of drug treatment in 1029 cases of BPH in patients from February 1998 to December 2004. According to the history of drug use, the patients were divided into 4 groups: finasteride group, alpha-receptor inhibitor group, finasteride and alpha-receptor inhibitor combination group and control group (untreated group). We gathered pathology sections of patients in all groups, and gave Gleason Score to each. The difference of incidence and pathology grading of prostate cancer were analyzed by Stata 7.0. RESULTS: The incidence of prostate cancer in the population of our study was 13.5%; The incidence in finasteride group, alpha-receptor inhibitor group, combination group and control group was 9.8%, 16.0%, 10.3% and 18.6%, respectively. There was significant difference between the two groups with the use of finasteride and the two groups without it (P < 0.05). In our study, the ratio of middle or high level pathology grading (Gleason ≥ 7) in prostate cancer patients was 58.3%, the ratio of middle or high level pathology grading prostate cancer patients in the four groups was 71.4%, 59.6%, 67.7% and 40.0%, respectively. In the comparison of composition ratio of middle or high level prostate cancer, there was significant difference between the two groups with the use of finasteride and the two groups without it (P < 0.05). CONCLUSIONS: Finasteride can lower the risk of prostate cancer, but increase the pathology grade of the prostate cancer which has occurred in the same time. The alpha-receptor inhibitor does not have the same effect.

[Robot-assisted laparoscopic radical cystectomy with extracorporeal urinary diversion].

OBJECTIVE: To present the technique and experience of robotic-assisted laparoscopic radical cystectomy (RARC) by da Vinci surgical system. METHODS: From December 2007 to September 2008, 4 patients underwent RARC and urinary diversion. The age of patients was 44 to 63 years old. The body mass index was 22.8 to 27.7. All their clinical stages were lower than T2N0M0. The technique for RARC involving ureters dissection, posterior dissection, lateral pedicle control, anterior dissection, dorsal vein complex control, neurovascular bundles sparing, lymphadenectomy, ureter-ileal anastomosis, urethra-neobladder anastomosis to either ileal conduit urinary diversion or neobladder reconstruction performed extracorporeally. RESULTS: All the operations were accomplished successfully. The urinary diversion of 2 case was ileal conduit and others was ileal orthophoria neobladder. The operation time was 300 to 450 min. The time of radical cystectomy was 150 to 180 min. The estimated blood loss was 100 to 500 ml. The postoperative hospital stay was 9 to 35 d. The bed rest time was 4 to 9 d. There was 1 patients who had incomplete intestinal obstruction at 8th postoperative day cured by conservative therapy. The patients were followed up for 3 to 12 months, all patients survived without tumor recurrence. The patients have satisfied urinary continence and normal renal functions without hydronephrosis after the operation. CONCLUSIONS: RARC is small incision and safe, the results are definite. It is one of the direction of minimally invasive urologic surgery.

[Usage of acellular dermal matrix allograft in surgical treatment of vesico-vaginal fistula and anterior urethral stricture: report of 9 cases].

OBJECTIVE: To assess the value of acellular dermal matrix allograft (ADMA) in surgical treatment of vesico-vaginal fistula (VVF) and anterior urethral stricture. METHODS: Four patients suffering from vesico-vaginal fistula and 5 cases with long anterior urethral stricture received surgical treatment in which ADMA were applied. In the VVF patients the ADMA inserted between the vagina and the bladder during transabdominal extraperitoneal repair. In the patients with anterior urethral stricture the ADMA was sutured to substitute the urethra after resection of the stenosis segment. RESULTS: No intraoperative or postoperative complications occurred. Immediate stoppage of urine leakage from the vagina was seen in the 4 VVF patients, and no recurrence was found during the follow-up of 4 - 12 months. Satisfactory voiding was achieved immediately after removing the catheter in 3 of the 5 cases of urethral stricture, although 2 of the 5 needed urethral sounding for about 2 months. Three months postoperatively all patients were voiding well and their urine flow rates were all normal. Urethrography revealed excellent caliber of the reconstructed urethra. CONCLUSION: In plastic surgery of lower urinary tract such as for VVF and urethra stricture, the ADMA may serve as an ideal replacement material for autologous tissue. Its usage avoids the need to harvest autologous tissue, thus providing a novel, safe, effective, microinvasive and economic method in urologic plastic surgery.

[Non-epithelial tissue tumors of the urinary bladder].

OBJECTIVE: To summarize the experience in the diagnosis and treatment of non-epithelial tissue tumor of urinary bladder. METHODS: >From 1953 to April 2002, a total of 28 patients with non-epithelial tissue tumor in 3 925 bladder tumor cases were analyzed. RESULTS: Painless gross hematuria, pelvic mass, urinary frequency and dysuria are symptoms of non-epithelial bladder tumor. Ultrasonic examination, computed tomography (CT) scan, cystoscopy and biopsy is used for diagnosis of the tumor. Seventeen of 28 patients (61.7%) were malignant neoplasms in 7 kinds of pathologic types, which was small cell carcinoma (5 cases), rhabdomyosarcoma (4 cases), leiomyosarcoma (4 cases), lymphoma (1 case), malignant fibrous histiocytoma (1 case), liposarcoma(1 case), melanoma (1 case) respectively. Eleven of 28 patients (39.3%) were benign tumors with 4 kinds of histologic types including 2 cases of cavernous hemangioma, 1 case of fibroma, 1 case of leiomyoma, 7 cases of pheochromocytoma. All benign tumor patients were treated with partial cystectomy, transurethral bladder tumor resect (TURBT) and fulguration. In 17 malignant neoplasms patients, 7 of them received partial cystectomy, 9 received radical cystectomy, and 1 patient's tumor was unresectable. Those malignant bladder tumor patient are followed up, but 3 years survival rates is only 8/17. CONCLUSIONS: Non-epithelial tissue tumor of the urinary bladder is rare with complicated pathologic types. Malignant neoplasms are more than benign tumors with very poor prognosis, benign tumors' prognosis is good. Diagnosis rate which was confirmed before operation is low. Dip biopsy under cystoscopy may enhance the diagnosis rate. Surgical treatment is the main therapy for non-epithelial tissue tumor of the urinary bladder. Because of the aggressive biologic behavior of malignant tumors, they should be identified promptly and treated appropriately. According to the histologic appearance radiotherapy and chemotherapy is mandatory in some cases.