Pub Date : 2020-02-15DOI: 10.3760/CMA.J.ISSN.1000-6702.2020.02.009
Zijian Tian, H. Hou, S. Lai, Shengjie Liu, Xingbo Long, Miao Wang, Jianye Wang, Ming Liu
Objective To analyze effects of androgen deprivation therapy on lipid metabolism and nutritional status in patients with prostate cancer. Methods The clinical data of 255 elderly patients (≥ 65 years old) with prostate cancer who received endocrine therapy and complete follow-up data from January 2010 to December 2018 were analyzed retrospectively. The median age of the 255 patients was 76 years(65-92). The average PSA of patients was (58.15±9.62) ng/ml, where 101 patients had PSA 20 ng/ml. All patients were diagnosed pathologically by prostate biopsy. As for Gleason score, Gleason score≤6, Gleason score=7 and Gleason score≥ 8 had 62, 103 and 90 patients, respectively. Endocrine therapy included maximum androgen blockade (197 cases) and drug castration (58 cases), and continued for at least 1 year. Among them, 123 cases had complete blood lipid index data, and the subgroup analysis was based on the age of 80 years old, including 98 cases aged 65 to 80 years old and 25 cases over 80 years old. A total of 186 cases had complete data of total protein and albumin, of which 147 cases were 65 years old and 80 years old and 39 cases were more than 80 years old. Before treatment, cholesterol was (4.08±0.87)mmol/L, including (4.14±0.86) mmol/L in the 65-80 years old group, (3.82±0.88) mmol/L in >80 years old group; triglyceride was (1.23 ±0.56) mmol/L, 65-80 age group was (1.26±0.56) mmol/L and >80 years old group was (1.11±0.57) mmol/L; High density lipoprotein cholesterol was(1.09±0.24)mmol/L, 65-80 age group was (1.10±0.25) mmol/L and >80 years group was (1.04±0.21) mmol/L. Low density lipoprotein cholesterol was (2.50±0.78)mmol/L, 65~80 age group was (2.55±0.77)mmol/L and (2.34±0.83) mmol/L in >80 years old group.The total protein before endocrine therapy was (63.81±5.93) g/L, including (63.95±5.79) g/L in the 65-80 years old group, (63.30±6.49) g/L in >80 years old group. In terms of pre-treatment albumin (39.68±3.50) g/L, including (39.82±3.60) g/L in the 65-80 years old group and (39.21±3.12) g/L in >80 years old group. The differences of various indexes before and after treatment were analyzed. Results The results of blood lipid data analysis of 123 cases showed that, there were increased significant differences(P 0.05). The results of data analysis of 186 cases of total protein and albumin showed that, the total protein after treatment was (62.81±7.34) g/L, which was not significantly different from that before treatment (P>0.05). The total protein in 65-80 years old group after treatment was (62.36±7.36) g/L, which decrease and have statistical significantly different from that before treatment (P 80 years old group after treatment was (64.49±7.12) g/L, it was higher than that before treatment, but the difference was not statistically significant (P>0.05). The level of albumin after endocrine therapy was (38.34±4.48) g/L, which was significantly different from that before treatment (P 80 years old group after treatment were (38.32±4
{"title":"Effects of endocrine therapy on lipid metabolism and nutritional status in elderly patients with prostate cancer","authors":"Zijian Tian, H. Hou, S. Lai, Shengjie Liu, Xingbo Long, Miao Wang, Jianye Wang, Ming Liu","doi":"10.3760/CMA.J.ISSN.1000-6702.2020.02.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2020.02.009","url":null,"abstract":"Objective \u0000To analyze effects of androgen deprivation therapy on lipid metabolism and nutritional status in patients with prostate cancer. \u0000 \u0000 \u0000Methods \u0000The clinical data of 255 elderly patients (≥ 65 years old) with prostate cancer who received endocrine therapy and complete follow-up data from January 2010 to December 2018 were analyzed retrospectively. The median age of the 255 patients was 76 years(65-92). The average PSA of patients was (58.15±9.62) ng/ml, where 101 patients had PSA 20 ng/ml. All patients were diagnosed pathologically by prostate biopsy. As for Gleason score, Gleason score≤6, Gleason score=7 and Gleason score≥ 8 had 62, 103 and 90 patients, respectively. Endocrine therapy included maximum androgen blockade (197 cases) and drug castration (58 cases), and continued for at least 1 year. Among them, 123 cases had complete blood lipid index data, and the subgroup analysis was based on the age of 80 years old, including 98 cases aged 65 to 80 years old and 25 cases over 80 years old. A total of 186 cases had complete data of total protein and albumin, of which 147 cases were 65 years old and 80 years old and 39 cases were more than 80 years old. Before treatment, cholesterol was (4.08±0.87)mmol/L, including (4.14±0.86) mmol/L in the 65-80 years old group, (3.82±0.88) mmol/L in >80 years old group; triglyceride was (1.23 ±0.56) mmol/L, 65-80 age group was (1.26±0.56) mmol/L and >80 years old group was (1.11±0.57) mmol/L; High density lipoprotein cholesterol was(1.09±0.24)mmol/L, 65-80 age group was (1.10±0.25) mmol/L and >80 years group was (1.04±0.21) mmol/L. Low density lipoprotein cholesterol was (2.50±0.78)mmol/L, 65~80 age group was (2.55±0.77)mmol/L and (2.34±0.83) mmol/L in >80 years old group.The total protein before endocrine therapy was (63.81±5.93) g/L, including (63.95±5.79) g/L in the 65-80 years old group, (63.30±6.49) g/L in >80 years old group. In terms of pre-treatment albumin (39.68±3.50) g/L, including (39.82±3.60) g/L in the 65-80 years old group and (39.21±3.12) g/L in >80 years old group. The differences of various indexes before and after treatment were analyzed. \u0000 \u0000 \u0000Results \u0000The results of blood lipid data analysis of 123 cases showed that, there were increased significant differences(P 0.05). The results of data analysis of 186 cases of total protein and albumin showed that, the total protein after treatment was (62.81±7.34) g/L, which was not significantly different from that before treatment (P>0.05). The total protein in 65-80 years old group after treatment was (62.36±7.36) g/L, which decrease and have statistical significantly different from that before treatment (P 80 years old group after treatment was (64.49±7.12) g/L, it was higher than that before treatment, but the difference was not statistically significant (P>0.05). The level of albumin after endocrine therapy was (38.34±4.48) g/L, which was significantly different from that before treatment (P 80 years old group after treatment were (38.32±4","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"41 1","pages":"126-130"},"PeriodicalIF":0.0,"publicationDate":"2020-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42770213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-15DOI: 10.3760/CMA.J.ISSN.1000-6702.2020.02.010
G. Zhu, J. Xing, Guobin Weng, Zhiquan Hu, Ning-chen Li, He Zhu, Pingsheng Gao, Zhihua Wang, Wei-zhi Zhu, Kai Zhang, Hongbo Li, Zhun Wu, R. Zhu, Xifeng Wei, Yanan Wang, Q. Xie, B. Fu, Xing-huan Wang, Lin Qi, Xin Yao, T. Pan, Delin Wang, Nan Liu, Jian-Ge Qiu, Jiang-gen Yang, Bao-wen Zhang, Zhuo-wei Liu, Hui Han, Gang Li, Bin Zhang, M. Na, Jingjing Lu, Lei Wang, Zichen Zhao, Y. Na
Objective To evaluate the clinical value of holographic image navigation in urological laparoscopic and robotic surgery. Methods The data of patients were reviewed retrospectively for whom accepted holographic image navigation laparoscopic and robotic surgery from Jan. 2019 to Dec. 2019 in Beijing United Family Hospital and other 18 medical centers, including 78 cases of renal tumor, 2 cases of bladder cancer, 2 cases of adrenal gland tumor, 1 cases of renal cyst, 1 case of prostate cancer, 1 case of sweat gland carcinoma with lymph node metastasis, 1 case of pelvic metastasis after radical cystectomy. All the patients underwent operations. In the laparoscopic surgery group, there were 27 cases of partial nephrectomy, 1 case of radical prostatectomy, 2 cases of radical cystectomy and 2 cases of adrenalectomy. In the da Vinci robotic surgery group of 54 cases, there were 51 cases of partial nephrectomy, 1 case of retroperitoneal lymph node dissection, 1 case of retroperitoneal bilateral renal cyst deroofing and 1 case of resection of pelvic metastasis. There were 41 partial nephrectomy patients with available clinical data for statistic, with a median age of 53.5 years (range 24-76), including 26 males and 15 females. The median R. E.N.A.L score was 7.8 (range 4-11). Before the operation, the engineers established the holographic image based on the contrast CT images and reports. The surgeon applied the holographic image for preoperative planning. During the operation, the navigation was achieved by real time fusing holographic images with the laparoscopic surgery images in the screen. Results All the procedures had been complete uneventfully. The holographic images helped surgeon in understanding the visual three- dimension structure and relation of vessels supplying tumor or resection tissue, lymph nodes and nerves. By manipulating the holographic images extracorporeally, the fused image guide surgeons about location vessel, lymph node and other important structure and then facilitate the delicate dissection. For the 41 cases with available clinical data including 23 cases of robotic-assisted partial nephrectomy and 18 cases of laparoscopic nephrectomy, the median operation time was 140(range 50-225)min, the median warm ischemia time was 23(range 14-60)min, the median blood loss was 80(range 5-1 200)ml. In the robotic surgery group, the median operation time was 140(range 50-215)min, the median warm ischemia time was 21(range 17-40)min, the median blood loss was 150(range 30-1 200)ml. In the laparoscopic surgery group, the median operation time was 160(range 80-225)min, the median warm ischemia time was 25(range 14-60)min, the median blood loss was 50(range 5-1 200)ml. All the patients had no adjacent organ injury during operation. There were 2 cases with Clavien Ⅱcomplications. One required transfusion and the other one suffered hematoma post-operation. However, the tumors were located in the renal hilus for these 2 cases and the R
{"title":"Application of holographic image navigation in urological laparoscopic and robotic surgery","authors":"G. Zhu, J. Xing, Guobin Weng, Zhiquan Hu, Ning-chen Li, He Zhu, Pingsheng Gao, Zhihua Wang, Wei-zhi Zhu, Kai Zhang, Hongbo Li, Zhun Wu, R. Zhu, Xifeng Wei, Yanan Wang, Q. Xie, B. Fu, Xing-huan Wang, Lin Qi, Xin Yao, T. Pan, Delin Wang, Nan Liu, Jian-Ge Qiu, Jiang-gen Yang, Bao-wen Zhang, Zhuo-wei Liu, Hui Han, Gang Li, Bin Zhang, M. Na, Jingjing Lu, Lei Wang, Zichen Zhao, Y. Na","doi":"10.3760/CMA.J.ISSN.1000-6702.2020.02.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2020.02.010","url":null,"abstract":"Objective \u0000To evaluate the clinical value of holographic image navigation in urological laparoscopic and robotic surgery. \u0000 \u0000 \u0000Methods \u0000The data of patients were reviewed retrospectively for whom accepted holographic image navigation laparoscopic and robotic surgery from Jan. 2019 to Dec. 2019 in Beijing United Family Hospital and other 18 medical centers, including 78 cases of renal tumor, 2 cases of bladder cancer, 2 cases of adrenal gland tumor, 1 cases of renal cyst, 1 case of prostate cancer, 1 case of sweat gland carcinoma with lymph node metastasis, 1 case of pelvic metastasis after radical cystectomy. All the patients underwent operations. In the laparoscopic surgery group, there were 27 cases of partial nephrectomy, 1 case of radical prostatectomy, 2 cases of radical cystectomy and 2 cases of adrenalectomy. In the da Vinci robotic surgery group of 54 cases, there were 51 cases of partial nephrectomy, 1 case of retroperitoneal lymph node dissection, 1 case of retroperitoneal bilateral renal cyst deroofing and 1 case of resection of pelvic metastasis. There were 41 partial nephrectomy patients with available clinical data for statistic, with a median age of 53.5 years (range 24-76), including 26 males and 15 females. The median R. E.N.A.L score was 7.8 (range 4-11). Before the operation, the engineers established the holographic image based on the contrast CT images and reports. The surgeon applied the holographic image for preoperative planning. During the operation, the navigation was achieved by real time fusing holographic images with the laparoscopic surgery images in the screen. \u0000 \u0000 \u0000Results \u0000All the procedures had been complete uneventfully. The holographic images helped surgeon in understanding the visual three- dimension structure and relation of vessels supplying tumor or resection tissue, lymph nodes and nerves. By manipulating the holographic images extracorporeally, the fused image guide surgeons about location vessel, lymph node and other important structure and then facilitate the delicate dissection. For the 41 cases with available clinical data including 23 cases of robotic-assisted partial nephrectomy and 18 cases of laparoscopic nephrectomy, the median operation time was 140(range 50-225)min, the median warm ischemia time was 23(range 14-60)min, the median blood loss was 80(range 5-1 200)ml. In the robotic surgery group, the median operation time was 140(range 50-215)min, the median warm ischemia time was 21(range 17-40)min, the median blood loss was 150(range 30-1 200)ml. In the laparoscopic surgery group, the median operation time was 160(range 80-225)min, the median warm ischemia time was 25(range 14-60)min, the median blood loss was 50(range 5-1 200)ml. All the patients had no adjacent organ injury during operation. There were 2 cases with Clavien Ⅱcomplications. One required transfusion and the other one suffered hematoma post-operation. However, the tumors were located in the renal hilus for these 2 cases and the R","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"41 1","pages":"131-137"},"PeriodicalIF":0.0,"publicationDate":"2020-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47297280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-15DOI: 10.3760/CMA.J.ISSN.1000-6702.2020.02.002
Chenyang Wang, Hao Liu, Jinli Han, Chun Jiang, Jian Huang
Objective To introduce and discuss the efficacy of a new technique to perform transperitoneal single-docking robot-assisted laparoscopic nephroureterectomy (RNU). Methods A total of 44 patients diagnosed with urothelial neoplasm of the renal pelvis or were investigated from January 2016 to November 2019. RNU was performed by a single surgeon. Among the 44 patients, 31 were male, and 13 were female. The median age was 63 (IQR: 58-71). The median body mass index (BMI) was 23.08 (IQR: 21.55-24.60) kg/m2. All operations were performed with general anesthesia. The patients were positioned 80 degrees flank with the diseased side up, and the head was tilted 10 degrees downwards. The camera port was placed one finger lateral to the umbilicus. For the right-sided tumors, robotic arm 1 was inserted through the trocar on the right pararectus line, 8 cm above the umbilicus, and robotic arm 2 was inserted through the trocar on the same line, 8 cm below the umbilicus. Assistant trocar 1 was placed where the anterior midline joins the perpendicular bisector of the camera port and robotic 2, and assistant trocar 2 was placed below the xiphoid process. For the left-sided tumors, all trocars were centrosymmetric to that of the right-sided tumors, except that assistant port 2 was placed 3 finger width above the pubic symphysis. The peritoneum was incised along the Toldt line, and the inferior vena cava was isolated (for left sided tumor, the abdominal aorta was isolated instead). The renal artery and vein were clipped with Hem-o-lok and ligated, and the kidney were isolated. The ureter was identified and isolated downwards across the common iliac artery and then clipped distal to the tumor site. The bladder cuff was resected and sutured under the laparoscopy. Results The median operation time was 145 (IQR: 130-175) min, with the median console time of 119 (IQR: 108.5-136.0) min, the anastomosis of bladder cuff of 12 min, and the median estimated blood loss of 50(20-100)ml. After the surgery, 6 Clavien-Dindo grade 2 complications occurred, including 2 chylous leakage, 1 hemostasis, 1 blood transfusion, 1 deep vein thrombus, and 1 acute coronary syndrome. The median length of stay (LOS) was 8 (IQR: 6.5-10.0) d. The median length of follow-up was 12 months. In total, 5 patients were dead, including 3 cancer-specific death. Four recurrence occurred and caused 3 death. The 2-year overall survival and progression-free survival were 68.2% and 77.9%, respectively. Conclusions The technique of RNU with simultaneous bladder cuff excision (BCE). Our technique improved the surgical outcome. The perioperative complication rate was low, and the short-term survival outcomes were satisfactory. Key words: Ureteral neoplasms; Upper tract urothelial carcinoma(UTUC); Nephroureterecto-my; Robotic surgery; Laparoscopic surgery
{"title":"Single-docking transperitoneal robotic-assisted nephroureterectomy: surgical techniques and outcomes","authors":"Chenyang Wang, Hao Liu, Jinli Han, Chun Jiang, Jian Huang","doi":"10.3760/CMA.J.ISSN.1000-6702.2020.02.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2020.02.002","url":null,"abstract":"Objective \u0000To introduce and discuss the efficacy of a new technique to perform transperitoneal single-docking robot-assisted laparoscopic nephroureterectomy (RNU). \u0000 \u0000 \u0000Methods \u0000A total of 44 patients diagnosed with urothelial neoplasm of the renal pelvis or were investigated from January 2016 to November 2019. RNU was performed by a single surgeon. Among the 44 patients, 31 were male, and 13 were female. The median age was 63 (IQR: 58-71). The median body mass index (BMI) was 23.08 (IQR: 21.55-24.60) kg/m2. All operations were performed with general anesthesia. The patients were positioned 80 degrees flank with the diseased side up, and the head was tilted 10 degrees downwards. The camera port was placed one finger lateral to the umbilicus. For the right-sided tumors, robotic arm 1 was inserted through the trocar on the right pararectus line, 8 cm above the umbilicus, and robotic arm 2 was inserted through the trocar on the same line, 8 cm below the umbilicus. Assistant trocar 1 was placed where the anterior midline joins the perpendicular bisector of the camera port and robotic 2, and assistant trocar 2 was placed below the xiphoid process. For the left-sided tumors, all trocars were centrosymmetric to that of the right-sided tumors, except that assistant port 2 was placed 3 finger width above the pubic symphysis. The peritoneum was incised along the Toldt line, and the inferior vena cava was isolated (for left sided tumor, the abdominal aorta was isolated instead). The renal artery and vein were clipped with Hem-o-lok and ligated, and the kidney were isolated. The ureter was identified and isolated downwards across the common iliac artery and then clipped distal to the tumor site. The bladder cuff was resected and sutured under the laparoscopy. \u0000 \u0000 \u0000Results \u0000The median operation time was 145 (IQR: 130-175) min, with the median console time of 119 (IQR: 108.5-136.0) min, the anastomosis of bladder cuff of 12 min, and the median estimated blood loss of 50(20-100)ml. After the surgery, 6 Clavien-Dindo grade 2 complications occurred, including 2 chylous leakage, 1 hemostasis, 1 blood transfusion, 1 deep vein thrombus, and 1 acute coronary syndrome. The median length of stay (LOS) was 8 (IQR: 6.5-10.0) d. The median length of follow-up was 12 months. In total, 5 patients were dead, including 3 cancer-specific death. Four recurrence occurred and caused 3 death. The 2-year overall survival and progression-free survival were 68.2% and 77.9%, respectively. \u0000 \u0000 \u0000Conclusions \u0000The technique of RNU with simultaneous bladder cuff excision (BCE). Our technique improved the surgical outcome. The perioperative complication rate was low, and the short-term survival outcomes were satisfactory. \u0000 \u0000 \u0000Key words: \u0000Ureteral neoplasms; Upper tract urothelial carcinoma(UTUC); Nephroureterecto-my; Robotic surgery; Laparoscopic surgery","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"41 1","pages":"85-89"},"PeriodicalIF":0.0,"publicationDate":"2020-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42410517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-15DOI: 10.3760/CMA.J.ISSN.1000-6702.2020.02.017
Sitong Chen, Zhiping Wang
Low-intensity pulsed ultrasound (LIPUS) is a form of ultrasound that delivered at a much lower intensity (<3 W/cm2) than traditional ultrasound and output in the mode of pulse wave, it is typically used for therapeutic purpose in rehabilitation medicine. It has minimal thermal effects due to its low intensity and pulsed output mode, and its non-thermal effects which is normally claimed to induce therapeutic effect in tissues attracting much attentions. LIPUS have been demonstrated to have a rage of biological effects on tissues, including accelerating soft-tissue regeneration, promoting bone-fracture healing, inhibiting inflammatory responses, etc. Hopefully, LIPUS may become an effective clinical procedure for the treatment of urological diseases, such as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), erectile dysfunction (ED), and stress urinary incontinence (SUI). It still needs an intense effort for basic and clinical investigators to explore the biomedical applications of microenergy medicine. Key words: Urologic diseases; Ultrasonic therapy; Review
{"title":"Application of low intensity pulsed ultrasound in treating urinary system diseases","authors":"Sitong Chen, Zhiping Wang","doi":"10.3760/CMA.J.ISSN.1000-6702.2020.02.017","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2020.02.017","url":null,"abstract":"Low-intensity pulsed ultrasound (LIPUS) is a form of ultrasound that delivered at a much lower intensity (<3 W/cm2) than traditional ultrasound and output in the mode of pulse wave, it is typically used for therapeutic purpose in rehabilitation medicine. It has minimal thermal effects due to its low intensity and pulsed output mode, and its non-thermal effects which is normally claimed to induce therapeutic effect in tissues attracting much attentions. LIPUS have been demonstrated to have a rage of biological effects on tissues, including accelerating soft-tissue regeneration, promoting bone-fracture healing, inhibiting inflammatory responses, etc. Hopefully, LIPUS may become an effective clinical procedure for the treatment of urological diseases, such as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), erectile dysfunction (ED), and stress urinary incontinence (SUI). It still needs an intense effort for basic and clinical investigators to explore the biomedical applications of microenergy medicine. \u0000 \u0000Key words: \u0000Urologic diseases; Ultrasonic therapy; Review","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"41 1","pages":"157-160"},"PeriodicalIF":0.0,"publicationDate":"2020-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47181883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.1000-6702.2020.01.008
Chengcun Zhu, F. Cheng, T. Rao, Wei-min Yu, Xiaobin Zhang, Y. Ruan, Run Yuan, Yu-qi Xia
Objective To evaluate efficacy and safety of retrograde intrarenal stone surgery for treatment of upper urinary calculi. Methods The clinical data of 640 patients with upper urinary tract calculi treated by retrograde intrarenal stone surgery (RIRS) in Renmin Hospital of Wuhan University from April 2016 to January 2019 were retrospectively analyzed. There were 424 males and 216 females. The awerage age was (46.2±12.8) years old, ranging 18 to 76 years old. The maximum diameter of the stone is (1.4±0.7) cm, ranging 0.6-3.2 cm. There were 126 cases with inferior calculi and 514 cases with non-lurgical calculi. There were 196 cases with unilateral ureteral calculi, 118 unilateral ureteral calculi cases with renal calculi, 236 cases with unilateral renal stones, and 90 cases with double kidney stones. 104 cases were placed with double J tube before operation and 496 cases were not placed before operation. There were 8 cases of horseshoe kidney, 30 cases of isolated kidney with renal insufficiency, 4 cases of pelvic ectopic kidney with dysplasia, 6 cases of congenital ureteral malformation and 2 cases of sponge kidney. Preoperative average hemoglobin was (133.2±5.6)g/L, ranging 126-188 g/L.And average serum creatinine was (84.4±12.2)μmol/L, ranging 74-242μmol/L before operation. All patients were treated with general anesthesia under the lithotomy position. The ureteroscopy combined with holmium laser lithotripsy was performed.The 200μm fiber was used, which the parameters were set as 12-45 W(0.5-1.5 J/10-30 Hz). The stone baskets were used to take stones according to actual conditions. The operation was performed by doctors of the same qualifications. Results All patients underwent successful operation. The mean operation time was (45.6±14.6)min. The average postoperative hospitalization was (4.8±1.5)d. The postoperative serious complication rate was 0.9%, including(2 cases of sepsis and 1 case of subcapsular hematoma. Of the 640 patients, 596 were admitted to the hospital for a double J tube and 44 were lost of follow-up. 552 patients met the stone removal criteria, 44 patients did not meet the stone removal criteria for other treatments, such as extracorporeal shock wave lithotripsy, ureteroscopy or observed regularly. The stone-free rate (SFR) was 92.6% (552/596) after 1-3 months. On the first postoperative day, serum creatinine was (76.0±10.6)(58-156) μmol/L, and postoperative hemoglobin was (126.4±9. 6)(120-176) g/L. There was no significant difference in preoperative and postoperative hemoglobin (t=2.02, P=0.064). Preoperative and postoperative creatinine (t=64.76, P<0.05) was statistically significant. Meanwhile, the stone size (χ2=29.569, P<0.05) and position (χ2=44.949, P<0.05) versus SFR the impact was statistically significant. Multivariate regression analysis showed that stone size was not an independent risk factor for stone clearance (P=0.639). The stone position was an independent risk factor for stone clearance (P=0.013).
{"title":"Clinical efficacy and safety analysis of retrograde intrarenal stone surgery for treatment of upper urinary calculi","authors":"Chengcun Zhu, F. Cheng, T. Rao, Wei-min Yu, Xiaobin Zhang, Y. Ruan, Run Yuan, Yu-qi Xia","doi":"10.3760/CMA.J.ISSN.1000-6702.2020.01.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2020.01.008","url":null,"abstract":"Objective \u0000To evaluate efficacy and safety of retrograde intrarenal stone surgery for treatment of upper urinary calculi. \u0000 \u0000 \u0000Methods \u0000The clinical data of 640 patients with upper urinary tract calculi treated by retrograde intrarenal stone surgery (RIRS) in Renmin Hospital of Wuhan University from April 2016 to January 2019 were retrospectively analyzed. There were 424 males and 216 females. The awerage age was (46.2±12.8) years old, ranging 18 to 76 years old. The maximum diameter of the stone is (1.4±0.7) cm, ranging 0.6-3.2 cm. There were 126 cases with inferior calculi and 514 cases with non-lurgical calculi. There were 196 cases with unilateral ureteral calculi, 118 unilateral ureteral calculi cases with renal calculi, 236 cases with unilateral renal stones, and 90 cases with double kidney stones. 104 cases were placed with double J tube before operation and 496 cases were not placed before operation. There were 8 cases of horseshoe kidney, 30 cases of isolated kidney with renal insufficiency, 4 cases of pelvic ectopic kidney with dysplasia, 6 cases of congenital ureteral malformation and 2 cases of sponge kidney. Preoperative average hemoglobin was (133.2±5.6)g/L, ranging 126-188 g/L.And average serum creatinine was (84.4±12.2)μmol/L, ranging 74-242μmol/L before operation. All patients were treated with general anesthesia under the lithotomy position. The ureteroscopy combined with holmium laser lithotripsy was performed.The 200μm fiber was used, which the parameters were set as 12-45 W(0.5-1.5 J/10-30 Hz). The stone baskets were used to take stones according to actual conditions. The operation was performed by doctors of the same qualifications. \u0000 \u0000 \u0000Results \u0000All patients underwent successful operation. The mean operation time was (45.6±14.6)min. The average postoperative hospitalization was (4.8±1.5)d. The postoperative serious complication rate was 0.9%, including(2 cases of sepsis and 1 case of subcapsular hematoma. Of the 640 patients, 596 were admitted to the hospital for a double J tube and 44 were lost of follow-up. 552 patients met the stone removal criteria, 44 patients did not meet the stone removal criteria for other treatments, such as extracorporeal shock wave lithotripsy, ureteroscopy or observed regularly. The stone-free rate (SFR) was 92.6% (552/596) after 1-3 months. On the first postoperative day, serum creatinine was (76.0±10.6)(58-156) μmol/L, and postoperative hemoglobin was (126.4±9. 6)(120-176) g/L. There was no significant difference in preoperative and postoperative hemoglobin (t=2.02, P=0.064). Preoperative and postoperative creatinine (t=64.76, P<0.05) was statistically significant. Meanwhile, the stone size (χ2=29.569, P<0.05) and position (χ2=44.949, P<0.05) versus SFR the impact was statistically significant. Multivariate regression analysis showed that stone size was not an independent risk factor for stone clearance (P=0.639). The stone position was an independent risk factor for stone clearance (P=0.013).","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"41 1","pages":"41-45"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41601035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.1000-6702.2020.01.019
B. Feng, Zhongjin Yue, Guanghui Yan, Zhiping Wang
Renal cell carcinoma is rarely diagnosed during pregnancy, but it is commonly reported urinary system tumors during pregnancy. The management is a real challenge due to the sparse literature and lack of standard guidelines. Following the continuous development of medical technology, the health and fertility needs of these patients have been well protected in recent years. The aim of this article is to review the epidemiology, risk factors, diagnosis, treatment, and prognosis of renal cell carcinoma during pregnancy. Key words: Carcinoma; Renal cell carcinoma during pregnancy; Diagnosis; Treatment
{"title":"Diagnosis and treatment of renal cancer during pregnancy","authors":"B. Feng, Zhongjin Yue, Guanghui Yan, Zhiping Wang","doi":"10.3760/CMA.J.ISSN.1000-6702.2020.01.019","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2020.01.019","url":null,"abstract":"Renal cell carcinoma is rarely diagnosed during pregnancy, but it is commonly reported urinary system tumors during pregnancy. The management is a real challenge due to the sparse literature and lack of standard guidelines. Following the continuous development of medical technology, the health and fertility needs of these patients have been well protected in recent years. The aim of this article is to review the epidemiology, risk factors, diagnosis, treatment, and prognosis of renal cell carcinoma during pregnancy. \u0000 \u0000 \u0000Key words: \u0000Carcinoma; Renal cell carcinoma during pregnancy; Diagnosis; Treatment","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"41 1","pages":"76-78"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44902925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.1000-6702.2020.01.016
Min Zhang
To study the diagnosis and treatment of small cell neuroendocrine prostatic carcinoma. A 60-year-old patient with pure small cell neuroendocrine carcinoma of prostate was admitted because of dysuria for 1 month. Digital rectal examination showed the prostate was hard. Result of histological biopsy were consistent with a diagnosis of small cell neuroendocrine carcinoma of prostate. Combination chemotherapy with radiotherapy regimen were proved to be effective. The patient′s symptoms were relieved obviously. The patient died about 15 months after admission. Small cell neuroendocrine carcinoma of prostate has a very poor prognosis. Systemic chemotherapy is the most important treatment available. Key words: Prostatic neoplasms; Small cell neuroendocrine carcinoma; Chemotherapy
{"title":"A case report of small cell neuroendocrine carcinoma of prostate","authors":"Min Zhang","doi":"10.3760/CMA.J.ISSN.1000-6702.2020.01.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2020.01.016","url":null,"abstract":"To study the diagnosis and treatment of small cell neuroendocrine prostatic carcinoma. A 60-year-old patient with pure small cell neuroendocrine carcinoma of prostate was admitted because of dysuria for 1 month. Digital rectal examination showed the prostate was hard. Result of histological biopsy were consistent with a diagnosis of small cell neuroendocrine carcinoma of prostate. Combination chemotherapy with radiotherapy regimen were proved to be effective. The patient′s symptoms were relieved obviously. The patient died about 15 months after admission. Small cell neuroendocrine carcinoma of prostate has a very poor prognosis. Systemic chemotherapy is the most important treatment available. \u0000 \u0000 \u0000Key words: \u0000Prostatic neoplasms; Small cell neuroendocrine carcinoma; Chemotherapy","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"41 1","pages":"66-67"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43957950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.1000-6702.2020.01.003
Qiang Zhao, Chen Liu, Jia Liu, Xingxing Tang, Yongpeng Ji, Yudong Cao, B. Hong, Te-li Liu, Zhi Yang, D. Peng, Yong Yang, Ning Zhang
Objective To investigate the relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopathological characteristics of patients treated with radical prostatectomy. Methods The clinicopahtological data of patients evaluated with 68Ga-PSMA PET-CT preoperatively and treated with radical prostatectomy between May 2016 and August 2019 were retrospectively reviewed. 31 patients with a mean age (63.1±4.9) and baseline PSA (72.71±173.15)ng/ml were enrolled. Their BMI mean (24.6±3.0)kg/m2. Baseline testosterone of 14 patients was (4.72±1.64)ng/ml.Based on the Gleason scores related ISUP classification, all patients were classified into grade one in 5 cases, grade 2in 7 cases, grade 3 in 4 cases, grade 4 in 10 cases and grade 5 in 5 cases. The clinical classification included 6 cases in T2a stage, 2 cases in T2b stage, 17 cases in T2c stage, 1 case in T3a stage, 4 cases in T3b stage and 1 case in T4 stage. SUVmax was accessed by two independent professional nuclear medicine physicians. SUVmax was 12.49±9.38. SPSS 16.0 software was used to do statistic analysis. Results The post-operative pathological results showed the surgical margin positive in 19 cases, negative in 12 cases, vascular positive in 5 cases, negative in 20 case, positive nerve invasion in 20 cases and negative in 11 cases. 2 patients were low risk, 7 patients were medium risk and 22 patients were high risk according to D′Amico classification. Based on the basis of PSA(≤10 or>10) and Gleason score(≤6 or>6), 6 patients were in group with low PSA and low Gleason score, 5 patients were low PSA and high Gleason score, 9 patients were high PSA and low Gleason score, 11 patients were high PSA and high Gleason score. SUVmax had a significant positive relationship with pathological ISUP(r=0.434, P=0.015) and SUVmax in patients with positive intravascular tumor emboli was significantly higher than those with negative intravascular tumor emboli(14.78±10.68 vs. 8.17±2.81, P=0.005). No significant correlation was found between SUVmax and baseline PSA, testosterone, pathologic T stage, surgical margin, nerve invasion, pelvic lymph node status as well as risk stratification. SUVmax could distinguish pathologic ISUP grade 5 with a maximum AUC 0.747 (P=0.033) and the sensitivity was 88.9%. The specificity was 77.3% when SUVmax≥11.34. SUVmax in patients with upgrading ISUP was significantly higher than that in patients with downgrading ISUP (16.01±5.40 vs. 4.98±2.11, P=0.007). Conclusions SUVmax measured on preoperative 68Ga-PSMA PET-CT may have a clinical significance in predicting unfavorable pathological factors for patients treated with radical prostatectomy. Key words: Prostatic neoplasms; Prostate cancer; Prostate-specific membrane antigen(PSMA); 68Ga; Positron-emission tomography(PET-CT); Maximum standardized uptake value(SUVmax); Gleason score
{"title":"The relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopahtological characteristics in patients treated with radical prostatectomy","authors":"Qiang Zhao, Chen Liu, Jia Liu, Xingxing Tang, Yongpeng Ji, Yudong Cao, B. Hong, Te-li Liu, Zhi Yang, D. Peng, Yong Yang, Ning Zhang","doi":"10.3760/CMA.J.ISSN.1000-6702.2020.01.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2020.01.003","url":null,"abstract":"Objective \u0000To investigate the relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopathological characteristics of patients treated with radical prostatectomy. \u0000 \u0000 \u0000Methods \u0000The clinicopahtological data of patients evaluated with 68Ga-PSMA PET-CT preoperatively and treated with radical prostatectomy between May 2016 and August 2019 were retrospectively reviewed. 31 patients with a mean age (63.1±4.9) and baseline PSA (72.71±173.15)ng/ml were enrolled. Their BMI mean (24.6±3.0)kg/m2. Baseline testosterone of 14 patients was (4.72±1.64)ng/ml.Based on the Gleason scores related ISUP classification, all patients were classified into grade one in 5 cases, grade 2in 7 cases, grade 3 in 4 cases, grade 4 in 10 cases and grade 5 in 5 cases. The clinical classification included 6 cases in T2a stage, 2 cases in T2b stage, 17 cases in T2c stage, 1 case in T3a stage, 4 cases in T3b stage and 1 case in T4 stage. SUVmax was accessed by two independent professional nuclear medicine physicians. SUVmax was 12.49±9.38. SPSS 16.0 software was used to do statistic analysis. \u0000 \u0000 \u0000Results \u0000The post-operative pathological results showed the surgical margin positive in 19 cases, negative in 12 cases, vascular positive in 5 cases, negative in 20 case, positive nerve invasion in 20 cases and negative in 11 cases. 2 patients were low risk, 7 patients were medium risk and 22 patients were high risk according to D′Amico classification. Based on the basis of PSA(≤10 or>10) and Gleason score(≤6 or>6), 6 patients were in group with low PSA and low Gleason score, 5 patients were low PSA and high Gleason score, 9 patients were high PSA and low Gleason score, 11 patients were high PSA and high Gleason score. SUVmax had a significant positive relationship with pathological ISUP(r=0.434, P=0.015) and SUVmax in patients with positive intravascular tumor emboli was significantly higher than those with negative intravascular tumor emboli(14.78±10.68 vs. 8.17±2.81, P=0.005). No significant correlation was found between SUVmax and baseline PSA, testosterone, pathologic T stage, surgical margin, nerve invasion, pelvic lymph node status as well as risk stratification. SUVmax could distinguish pathologic ISUP grade 5 with a maximum AUC 0.747 (P=0.033) and the sensitivity was 88.9%. The specificity was 77.3% when SUVmax≥11.34. SUVmax in patients with upgrading ISUP was significantly higher than that in patients with downgrading ISUP (16.01±5.40 vs. 4.98±2.11, P=0.007). \u0000 \u0000 \u0000Conclusions \u0000SUVmax measured on preoperative 68Ga-PSMA PET-CT may have a clinical significance in predicting unfavorable pathological factors for patients treated with radical prostatectomy. \u0000 \u0000 \u0000Key words: \u0000Prostatic neoplasms; Prostate cancer; Prostate-specific membrane antigen(PSMA); 68Ga; Positron-emission tomography(PET-CT); Maximum standardized uptake value(SUVmax); Gleason score","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"41 1","pages":"13-18"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44882401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.1000-6702.2020.01.005
Bijun Lian, Jing Li, Huan Chen, Feng Zhu, Min Qu, Yan Wang, Zepeng Jia
Objective To investigte the efficacy of docetaxel combined with androgen deprivation therapy for the treatment of metastatic hormone-sensitive prostate cancer based on Chinese population. Methods A total of 497 patients were enrolled from January 2004 to July 2018 in the Changhai Hospital. 459 patients received androgen deprivation therapy alone and 38 patients received androgen deprivation therapy combined with docetaxel. The mean age was (72.1±8.7)years. The median PSA level was 100.0 ng/ml, ranging 42.3-999.0 ng/ml. Patients of clinical T2, T3, T4 stage were 213(42.9%), 160(32.2%), 124(24.9%), respectively. Patients of clinical N0, N1, Nx stage were 319(64.2%), 144(29.0%), 34(6.8%), respectively. Patients of clinical M0, M1a, M1b, M1c, Mx stage were 100(20.1%), 51(10.3%), 332(66.8%), 9(1.8%), 5(1.0%), respectively. Gleason scores of biopsy showed that 146(29.4%) patients was ≤7, 103(20.7%) was 8 and 248(49.9%)was ≥9. Propensity score matching was used to match the baseline between groups. Caliper value was set at 0.02. SPSS 22 software was used to achieve a 1∶1 match between the two groups. There were no statistical difference in the age(P=0.102), PSA(P=0.713), T stage(P=0.113), N stage(P=0.226), M stage(P=0.514), Gleason score(P=0.612), tumor loading(P=0.812)between the two groups. The castration resistance-free rate and cancer specific survival rate of the two groups were compared by log-rank and breslow-wilcoxon test. Furthermore, forest plots were used to display the analysis results of different subgroups such as age, PSA, clinical stage, Gleason score, tumor load, whether patients had received palliative resection, and the differences in castration resistance-free rate were compared between the subgroups with high tumor load. Results The median follow-up time was 22.6 months in the androgen deprivation therapy group and 13.7 months in the combined therapy group. The number of patients with castration resistance in the two groups was 23 and 17, respectively. There were 3 and 6 deaths, respectively. There was no statistically significant difference in the overall progression time to castration resistance between the two groups (10.3 m vs. 16.5 m, P>0.05), and no statistically significant difference in the prostate cancer specific survival rate (21.9 m vs.14.8 m, P>0.05). When subgroup analysis was performed, it was found that patients in the high-metastasis-volume subgroup who received the combination therapy had a significantly longer castration resistance free lifetime (10.6 m vs. 7.2 m, P=0.044), but there was no significant difference in the low- metastasis-volume subgroup(10.5 m vs.12.6 m, P>0.05). Conclusion Docetaxel combined with androgen deprivation therapy can improve the castration resistance free rate in patients with high metastasis volume, but not in low metastasis volume group. Key words: Prostatic neoplasms; Prostate cancer; Docetaxel; Chemotherapy; Androgen deprivation therapy; Propensity score mat
目的探讨多西紫杉醇联合雄激素剥夺治疗转移性激素敏感性前列腺癌在中国人群中的疗效。方法选取2004年1月至2018年7月在长海医院接受雄激素剥夺治疗的497例患者，其中单独接受雄激素剥夺治疗的459例，联合多西紫杉醇治疗的38例。平均年龄(72.1±8.7)岁。中位PSA水平为100.0 ng/ml，范围为42.3 ~ 999.0 ng/ml。临床T2、T3、T4期患者分别为213例(42.9%)、160例(32.2%)、124例(24.9%)。临床N0、N1、Nx期分别为319例(64.2%)、144例(29.0%)、34例(6.8%)。临床M0、M1a、M1b、M1c、Mx期患者分别为100例(20.1%)、51例(10.3%)、332例(66.8%)、9例(1.8%)、5例(1.0%)。活检Gleason评分显示≤7者146例(29.4%)，8者103例(20.7%)，≥9者248例(49.9%)。倾向评分匹配用于组间基线的匹配。卡尺值设为0.02。采用SPSS 22软件对两组数据进行1∶1匹配。两组患者年龄(P=0.102)、PSA(P=0.713)、T分期(P=0.113)、N分期(P=0.226)、M分期(P=0.514)、Gleason评分(P=0.612)、肿瘤负荷(P=0.812)比较，差异均无统计学意义。采用log-rank和brreslow -wilcoxon检验比较两组患者的去势抵抗率和肿瘤特异性生存率。采用森林图显示年龄、PSA、临床分期、Gleason评分、肿瘤负荷、是否行姑息性切除等不同亚组的分析结果，比较高肿瘤负荷亚组间去势无阻力率的差异。结果雄激素剥夺治疗组中位随访时间为22.6个月，联合治疗组中位随访时间为13.7个月。两组出现去势抵抗的患者分别为23例和17例。分别有3人和6人死亡。两组患者到去势抵抗的总进展时间(10.3 m vs. 16.5 m, P>0.05)差异无统计学意义，前列腺癌特异性生存率(21.9 m vs.14.8 m, P>0.05)差异无统计学意义。亚组分析发现，接受联合治疗的高转移量亚组患者的去势抵抗自由寿命明显更长(10.6 m vs. 7.2 m, P=0.044)，而低转移量亚组患者的去势抵抗自由寿命无显著差异(10.5 m vs.12.6 m, P= 0.05)。结论多西紫杉醇联合雄激素剥夺治疗可提高高转移量患者的去势抵抗率，而对低转移量组无改善作用。关键词:前列腺肿瘤;前列腺癌;多西他赛;化疗;雄激素剥夺疗法;倾向评分匹配
{"title":"A retrospective study of docetaxel combined with ADT therapy in the treatment of metastatic hormone-sensitive prostate cancer","authors":"Bijun Lian, Jing Li, Huan Chen, Feng Zhu, Min Qu, Yan Wang, Zepeng Jia","doi":"10.3760/CMA.J.ISSN.1000-6702.2020.01.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2020.01.005","url":null,"abstract":"Objective \u0000To investigte the efficacy of docetaxel combined with androgen deprivation therapy for the treatment of metastatic hormone-sensitive prostate cancer based on Chinese population. \u0000 \u0000 \u0000Methods \u0000A total of 497 patients were enrolled from January 2004 to July 2018 in the Changhai Hospital. 459 patients received androgen deprivation therapy alone and 38 patients received androgen deprivation therapy combined with docetaxel. The mean age was (72.1±8.7)years. The median PSA level was 100.0 ng/ml, ranging 42.3-999.0 ng/ml. Patients of clinical T2, T3, T4 stage were 213(42.9%), 160(32.2%), 124(24.9%), respectively. Patients of clinical N0, N1, Nx stage were 319(64.2%), 144(29.0%), 34(6.8%), respectively. Patients of clinical M0, M1a, M1b, M1c, Mx stage were 100(20.1%), 51(10.3%), 332(66.8%), 9(1.8%), 5(1.0%), respectively. Gleason scores of biopsy showed that 146(29.4%) patients was ≤7, 103(20.7%) was 8 and 248(49.9%)was ≥9. Propensity score matching was used to match the baseline between groups. Caliper value was set at 0.02. SPSS 22 software was used to achieve a 1∶1 match between the two groups. There were no statistical difference in the age(P=0.102), PSA(P=0.713), T stage(P=0.113), N stage(P=0.226), M stage(P=0.514), Gleason score(P=0.612), tumor loading(P=0.812)between the two groups. The castration resistance-free rate and cancer specific survival rate of the two groups were compared by log-rank and breslow-wilcoxon test. Furthermore, forest plots were used to display the analysis results of different subgroups such as age, PSA, clinical stage, Gleason score, tumor load, whether patients had received palliative resection, and the differences in castration resistance-free rate were compared between the subgroups with high tumor load. \u0000 \u0000 \u0000Results \u0000The median follow-up time was 22.6 months in the androgen deprivation therapy group and 13.7 months in the combined therapy group. The number of patients with castration resistance in the two groups was 23 and 17, respectively. There were 3 and 6 deaths, respectively. There was no statistically significant difference in the overall progression time to castration resistance between the two groups (10.3 m vs. 16.5 m, P>0.05), and no statistically significant difference in the prostate cancer specific survival rate (21.9 m vs.14.8 m, P>0.05). When subgroup analysis was performed, it was found that patients in the high-metastasis-volume subgroup who received the combination therapy had a significantly longer castration resistance free lifetime (10.6 m vs. 7.2 m, P=0.044), but there was no significant difference in the low- metastasis-volume subgroup(10.5 m vs.12.6 m, P>0.05). \u0000 \u0000 \u0000Conclusion \u0000Docetaxel combined with androgen deprivation therapy can improve the castration resistance free rate in patients with high metastasis volume, but not in low metastasis volume group. \u0000 \u0000 \u0000Key words: \u0000Prostatic neoplasms; Prostate cancer; Docetaxel; Chemotherapy; Androgen deprivation therapy; Propensity score mat","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":"41 1","pages":"26-31"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45306650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.1000-6702.2020.01.017
Zhilong Hu, Hongsong Bai
Bladder cancer is one of the tenth most common malignant tumors in Chinese men. Almost 20% to 30% patients are diagnosed as the muscle-invasive bladder cancer (MIBC) at the first diagnosis.In the past, radical cystectomy (RC) was the first-line treatment with MIBC.The current researches' results show that, neoadjuvant chemotherapy combined with RC can improve the tumor complete response rate and prolong the overall survival of patients with MIBC, comparing with the RC alone. It has become the recommended standard first line treatment for MIBC, which has the possiblity of preserving bladder. Lots of researches indicate that the application of cisplatin-based neoadjuvant chemotherapy in patients with MIBC is becoming more and more popular. However, there is still the possibility of ineffectiveness or tumor progression. Therefore, discussions about the sensitivity of neoadjuvant chemotherapy have always been a hot spot in urological tumor research. In order to provide guidance and help for clinical work, the article reviews the sensitivity of neoadjuvant chemotherapy of bladder urothelial carcinoma. Key words: Urinary bladder neoplasms; Neoadjuvant chemotherapy; Sensitivity; Markers
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