[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to investigate the minimally invasive cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) approach in the management of renal cell carcinoma (RCC) with level III or IV inferior vena cava (IVC) thrombus and evaluate the survival outcomes.
We performed a retrospective analysis on 32 RCC patients with IVC thrombus that underwent nephrectomy and thrombectomy via the minimally invasive CPB/DHCA approach between January 2007 and December 2013. Perioperative variables (for example, operative time, CPB duration, and circulatory arrest duration), estimated blood loss, hospital stay, perioperative complications, and survival data were recorded and analyzed.
Thirty-two patients (median age: 56 years) were treated surgically using the CPB and DHCA approach for RCC with a level III (n = 25) or level IV (n = 7) tumor thrombus. The median operation time was 360 min (interquartile range (IQR): 300 to 435 min) with median CPB and DHCA durations of 149 min and 23 min, respectively. The median estimated blood loss was 2,500 ml. Four complications were observed but no deaths occurred perioperatively. The median follow-up was 25 months (range: 4 to 64 months). The mean overall survival (OS) was 28.2 ± 4.6 months while the disease-free survival (DFS) was 19.5 ± 11.6 months. In patients with M0 disease, ten patients developed metastases and were treated with sorafenib as an adjuvant therapy. The mean OS and DFS of this subgroup were 25.4 ± 12.8 months and 16.0 ± 14.2 months, respectively.
Radical nephrectomy and thrombectomy using CPB and DHCA to treat RCC is a relatively safe approach associated with low morbidity and mortality. This minimally invasive procedure may help minimize surgical trauma and improve perioperative outcomes.
Preview · Article · Apr 2015 · World Journal of Surgical Oncology
[Show abstract][Hide abstract] ABSTRACT: Mucinous tubular and spindle cell carcinoma of kidney (MTSCC-K) is a rare variant of renal tumor. The current data show most of MTSCCs are of low malignant potential and rare cases metastatic to lymph nodes have been reported; however, the recorded computed tomography (CT) and follow up data are limited.Material and method: In the present study, we retrospectively analyzed CT and clinicopathological data of eight patients with renal MTSCC-K.
A total of eight cases, including six females and two males, were included in this analysis with a mean age of 48.4 (range 25 to 81) years. Mean tumor size was 4.2 (range 2.5 to 10.0) cm. Preoperative CT demonstrated that all tumors were slightly enhanced on both corticomedullary and nephrographic phase, which was different from many other renal cell carcinomas. Three of them were treated with open radical nephrectomy, three with laparoscopic radical nephrectomy and the other two with laparoscopic partial nephrectomy. No postoperative therapy was applied. Patients were followed up for 15 to 64 months and there was no evidence of recurrence and metastasis.
The MTSCC-K has special clinicopathological characteristics, low degree of malignancy and relative good prognosis. The diagnosis mainly depends on the histopathological examination and CT may help to differentiate with papillary renal cell carcinoma. Surgical treatment is recommended and additional therapies are not necessary.Virtual slides: The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/8435581771088249.
Preview · Article · Dec 2013 · Diagnostic Pathology
[Show abstract][Hide abstract] ABSTRACT: Objective:
To investigate the differences between tumor sizes measured by preoperative computed tomography (CT) imaging and pathologic examination of surgical specimens in Chinese patients who received extirpative surgery for renal tumors.
From September 2008 to September 2010, 204 patients with renal tumors treated in the Renji Hospital were enrolled in this study, and their clinicopathological data were collected and analyzed. The paired Student's t-test was used to compare the mean radiological tumor maximum diameter and the mean pathological tumor maximum diameter. All cases in which post-operative down-staging or up-staging occurred due to the discrepancy between radiological and pathological tumor maximum diameters were identified. In addition, the relationship between radiological and pathological tumor maximum diameters and histological subtypes was analyzed.
Overall, the radiological mean maximum diameter of tumors on CT was 48.3 mm and the pathological mean maximum diameter was 47.0 mm. On average, CT overestimated pathological size by 1.3 mm (P = 0.018). CT overestimated pathological tumor size in 111 (54.4%) patients, underestimated in 71 (34.8%) patients and equal pathological size in 22 (10.8%) patients. Among the 190 patients with pT1 or pT2 tumors, there was a discrepancy between clinical and pathological staging in 35 (18.4%) patients. Of these, 29 (15.3%) patients were down-staged post-operatively and 6 (3.2%) were up-staged. When subjects were categorized according to radiographic tumor size associated with clinical stage, statistically significant difference (average of 1.76 mm) was observed between radiographic and pathologic maximum diameters ranging 41-70 mm (P = 0.035). For clear cell carcinoma, mean radiographic tumor maximum diameter was significantly larger than the pathologic maximum diameter by 1.69 mm (P = 0.003).
There is a statistically significant but small difference (1.3 mm) between mean radiological and mean pathological tumor maximum diameters. For some patients, this difference leads to a discrepancy between clinical and pathological staging, which may have implications on pre-operative clinical decision and prognosis prediction.
No preview · Article · Oct 2013 · Zhonghua zhong liu za zhi [Chinese journal of oncology]
[Show abstract][Hide abstract] ABSTRACT: Forkhead box protein M1 (FoxM1) is crucial in the regulation of various biological processes, including cell proliferation, organogenesis, and angiogenesis. Overexpression of FoxM1 is associated with carcinogenesis. In this study, immunohistochemistry was carried out to examine FoxM1 expression in clear cell renal cell carcinoma (ccRCC), and these data were examined for correlation with clinicopathological parameters and prognosis. FoxM1 protein had high expression in 37 of 87 cases of ccRCC (42.5 %), which was significantly higher than in normal tissues, and FoxM1 overexpression was significantly associated with tumor stage (P = 0.005) and recurrence (P = 0.027). The Kaplan-Meier survival analysis demonstrated that FoxM1 expression was significantly associated with shorter recurrence-free survival and overall survival (P = 0.007 and P = 0.008, respectively). Multivariate analysis further demonstrated that FoxM1 was an independent prognostic factor for patients with ccRCC. So FoxM1 might be a potential molecular marker to predict the prognosis of patients with ccRCC.
No preview · Article · Mar 2013 · Medical Oncology
[Show abstract][Hide abstract] ABSTRACT: High-mobility group box 1 (HMGB1) is a versatile protein with intranuclear and extracellular functions that is involved in numerous biological and pathological processes, such as transcription, DNA repair, and response to infection and inflammation. HMGB1 overexpression has been reported in a variety of human cancers. However, the clinical significance of HMGB1 expression in bladder cancer (BC) remains unclear. This study is aimed to investigate the correlations between HMGB1 expression and prognosis in patients with BC.
HMGB1 protein expression in 164 primary BC tissue specimens was analyzed by immunohistochemistry, and its association with clinicopathologic factors and prognosis was also analyzed.
HMGB1 protein had high expression in 87 of 164 cases of BC (53%). HMGB1 overexpression was significantly associated with tumor grade (P < 0.001), and stage (P = 0.001). The Kaplan-Meier survival analysis demonstrated that HMGB1 expression was significantly associated with shorter disease-free survival and overall survival (both P < 0.001). Multivariate analysis further demonstrated that HMGB1 was an independent prognostic factor for patients with BC.
HMGB1 might be a new molecular marker to predict the prognosis of patients with BC.
No preview · Article · Jul 2012 · Journal of Surgical Oncology
[Show abstract][Hide abstract] ABSTRACT: To investigate the clinicopathological features and prognosis of chromophobe renal cell carcinoma (ChRCC).
The clinical data of 68 ChRCC cases treated in our department between January 2003 and September 2010 were collected and retrospectively analyzed. The prognostic factors were evaluated by Log-rank test. Kaplan-Meier survival curve was used to estimate the survival rate.
Fifty cases were treated with radical nephrectomy and 18 with partial nephrectomy. The mean tumor size was 5.7 cm (1.5 - 16.0 cm). The TNM stages were as follows: pT1aN0M0 in 25, pT1bN0M0 in 22, pT2aN0M0 in 9, pT2bN0M0 in 5, and pT3aN0M0 in 7. According to the Fuhrman grading system, 8 patients were classified as grade I, 42 cases were grade II, 14 cases were grade III, and 4 cases were grade IV. The 3-year and 5-year survival rates were 93.0% and 90.0%, respectively. The log-rank test showed that tumor size (> 7 cm vs. ≤ 7 cm) (P = 0.004), TNM stage (T1-2 vs. T3-4) (P = 0.008) and urinary collecting system invasion (P = 0.024) were associated with survival time. The multivariable Cox regression model revealed that tumor size (> 7 cm vs. ≤ 7 cm) was an independent predictor of aggressive ChRCC (P = 0.038).
ChRCC is a distinct type of renal cell carcinoma exhibiting a low degree of malignancy. Most tumors are larger, but predominantly with a favorable prognosis. Fuhrman nuclear grading is not suitable for ChRCC. Tumor size (> 7 cm vs. ≤ 7 cm) is an independent predictor of prognosis of ChRCC.
No preview · Article · Jul 2012 · Zhonghua zhong liu za zhi [Chinese journal of oncology]
[Show abstract][Hide abstract] ABSTRACT: To evaluate the natural outcome of a surveillance strategy for enhancing renal masses associated with von Hippel-Lindau disease (VHL). From January 1988 to June 2011, a watchful waiting strategy was carried out in 16 cases with 42 enhancing renal masses. Clinical data were reviewed to determine tumor growth rate, subsequent interventions, and outcome of follow-up. During a median follow-up of 83 months (range, 55-279), 18 surgical interventions were performed in 13 cases; local recurrence of tumor occurred in 4 cases; 4 patients died (two of metastasis disease, one of CNS Hemangioblastomas with hemorrhage, and one of an unrelated disease) and 12 survived. The median follow-up duration for 42 renal masses was 56 months (range, 19-116 months). The mean tumor growth rate observed was 0.529 cm/year (range, 0.036-1.870 cm/year). The mean growth rate of the tumors larger than 3 cm was 0.573 cm/year, which was not significantly different from that of those smaller tumors (growth rate 0.507 cm/year, P = 0.5905). There was no significant correlation between initial tumor size and growth rate in our cohort with a correlation coefficient of 0.149(P = 0.3480). At the last follow-up, 38 (90.5%) tumors were larger than 3 cm and no metastasis disease developed among tumors ≤4 cm. Progression to metastatic disease was detected in 2 patients. The majority of the enhancing renal masses with VHL disease may still be indolent and do not metastasize during a long period of follow-up even in tumors larger than 3 cm. Metastatic potential during active surveillance appears to be low in VHL patients with Renal tumors ≤4 cm.
[Show abstract][Hide abstract] ABSTRACT: Prostate cancer is one of the most common malignancies in men. Previous research has determined that androgen deprivation therapy (ADT) may be accompanied by an unfavourable metabolic profile. In this prospective study, 133 men were recruited, including 46 prostate cancer patients who had undergone bilateral orchiectomy and been on flutamide (the ADT group), 37 men with prostate cancer who had undergone radical prostatectomy (the non-ADT group) and 50 normal control subjects (the control group). All subjects were followed for at least 12 months. From baseline to 3 months, men in the ADT group had increased levels of fasting serum insulin and low-density lipoprotein compared to the other two groups (P<0.05). No obvious changes were found in the other parameters (P>0.05). After 12 months, men in the ADT group had increased levels of waist circumference, fasting serum insulin and glucose, total cholesterol, high-density lipoprotein and low-density lipoprotein compared to the other two groups (P<0.05). Additionally, the morbidity rate of metabolic syndrome in the ADT group was higher (P<0.05) compared to the other two groups. ADT through surgical castration for men with prostate cancer may be associated with unfavourable metabolic changes. The benefits of the therapy should be balanced prudently against these risks.
Preview · Article · Jul 2011 · Asian Journal of Andrology
[Show abstract][Hide abstract] ABSTRACT: Ubiquitin-like with PHD and ring finger domains 1 (UHRF1) is a novel anti-apoptotic gene, and overexpression of UHRF1 is involved in tumorigenicity. Here, immunohistochemistry was used to detect UHRF1 expression in non-muscle-invasive bladder cancer (NMIBC), and these data were examined for correlation with clinicopathological parameters and prognosis. The UHRF1 expression rate was 49.2% in a total of 118 bladder cancer tissues, which was significantly higher than in normal tissues, and UHRF1 expression has a significantly positive correlation with tumor grade (P = 0.027) and recurrence (P = 0.013). Survival analysis showed that UHRF1 high expression patients' mean survival time (42.59 months) was significantly shorter than that (71.36 months) of UHRF1 low expression patients (P = 0.0002). Multivariate analysis showed that UHRF1 overexpression was an independent prognostic factor for tumor recurrence (P < 0.0001). So UHRF1 may be a molecular marker to predict the recurrence of NMIBC.
No preview · Article · May 2011 · Medical Oncology
[Show abstract][Hide abstract] ABSTRACT: To evaluate and compare the clinical efficacy and safety of the highly selective alpha receptor antagonist tamsulosin and its combination with the M receptor antagonist tolterodine in the treatment of refractory lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH).
We included in this study 184 BPH patients with refractory LUTS with the disease course of 4 weeks to 2 years, whose LUTS were not alleviated after a week's treatment with tamsulosin. The patients were randomly divided into Groups A and B, the former (n=89) treated with tamsulosin at 0.2 mg qd and the latter (n=95) given tolterodine at 2 mg bid in addition to tamsulosin medication, both for 4 weeks. Scores on IPSS, QOL and Qmax were obtained before and after the treatment, and the improvement of LUTS evaluated after the medication.
The tamsulosin group showed no significant differences before and after the treatment in the scores on IPSS (13.23 +/- 4.39 vs. 12.21 +/- 4.07), QOL (4.23 +/- 1.27 vs 3.53 +/- 0.95) and Qmax ([12.3 +/- 8.39] ml/s vs. [14.1 +/- 8.62] mls) (P > 0.05), while the combination group exhibited significantly higher scores on IPSS and QOL and lower score on Qmax after the medication than before it (IPSS: 14.45 +/- 5.31 vs. 6.56 +/- 2.03, P < 0.05; QOL: 4.45 +/- 0.79 vs. 2.34 +/- 0.73, P < 0.05; Qmax: [11.4 +/- 9.21] ml/s vs. [15.5 +/- 8.35] ml/s, P < 0.01). No severe complications were found in any of the cases.
Combination of tamsulosin and tolterodine can significantly alleviate refractory LUTS and improve QOL without causing serious adverse events in BPH patients.
No preview · Article · Sep 2010 · Zhonghua nan ke xue = National journal of andrology
[Show abstract][Hide abstract] ABSTRACT: To investigate the germ line mutations in Chinese kindreds with von Hippel-Lindau syndrome (VHL) and to explore its role in clinical management.
The clinical and familial data were reviewed from 6 Chinese kindreds with VHL, of which the VHL germ line mutation in 21 members was analysed by polymerase chain reaction and sequencing analysis.
Among 6 kindreds, there were 5 type I and 1 type IIA. The germ line mutations consisted of 4 missense mutations, 1 nonsense mutation and 1 deletion, of which 4 mutations existed in exon 1, 1 in exon 2 and 1 in exon 3. Of the 21 members who volunteered for genetic analysis, 14 members presented the VHL germ line mutations, including 10 affected patients, 1 suspected patients and 3 carriers.
The germ line mutations in Chinese kindreds with VHL could be dominant in exon 1. It plays an important role in early detection of asymptomatic patients and the carriers, in the diagnosis of VHL and the clinical screening for members in the VHL families.
No preview · Article · May 2007 · Zhonghua yi xue yi chuan xue za zhi = Zhonghua yixue yichuanxue zazhi = Chinese journal of medical genetics
[Show abstract][Hide abstract] ABSTRACT: To summarize the experience of radical retropubic prostatectomy (RRP) and the multi-factors which influence on the prognosis and long life quality.
From January 1993 to March 2005, 132 cases radical retropubic prostatectomy were performed. The patients were divided into 2 groups: the early group and recent group. Eleven items in peri-operative time and follow up results were analysed. The erection function of 78 cases were investigated with international index of erectile function 5 score. In these patients, nocturnal electrobioimpedance volumetric assessment (NEVA) were observe in 19 cases.
Comparing of the 2 groups, the index connected with operative skill changed to optimization. No one died of prostate cancer in 63 follow up patients. Nine cases showed biochemical failure with criterion as prostate specific antigen > 0.4 microg/L. Fifty patients passed urine normal post-operation in 6 months. Eight patients had stress incontinence and 5 had entire incontinence at 6 month. Four patients had vesical neck stricture. Another follow up result shows 33 (58.9%) erection function recovered in 55 bilateral nerve-sparing operation and 7 recovered in 22 of unilateral nerve-sparing operation. NEVA shows 14 cases with artery supply insufficient in whom 4 regained erection function and 5 cases vein leakage in whom no one recovered.
The radical retropubic prostatectomy remains the procedure of choice for the cure of localized prostatic cancer. The keys for the operation are anatomic dissection, preservation of the neurovascular bundle and good skill. These are also important for a good life quality for the patients.
No preview · Article · Mar 2006 · Zhonghua wai ke za zhi [Chinese journal of surgery]