[Show abstract][Hide abstract] ABSTRACT: 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.
[Show abstract][Hide abstract] ABSTRACT: Objective: To review the natural history and growth kinetics of small renal masses (SRMs). Data Sources: The literature concerning natural history and growth kinetics of SRMs was collected from PubMed published from 1990 to 2014. Study Selection: We included all the relevant articles on the active surveillance (AS) or delayed treatment for SRMs in English, with no limitation of study design. Results: SRMs under AS have a slow growth potential in general. The mean linear growth rate is 0.33 cm/year, the mean volumetric growth rate is 9.48 cm3/year. The rate of metastasis during AS is below 2%. Some factors are associated with the growth rate of SRMs, including tumor grade, histological subtype, initial tumor size, age, radiographic characteristics, and molecular markers. No definite predictor of growth rate of SRMs is defined at present. SRMs with high tumor grade and the subtype of clear cell renal cell carcinoma may have aggressive growth potential. Conclusions: AS is a reasonable choice for elderly patients with SRMs, who are at high risk from surgery. Progression during observation is the biggest concern while performing AS. There is no definite predictor of progression for SRMs under AS. Percutaneous renal biopsy providing immunohistological and genic biomarkers may improve the understanding of natural history of SRMs.
No preview · Article · May 2015 · Chinese medical journal
[Show abstract][Hide abstract] ABSTRACT: Objectives:
To compare the treatment of laparoscopic (LPN) versus open partial nephrectomy (OPN) in patients with multilocular cystic renal cell carcinoma (MCRCC).
Thirty-seven patients diagnosed with MCRCC were reviewed retrospectively between January 2007 and January 2013 at our institution. They were divided into two groups: group 1 (LPN) consisted of 19 patients (51.4%) and group 2 (OPN) of 18 patients (48.6%). RENAL and the Preoperative Aspects and Dimensions Used for an Anatomical classification were applied to predict perioperative complications, which were graded based on the Clavien-Dindo classification.
The two groups were comparable with regard to all of the patients' baseline characteristics. In group 1, the mean operative time was 142.1 min, including the mean warm ischemia time (WIT) of 32.6 min; the mean estimated blood loss (EBL) was 96.1 ml, the mean retroperitoneal drainage lasted 3.6 days, and the mean postoperative hospital stay was 5.3 days. In group 2, the figures were 126.6 and 23.5 min, 223.3 ml, and 4.6 and 8.7 days, respectively. The differences in WIT, EBL, drainage days and hospitalization were statistically significant between both groups (p < 0.05). No recurrence or new lesions occurred in these patients during a mean follow-up of 37.8 months.
Our single-center experience suggests that although it remains technically complex, demanding and challenging for MCRCC, LPN can still induce favorable perioperative results and survival rates in MCRCC are comparable with OPN.
No preview · Article · Aug 2014 · Urologia Internationalis
[Show abstract][Hide abstract] ABSTRACT: To report on the perioperative outcomes of laparoscopic partial nephrectomy (LPN) for multilocular cystic renal cell carcinoma (MCRCC) and evaluate the feasibility of this minimally invasive technique as a potential gold standard treatment for MCRCC.
We retrospectively reviewed the database of surgically pathological findings of patients who were diagnosed with MCRCC at Peking University First Hospital and Chinese PLA General Hospital (Beijing, China) between May 2009 and January 2013. A total of 42 patients with an average age of 48.3 years who were treated with LPN were collected. The patients' perioperative outcomes were reported and analyzed.
All operations were performed successfully without massive hemorrhage or open conversion. None of patients received lymph node dissection or metastasectomy. Two patients required postoperative transfusion with a mean amount of 175 cc packed red blood cells. Only three patients experienced mild postoperative complications. The mean operative time was 2.4 +/- 1.2 hours, including the mean warm ischemia time (WIT) of 23.2 +/- 5.7 minutes. The mean estimated blood loss was 72.0 +/- 49.6 ml. The mean retroperitoneal drainage was 4.4 +/- 1.7 days. The mean postoperative hospital stay was 6.1 +/- 1.9 days. Pathologically, 40 (95.2%) of the tumors presented as stage pT1abN0M0, while the remaining two (4.8%) presented as stage pT2aN0M0. No recurrences or new lesions occurred in these patients at a mean follow-up time of 30.0 months.
Although the effective option of LPN is not yet the gold standard treatment for conventional renal cell carcinoma, it should be strongly recommended as a potential gold standard treatment for MCRCC due to the benign nature of MCRCC and the excellent perioperative outcomes provided by LPN.
Preview · Article · Apr 2014 · World Journal of Surgical Oncology
[Show abstract][Hide abstract] ABSTRACT: There is currently no consensus about the pattern and risk factors of bladder recurrence after nephroureterectomy, especially in the Chinese population. We evaluated the pattern and risk factors based on data from a large Chinese center.
The clinical and pathological data of 438 patients with upper tract urothelial carcinoma (UTUC), who underwent nephroureterectomy at Peking University First Hospital, Beijing, China between 2000 and 2010, was retrospectively analyzed. Univariate analysis by log-rank test and multivariate analysis by Cox proportional hazards regression model were used to determine the independent risk factors.
A total of 135 patients (30.8%) developed intravesical recurrence within a median follow-up of 45 months (range: 12-144 months). The median interval of bladder recurrence was 15 months (range: 2.0-98.0 months), and the two peaks for recurrence were 4-6 months and 17-19 months. Lower tumor grade, tumor multifocality, concomitant carcinoma in situ (CIS) and tumors located in the lower ureter were significant risk factors by univariate and multivariate analysis. A risk-scoring system was developed and a significant difference was found between different risk evaluations. Patients with concomitant CIS tended to develop a late bladder recurrence. One hundred and eighteen patients (87.4%) received transurethral resection after bladder tumor recurrence.
Lower tumor grade, tumor multifocality, concomitant CIS and tumors located in the lower ureter tend to be predictive for bladder recurrence after nephroureterectomy, although the underlying mechanism is not fully elucidated, and the scoring system could help risk stratification. Most recurrent tumors could be treated by transurethral resection and there were two peaks for recurrence, which is probably related to the mechanisms and may be unique to the Chinese population.
No preview · Article · Dec 2013 · Journal of the Formosan Medical Association
[Show abstract][Hide abstract] ABSTRACT: To evaluate the prevalence of baseline chronic kidney disease (CKD) in a large cohort of patients with renal masses in a single Chinese institution. Estimated glomerular filtration rate (eGFR) and CKD stage are more clinically relevant to predict the risk of morbidity and mortality in patients after nephrectomy. But, sCr reflects renal function poorly.
We retrospectively identified patients undergoing kidney surgery between January 2002 and June 2012. eGFR was calculated using the modification of diet in renal disease formulas modified based on Chinese people. CKD stages I-V were defined using the National Kidney Foundation definitions.
A total of 2769 patients had adequate data available to calculate a preoperative eGFR (mL/min/1.73m(2)) with renal cancer confirmed by pathology. Of all patients, 97.7 % awaiting surgery at our institution had a "normal" baseline sCr (≤1.4 mg/dL), and 3.2 % of patients had CKD stage III or worse. Of the 401 patients ≥70 years old, 16.7 % (67/401) had CKD stage III.
Many patients with a seemingly normal sCr have CKD stage III or worse, especially in patients over 70 years old. Given the high prevalence of baseline CKD in patients with renal cancer, it is important to preserve renal parenchyma when treating them surgically.
No preview · Article · Oct 2013 · World Journal of Urology
[Show abstract][Hide abstract] ABSTRACT: Objective:
To compare the treatment outcome of laparoscopic versus open surgery for renal masses with infrahepatic (levels I and II) tumor thrombus and analyze the largest series of retroperitoneal experience in such cases from China.
Materials and methods:
Forty-nine patients with renal masses with infrahepatic tumor thrombus were analyzed retrospectively between January 2009 and January 2013 at our institution. The diagnosis was confirmed by computed tomography and/or magnetic resonance imaging preoperatively. They were divided into two groups based on the detailed surgical approach applied. Group 1 (A, pure laparoscopic; B, laparoscopic nephrectomy with open thrombectomy) consisted of 17 patients (34.7%) and group 2 (pure open) consisted of 32 patients (65.3%).
The two groups were comparable with regard to all of the patients' baseline characteristics. All operations were performed successfully without severe complications. In group 1, the mean operative time was 208.5 minutes, the mean estimated blood loss was 147.1 mL, the mean postoperative hospital stay was 5.8 days, and only two patients (11.8%) accepted blood transfusion with a mean quantity of 300 mL. In group 2, the figures were 268.3 minutes, 1345.3 mL, 12.5 days, respectively, and a total of 17 patients (53.1%) received transfusion with a mean quantity of 1488.2 mL. The differences of all these parameters were statistically significant between both groups (p<0.05). However, comparisons between the group 1A and 1B in all of the perioperative characteristics were not statistically significant. During a mean follow-up of 18.2 months, 13 patients in group 1 and 26 patients in group 2 survived. The difference in the cancer-survival rates between both groups was not statistically significant.
Although it remains technically complex, demanding and challenging for renal masses with infrahepatic tumor thrombus, laparoscopic surgery with a retroperitoneal approach can make favorable perioperative results and comparable survival rates in selectively less complex patients compared with the traditional open surgery.
No preview · Article · Sep 2013 · Journal of endourology / Endourological Society
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Intravesical recurrence after treatment of primary upper urinary tract urothelial carcinomas (UUT-UCs) is common. While intravesical instillation is widely used to prevent recurrence after transurethral resection for primary bladder tumors, there is still no consensus on the prophylactic capability of intravesical chemotherapy in preventing bladder tumor recurrence after surgery for UUT-UCs.
A meta-analysis of the published results of clinical trials was performed to compare radical surgery alone or surgery plus postoperative intravesical chemotherapy. The primary end point was to determine the percentage of patients with recurrence in the different groups.
Our study includes five trials with recurrence information on 614 patients. During follow-up, 55 of 268 (20.5%) patients who received postoperative instillation had bladder recurrence compared to 127 of 346 (36.7%) patients who had no adjuvant treatment--a decrease of 41% in the odds of recurrence with chemotherapy (odds ratio 0.48, 95% confidence interval 0.33-0.69, p = 0.0001). No serious adverse events were reported. Subgroup analyses were temporarily unavailable.
Postoperative intravesical chemotherapy significantly decreases the risk of bladder recurrence after nephroureterectomy for primary UUT-UCs. Postoperative intravesical instillation is considered the treatment of choice after nephroureterectomy.
Full-text · Article · Aug 2013 · Urologia Internationalis
[Show abstract][Hide abstract] ABSTRACT: Sunitinib has been proved an effective new option for treatment of metastatic renal cell carcinoma (mRCC). Analysis of clinical data of 22 patients, who were exposed to sunitinib for at least 1 year, was conducted to evaluate the long-term efficacy and safety of sunitinib for the treatment of mRCC.
A total of 54 patients with mRCC were treated with sunitinib malate, 50 mg/d orally, on a 4-weeks-on and 2-weeks-off dosing schedule in Peking University First Hospital. Treatment continued until disease progression, unacceptable adverse events (AEs), or death. Among them, 22 patients continued treatment for at least 1 year. The clinical data of these 22 patients were prospectively collected for analysis. AEs were assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 3.0. Tumor response was evaluated in accordance with the Response Evaluation Criteria in Solid Tumors.
Median progression-free survival was 19.5 months until last follow-up. The best efficacy results achieved were complete response, partial response, and stable disease for 2, 9, and 11 patients, respectively. Objective response rate was 50%. The most common AEs were hand-foot syndrome (95%) and hypertension (91%). Other common AEs were thyroid-stimulating hormone elevation (82%), platelet decrease (77%), and loss of appetite (77%). Only one patient withdrew from treatment for cardiac infarction. Another nine patients experienced dose modifications or short-term suspensions.
Long-term exposure to sunitinib malate showed encouraging efficacy in the treatment of mRCC. At the same time, the tolerability was good.
No preview · Article · Aug 2013 · Chinese medical journal
[Show abstract][Hide abstract] ABSTRACT: To analyse the predictive factors for worse pathological outcome (muscle invasive pT2+, non-organ-confined pT3+ or N+ and histological Grade 3) of upper tract urothelial carcinoma (UTUC) in a Chinese population from a nationwide high-volume centre in China.
Predictors were studied by retrospectively reviewing the clinicopathological data of 729 consecutive patients with UTUC treated in our centre from January 2002 to December 2010. Univariate and multivariate logistic regression analyses were used.
There were more female patients (56.4%) than males and more tumours were located in the ureter (52.7%) than in the pelvis. In multivariate analysis, male gender (hazard ratio [HR] 1.898, P = 0.001), sessile architecture (HR 3.249, P < 0.001), high grade (HR 5.007, P < 0.001), ipsilateral hydronephrosis (HR 4.768, P < 0.001), renal pelvis location (HR 2.620, P < 0.001) and tumour without multifocality (HR 1.639, P = 0.028) were predictive factors for muscle-invasive UTUC. Male gender (HR 2.132, P < 0.001), renal pelvis location (HR 3.466, P < 0.001), tumour without multifocality (HR 2.532, P = 0.001), sessile tumour architecture (HR 3.274, P < 0.001), and high grade (HR 3.019, P < 0.001) were predictive factors for non-organ-confined disease. Chronological old age (HR 1.047, P < 0.001), sessile tumour architecture (HR 25.192, P < 0.001), ipsilateral hydronephrosis (HR 1.689, P = 0.024), and positive urinary cytology (HR 1.997, P = 0.006) were predictive factors for histological Grade 3 UTUC.
There was a predominance of female patients and ureteric tumours in UTUCs of this Chinese population. Male gender, sessile architecture, tumour location, tumour without multifocality, high histological grade and preoperative ipsilateral hydronephrosis were independent predictive factors for worse pathological outcome of UTUCs.
No preview · Article · Jul 2013 · BJU International
[Show abstract][Hide abstract] ABSTRACT: Objective
To investigate the clinical significance of preoperative aspects and dimensions used for anatomic (PADUA) and radius exophytic/endophytic nearness anterior/posterior location (RENAL) scoring systems for renal neoplasms in patients undergoing laparoscopic partial nephrectomy. MethodsA retrospective analysis was carried out on clinical data of 245 Chinese patients with renal neoplasms undergoing laparoscopic partial nephrectomy from June 2008 to June 2012. The perioperative complications and variables, as well as PADUA and RENAL score, were compared. ResultsThe PADUA and RENAL scoring systems were significantly associated with percent change in estimated glomerular filtration rate (P=0.032 and P=0.026 respectively), whereas the RENAL scoring system was also significantly associated with warm ischemia time (P=0.032). On multivariate analysis, both scores were able to predict percent change in estimated glomerular filtration rate (PADUA, P=0.011; RENAL, P=0.028). There were no significant associations between the two scoring systems assessed and the occurrence of complications or tumor stage. The correlation between PADUA classification and RENAL nephrometry score was significant (P<0.0001). Fleiss' generalized kappa was 0.69-0.89 for the various components of the PADUA score and 0.67-0.89 for the RENAL nephrometry components. Conclusions
The PADUA classification and RENAL nephrometry score are comprehensive assessment tools for delineating renal tumor anatomy. The reproducibility of the PADUA and RENAL scores is substantial, but further research is required to evaluate its performance in more accurately predicting operative and patient-related outcomes.
Preview · Article · May 2013 · International Journal of Urology
[Show abstract][Hide abstract] ABSTRACT: We investigated the importance of HMGN5, a nuclear protein that binds to nucleosomes, unfolds chromatin, and affects transcription, in the LNCaP prostate cancer cell line. We also examined the molecular mechanisms that promote apoptosis of LNCaP cells after infection with small interfering RNA (siRNA) targeting HMGN5 (siRNA-HMGN5). The androgen-dependent LNCaP human prostate cancer cells were infected with siRNA-HMGN5. Apoptosis was detected using the Annexin V-PE/7-AAD double staining and the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) assays. Mitochondrial membrane potential was measured by JC-1 staining. HMGN5 and GAPDH mRNA expression were determined using real-time PCR. Bcl-2 and other apoptosis-related protein levels were determined by Western blot analysis. Caspase activity was measured by cleavage of the caspase substrate. Infection with siRNA targeting HMGN5 efficiently and specifically reduced the HMGN5 expression in LNCaP cells. The downregulation of HMGN5 induced remarkable apoptosis of LNCaP cells and resulted in the reduction of mitochondrial membrane potential. The induction of cell apoptosis was accompanied by the upregulation of Bax, the Bax/Bcl-2 ratio and the activation of caspase3. The HMGN5-targeted siRNA was effective in downregulating the expression of HMGN5 in androgen-dependent prostate cancer cells and inducing cell apoptosis via the regulation of a caspase-related mitochondrial pathway and Bcl-2 family proteins. This study suggests that HMGN5 may be a potential molecular target with therapeutic relevance for the treatment of prostate cancer.
Full-text · Article · Apr 2012 · Asian Journal of Andrology
[Show abstract][Hide abstract] ABSTRACT: The nucleosome binding protein 1 (HMGN5/NSBP1) is a member of the HMGN protein family and is highly expressed in several kinds of cancer. Nevertheless, the role of NSBP1 in clear cell renal cell carcinoma (ccRCC) remains unclear. This study aimed to confirm the oncogenic role of NSBP1 in ccRCC using in vitro and in vivo models and explore the mechanism by which NSBP1 contributes to ccRCC tumorigenesis.
NSBP1 expression was detected in renal tissues from 152 ccRCC patients by immunohistochemistry, and examined in ccRCC cell lines by RT-PCR and Western blot analysis. ccRCC cells were transfected by NSBP1 RNAi and cell viability, apoptosis and invasion were detected by cell vitality test, flow cytometry and transwell assay in vitro. Xenograft in nude mice was also employed to examine the tumorigenesis of ccRCC cells depleted of NSBP1.
Immunohistostaining showed strong immunoreactivity of NSBP1 in all ccRCC tissues and NSBP1 expression level was associated with tumor grade (p = 0.04). NSBP1 expression at mRNA and protein levels was high in ccRCC cell lines. Knockdown of NSBP1 induced cell cycle arrest and apoptosis, and inhibited invasion in 786-O cells. Western blot analysis demonstrated increased expression of Bax and decreased expression of Bcl-2, CyclinB1, VEGF, VEGFR-2, MMP-2, MMP-9, c-fos and c-jun in 786-O cells depleted of NSBP1. In vivo study further showed that knockdown of NSBP1 affected the tumorigenesis of ccRCC cells in nude mice.
NSBP1 plays oncogenic role in ccRCCs by promoting cell proliferation and invasion, and could be exploited as a target for ccRCC treatment.
Full-text · Article · Mar 2012 · Journal of Experimental & Clinical Cancer Research
[Show abstract][Hide abstract] ABSTRACT: To evaluate the feasibility of laparoscopic adrenalectomy in the treatment of adrenal ganglioneuromas.
The clinical data of 12 cases of adrenal ganglioneuromas undergoing laparoscopic adrenalectomy between February 2002 and August 2010 were reviewed retrospectively.
None of them had endocrine function. The average long diameter of ganglioneuromas was 6.5 cm (range: 1.5 - 16.8 cm). Ten tumors were resected through retroperitoneal approach with an average long diameter of 6.0 cm and another two through transperitoneal approach with 7.5 and 10.7 cm in size respectively. Three tumors surrounded renal pedicle and one adhered to kidney. The average operative duration was 144 minutes, average blood loss 194 ml and average postoperative hospitalization stay 5.4 days. None had local recurrence and distant metastasis during a mean follow-up period of 45 months.
Laparoscopic adrenalectomy is both safe and feasible for adrenal ganglioneuromas if an appropriate approach is chosen and renal pedicle well-protected.
No preview · Article · Feb 2012 · Zhonghua yi xue za zhi
[Show abstract][Hide abstract] ABSTRACT: To discuss the pathological and clinical characteristics, treatments and prognosis of chromophobe renal cell carcinoma (CRCC).
We developed a database that contained 1,870 patients who were diagnosed with renal cell carcinoma (RCC) and who underwent surgery in our hospital between 2002 and 2010. Afterward, the clinical and pathological data of 53 CRCC cases were extracted and analyzed.
The mean age of the 53 patients at diagnosis was 50.2 years (range, 21-88 years), and the ratio of male to female was 1:1. All tumors were unilateral and a majority of them (69.8%) were discovered incidentally. The mean tumor size was 5.8 ± 3.2 cm (range, 2-20 cm). Stage T1, T2, and T3 tumors, in accordance with 2004 TNM classification, accounted for 75.5, 13.2 and 11.3% of all cases, respectively. By histologic grading, 11.3, 73.6 and 15.1% of the tumors were G1, G2, and G3, respectively. Forty-one (77.4%) patients underwent radical nephrectomy, 12 (22.6%) underwent partial nephrectomy. Forty-five (84.9%) patients with follow-up results were alive after a mean follow-up of 34 months (range, 4-79 months). Tumor metastasis was discovered in 2 patients: one tumor metastasis was found in the liver 4 months postoperation, and the other was found in the lumbar vertebrae 47 months postoperation. No local recurrence was found. The overall survival rate was 100%.
CRCC is an uncommon subtype of RCC, with a favorable prognosis. Chinese patients are seemingly younger at diagnosis. Prediction of prognosis is still difficult.
No preview · Article · Dec 2011 · Journal of Cancer Research and Clinical Oncology
[Show abstract][Hide abstract] ABSTRACT: Few studies have evaluated the growth pattern of renal cell carcinoma (RCC) in patients with delayed treatment. This report investigated the growth rate and stage progression of incidentally discovered RCC following a long period of active surveillance.
Thirty-two patients who did not receive immediate surgical treatment for renal solid masses that later proved to be RCC were reviewed retrospectively. Annual tumor growth rates were calculated according to changes in the maximal diameter on CT or MRI. Clinical and pathological characteristics associated with tumor growth rate and stage progression were analyzed.
The median tumor size grow from 2.14 (range, 0.30-6.70) cm to 4.33 (range, 1.40-8.80) cm after a median 46.0 months observation period. The average tumor growth rate was 0.80 (range, 0.16-3.80) cm/year. Clear cell carcinoma (0.86 cm/year) tended to grow faster than papillary cell carcinoma (0.28 cm/year) (P = 0.066). The mean growth rate of grade 2 tumors (0.88 cm/year) was faster than that of grade 1 tumors (0.36 cm/year) (P = 0.041). Thirteen tumors (40.6%) were upstaged at a median 48 months after initial presentation. Cox regression analysis revealed initial tumor size as the only risk factor for upstaging (P = 0.018). No local and systemic recurrences were noted in our cohort after the intervention at a median of 47 (range, 6-248) months of follow-up.
RCCs were found to be slow growing in a group of untreated renal cell carcinoma patients. However, some tumors progressed in stage under observation. The growth rate of RCC tended to correlate with histologic grade and histologic subtype.
No preview · Article · Nov 2011 · Journal of Cancer Research and Clinical Oncology
[Show abstract][Hide abstract] ABSTRACT: The tyrosine kinase inhibitors (TKIs) sunitinib, the first targeted agent for the first line treatment of metastatic renal cell carcinoma (RCC), targets the vascular endothelial growth factor (VEGF) pathway. The objective of this study was to investigate the efficacy and safety of sunitinib in treating metastatic clear-cell RCC and to confirm if hypertension is an effective predictive factor.
A total of 36 patients with metastatic RCC were enrolled between June 2008 and December 2010. Among them 29 cases were first line therapy and 7 cases were in progression on first-line cytokine or sorafinib therapy. The pathology of all patients was confirmed predominant in clear cell type. Sunitinib mono-therapy was administered in repeated 6-week cycles of daily oral therapy for 4 weeks, followed by 2 weeks off in 34 patients; and 3 patients were administered with 37.5 mg/d continuously until disease progression or unacceptable toxicities occurred. Overall response rate and safety were evaluated. We divided patients into Group A and Group B according to the blood pressure level.
The median follow-up was 15 months (10 cycles, range 1.5 - 30.0 months (1 - 20 cycles)). Ten patients (29.4%) achieved partial responses (PR); 23 patients (67.6%) demonstrated stable disease (SD) lasting ≥ 2 cycles. Seventeen patients (50%) developed progressive disease (PD) during follow-up. The median progression-free survival (PFS) was 15 months (range 3.0 - 28.5) months. A total of 9 patients died; the overall survival has not been reached; the median survival time of the deceased patients was 13 months (range 7 - 24) months. The most common adverse events were hand-foot syndrome (77.8%), thrombocytopenia (75.0%), hypertension (61.1%) and diarrhea (46.0%). Most adverse events were reversible by treatment interruption. Twenty-two patients (61.1%) developed hypertension; and hypertension was associated with a long time to disease progression and long overall survival (P = 0.004, 0.000, respectively).
The results of this study demonstrate the efficacy and manageable adverse event profile of sunitinib as a single agent in first- or second-line therapy for patients with metastatic clear cell RCC. Further, sunitinib-associated hypertension may be a strong predictive marker for treatment efficacy in metastatic RCC.
Full-text · Article · Sep 2011 · Chinese medical journal
[Show abstract][Hide abstract] ABSTRACT: To summarize the clinical outcome and adverse events of estrogen therapy for hormone refractory prostate cancer.
A total of 32 patients with hormone refractory prostate cancer received diethylstilbestrol (DES) 2 mg daily at our institute. The data of PSA (prostate-specific antigen) change, time to progression, overall survival rate, disease-specific survival rate and adverse events were collected and analyzed.
The data of 29 patients were complete. The mean duration of DES dosing was 8.6 ± 0.9 months. Among them, 8 (27.5%) patients achieved a PSA response with a 50% decrement of PSA or more. Seven (24.1%) patients had a stable level of PSA (50% < PSA < 125%) while 14 of 29 (48.3%) maintained a PSA progression with a 25% increment of PSA or more. The overall median time to progression was 4 (1 - 12) months. And the median time to progression was 6 (5-12) months in the PSA response group. The overall survival rate was 48.3% and disease-specific survival rate 55.2%. The main adverse events were gynecomastia (10/29, 34.5%) and deep vein thrombosis (3/29, 10.3%).
When used for the treatment of hormone refractory prostate cancer, diethylstilbestrol at a daily dose of 2 mg can achieve a PSA response in 27.5% patients and a PSA stability in 24.1% patients. And the median time to progression is 4 months. Estrogen is efficacious for the patients with hormone refractory prostate cancer.
No preview · Article · Aug 2011 · Zhonghua yi xue za zhi
[Show abstract][Hide abstract] ABSTRACT: To discuss the surgical skills and clinical value of complete transperitoneal laparoscopic nephroureterectomy.
We collected and analyzed the clinical data of 25 patients (14 renal pelvic carcinoma and 11 carcinoma of ulreter, right side 15 and left side 10) who underwent complete transperitoneal laparoscopic nephroureterectomy for the upper urinary tract urothelial carcinoma (UUT-UC) in Peking University First Hospital from May 2010 to April 2011.
All the operations were successfully done by one surgeon with standard 4 or 5 trocars technique. The mean operative time was 150 min (120-180 min), the blood loss about 20-100 mL (mean 40 mL) and no severe complications observed. The postoperative hospital stay was 4-6 days with an average length of 5.5 days. The mean follow-up was 5.5 (1-11) months. One of 19 patients underwent trans urethral resection of bladder tumour (TURBT) for recurrent non-muscle invasive bladder tumor.
Complete transperitoneal laparoscopic nephroureterectomy is a minimally invasive, safe and effective way to treat UUT-UC. The patients recover soon and have a shorter length of stay.
No preview · Article · Aug 2011 · Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences