Efficacy of salvage surgery versus re-irradiation for isolated regional lymph node recurrence in patients with nasopharyngeal carcinoma.

BACKGROUND: To compare the clinical characteristics and prognoses of patients with isolated regional lymph node recurrent nasopharyngeal carcinoma (irrNPC) who underwent surgery or re-irradiation treatment. METHODS: We retrospectively reviewed 124 irrNPC patients who underwent initial radiotherapy between January 2010 and December 2020. The staging of regional lymph node recurrence was as follows: 75.8% for rN1, 14.5% for rN2, and 9.7% for rN3. Fifty-five patients underwent regional lymph node surgery (Surgery group), and sixty-nine patients received salvage radiotherapy with or without chemotherapy (Re-irradiation group). The survival rate was compared using Kaplan‒Meier analysis and evaluated by the log-rank test. Cox proportional hazard models were used to analyze prognostic factors. RESULTS: The median follow-up time was 70 months, the 5-year overall survival (OS) was 74%, and the median survival time was 60.8 months. There were no significant differences in 5-year OS (75.6% vs. 72.4%, P = 0.973), regional recurrence-free survival (RRFS, 62.7% vs. 71.1%, P = 0.330) or distant metastasis-free survival (DMFS, 4.2% vs.78.7%, P = 0.677) between the Surgery group and Re-irradiation group. Multivariate analysis revealed age at recurrence, radiologic extra-nodal extension (rENE) status, and recurrent lymph node (rN) classification as independent prognostic factors for OS. The rENE status was an independent prognostic factor for DMFS. Subgroup analysis of the Surgery group revealed that the rN3 classification was an adverse prognostic factor for OS. Age at recurrence ≥ 50 years, GTV-N dose, and induction chemotherapy were found to be independent prognostic factors for OS, RRFS, and DMFS, respectively, in the Re-irradiation group. CONCLUSIONS: For NPC patients with isolated regional lymph node recurrence after initial radiotherapy, those who underwent surgery had survival prognosis similar to those who underwent re-radiotherapy with or without chemotherapy. A prospective study is needed to validate these findings.

Plasma Epstein-Barr virus microRNA BART8-3p as a potential biomarker for detection and prognostic prediction in early nasopharyngeal carcinoma.

Epstein-Barr virus (EBV) encoded microRNA BART8-3p (miR-BART8-3p) was significantly associated with the metastasis in nasopharyngeal carcinoma (NPC). To explore the clinical values of plasma miR-BART8-3p in patients with early NPC. We retrospectively analyzed 126 patients with stage I and II NPC. A receiver operating characteristic curve was used to examine the diagnostic performance. Kaplan‒Meier analysis was applied to determine survival differences. Cox regression was used for univariate and multivariate analyses. Compared to healthy subjects, plasma EBV miR-BART8-3p was highly expressed in early NPC patients. The sensitivity, specificity, and area under the curve value of plasma miR-BART8-3p combined with plasma EBV DNA was up to 88.9%, 94.4%, and 0.931. Compared to patients with low expression of miR-BART8-3p, patients with high expression of miR-BART8-3p had poorer 5-year overall survival (OS) (98.9% vs. 91.1%, P = 0.025), locoregional recurrence-free survival (LRRFS) (100% vs. 83.9%, P < 0.001) and distant metastasis-free survival (DMFS) (98.9% vs. 88.0%, P = 0.006). Risk stratification analysis revealed that high-risk patients (with high levels of EBV DNA and miR-BART8-3p) had inferior OS, LRRFS, and DMFS than low-risk patients (without high levels of EBV DNA and miR-BART8-3p). Multivariate analysis verified that the high-risk group was an unfavorable factor for OS, LRRFS, and DMFS. A combination of plasma EBV miR-BART8-3p and EBV DNA could be a potential biomarker for the diagnosis and prognosis in early NPC.

Risk-adapted locoregional radiotherapy strategies based on a prognostic nomogram for de novo metastatic nasopharyngeal carcinoma patients treated with chemoimmunotherapy.

To develop a prognostic nomogram for individualized strategies on locoregional radiation therapy (LRRT) in patients with de novo metastatic nasopharyngeal carcinoma (dmNPC) treated with chemoimmunotherapy. Ninety patients with dmNPC treated with chemoimmunotherapy and diagnosed between 2019 and 2022 were included in our study. Cox regression analysis was performed to identify independent prognostic factors for overall survival (OS) and progression-free survival (PFS) to establish a nomogram. With a median follow-up of 17.5 months, the median PFS and OS were 24.9 months and 29.4 months, respectively. Sixty-nine patients and twenty-one patients were included in the LRRT group and without LRRT group, respectively. Multivariate analysis revealed that younger age, lower EBV DNA copy number before treatment, a single metastatic site, more cycles of chemotherapy and immunotherapy were significantly associated with better OS. A prognostic nomogram was constructed incorporating the above 5 independent factors, with a C-index of 0.894. Patients were divided into low- and high-risk cohorts based on nomogram scores. A significant improvement in OS was revealed in the LRRT group compared with the without-LRRT group for patients in the high-risk cohort (HR = 2.46, 95% CI 1.01-6.00, P = 0.049), while the OS was comparable between the two groups in the low-risk cohort. Our study indicates that LRRT may be associated with better prognosis in high-risk patients with dmNPC in the era of immunotherapy.

Individualized Concurrent Chemotherapy for Patients with Stage III-IVa Nasopharyngeal Carcinoma Receiving Neoadjuvant Chemotherapy Combined with Definitive Intensity-Modulated Radiotherapy.

PURPOSE: This retrospective study aimed to re-evaluate the effect of concurrent chemotherapy in patients with locally advanced nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS: A total of 498 patients who received neoadjuvant chemotherapy (NCT) combined with concurrent chemoradiotherapy (CCRT) or IMRT were retrospectively reviewed. The distribution of baseline characteristics was balanced using propensity score matching. Additionally, the results of NCT+IMRT and NCT+CCRT were compared using Kaplan-Meier survival analysis, and differences in survival rates were analyzed using the log rank test. RESULTS: There were no significant differences in overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and local progression-free survival (LRFS) between the two groups. Patients were further categorized into risk subgroups based on pretreatment Epstein-Barr virus (EBV) DNA cutoff values using receiver operating characteristic curve analysis. There were no statistically significant differences in OS, PFS, DMFS, and LRFS between patients who received NCT+CCRT and NCT+IMRT in the high-risk group. In the low-risk group, although there were no differences between NCT+CCRT and NCT+IMRT in OS, PFS, and LRFS, patients who received NCT+CCRT had better DMFS than those who received NCT+IMRT. CONCLUSION: Pretreatment EBV DNA level can be used to individualize concurrent chemotherapy for patients with locally advanced NPC. Patients with low pretreatment EBV DNA levels may benefit from concurrent chemotherapy, whereas those with high levels may not. Other treatment modalities need to be explored for high-risk patients to improve their prognosis.

Identification of an individualized therapy prognostic signature for head and neck squamous cell carcinoma.

BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) are the most common cancers in the head and neck. Therapeutic response-related genes (TRRGs) are closely associated with carcinogenesis and prognosis in HNSCC. However, the clinical value and prognostic significance of TRRGs are still unclear. We aimed to construct a prognostic risk model to predict therapy response and prognosis in TRRGs-defined subgroups of HNSCC. METHODS: The multiomics data and clinical information of HNSCC patients were downloaded from The Cancer Genome Atlas (TCGA). The profile data GSE65858 and GSE67614 chip was downloaded from public functional genomics data Gene Expression Omnibus (GEO). Based on TCGA-HNSC database, patients were divided into a remission group and a non-remission group according to therapy response, and differentially expressed TRRGs between those two groups were screened. Using Cox regression analysis and Least absolute shrinkage and selection operator (LASSO) analysis, candidate TRRGs that can predict the prognosis of HNSCC were identified and used to construct a TRRGs-based signature and a prognostic nomogram. RESULT: A total of 1896 differentially expressed TRRGs were screened, including 1530 upregulated genes and 366 downregulated genes. Then, 206 differently expressed TRRGs that was significantly associated with the survival were chosen using univariate Cox regression analysis. Finally, a total of 20 candidate TRRGs genes were identified by LASSO analysis to establish a signature for risk prediction, and the risk score of each patient was calculated. Patients were divided into a high-risk group (Risk-H) and a low-risk group (Risk-L) based on the risk score. Results showed that the Risk-L patients had better overall survival (OS) than Risk-H patients. Receiver operating characteristic (ROC) curve analysis revealed great predictive performance for 1-, 3-, and 5-year OS in TCGA-HNSC and GEO databases. Moreover, for patients treated with post-operative radiotherapy, Risk-L patients had longer OS and lower recurrence than Risk-H patients. The nomogram involves risk score and other clinical factors had good performance in predicting survival probability. CONCLUSIONS: The proposed risk prognostic signature and Nomogram based on TRRGs are novel promising tools for predicting therapy response and overall survival in HNSCC patients.

Plasma Epstein-Barr viral DNA load after completion of two cycles of induction chemotherapy predicts outcomes for patients with advanced-stage nasopharyngeal carcinoma.

OBJECTIVES: To evaluate the prognostic value of plasma Epstein-Barr virus DNA level following the completion of two induction chemotherapy cycles (ICT; post2CICT-DNA) in locoregionally advanced nasopharyngeal carcinoma (LA-NPC). MATERIALS AND METHODS: This retrospective study included 534 patients with LA-NPC. Recursive partitioning analysis (RPA) was applied to derive a prognostic model for risk stratification. Kaplan-Meier survival analysis was used to determine the survival results, and survival rates were compared using the log-rank test. The Cox proportional hazard model was used for univariate and multivariate analyses. RESULTS: Multivariate analyses revealed that post2CICT-DNA and N stage were independent predictors of overall survival (OS; P = 0.001 and P = 0.001, respectively), and post2CICT-DNA, pre-treatment DNA, and N stage were independent predictors of progression-free survival (PFS; P = 0.002, P = 0.001, and P = 0.021, respectively).Based on prognostic factors (pre-treatment DNA, post2CICT-DNA, and N stage), patients were stratified into three risk subgroups, with 288 patients in the low-, 213 in the intermediate-, and 33 in the high-risk group. The three-year OS rate of the low-, intermediate- and high-risk groups were 99.3% (95% CI 98.3%-100.0%), 90.0% (95% CI 85.5%-94.5%) and 67.0% (95% CI 49.9%-84.1%, P < 0.001 for each of the two groups), respectively. CONCLUSION: Plasma EBV-DNA level after two ICT cycles is a powerful predictor of prognosis in patients with LA-NPC. RPA analysis revealed that stage N3 patients with detectable post2CICT-DNA are at the highest risk of treatment failure, and future clinical trials should focus on early-treatment modification strategies for these patients.

Dysregulated expression of homebox gene HOXA13 is correlated with the poor prognosis in bladder cancer.

BACKGROUND: The homeobox (HOX) genes have been implicated playing important roles in many human cancers. HOXA13 is a member of HOX genes that encode transcription factors regulating embryonic development and cell fate. In the present study, we aimed to investigate the expression and prognostic significance of HOXA13 in bladder cancer. METHODS: Immunohistochemical staining was initially performed to screen the differentially expressed HOXA13 between bladder cancer tissues and paired adjacent non-cancerous tissues. Subsequent Western blotting analysis validation was conducted using tissue samples from patients with bladder cancer. RESULTS: The expression level of HOXA13 was significantly higher in bladder cancer tissues compared to that in adjacent non-cancerous tissues (P < 0.001). The χ2-test showed that expression of HOXA13 was positively correlated with lymphatic metastasis (P = 0.013), bladder tumor TNM stage (P = 0.002) and pathological grade (P < 0.001). Kaplan-Meier survival analysis revealed that patients with bladder cancer with high expression of HOXA13 had shorter overall survival time (P = 0.001) and disease-free survival time (P = 0.001) compared to patients with low expression of HOXA13. Multivariate analysis indicated that HOXA13 was an independent prognostic factor for overall survival for bladder cancer patients. CONCLUSIONS: The results of our study show that high expression of HOXA13 is associated with the progression of bladder cancer and that HOXA13 might serve as a biomarker for prognosis of bladder cancer.

Primary malignant fibrous histiocytoma of the renal pelvis: a 78-month follow-up case report.

Primary malignant fibrous histiocytoma of the renal pelvis is extremely rare. This article reports a pathologically confirmed case. Surgery is the main treatment for this disease. Chemotherapy and radiotherapy have been reported to be ineffective. It is difficult to differentiate it from urothelial tumor of the renal pelvis and renal cell carcinoma by preoperative laboratory and radiological evaluation. Immunohistochemical study is helpful in confirming the diagnosis of the disease. This report discusses the clinical manifestations, pathohistological characteristics, treatment, and prognosis of the case reported.

[Transperitoneal laparoscopic ureterolithotomy for upper ureteral calculi: a report of 1171 cases].

OBJECTIVE: To evaluate clinical outcomes and values of transperitoneal laparoscopic ureterolithotomy. METHODS: A total of 1171 patients with upper ureteral calculi were recruited during September 1999 to February 2012. The etiologies included impacted calculi (n = 1100), non-impacted calculi (n = 71), multiple ureteral calculi (n = 51) and combined small calculi in unilateral kidney (n = 139). Maximum diameter of calculi was 1.5 (0.8-2.6) cm. All patients underwent transperitoneal laparoscopic ureterolithotomy and double J stent was implanted intraoperatively. RESULTS: Two cases were converted into open operation. Calculi moving up into pelvis occurred in 27 cases. And 25 cases converted into laparoscopic pyelolithotomy and stones were removed successfully. Two cases received extra extracorporeal shock wave lithotripsy postoperatively. The remaining 1142 cases were treated successfully with an operative duration of 56.1 (26-160) min and an estimated volume of blood loss at 45.2 (10-250) ml. The period of drainage tube was 3.1 (1-7) days. Postoperative hospitalization stay was 4.8 (3-9) days. One patient suffered urine leakage and healed at Day 6 days post-operation. Ten cases suffered D-J stent bladder non-arrival or retraction and double J stents were extracted by ureteroscopy. One case suffered paralytic ileus and recovered 7 days later. Another case suffered severe hematuria. No intestine or adjacent viscera injury was observed. The follow-up period of 827 cases was 7.3 (24-108) months. Among 12 cases of ureteral stricture, ureteral dilation (n = 7) and ureteral anastomosis (n = 3) were performed. For 5 cases of renal atrophy, 3 underwent nephrectomy because of recurrent lumbago or persistent urinary infection. CONCLUSIONS: Transperitoneal laparoscopic ureterolithotomy has the advantages of minimal morbidity, little postoperative discomfort and high stone clearance rate over open surgery. It should be widely adopted for the patients with upper ureteral impacted calculi.

A new plastic surgical technique for adult congenital webbed penis.

OBJECTIVE: To introduce a novel surgical technique for correction of adult congenital webbed penis. METHODS: From March 2010 to December 2011, 12 patients (age range: 14-23 years old) were diagnosed as having a webbed penis and underwent a new surgical procedure designed by us. RESULTS: All cases were treated successfully without severe complication. The operation time ranged from 20 min to 1 h. The average bleeding volume was less than 50 ml. All patients achieved satisfactory cosmetic results after surgery. The penile curvature disappeared in all cases and all patients remained well after 1 to 3 months of follow-up. CONCLUSIONS: Adult webbed penis with complaints of discomfort or psychological pressure due to a poor profile should be indicators for surgery. Good corrective surgery should expose the glans and coronal sulcus, match the penile skin length to the penile shaft length dorsally and ventrally, and provide a normal penoscrotal junction. Our new technique is a safe and effective method for the correction of adult webbed penis, which produces satisfactory results.

Superselective internal iliac arterial embolization for severe hemorrhage following radical prostatectomy.

Severe hemorrhage following a prostatectomy is a rare and serious complication. A 63-year-old male with severe hemorrhage following radical prostatectomy which led to hypovolemic shock presented at our department and was treated with superselective internal iliac arterial embolization. At 6 months follow-up, the patient had recovered well, regained excellent urinary continence and the pelvic hematoma was absorbed using ultrasound examination. We concluded that rapid diagnosis by computed tomography angiography and early superselective embolization of internal iliac artery should be considered as the treatment of choice in severe hemorrhage cases following radical prostatectomy.

[Transperitoneal laparoscopic modified lymph node dissection for clinical stage I nonseminomatous germ cell testicular carcinoma].

OBJECTIVE: To evaluate the feasibility and short-term clinical effect of transperitoneal laparoscopic modified retroperitoneal lymph node dissection (LmRPLND) in the management of clinical Stage I nonseminomatous germ cell testicular tumors. METHODS: From October 2004 to July 2006, 7 patients aged 26-36 (mean 30) years underwent LmRPLND with modified unilateral template dissection for clinical Stage I nonseminomatous germ cell testicular tumors, which were 3.0 cm x 2.5 cm x 2.0 cm to 6.5 cm x 4.5 cm x 3.0 cm in size, 3 cases on the left and 4 on the right, all diagnosed by ultrasound, computerized tomography (CT) and chest X-ray and confirmed by biopsy following radical orchiectomy. Those with positive lymph nodes received 3 courses of chemotherapy. RESULTS: Success was achieved in all the 7 cases, the operative time ranging from 120 to 210 min (mean 160 min), blood loss from 50 to 200 ml (mean 150 ml), and with no blood transfusion. The drainage tubes were removed 1-2 days after surgery. The mean postoperative hospital stay was 5.5 days. The follow-up lasted 6-32 (mean 14) months, which revealed normal erection and ejaculation in all the patients, but no major postoperative complications. Pathologically, lymph nodes were negative in 6 cases and positive (1/18) in 1. Normal results were obtained in HCG and AFP tests as well as in retroperitoneal ultrasound and chest X-ray examinations. The patient with positive lymph nodes was treated by adjuvant chemotherapy for 3 courses and found free of malignancy during a 6-month follow-up. CONCLUSION: LmRPLND is a safe and minimally invasive treatment option for patients with clinical Stage I nonseminomatous germ cell testicular carcinoma. With fewer complications and faster recovery, it appears to be a desirable substitute for the open procedure.

[Diagnosis and surgical management of renal cell carcinoma with inferior vena cava tumor thrombus--a report of 6 cases with literature review].

BACKGROUND & OBJECTIVE: The management of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus is difficult in clinical practice. Complete surgical removal of the primary tumor with its extension along the IVC is the only hope for a potential cure. The diagnosis of vena caval invasion, especially the determination of tumor thrombus extension, is important for surgical approach planning. This report was to summarize our experiences on treating RCC with IVC tumor thrombus, and explore the diagnosis and surgical management. METHODS: Clinical data, including preoperative diagnosis, operation pattern, and prognosis, of 6 RCC patients with IVC tumor thrombus, treated from 2000 to 2004 in our hospital, were reviewed retrospectively. RESULTS: Diagnoses of the 6 cases of RCC with IVC tumor thrombus were made by ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI) preoperatively. Of the 6 cases, 1 was renal vein thrombus, 3 were infrahepatic thrombus, 2 were hepatic thrombus. Operations were performed for all 6 patients with 5 successes except 1 death during the operation. The patients were followed-up for 3-30 months after operation; 2 died of distant metastases 3 and 9 months after operation, and the other 3 survived disease-freely. CONCLUSIONS: CT and MRI are the best ways to diagnose RCC with IVC tumor thrombus. Surgical treatment is the preferred approach for the patients without distant metastases and lymph node involvement. Surgical strategy depends on the tumor thrombus extension and the vena wall involvement status.

[Effect of electrovaporization on the prostate and its surrounding tissues].

OBJECTIVE: Transurethral electrovaporization of the prostate (TVP) for benign prostatic hyperplasia (BPH) has proven to be efficacious with lower morbidity than transurethral resection of the prostate (TURP) on clinical studies. However, no histopathologic data are available to support the clinical findings in human studies. The following study was done using a canine model in an effort to evaluate these histopathologic changes. METHODS: Nine canines received antegrade electrovaporization or resection of the prostate, via an open cystoma, using Storz series resectoscope and video equipment. The dogs were sacrificed and their prostates harvested at 0 week (immediately after operation), 1 week or 5 weeks after electrovaporization or resection. The prostates were evaluated grossly as well as histologically for cavitary defects and depth of necrosis. RESULTS: Prostate examination revealed superficial necrosis (less than 1.8 mm deep) at 0 week following the 270 watts operation, and less than 3 mm deep necrosis with acute inflammation and focal hemorrhage at 1 week. The depths of necrosis were less than 1.3 mm and 2.2 mm at 0 week and 1 week after the 180 W electrovaporizion. And the 120 W resection resulted in necrosis 1.1 mm and 1.6 mm deep at most, which was localized in the vaporized prostate only, with no histopathologic change in the surrounding tissues. Epithelial stratification was underway by the fifth week, but with inflammation. CONCLUSION: TVP in the canine model showed only shallow necrosis at the site of the vaporization. These data provide a histopathologic rationale for the minimal morbidity and efficacious nature of this technique demonstrated in clinical studies.

[Twenty-eight cases report of transurethral resection of the prostate combined with repair of inguinal hernia].

OBJECTIVES: To discuss the surgical method of benign prostatic hyperplasia (BPH) with inguinal hernia. METHODS: Twenty eight cases of BPH with inguinal hernia were treated with transurethral resection of the prostate (TURP) combined with repair of inguinal hernia by PPM at the same time. RESULTS: All patients had been followed up for six months to four years, in which recurrence of hernia or other complications were not found. Qmax was more than 15 ml/s after operations, and IPSS were about 0-7 scores for all patients. The mean time of hospitalization was 4.2 days. CONCLUSIONS: TURP combined with repair of inguinal hernia at the same time is a simple and effective method, which can avoid second operation, and it is more significance to the aged especially.