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Chinese Journal of Urology ; (12): 19-23, 2021.
Article in Chinese | WPRIM | ID: wpr-911167


A 69-year old man presented with high-risk metastatic prostate cancer. After 7 months of androgen deprivation therapy (ADT), he progressed to metastatic castration resistant prostate cancer. We suggested him comprehensive therapy, including Abiraterone, chemo-therapy, radio-therapy, platinum chemo-therapy and Enzalutamide, which proved effective with his long term survival.

Chinese Journal of Surgery ; (12): 227-230, 2018.
Article in Chinese | WPRIM | ID: wpr-809856


Objective@#To study the clinical characteristics, image findings, therapeutic method and prognosis of metanephric adenoma.@*Method@#The clinical characteristic, image findings, operation methods and prognosis of 16 metanephric adenoma patients treated at Department of Urology, Peking University First Hospital from January 2004 to March 2016 were analyzed retrospectively.@*Results@#There were 6 male and 10 female patients in the study. The mean age of patients was 33.7 years (ranging from 14 to 83 years). Two patients came to the hospital because of fever, while other 14 patients had no symptoms and found renal tumor by medical examination. One case was found polythemia vera and another 1 case showed mild anemia. Serum creatine of all the cases were in normal range. The tumor of 11 cases were at left side and 5 cases were at right. All patients took urinary tract ultrasound. Fifteen patients took CT examination. Among them, 14 cases were solid mass and 1 case was cystosolid.CT value was (41±4) HU. CT scan showed that the tumor was slight enhanced and CT value increased to (77±9) HU. Six patients took MRI examination. The MRI showed high or low signal of T1WI or T2WI scans.Tumor size was (4.7±3.9)cm (ranging from 1.7 to 17.5 cm). All 16 patients took operation and 11 of them took laparoscopic surgery while the other 5 cases took open surgery. Eleven cases took partial nephrectomy, 4 cases took nephrectomy and 1 case took nephroureterectomy. The surgical procedures were all successful and no complications occured during perioperative period. All cases were all confirmed metanephric adenoma by postoperative pathology and surgery cut edge were all negative. Immunohistochemical study showed that the positive rate of Vimentin, CD57, AE1/AE3, WT1, CK7 and AMACR respectively were 16/16, 15/16, 12/16, 10/16, 3/16 and 2/16. The median follow-up time of 16 cases was 44 months (ranging from 8 to 125 months) and none had recurrence or metastasis.One case died 125 months after surgery because of advanced age(83 years old).@*Conclusions@#Metanephric adenoma is difficult to be diagnosed relying on clinical characteristics and image features. Pathology can help confirm the diagnosis. Partial nephrectomy is the first choice for operation and can achieve good prognosis. But it still needs a regular follow-up.

Chinese Journal of Surgery ; (12): 942-946, 2017.
Article in Chinese | WPRIM | ID: wpr-809647


Objective@#To investigate the clinical features and prognosis of rare subtypes of renal cell carcinoma.@*Methods@#This retrospective study collected the data of 52 rare subtypes of renal cell carcinoma of patients who underwent surgery from January 2002 to December 2014 at Department of Urology, Peking University First Hospital. There were 12 patients with collecting duct carcinoma, 5 patients with Xp11.2 translocation renal cell carcinoma, 5 patients with mucinous tubular and spindle cell carcinoma, 30 patients with unclassified renal cell carcinoma. The study group included 25 male and 27 female patients, with mean age of 52 years. The mean tumour size was (6.5±3.9) cm (range: 1.5 to 21.0 cm). The basic clinical features, gross appearance, Fuhrman nuclear grade, TNM staging and prognosis of rare subtypes of RCC were studied. The OS curves were obtained for rare subtypes of renal cell carcinoma using the Kaplan-Meier method and compared using a Log-rank test.@*Results@#The rate of lymph node and distant metastasis were 34.6% (18/52) and 17.3% (9/52). Malignancies were screened and detected by color Doppler ultrasonography or CT scan, however, no case was diagnosed before operation or aspiration, all cases were confirmed by the pathological examination. The average period of postoperative follow-up process was 65 months, and the mean survival time was (34±23) months.@*Conclusion@#The clinical features of rare subtypes of renal cell carcinoma are similar to those of clear cell renal cell carcinoma, while the imaging changes will be helpful for diagnosis before operation.

Chinese Journal of Surgery ; (12): 738-741, 2017.
Article in Chinese | WPRIM | ID: wpr-809370


Objective@#To study the impact to operation safety of preoperative renal artery embolization for management of ≥10 cm renal cell carcinoma.@*Methods@#The clinical data of 239 cases with ≥10 cm renal cell carcinoma which all had underwent operation in Department of Urology, Peking University First Hospital from January 2002 to December 2014 were retrospectively analyzed. Fifty-three patients underwent preoperative renal artery embolization (therapeutic group) and 186 patients did not (control group). The effect of embolization on operative time, transfusion requirements, hospitalization, ICU stay and perioperative complications were analyzed by comparing the two groups using rank sum test and χ2 test or Fisher exact test.@*Results@#Comparing the therapeutic group and control group, there was significant difference in tumor location (on the left or right). The mean age, sex, mean primary tumor size, and TNM stage were similar in both groups. Comparing the therapeutic group and control group, there were more open surgeries in therapeutic group (96.2% vs. 82.3%, χ2=6.438, P=0.013). There were no significant differences in mean operative time (238 (525) minutes vs. 208 (583) minutes, Z=-2.182, P=0.062). The mean blood transfusion (700 (1 900) ml vs. 925 (8 800) ml, Z=-1.064, P=0.006) had significant difference. The therapeutic group had a longer mean hospitalization (21 (50) days vs. 15 (79) days, Z=-4.322, P=0.000) and higher rate of intensive care unit stay (54.7% vs. 34.4%, χ2=6.103, P=0.027). There was no significant difference in perioperative complications between two groups (0 vs.3.2%, P=0.408).@*Conclusion@#Preoperative renal artery embolization in ≥10 cm renal cell carcinoma patients undergoing operation provides benefit in increasing operation safety and reducing perioperative death.

Chinese Journal of Urology ; (12): 916-919, 2016.
Article in Chinese | WPRIM | ID: wpr-505252


Objective To analyze the clinical characteristics,pathology,CT characteristics and targeted therapy of primary retroperitoneal leiomyosarcoma treated at our institution during the past 20 years.Methods A retrospective review was performed among 11 patients of this disease.The main performances were hematuria,abdominal mass and abdominal pain.Non-enhanced CT scanning showed soft tissue density in all cases.Tri-phase enhanced scanning showed reinforcement in different degrees.Pathology results showed tissue necrosis.The pathology featured by routine HE and immumohistochemical staining.Results Surgical treatment was performed in all 11 patients.Postoperative pathology showed that median tumor diameter was 14.40cm.Spindle cell,cellular abnormity and mitotic figures could be seen through light microscope.During follow-up,3 cases recurrenced after 2 months,3 years and 5 years respectively.Conclusions Primary retroperitoneal leiomyosarcoma might have a high fatality rate and high recurrence rate.The clinical and CT features are unapparent.Pathology diagnosis is reliable,surgery is necessary to prolong life and cure disease.

Article in Chinese | WPRIM | ID: wpr-502825


Objective:To evaluate the impacts of clinical,pathological,and laboratory factors on on-cological outcomes of patients with T3 N0 M0 renal cell carcinoma.Methods:The clinical data,laboratory exam results,and follow-up outcomes of 182 patients with T3 N0 M0 renal cell carcinoma who underwent nephrectomy from 2007 to 2012 in Peking University First Hospital were retrospectively collected.The 5-year cancer-specific survival and 5-year recurrence-free survival of all the patients were calculated using Kaplan-Meier method,and the statistical significance between the survival curves were compared using the Log-rank test.Variables with significant differences in the univariate analysis were subjected to the multivariate analysis by Cox regression model.All the comparisons were conducted using two-tailed test and P <0.05 was considered statistically significant.Results:A total of 182 patients were included in this study.Of all the 182 patients,126 were male (69.23%)and 56 were female (30.77%).The mean age was (56.75 ±12.45)years.The median follow-up time was 48 months (3 -99 months).At the end of the follow-up,50 patients (27.47%)died due to the disease after a median of 29.74 months and 59 patients (32.42%)had tumor recurrence after a median of 22.12 months.The 5-year cancer-specific survival of all patients was 68.30% (95% CI:60.16% -75.84%);the 5-year recurrence-free survival was 60.70% (95% CI:53.16% -68.84%).In the univariate analysis,diabetes mellitus, tumor invasion status,Fuhrman grade,serum album,serum cholestenone,anemia,and neutrophils per-centage were associated with the cancer-specific survival and Fuhrman grade,serum album and anemia were associated with the recurrence-free survival.Variables with significant differences on univariate analysis were included in Cox multivariate regression analysis.Multivariate Logistic regression analysis showed that diabetes mellitus (HR =2.434,95% CI:1.243 -4.769,P =0.010),hypoalbuminemia (HR =2.188,95% CI:1.074 -1.074,P =0.031),and anemia (HR =3.320,95% CI:1.839 -5.991,P <0.001)were independent risk factors significantly associated with cancer-specific survival;and higher Fuhrman grade (HR =2.552,95% CI:1.433 -4.545,P =0.001),anemia (HR =2.535, 95% CI:1.497 -4.293,P =0.001)were independent factors significantly associated with recurrence-free survival.Conclusion:Diabetes mellitus,hypoalbuminemia,and anemia were independent risk fac-tors significantly associated with cancer-specific survival of T3 N0 M0 renal cell carcinoma patients;higher Fuhrman grade and anemia were independent risk factors significantly associated with tumor recurrence of T3 N0 M0 renal cell carcinoma patients.