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OBJECTIVE：To estab lish fingerprint of Duzhong butiansu pill s，analyze its chemical pattern recognition ，and determine the contents of 7 components in Duzhong butiansu pills ，so as to provide reference for the quality control of the preparation. METHODS ：HPLC method was adopted. The determination was performed on Pntulips BP-C 18 Plus column with 0.2％ phosphoric acid water-acetonitrile as mobile phase （gradient elution ）at the flow rate of 1.0 mL/min. The detection wavelength was set at 330 nm，and column temperature was 35 ℃. The sample size was 20 μL. With paeonol as the reference，the HPLC fingerprints of 12 batches of Duzhong butiansu pills （S1-S12） were established with Similarity Evaluation System for TCM Chromatographic Fingerprint （2012 edition）； common peaks were determined and the similarity was evaluated. The chromatographic peaks were identified by comparing with the reference substance. SPSS 21.0 and SIMCA 13.0 software were used for cluster analysis and principal component analysis ，and 22 common peaks were evaluated. The contents of the identified components in 12 batches of samples was determined by the above HPLC method. RESULTS ：A total of 22 common peaks were identified in the HPLC fingerprint of 12 batches of Duzhong butiansu pills ，and the similarity was no loss than 0.960. There were 7 chemical components identified ，which were gallic acid （peak 1），chlorogenic acid （peak 3），liquiritoside（peak 6），hyperoside （peak 7），verbascoside（peak 8），icariin（peak 14）and paeonol （peak 15）. Among the 12 batches of samples ，S1，S3-S5，S7， S9 and S 11 were classified as one category ，S2，S10 and S 124Y091 were clustered into one category ，S6 was one category and S was one category. The 22 common peaks were divided into three principal components. The characteristic value （15.130） and contribution rate （68.775％） of principal component 1 were the largest ，and the score coefficients of peak 3（0.305）and peak 4（0.298）were the highest. Among 12 batches of samples，the cont ents of above 7 components were 18.196 231.951 3，0.000 6-0.049 4，0.234 8-0.415 9，0.039 5-0.079 1，0.053 5-0.249 3，0.000 5-0.000 8，0.646 4-1.146 9 mg/g，respectively. CONCLUSIONS：HPLC fingerprint of Duzhong butiansu pills is established successfully. Twelve batches of samples are clustered into 4 category. Peak 3（chlorogenic acid ）and peak 4（unknown）may be the important factors causing the difference of samples. The content of gallic acid is the highest among the 7 components.
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Radical cystectomy surgery is the main surgery for muscle invasive bladder caner and some high-risk non-invasive bladder cancer.It is the most complex surgery in Urology and is accompanied by the most of complications.Enhanced recovery after surgery aims to mitigate the surgical stress response,which can reduce the morbidity of complications,hospital stay time and the cost.This article is to summarize the enhanced recovery after surgery protocols in radical cystectomy surgery.
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Objective To discuss the correlation between female chronic pelvic pain and pelvic floor anatomy.Methods The female patiems of chronic pelvic pain 179 cases,age 28-67 years,average 49.4 years;pelvic pain history 8 months-9 years,average 2.8 years;167 cases has childbirth history,43 cases has surgery history,which gynecological surgery 31 cases,and urinary surgery 7 cases,and anus surgery 5 cases.Results High incidence of female pelvic pain were 30-60 age (incidence of 54.8％),93.3％ has birth history,24％ has operation history,the myofascial tissue pain higher than the organ,were 87.4％ than 12.6％ (P ＜ 0.01),the front of pelvic pain higher than back,were 65.6％ than 21.8％ (P ＜ 0.01).Conclusions Female chronic pelvic pain associated with the particularity of the pelvic anatomy and physiological,with the tissue of pelvic floor and urogenital diaphragm of primary injure and chronic inflammation is an important cause of chronic pelvic pain.
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OBJECTIVE:To observe the efficacy and safety of Aidi injection combined with oxaliplatin and tegafur gimeracil oteracil potassium in the treatment of advanced colorectal cancer. METHODS:100 patients with advanced colorectal cancer were ran-domly divided into control group and observation group. Control group was treated with Tegafur gimeracil oteracil potassium cap-sule,body surface area1.50 m2,60 mg,it was orally tak-en after breakfast and dinner d1-28,the drug was stopped for 14 d after 28 d treatment+oxaliplatin 85-130 mg/m2 adding into 500 ml of 5% Glucose injection by intravenous infusion for 2 h. Observation group was additionally treated with Aidi injection 100 ml add-ing into 500 ml of 5% Glucose injection by intravenous infusion,once a day,d1-7,which was repeated every 14 d and was twice. The clinical efficacy,toxicity reactions,improvement of life quality and one-year survival rates in the two groups were observed. RESULTS:There was no statistically significant difference in the total effective rate between 2 groups (P>0.05). The improve-ment rate of life quality and one-year survival rate in the observation group were significantly higher than control group,the inci-dence rates of granulocytopenia,platelet decline,oral ulcer and peripheral neurotoxicity in observation group were significantly low-er than control group, there was significant difference between 2 groups (P<0.05). CONCLUSIONS:The life qnality and one-year surviral rate of Aidi injection combined with oxaliplatin and tegafur gimeracil oteracil potassium is better than only oxalipl-atin combined with tegafur gimeracil oteracil potassium in the treatment of advanced colorectal cancer,with better safety.
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Background and purpose:Laparoscopic retroperitoneal adrenalectomy makes access to the adrenal glands easier and less invasive than open surgery. The aim of this study was to evaluate the clinical efifcacy of laparoscopic retroperitoneal adrenalectomy.Methods:A total of 130 patients who underwent retroperitoneal adrenalectomy for adrenal mass from Jan. 2007 to Dec. 2012 in Fudan University Shanghai Cancer Center were retrospectively assessed. Their clinicopathological factors, perioperative complications and short-term prognostic data were retrieved from the medical records.Results:One hundred and twenty-seven of 130 patients underwent retroperitoneal adrenalectomy successfully, and 3 patients were converted to open surgery due to severe bleeding. Among 130 patients, 63 were male and 67 were female, with the mean age 50.0 years. The pathological results of the 130 patients indicated adrenocortical adenoma in 68, pheochromocytoma in 15, medullary lipoma in 13, adrenal cysts in 10 , ganglioneuroma in 7, metastatic cancer in 5, adrenal hyperplasia in 4, schwannoma in 3, lymphangioma in 2, adrenal hematoma in 1, adrenal cortical carcinoma in 1, adrenal angiosarcoma in 1 and the deputy spleen in 1 (one patient suffering from both pheochromocytoma and ganglioneuroma). The maximum diameters were ranging from 0.5 to 9.0 cm, and mean diameter was 3.48 cm. The average blood loss in surgery was 62.73 mL. Mean length of stay in hospital was 7 d. GradeⅠ complications occurred in 5 patients, including 2 of fever, 1 of food allergy, 1 of drug allergy and 1 of hypokalemia.Conclusion: Retroperitoneal adrenalectomy should be considered as the procedure of choice for the resection of most adrenal tumors in skilled centers with the advantages of minimal invasion, increased safety and faster recovery.
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Objective To analyze the risk factors of urolithiasis in pregnancy and the relationship between urolithiasis in pregnancy and pregnancy outcomes.Methods From January 2004 to December 2009,the clinical data of 162 pregnant women (Group A),diagnosed as upper urinary tract calculi,were reviewed,retrospectively.Their age ranged from 18 to 41 years (mean 24±5 years).Seven of them had history of urolithiasis before pregnant.At the same time,150 pregnant women without urinary stone (Group B) were also included in this study,whose mean age was 23±5 years.In addition,150 women without pregnant and urinary stone (Group C) were included in this study,whose mean age was 24±4 years.The blood and urine routine results,blood uric acid and electrolytes were recorded and compared among those groups.In group A,119 cases had symptomatic urolithiasis.Surgical intervention was performed in 24 cases and the conservative therapy was performed in 95 cases.The rates of abortion,premature delivery and cesarean delivery were compared between two groups.Results Compared group A with group B and group C,there were significant differences in the urine WBC (145.16±202.18 vs.46.00± 119.50 and 55.33 ± 145.36 per high power lens) and urine ketone body (2.41 ± 6.14 mmol/L vs.0.30± 1.75 mmol/L and 0.17± 1.26 mmol/L) (P＜0.05).Meanwhile,there were significant differences in the blood leukocytes [(11.39±3.89)× 109/L,(10.78±2.98) ×109/L vs.(6.21±1.48) × 109/L],the blood uric acid (331.12±215.22 μmol/L,329.32± 88.50 μmol/L vs.280.01±69.88 μmol/L),the urine protein (0.29±2.00 mmol/L,0.10±0.19 mmol/L vs.0.02±0.09 mmol/L),urine glucose (2.50±8.44 mmoL/L,2.35±8.63 mmol/L vs.0.25± 1.97 mmol/L) and urine erythrocyte (76.60±98.11,77.43±71.00 vs.13.77±37.93 per high power lens) (P＜0.05).In those patients with symptomatic urolithiasis,there was 1 case of abortion in the conservative treatment and surgery intervention groups,respectively.The premature delivery rate and cesarean delivery rate were 5.3％ vs.0％ and 17.9％ vs.4.2％,respectively.Conclusions The blood leukocytes,blood uric acid,urine protein,urine glucose and urine erythrocytes are significantly high in pregnant women than those in non-pregnant women.However,the relationship between those abnormality and urolithiasis in pregnancy is still indefinite.Since the urine leukocytes and ketone increase obviously,it might suggest that the occurrence of the urine calculi is related with the metabolism of nourishment and electrolytes,urinary tract infection in pregnancy.The surgery intervention may be a risk of fetus miscarriage.
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Objective To measure the reconstructed cranial CT images,and to clarify the safety range of unilateral nasal transsphenoidal approach for pituitary surgery.Methods 100 normal pituitary cranial CT images were randomly selected,and the three-dimensional reconstruction was performed by using the CT images of perpendicular and parallel to the edge of the two eyes as base line, and the distance and angle in unilateral nasal transsphenoidal approach for pituitary surgery from the sagittal plane in the middle of the nasal meatus and the plane through the tip of the nose and both ends of dorsum sellae were measured,respectively. The angles and distances were compared when grouped the data by gender and age. Results Angle A1 (the angle between the tip of the nose and the tuberculum sellae and saddle back root line in the sagittal plane)in the sagittal plane of the middle nasal meatus was (11.22±1.35)°,95% confidence interval was 8.92°-13.76°degrees;the distance D1(the distance on the line between tuberculum sellae and saddle back root, and the line was formed by the plate contained the angle A1 and sellar floor)was (16.71 ± 2.07)mm,95% confidence interval was 13.11-19.93 mm.Angle A2 (the angle between the tip of the nose and the saddle back ends)which was in the plane through the tip of the nose and both ends of dorsum sellae was (8.91±1.19)°,95% confidence interval was 7.12°-10.72°;the distance D2(the distance on the line between the saddle back ends,and the line was formed by the plate contained the angle A2 and sellar floor)was (14.23±2.09)mm,95% confidence interval was 10.81-17.92 mm. The four parameter data was normally distributed,and there was no significantly statistic difference between different gender and ages (P>0.05).Conclusion The angle of the movement for unilateral nasal transsphenoidal approach for pituitary surgery operation in the sagittal plane in the middle of the nasal meatus should be less than (11.22 ± 1.35)°,and the distance of the movement should be less than (16.71±2.07)mm. The angle of the movement in the plane through the tip of the nose and both ends of dorsum sellae should be less than (8.9 1 ± 1.1 9 )°, and the distance of the movement should be less than (14.23±2.09)mm.
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Objective To validate the Memorial Sloan-Kettering Cancer Center(MSKCC)score model and evaluate the clinical efficacy of vascular endothelial growth factor(VEGF)-targeted agents in the treatment of advanced renal cell carcinoma(RCC)in China.Methods Three hundred and forty-five patients with advanced RCC and average age of 57(17-90)years were treated with VEGF-targeted agents.There were 306 cases of clear cell RCC,20 cases of papillary RCC,4 cases of chromophobe RCC,5 cases of renal collecting duct carcinoma,3 cases of medullary carcinoma and 7 cases of unclassified RCC.The main metastatic lesions were located at lung,bone and lymph nodes.Of them,205 cases were given the treatment of sorafenib 400 mg bid without off treatment,while 140 cases received sunitinib treatment in repeated six week cycles consisting of four weeks of sunitinib 50 mg daily followed by two weeks off treatment.Overall survival(OS)was estimated by the Kaplan-Meier method.Log-rank test and Harrell concordance index analysis were used to validate the MSKCC score model.Results The median follow-up period were 23(1-68)months in the whole group.The OS was 33 months,and survival rates at 1,2,3 year were 77.6％,59.3％,46.6％,respectively.According to the MSKCC score model,the patients were segregated into three risk categories: the favorable-risk group(no prognostic factors;n =169;49.0％),in which median OS(mOS)was 46 months and 2 year OS was 75.8％;the imtermediate-risk group(one or two prognostic factors;n =150;43.5％),in which mOS was 24 months and 2 year OS was 47.7％;and the poorrisk group(three to five prognostic factors;n =26;7.5％),in which mOS was 8 months and 2 year OS was 10.1％(log-rank P ＜ 0.01).The concordance index was 0.687.Conclusions VEGF-targeted agents are effective in Chinese advanced RCC patients.The MSKCC score model can be incorporated into judging individualizing tumor prognosis and communicating about the treatment options with patients who are using VEGF-targeted agents.
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Background and purpose: Platelet to lymphocyte ratio (PLR) is an important factor reflected systematic inflammation. The clinical value of PLR has not been confirmed. The present study was to explore the value of preoperative PLR in predicting clinical stage and prognosis in upper tract urothelial carcinoma. Methods:Patients who underwent surgical therapy with postoperative pathology upper tract urothelial carcinoma without metastasis from Jan. 2007 to Mar. 2012, were collected. Following up was done by telephone and clinic work, 150 vs 1 was taken as the threshold value of PLR, and the association of PLR with tumor stage, whether suffered bladder cancer as comorbidity, recurrent or metastasis, overall survival, tumor lesion, preoperative hematuria, gender and age was analyzed. We further analyzed the association difference of disease free survival (DFS) time and overall survival (OS) time between different PLR groups. Results:Fifty-one cases of UTUC were collected, and the postoperative mean following up time is 21 (9–51) months. Twenty cases recurred or metastasis and 9 cases died. The mean DFS time was 15 (2–51) months,and the mean OS time was 21 (9–51) months. One-factor analysis of variance showed that preoperative PLR was associated with tumor stage, overall survival rate, hematuria and gender, and the P value were 0.028, 0.008, 0.045, 0.036 respectively. High PLR group was intended to be non-organ confined disease, the sensitivity was 57%and the specificity was 74%. Survival analysis by Kaplan-Meier method showed there is no statistical difference in DFS between high and low PLR groups (P=0.155). But OS time in high PLR group was significantly less than that in low PLR group (P=0.006). Cox regression confirmed that only tumor stage is an independent prognostic factor of OS (P=0.029). Conclusion:PLR has potential clinical value in predicting advanced stage disease and Cox regression confirmed that only tumor stage is an independent prognostic factor of OS.
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Objective To analyze prognosic factors for patients with hormone refractory prostate cancer (HRPC) after chemotherapy of docetaxel/mitoxantrone plus prednisone and to explore the relationship between prostate specific antigen (PSA) parameters and prognosis. Methods Data from 68 patients with CRPC after chemotherapy were collected and analyzed retrospectively.The median age of these patients were 65 years old with 28 cases of biopsy Gleason score ＜ 8 and 35 cases of ≥ 8.The median serum PSA at diagnosis,nadir and pre-chemotherapy baseline were 142 ng/ml,0.5 ng/ml and 33.0 ng/ml,respectively.There were 38 patients in docetaxel group and 30 in mitoxantrone group.PSA doubling time ( PSADT),progression free survival (PFS) and overall survival (OS) was calculated.Chi square test was used in analysis of chemotherapy effect and Cox proportional hazards regression model was applied to identify the predictors for PFS and OS.The median value of continuous variable as cutoff point was used to divide patients into two groups to compare.Risk ratio and 95％ confidence interval (CI) was calculated. Results 38 (55.9％)patients experienced effective chemotherapy. The effective rate were 33％ and 74％ for PSADT ＜ 1.6 months and ≥ 1.6 months group,85％ and 49％ for M0 and M1 stage group,and 69％ and 40％ for docetaxel and mitoxantrone group,(P ＜ 0.05).The median PFS was (3.5 ± 0.5) months for all patients,which were (2.7 ±0.4) months and (5.9 ±0.6) months for patients with PSADT ＜ 1.6 months and ≥ 1.6 months group,(5.0 ± 0.6) months and (2.7 ± 0.5 ) months for patients with docetaxel and mitoxantrone group,and (5.7 ± 0.8) months and ( 3.4 ± 0.6) months for patients with Gleason score ＜ 8 and ≥ 8 group (P ＜0.05).26 case died in the end and the median OS was (28.3 ± 2.6) months for these patients,which were (15.7 ± 3.4) months and (31.6 ± 1.2) months for patients with PSADT ＜ 1.6 months and ≥1.6 months group,(29 ± 4.1 ) months and (28 ± 3.2) months for patients with docetaxel and mitoxantrone group,and (28.7 ± 2.6) months and (24.3 ± 5.6) months for patients with Gleason score ＜ 8 and ≥ 8 group (P ＜ 0.05). Conclusions The effective rate of chemotherapy was related with PSADT,chemotherapy strategy and M stage.PSADT,chemotherapy strategy and Gleason score may be independent predictors for patients with HRPC taking chemotherapy.Patients with PSADT ≥ 1.6 months,docetaxel chemotherapy and Gleason score ＜ 8 will have longer PFS and OS.
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Objective To construct and evaluate a nomogram for predicting the risk of peri-operative complications after radical retro-pubic prostatectomy (RRP) with standard classification criteria.Methods The peri-operative complications and clinicopathological data of 240 patients (50-82 years old) who had undergone RRP for prostate cancer from June 2006 to June 2011 were retrospectively collected.Gleason score:95 cases ＜ 7; 145 patients ≥ 7;Clinical staging:cT1 is 1 case (0.4％),T2a 5 cases (2.1％),T2b 7 cases (2.9％),T2c 162 cases (67.5％),T3a 26 cases (10.8％),T3b 39 cases (16.3％).The peri-operative complications (in 30 days after surgery) were classified by Clavien-Dindo Classification system (the occurrence rates are as follows:rectum injury 1.6％,wound infection 2.0％,deep venous thrombosis 1.2％,urinary leak 5.0％,lymphocele 4.5％,myocardial infarction 5.8％,second look operation 1.6％),and a logistic regression model was used to construct the nomogram.Results BMI,N staging and Blood loss more than 200ml during surgery were independent prognostic factors of RRP morbidity in multivariate logistic regression.The nomogram predicting the risk of peri-operative complications showed relative good concordance index (0.633) and good calibration. Conclusions Based on the clinicopathological factors,a nomogram to predict the probability of peri-operative complications in patients undergone RRP was constructed.This statistical tool may be beneficial in judging operation risk and help consulting with patient before or after surgery.
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ObjectiveTo analyze the clinical features,diagnosis and treatment of male idiopathic hypogonadotropic hypogonadism (IHH).MethodsClinical data of 92 male IHH cases were analyzed retrospectively.ResultsThe mean age at evaluation was 21.0 ± 3.2 yrs,and 52 patients were diagnosed with Kallman syndrome (KS; IHH with anosmia/hyposmia) while the remainder were normosmic IHH (nIHH).All had normal radiological imaging of the hypothalamic and pituitary areas.The level of serum LH,FSH and T was low,and the clinical parameters (development of secondary sexual characteristics,sexual function,and serum testosterone levels.) were significantly improved after hormone replacement therapy.ConclusionsDiagnosis and differential diagnosis of IHH can be clearly defined based on clinical features and laboratory results.Hormone replacement therapy is an effective treatment option.
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Objective To evaluate the prognostic value of bilateral inguinal lymph node metastases in node-positive penile cancer. Methods Sixty patients with surgically resected node-positive penile cancer were analyzed. All the patients underwent regional lymph node dissection. Recurrence free survival curves were plotted by Kaplan-Meier method and compared by the Log-rank test. Multivariate survival analysis was performed using Cox regression model. Results Of all the patients, 18 cases had bilateral inguinal lymph node metastases. The 3-year recurrence free survival rate in patients with bilateral invovlement was significantly lower than those with unilateral disease (26.7 % vs 65.3 %, χ2 =10.6, P=0.001). In order to evaluate wether the prognostic significance of bilateral lymph node metastases was dependent of increased number of positive nodes, the two predictors were included in multivariate survival analysis.Both the number of metastatic nodes and bilateral nodal disease were independent prognostic factors (P ＜0.05).Comparisons of survival curves showed those patients with bilateral nodal disease and more than 2 metastatic nodes had worst outcome. Conclusion Bilateral inguinal lymph node metastases is an important prognostic factor in penile cancer irrespective of the number of positive lymph node.
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Objective To construct a nomogram for estimating disease free survival of node-positive penile cancer treated with surgery.MethodsThe clinicopathological data of 32 node-positive penile squamous cell carcinoma patients were retrospectively reviewed.All patients had undergone primary tumor excision and regional lymphadenectomy.The pathological records showed that 10 were N1,13 were N2 and 9 were N3.Median level of preoperative squamous cell carcinoma antigen (SCCAg) was O.9 μg/L.With a median follow-up of 16.5 months,13 patients developed recurrence.Based on the stage,histological grade and preoperative serum squamous cell carcinoma antigen level,a nomogram was drawn on the basis of the Cox regression model.Results Stage and preoperative serum SCCAg levels were independent prognostic factors for disease free survival in node-positive penile cancer treated with surgery.The hazard ratio of SCCAg level and N stage was 2.76 (95％ CI:1.40-5.44,P=0.0034) and 28.51 (95％ CI:2.55 -319.11,P =0.0066).The nomogram demonstarted good discrimination and calibration with a concordance index of 0.855.Conclusions Based on the N stage and preoperative serum SCCAg level,a nomogram to predict disease free survival in node-positive penile cancer treated with surgery was set up.The prediction model could be helpful in predicting the risk of recurrence.
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Objective To evaluate the clinical efficacy and side effects of sunitinib in the treatment of advanced renal cell carcinoma. Methods Forty-five patients with advanced renal cell carcinoma and an average age of 48.6 yrs were treated with sunitinib. Among the study group, 25 were male and 20 were female. In group one, patients received sunitinib treatment in repeated six week cycles consisting of four weeks of sunitinib 50 mg daily followed by two weeks off treatment (schedule 4/2). In group two, a single daily dose of sunitinib 37.5 mg was administrated to 20 patients without off treatment. A CT scan was used to evaluate the treatment efficacy after each cycle and the side effects were recorded accordingly. Results Clinical efficacy could be evaluated in 40 patients. Of these, two achieved complete response, eight achieved partial response, 27 were stable and the remaining eight experienced disease progression with four patients dying during the study period. The side effects of sunitinib in group one and in group two included hypertension 32% (8/25) and 10% (2/20), P=0.02; liver function impairment 32% (8/25) and 20% (4/20), P=0.011; hand-foot skin reaction 68% (17/25) and 60% (12/20), respectively. The incidence of major side effects of sunitinib were different in Chinese patients than from what had been previously reported in studies conducted in US and Europe. Generally, most of the sunitinib side effects were easy to manage. Conclusions There weredifferences between the two groups of Chinese patients treated with different sunitinib protocols. The protocol of sunitinib 37.5mg daily without off-treatment was better than the protocol of sunitinib 50mg daily (schedule 4/2) in regard to liver function impairment and hypertension.
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Objective To investigate the efficacy of Sunitinib in treating metastatic non-clear cell renal cell carcinoma (RCC).Methods Twenty-two metastatic non-clear cell subtype renal cell carcinoma patients with a median age of 46 years (29 -76 years) were treated with Sunitinib.Fourteen cases were found have metastasis post radical nephrectomy,and the remaining eight cases with metastasis received cytoreductive surgery.Pathological diagnosis showed 12 papillary RCCs,one chromophobe RCC,three collecting duct RCCs,and six unclassified RCCs.The metastatic lesions were located in the lung,lymph nodes,adrenal gland,bone,liver,and thyroid gland.The patients were given the treatment of sunitinib 50 mg qd four weeks on and two weeks off.The median time of treatment was 11 months (4.5 - 24 months).Results The objective control rate was 73％.Three papillary RCC and one chromophobe RCC reached partial remission (PR) and 12 cases maintained stable disease (SD) for more than 12 weeks.And the remaining six cases progressed (PD).Conclusions Sunitinib has definitive efficacy in metastatic papillary RCC,chromophobe RCC,collecting duct RCC and unclassified RCC.Metastatic lesions in lungs and lymph nodes might be more sensitive to Sunitinib.
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Objective To evaluate the efficacy of sorafenib in treating metastatic renal cell carcinoma with sarcomatoid feature.Methods Fourteen patients with metastatic renal cell carcinoma and previous nephrectomy were treated with sorafenib single agent.The average age was 61 years(45-77years).All patients were pathologically confirmed with sarcomatoid features in the primary tumors and the percentage of sarcomatoid element was recorded from 20% to 100%.Eight cases were diagnosed as clear cell carcinoma with sarcomatoid feature,2 cases papillary renal cell carcinoma (RCC) with sarcomatoid feature,and 4 cases with pure sarcomatoid RCC.The metastatic lesions were located at lung,lymph node,adrenal gland,bone,and liver.The median time of treatment was 8 months (3-19 months).Results Two cases who just had lymph node metastasis reached partial remission.Their percentages of sarcomatoid lesion were 100% and 20%.Seven cases maintained stable disease for more than 12 weeks and the last 5 cases progressed.To Jul 2009,9 patients progressed and the median progression free survival was 6 months(0-19 months).No significant correlation was seen between both objective response rate and progression free survival and the percentage of sarcomatoid element.Conclusions Although sorafenib has some effect in advanced renal cell carcinoma with sarcomatoid feature,the prognosis of these patients is relatively poor.The percentage of sarcomatoid element does not seem to correlate with the treatment efficacy.
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Objective To investigate the efficacy of sorafenib in treating metastatic non-clear cell renal cell carcinoma(RCC).Methods Twenty-one patients with metastatic non-clear cell subtype renal cell carcinoma were treated with sorafenib.Thirteen cases were male,8 were female,with a median age of 45 years(25-76 years).Metastasis occurred in 12 cases after radical nephrectomy,and the other 9 cases received cytoreductive surgery.Pathological diagnosis showed 15 papillary RCCs,1 chromophobe RCC,and 5 unclassified RCCs.The metastatic lesions were located at lung,lymph node,adrenal gland,bone,liver,and thyroid gland.The patients were given the treatment of sorafenib 400 mg bid,or sorafenib 400 mg bid in combination with interferon-α 3 MIU,IH.5 days per week,and the median time of treatment was 8 months (2-21 months).Results Three cases (14.3%)with 1 papillary RCC,1 chromophobe RCC,and 1 unclassified RCC reached partial remission(PR) and 13 cases (61.9%) maintained stable disease (SD) for more than 12 weeks.And the rest 5 cases(23.8%) progressed(PD).To Jul 2009,13 cases progressed and the median progression free survival was 7 months(0-21 months).Conclusions Sorafenib has definitive efficacy in metastatic papillary RCC,chromophobe RCC,and unclassified RCC.Metastatic lesions in lungs and Lymph nodes might be more sensitive to sorafenib.
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Objective To investigate the efficacy and toxicity of sorafenib dose escalation in treating patients with advanced renal cell carcinoma who progressed after rutine dosage of sorafenib.Methods Twenty-four patients with advanced renal cell carcinoma who progressed after 4-22 months' rutine sorafenib treatment(400 mg bid po.) received dose escalation therapy.Nineteen cases were male,5 were female,with the average age of 52 years.Ten cases added their doses to 600 mg bid,and 14 cases escalated to 800 mg bid.Results Four cases(16.7%) progressed after one month's treatment of sorafenib dose escalation,and quited the study.In the other 20 cases,1(4.2%) reached partial remission with a tumor shrinkage of 42.5% and 19(79.2%) maintained stable disease for more than 12 weeks.To Jul 2009,another 10 cases progressed,and the median progression free survival(PFS) for the PR and SD patients was 7 months(3-14 months).The disease control rate was 79.2%,and the median PFS was 5 months(0-14 months) for the entire group of 24 cases.Common toxicities after dose escalation of sorafenib were similar to those of rutine dosage.Although the grade of hand-foot reaction,diarrhea,fatigue,and neutropenia were more severe,no grade 4 toxicities were observed during the treatment.Grade of toxicities would decrease when the time of treatment prolonged.Conclusions Sofafenib dose escalation is a feasible and effective treatment for the patients with advanced renal cell carcinoma who failed to rutine dosage of sorafenib.The disease control rate of this therapy is relatively high.The toxicities do not increase much,and could be well tolerated by most patients.
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Objective To analyze the predictive factors of anti-androgen withdrawal in the treatment of androgen independent prostate cancer. Methods 347 cases of advanced metastatic prostate cancer in our prostate cancer database were filtered. All the cases were treated with maximal androgen blockade and had full pathological and clinical information. 237 cases developed to the androgen independent stage during the maximal androgen blockade treatment. Among them, 90 cases were treated with anti-androgen withdrawal. This 90 cases were followed up and the last follow-up date was 30 September 2009. The Logistic regression of univariate and multivariate analysis were used to find the predictive factors for the effectiveness of anti-androgen withdrawal, which including baseline PSA, Gleason score, clinical stage, way of castration, kind of anti-androgen, PSA nadir during maximal androgen blockade, time to PSA nadir, PSAV at the time of AIPC, PSADT at the time of AIPC, the effective duration of maximal androgen blockade, age at the time of AIPC and PSA at the initiation of anti-androgen withdrawal. Results Of the 90 cases treated with anti-androgen withdrawal, 3 cases were excluded for analysis because of the incomplete information. Among the 87 cases, 17 cases were effective with the anti-androgen withdrawal treatment while the other 70 cases were ineffective. At the last follow-up, 3 cases were still effective. The median effective duration of anti-androgen withdrawal was 4 months. The univariate analysis indicated that PSAV at the time of AIPC (P=0.033), PSADT at the time of AIPC (P=0.009) and PSA at the initiation of anti-androgen withdrawal (P=0.002)were predictive factors. The multivariate analysis indicated that PSAV (P=0.042) and PSADT at the time of AIPC (P= 0.036) were independent predictive factors for the effectiveness of anti-androgen withdrawal. Conclusions Among the androgen independent advanced metastatic prostate cancer patient, there were about 19. 5% cases effective with the anti-androgen withdrawal treatment and the median effective duration was 4 months. PSAV and PSADT at the time of AIPC were independent predictive factors for the effectiveness of anti-androgen withdrawal.