The Clinical Validity of Urinary Pellet DNA Monitoring for the Diagnosis of Recurrent Bladder Cancer.

The aim of this study was to evaluate the clinical validity of monitoring urine pellet DNA (upDNA) of bladder cancer (BC) by digital PCR (dPCR) as a biomarker for early recurrence prediction, treatment efficacy evaluation, and no-recurrence corroboration. Tumor panel sequencing was first performed to select patient-unique somatic mutations to monitor both upDNA and circulating tumor DNA (ctDNA) by dPCR. For longitudinal monitoring using upDNA as well as plasma ctDNA, an average of 7.2 (range, 2 to 12) time points per case were performed with the dPCR assay for 32 previously treated and untreated patients with BC. Clinical recurrence based on imaging and urine cytology was compared using upDNA variant allele frequency (VAF) dynamics. A continuous increasing trend of upDNA VAF ≥1% was considered to indicate molecular recurrence. Most (30/32; 93.8%) cases showed at least one traceable somatic mutation. In 5 of 7 cases (71.4%) with clinical recurrence, upDNA VAF >1% was detected 7 to 15 months earlier than the imaging diagnosis. The upDNA VAF remained high after initial treatment for locally recurrent cases. The clinical validity of upDNA monitoring was confirmed with the observation that 26 of 30 cases (86.7%) were traceable. Local recurrences were not indicated by ctDNA alone. The results support the clinical validity of upDNA monitoring in the management of recurrent BC.

Efficacy of combination therapy with pembrolizumab and axitinib for metastatic renal collecting duct cell carcinoma: A report on two cases.

Introduction: Immunotherapy-based combinations have become the standard first-line therapy for metastatic renal cell carcinoma. However, combined immunotherapy for renal collecting duct carcinoma had been reported, but its therapeutic efficacy had been unclear. Case presentation: The first case was a 62-year-old man treated with pembrolizumab and axitinib for renal collecting duct carcinoma with multiple bone metastases. After 7 months, the primary and metastatic lesions shrunk and were evaluated as a partial response. The second case was a 71-year-old man treated with pembrolizumab and axitinib for renal collecting duct carcinoma with lymph node and lung metastases. After 9 months, the primary and metastatic lesions shrunk and were evaluated as a partial response. In both cases, the tumor cell expression of programmed death ligand-1 was negative, and CD4+ and CD8+ cells were observed in the tumor. Conclusion: Combined immunotherapy with pembrolizumab and axitinib may be effective for metastatic renal collecting duct carcinoma.

Hyperprogressive disease after avelumab maintenance therapy in a patient with advanced ureter cancer: A case report.

In the early stages of immunocheckpoint inhibitor administration, we should be aware of rapid cancer progression, known as hyperprogressive disease, in real-world clinical practice. We report a case of a 73-year-old man who presented with right abdominal pain and was diagnosed with advanced right ureteral cancer involving the duodenum. He received four cycles of chemotherapy with gemcitabine plus cisplatin, followed by maintenance with avermab. After two cycles of avermab within a month, his primary cancer dramatically progressed and he died. This is the first report of a case in which unresectable ureteral cancer caused hyperprogressive disease after avelumab maintenance therapy.

Advance renal pelvic cancer caused obstructive jaundice: A case report.

We report a case of advanced renal pelvic cancer in a 69-year-old woman who presented with fatigue, appetite loss, and yellow sclera. Contrast-enhanced computed tomography revealed a large lesion mass extending from the right renal pelvis to the duodenum and surrounding enlarged lymph nodes. Gastroduodenal endoscopy revealed a mass in the ampulla of Vater, and an endoscopic biopsy was performed. Histological and immunohistochemical examination of the biopsy specimen confirmed a diagnosis of urothelial carcinoma. To the best of our knowledge, this is the first report of advanced renal pelvic cancer causing obstructive jaundice.

[Primary malignant lymphoma of the ureter: a case report].

A 58-year-old man who had right hydronephrosis pointed out by medical checkup visited our hospital. Computed tomography and retrograde pyelography revealed a soft tissue mass in the middle portion of the right ureter. Urine cytology specimen from the right ureter suggested transitional cell carcinoma. Under the diagnosis of right ureteral cancer, we performed right total nephro-ureterectomy, partial cystectomy. The histopathological examination showed non-Hodgkin lymphoma (large B-cell type) of the ureter. Our diagnosis was Clinical Stage IE of the Ann Arbor Classification. The patient received only the first course of systemic chemotherapy (THP-cop), because he suffered severe thrombocytopenia in the course of the chemotherapy. No recurrence was found for 15 months after operation, and at present he is disease-free.

[The use of predeposited autologous blood transfusion for radical prostatectomy].

PURPOSE: In reference to the cases in which radical prostatectomy was performed after storage of autologous blood, we retrospectively study the usefulness of this procedure and proper amount of blood stored. PATIENTS AND METHODS: The subjects included 62 cases in which radical prostatectomy was performed after storage of autologous blood from October, 1997 to March, 2000. As the amount of blood to be stored, either 800 ml or 1,200 ml was selected optionally as the amount of blood to be stored, and blood was stored at a rate of 400 ml once a week. Erythropoietin, 24,000 units was injected subcutaneously after storage of blood, and an iron preparation 200 mg/day was administered orally throughout the period. RESULTS: Homologous blood transfusion could be avoided in 58 out of 62 cases, the avoidance rate being 93.5%. With 200 ml of autologous blood as 1 unit, 104 units out of 330 units were discarded, the disposal rate being 31.5%. To lower the disposal rate, we studied whether there is any parameter that can predict the loss of blood preoperatively. As a result, we found a significant difference in the loss of blood between the body mass index of less than 24 and that of more than 24. Blood storage and transfusion produced no side-effects. CONCLUSION: Storing autologous blood in radical prostatectomy is considered useful since homologous blood transfusion can be avoided at a high percentage and no side-effects are produced. The body mass index is useful for predicting the loss of blood and determining a proper amount of blood to be stored.