Prognostic significance of inflammation-based prognostic scoring in patients with upper urinary tract urothelial carcinoma

ABSTRACT Objectives: To investigate whether Glasgow Prognostic Score has prognostic significance in patients with upper urinary urothelial carcinoma. Patients and methods: We retrospectively reviewed the clinical records of 74 patients with upper urinary urothelial carcinoma. We set the cut-off value for C-reactive protein as 1.0mg/dL, and 3.5mg/dL for albumin as Glasgow Prognostic Score. Their blood data including albumin and C-reactive protein for Glasgow Prognostic Score and cytokeratin 19 fragment 21-1 as a tumor marker were measured before starting treatment. The patients were stratified into three groups with Glasgow Prognostic Score: The Group-1, albumin ≥3.5g/dL and C-reactive protein < 1.0mg/dL; Group-2, albumin < 3.5g/dL or C-reactive protein ≥1.0mg/dL; Group-3, albumin < 3.5g/dL and C-reactive protein ≥1.0mg/dL. Results: The median follow-up for all patients was 26.9 months (range: 10.9-91.1 months), during which 37 (50%) patients died. There was a significant difference in the estimated survival rate among the 3 groups stratified by Glasgow Prognostic Score. The estimated survival rate in the Group-1 was significantly higher than those in Groups 2 and 3. In the univariate analysis C-reactive protein, serum cytokeratin 19 fragment 21-1 and Glasgow Prognostic Score were significant predictors of overall survival. On the multivariate analysis, serum cytokeratin 19 fragment 21-1 and Glasgow Prognostic Score were independently associated with shorter overall survival. Conclusion: Our review suggests Glasgow Prognostic Score may play as a prognostic predictor for upper urinary urothelial carcinoma.

Prognostic significance of inflammation-based prognostic scoring in patients with upper urinary tract urothelial carcinoma.

OBJECTIVES: To investigate whether Glasgow Prognostic Score has prognostic significance in patients with upper urinary urothelial carcinoma. PATIENTS AND METHODS: We retrospectively reviewed the clinical records of 74 patients with upper urinary urothelial carcinoma. We set the cut-off value for C-reactive protein as 1.0mg/dL, and 3.5mg/dL for albumin as Glasgow Prognostic Score. Their blood data including albumin and C-reactive protein for Glasgow Prognostic Score and cytokeratin 19 fragment 21-1 as a tumor marker were measured before starting treatment. The patients were stratified into three groups with Glasgow Prognostic Score: The Group-1, albumin ≥3.5g/dL and C-reactive protein < 1.0mg/dL; Group-2, albumin < 3.5g/dL or C-reactive protein ≥1.0mg/dL; Group-3, albumin < 3.5g/dL and C-reactive protein ≥1.0mg/dL. RESULTS: The median follow-up for all patients was 26.9 months (range: 10.9-91.1 months), during which 37 (50%) patients died. There was a signifi cant difference in the estimated survival rate among the 3 groups stratified by Glasgow Prognostic Score. The estimated survival rate in the Group-1 was significantly higher than those in Groups 2 and 3. In the univariate analysis C-reactive protein, serum cytokeratin 19 fragment 21-1 and Glasgow Prognostic Score were significant predictors of overall survival. On the multivariate analysis, serum cytokeratin 19 fragment 21-1 and Glasgow Prognostic Score were independently associated with shorter overall survival. CONCLUSION: Our review suggests Glasgow Prognostic Score may play as a prognostic predictor for upper urinary urothelial carcinoma.

[The pathophysiology underlying overactive bladder syndrome possibly due to benign prostatic hyperplasia].

The pathophysiology in the development of overactive bladder syndrome (OAB) possibly due to benign prostatic hyperplasia (BPH) has not fully been understood. The clinical study in male outpatients aged over 50 years with lower urinary tract symptoms showed that the frequency of urgency was significantly associated with aging, bladder outlet obstruction (BOO) and benign prostatic enlargement (BPE). From the results of the experiments we did using rats, the mechanisms underlying the development of OAB were suggested as follows. The functional impairment of acetylcholine neuron in the central nervous system is induced by aging and decreases the bladder capacity. Non-voiding contractions of the bladder may have some bearing on OAB associated with BOO. The C-fiber in the urethra may be involved in the generation of the detrusor overactivity associated with BPE. These results showed that the pathophysiology of OAB related to BPH is quite complex, suggesting that a multidisciplinary approach is necessary for the treatment.

[A case of urinary and miliary tuberculosis detected during examination for renal failure].

A case of urinary and miliary tuberculosis in a 51-year-old male is reported. The patient with the complaint of low grade fever at night and appetite loss had visited another clinic. Laboratory data showed renal failure (serum creatinine 3.9 mg/dl, BUN 35.1 mg/dl) and he was referred to our hospital. Ultrasonography and computed tomography (CT) revealed bilateral hydronephrosis. Therefore we suspected postrenal renal failure. We performed cystoscopy in order to perform retrograde pyelography and to indwell double J stent. The bladder showed yellow-whitish nodules all over the bladder. Tuberculous bacilli were detected in the urine by smear, polymerase chain reaction (PCR) and culture. Chest radiography and CT revealed multiple granular nodules and so diagnosed miliary tuberculosis. Immediately combination chemotherapy of with isonicotinic acid hydrozide, rifapicin, ethanbutal and pirazinamide was administered. Histopathology by bladder biopsy showed epithelioid cell granuloma. Chemotherapy was effective, but the vesical capacity was contracted to less than 50 ml, and we suspect that the patient will need vesical augmentation.

[A case of liposarcoma of the renal capsule].

A 58-year-old woman was referred to our institution for treatment of a left renal tumor revealed by follow-up computed tomography (CT) of a pancreatic tumor. The CT showed a heterogeneous, perirenal mass containing areas of fat density. Angiography showed no feeding artery. Left nephrectomy was performed and pathological examination revealed a well-differentiated liposarcoma of the renal capsule. At the third-month follow-up, the patient was completely asymptomatic and free of recurrence. Primary tumors of the renal capsule are uncommon and liposarcoma of the renal capsule is distinctly rare. There have been only 17 reports of liposarcoma arising from the renal capsule in Japan. We, herein, report a case of liposarcoma of the renal capsule.

[Two cases of renal cell carcinoma with ascites after interleukin-2 therapy].

One of the most common and problematic side effects of interleukin-2 therapy (IL-2) is vascular leak syndrome (VLS). VLS is characterized by an increase in vascular permeability accompanied by extravasation of fluids and proteins from the capillary vessels into the tissues resulting in interstitial edema, weight gain, pleural effusion, ascites in severe form, multiple organ failure. We, herein, report two cases of VLS, which occurred following IL-2 therapy against metastatic renal cell carcinoma. One of them died of multiple organ failure one month after the cessation of IL-2 therapy.

Mixed tumor of paratesticular rhabdomyosarcoma and an adenomatoid tumor in an elderly patient.

We report a case of a mixed tumor of paratesticular rhabdomyosarcoma and an adenomatoid tumor in an elderly patient. Rhabdomyosarcoma is one of the most common childhood tumors; however, it rarely occurs in the elderly. In addition, to our knowledge, paratesticular rhabdomyosarcoma and adenomatoid tumor rarely form mixed tumors. Finally, we consider the pathogenesis of diploblastic tumors.

[Empyema of the ureteral stump with multiple stones after nephrectomy].

A 64-year-old woman, who had undergone right nephrectomy because of right incomplete double pyeloureter and dysplastic kidney with a ureteral stone at the age of 25, presented with a chief complaint of repeated urinary tract infection associated with right lower abdominal pain. A diagnosis of empyema of the ureteral stump with multiple stones was made based on X-ray findings and cystoscopy. In December 1999, the right residual ureter and ureteral stones were removed. Histopathologically, non-specific inflammatory change and fibrosis of the wall were observed. The ureter including the stones should have been resected at the previous nephrectomy.

[Fibrous pseudotumor of the tunica vaginalis testis: a case report].

A case of fibrous pseudotumor originating from the tunica vaginalis testis is reported. A 42-year-old man was referred to our hospital with the complaint of painless nodules along his right epididymis. There was no evidence of specific history. Ultrasonography showed an isoechoic small mass attached to the right testis. Inflammatory granulomas of the right epididymis were suspected, and an operation was carried out. The operative appearance indicated tumors of various sizes originating from the tunica vaginalis testis. Tumors were resected with the tunica vaginalis testis. Pathological diagnosis of the tumor was a fibrous pseudotumor. We reviewed and discussed 33 cases of intrascrotal fibrous pseudotumor, including our case, in the Japanese literature.