RESUMO
We evaluated the impact of tumor shrinkage (TS) induced by molecular targeted therapy as the first-line systemic therapy on the survival of patients with metastatic renal cell carcinoma (mRCC). A total of 67 patients with mRCC who received first-line molecular targeted therapy were included in this study. Sixty patients were evaluable by response evaluation criteria in solid tumors. Patients underwent the first evaluation at 8-12 weeks after the start of the therapy. Twenty patients had TS â§30%, 32 from 30% to -20%, and 8 â¦-20%. The median overall survival periods of patients who achieved TS â§30%, from 30% to -20%, and â¦-20% at first evaluation were 41.0, 35.0, and 11.5 months, respectively. Univariate and multivariate analyses showed that TS ofâ§0%, in addition to negative C-reactive protein and the absence of bone metastasis were good predictors of overall survival. The patients who achieved 0% or more at the initial evaluation had longer survival than those who had no tumor reduction (40.0 months vs 12.0 months, p<0. 001). These findings suggest that early TS affects overall survival in real practice. We should consider alternative therapies for patients who have not achieved tumor reduction at the initial evaluation.
Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Carcinoma de Células Renais/tratamento farmacológico , Humanos , Neoplasias Renais/tratamento farmacológico , Terapia de Alvo Molecular , Prognóstico , Estudos Retrospectivos , Resultado do TratamentoRESUMO
A female septuagenarian had poorly controlled diabetes mellitus for more than 20 years. She had persistent pyuria, but did not seek further examination. In 2019, she was transported to our hospital by ambulance for sudden abdominal pain. Physical examination showed a sign of panperitonitis with sepsis. Computed tomography showed ascites and intraperitoneal free air. In addition, there was also a defect in the bladder wall, suggesting bladder rupture. Blood tests showed a marked increase in serum creatinine in addition to increased inflammatory reactants. Because perforation of gastrointestinal tract could not be excluded, an emergency laparotomy was performed. An intraperitoneal perforation of the posterior wall of the bladder was revealed, though there was no intestinal damage. The bladder wall was repaired and cystostomy was performed followed by irrigation and drainage of the abdominal cavity. After the operation, her abdominal symptom resolved and her general status improved. We speculated that voiding disturbance due to neurogenic bladder associated with diabetes mellitus and chronic infection caused the spontaneous bladder rupture. Most cases of spontaneous bladder rupture are associated with a history of pelvic surgery or irradiation, which suggests that this case is extremely rare. In patients with repeated urinary tract infection and underlying disease affecting bladder function, evaluation and appropriate management of bladder dysfunction should be performed ; otherwise, spontaneous bladder rupture may occur.
Assuntos
Doenças da Bexiga Urinária , Bexiga Urinaria Neurogênica , Cistostomia , Feminino , Humanos , Ruptura EspontâneaRESUMO
A 72-year-old man was referred to our hospital for examination of a right adrenal tumor incidentally found by computed tomography for close inspection of lumbago. The computed tomography scan and magnetic resonance imaging showed a 51×54×43 mm solid tumor in the right adrenal region. Endocrinological examinations were within normal limits. Because we could not diagnose his condition due to atypical radiographic findings preoperatively and exclude a malignant tumor, laparoscopic right adrenalectomy was performed. The tumor was histologically diagnosed as ganglioneuroma originating from the right adrenal glands.
Assuntos
Neoplasias das Glândulas Suprarrenais , Ganglioneuroma , Adrenalectomia , Idoso , Humanos , Imageamento por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios XRESUMO
Background: We clarified the predictive factors for changes in the status of medications for lower urinary tract symptoms (LUTS) 2 years after local radiotherapy for nonmetastatic prostate cancer. Materials and methods: We retrospectively included patients who underwent local external radiotherapy for nonmetastatic prostate cancer in 8 institutions between April 2001 and March 2016. Patients were divided into the medication and no-medication group based on the use of drugs for LUTS before radiotherapy. We defined improvement of LUTS as when the patient did not require medication for LUTS at 24 months after radiotherapy in the medication group and as deterioration when medication was required in the no-medication group. Logistic regression analysis was used to evaluate predictive factors for changes in medication status. Results: Altogether, 505 patients were divided into a no-medication group (n = 352) and a medication group (n = 153). The number of patients with deterioration and improvement in LUTS was 49 (14%) and 36 (23%), respectively. In the multivariate analysis, the predictive variables for deterioration were the International Prostate Symptom Score (≥8; odds ratio [OR], 2.21; p = 0.014) and the biopsy Gleason score (≤3 + 4 = 7; OR, 2.430; p = 0.008) in the no-medication group, whereas those for improvement were age (<75 years old; OR, 5.81; p = 0.002), the quality of life score (<3; OR, 3.15; p = 0.028), and a positive biopsy core rate (≥50%; OR, 2.530; p = 0.027) in the medication group. Conclusions: These predictive factors for changes in the status of medications for LUTS at 2 years after external radiotherapy may help determine the definitive therapy for nonmetastatic prostate cancer.
RESUMO
Effective management of immune-related adverse events in patients receiving immunotherapy for cancer is problematic. In this report, we present the case of a 58-year-old man with advanced clear cell renal cell carcinoma who responded well to a combination of ipilimumab and nivolumab. However, after two courses of treatment, he developed fulminant hepatitis and died. An autopsy confirmed that the primary lesion in the left kidney was more than 99% necrotic with only six small residual tumor lesions. These lesions were infiltrated by large numbers of CD8-positive/TIA-1-positive lymphocytes. However, a metastatic lesion in the right kidney harbored few lymphocytes. Furthermore, the tumor cells in the metastatic lesion and one of the residual lesions showed decreased expression of HLA class I molecules, which are a prerequisite for cytotoxic T-lymphocyte-mediated immunotherapy in tumor cells. In this patient, more than 80% of hepatocytes were destroyed and the parenchyma was infiltrated with CD8-positive/TIA-1-positive lymphocytes. The patient had polyuria, which was attributed to neurohypophysitis caused by the infiltration of CD8-positive/TIA-1-positive lymphocytes. We believe that this is an instructive case for immuno-oncologists.