The DDD score outperforms the RENAL score in predicting high-grade renal cell carcinoma.

OBJECTIVES: To explore the relationship between Fuhrman grade of renal cell carcinoma (RCC) and the DDD score. METHODS: We reviewed the records of 527 nonmetastatic RCC patients. Demographic, clinical, and pathologic characteristics were reviewed. Binary logistic regression was used to explore the independent risk factors for high-grade RCC (HGRCC). RESULTS: Sex, BMI (Body Mass Index), RNS, and DDD score were significantly correlated with HGRCC. Based on these independent risk factors, we constructed two predictive models integrating the RNS and DDD scores with sex and BMI to predict tumor grade. The calibration curves of the predictive model showed good agreement between the observations and predictions. The concordance indexes (C-indexes) of the predictive models were 0.768 (95% CI, 0.713-0.824), and 0.809 (95% CI, 0.759-0.859). Receiver operating characteristic (ROC) curves were performed to compare the predictive power of the nomograms, and the prediction model including the DDD score had better prognostic ability (p = 0.01). CONCLUSIONS: This study found that RNS, DDD score, BMI, and sex were independent predictors of HGRCC. We developed effective nomograms integrating the above risk factors to predict HGRCC. Of note, the nomogram including the DDD score achieves better prediction ability for HGRCC.

[Diagnostic efficacy of prostate cancer using targeted biopsy with 6-core systematic biopsy for patients with PI-RADS 5].

OBJECTIVE: To investigate the diagnostic efficacy of targeted biopsy (TBx), systematic biopsy (SBx), TBx+6-core SBx in prostate cancer (PCa) / clinically significant prostate cancer (cs-PCa) for patients with prostate imaging reporting and data system (PI-RADS) score of 5, and thereby to explore an optimal sampling scheme. METHODS: The data of 585 patients who underwent multiparametric magnetic resonance imaging (mpMRI) with at least one lesion of PI-RADS score 5 at Peking University First Hospital from January 2019 to June 2022 were retrospectively analyzed. All patients underwent mpMRI / transrectal ultrasound (TRUS) cognitive guided biopsy (TBx+SBx). With the pathological results of combined biopsy as the gold standard, we compared the diagnostic efficacy of TBx only, SBx only, and TBx+6-core SBx for PCa/csPCa. The patients were grouped according to mpMRI T-stage (cT2, cT3, cT4) and the detection rates of different biopsy schemes for PCa/csPCa were compared using Cochran's Q and McNemar tests. RESULTS: Among 585 patients with a PI-RADS score of 5, 560 (95.7%) were positive and 25(4.3%) were negative via TBx+SBx. After stratified according to mpMRI T-stage, 233 patients (39.8%) were found in cT2 stage, 214 patients (36.6%) in cT3 stage, and 138 patients (23.6%) in cT4 stage. There was no statistically significant difference in the detection rate of PCa/csPCa between TBx+6-core SBx and TBx+SBx (all P>0.999). Also, there was no statistically significant difference in the detection rate of PCa/csPCa between TBx and TBx+SBx in the cT2, cT3, and cT4 subgroups (PCa: P=0.203, P=0.250, P>0.999; csPCa: P=0.700, P=0.250, P>0.999). The missed diagnosis rate of SBx for PCa and csPCa was 2.1% (12/560) and 1.8% (10/549), and that of TBx for PCa and csPCa was 1.8% (10/560) and 1.4% (8/549), respectively. However, the detection rate of TBx+6-core SBx for PCa and csPCa was 100%. Compared with TBx+SBx, TBx and TBx+6-core SBx had a fewer number of cores and a higher detection rate per core (P < 0.001). CONCLUSION: For patients with a PI-RADS score of 5, TBx and TBx+6-core SBx showed the same PCa/csPCa detection rates and a high detection rates per core as that of TBx+SBx, which can be considered as an optimal scheme for prostate biopsy.

Prognostic significance of the combination of preoperative hemoglobin and albumin levels and lymphocyte and platelet counts (HALP) in patients with renal cell carcinoma after nephrectomy.

BACKGROUND: To evaluate the prognostic significance of the novel index combining preoperative hemoglobin and albumin levels and lymphocyte and platelet counts (HALP) in renal cell carcinoma (RCC) patients. METHODS: We enrolled 1360 patients who underwent nephrectomy in our institution from 2001 to 2010. The cutoff values for HALP, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were defined by using X-tile software. Survival was analyzed by the Kaplan-Meier method, with differences analyzed by the log-rank test. Multivariate Cox proportional-hazards model was used to evaluate the prognostic significance of HALP for RCC. RESULTS: Low HALP was significantly associated with worse clinicopathologic features. Kaplan-Meier and log-rank tests revealed that HALP was strongly correlated with cancer specific survival (P < 0.001) and Cox multivariate analysis demonstrated that preoperative HALP was independent prognostic factor for cancer specific survival (HR = 1.838, 95%CI:1.260-2.681, P = 0.002). On predicting prognosis by nomogram, the risk model including TNM stage, Fuhrman grade and HALP score was more accurate than only use of TNM staging. CONCLUSIONS: HALP was closely associated with clinicopathologic features and was an independent prognostic factor of cancer-specific survival for RCC patients undergoing nephrectomy. A nomogram based on HALP could accurately predict prognosis of RCC.

Preoperative Prognostic Nutritional Index is a Significant Predictor of Survival with Bladder Cancer after Radical Cystectomy: a retrospective study.

BACKGROUND: To explore the prognostic significance of preoperative prognostic nutritional index (PNI) in bladder cancer after radical cystectomy and compare the prognostic ability of inflammation-based indices. METHODS: We retrospectively analyzed data for 516 patients with bladder cancer who underwent radical cystectomy in our institution between 2006 to 2012. Clinicopathologic characteristics and inflammation-based indices (PNI, neutrophil/lymphocyte ratio [NLR], platelet/lymphocyte ratio [PLR], lymphocyte/monocyte ratio [LMR]) were evaluated by pre-treatment measurements. Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier method and compared by log-rank test. Multivariate analysis with a Cox proportional hazards model was used to confirm predictors identified on univariate analysis. The association between clinicopathological characteristics and PNI or NLR was tested. RESULTS: Among the 516 patients, the median follow-up was 37 months (interquartile range 20 to 56). On multivariate analysis, PNI and NLR independently predicted OS (PNI: hazard ratio [HR] = 1.668, 95% CI: 1.147-2.425, P = 0.007; NLR: HR = 1.416, 95% CI:1.094-2.016, P = 0.0149) and PFS (PNI: HR = 1.680, 95% CI:1.092-2.005, P = 0.015; NLR: HR = 1.550, 95% CI:1.140-2.388, P = 0.008). Low PNI predicted worse OS for all pathological stages and PFS for T1 and T2 stages. Low PNI was associated with older age (>65 years), muscle-invasive bladder cancer, high American Society of Anesthesiologists grade and anemia. CONCLUSION: PNI and NLR were independent predictors of OS and PFS for patients with bladder cancer after radical cystectomy and PNI might be a novel reliable biomarker for bladder cancer.

Sorafenib versus sunitinib as first-line treatment agents in Chinese patients with metastatic renal cell carcinoma: the largest multicenter retrospective analysis of survival and prognostic factors.

BACKGROUND: To compare the efficacy of sorafenib and sunitinib with regard to overall survival (OS) and progression free survival (PFS) in Chinese patients with metastatic renal cell carcinoma (mRCC). METHODS: A multicenter, retrospective study was performed to elucidate the relationship between clinical variables and prognosis comparing sorafenib and sunitinib as first-line treatment agents in Chinese patients with mRCC. Between September 2006 and December 2014, 845 patients received either sorafenib (400 mg bid; n = 483) or sunitinib (50 mg q.d; n = 362). The primary end point was OS and PFS. RESULTS: The percentage of patients with low and moderate risk according to Memorial Sloan-Kettering Cancer Centre (MSKCC) score was significantly higher in sunitinib group, and that with high risk was significantly higher in sorafenib group (15.1 vs. 5.2%; p < 0.001). Median OS was similar in sorafenib and sunitinib group (24 vs. 24 months; p = 0.298). Sorafenib group exhibited higher mPFS compared to sunitinib group (11.1 vs. 10.0 months; p = 0.028). Treatment (sorafenib vs sunitinib), pathology, Eastern Cooperative Oncology Group (ECOG) performance status, MSKCC scores, Heng's criteria of risk, and number of metastases were identified as significant predictors for OS and along with liver metastasis for PFS. Clinical outcomes in terms of mOS was significantly better with sorafenib in patients ≥65 years of age (p = .041), ECOG 0 (p = 0.0001), and median MSKCC risk score (p = 0.008). CONCLUSIONS: Sorafenib and sunitinib are both effective in treating mRCC. However, sorafenib might be more effective in elderly patients (≥65 years) and in patients with an ECOG status of 0, classified under MSKCC moderate risk.

Partial nephrectomy for T3aN0M0 renal cell carcinoma: shall we step forward?

OBJECTIVES: To evaluate the prognosis of non-metastatic T3a renal cell carcinoma (RCC) with partial nephrectomy (PN). PATIENTS AND METHODS: We retrospectively evaluated 125 patients with non-metastatic T3a RCC. Patients undergoing PN and radical nephrectomy (RN) were strictly matched by clinic-pathologic characteristics. Log-rank test and Cox regression model were used for univariate and multivariate analysis. RESULTS: 18 pair patients were matched and the median follow-up was 35.5 (10-86) months. PN patients had a higher postoperative eGFR than RN patients (P=0.034). Cancer-specific survival (CSS) and recurrence-free survival (RFS) did not differ between two groups (P=0.305 and P=0.524). On multivariate analysis, CSS decreased with positive surgical margin and anemia (both P<0.01) and RFS decreased with Furhman grade, positive surgical margin, and anemia (all P<0.01). CONCLUSIONS: For patients with non-metastatic pT3a RCC, PN may be a possible option for similar oncology outcomes and better renal function.

[Predictor analysis of PSA response of docetaxel combined with prednisone in the treatment of metastatic castration resistant prostate cancer].

OBJECTIVE: To investigate the factors that may predict the effectiveness of metastatic castration resistant prostate cancer (mCRPC) patients who received docetaxel plus prednisone treatment. METHODS: We retrospectively collected the clinical data of mCRPC patients who has received docetaxel chemotherapy in Peking University First Hospital between February 2010 and March 2015, and the clinical factors were analyzed using univariate analysis. RESULTS: A total of 60 cases of patients were treated, of whom 33 with complete clinical data were analyzed. PSA responsive was defined as PSA declining ≥50% of baseline and without progression according to RESCIST criteria. The median PSA at chemotherapy was 153.4 µg/L (6.6-9 952.0 µg/L), and a total of 20 cases (60.6%) were PSA responsive. Univariate analysis found that lower Gleason score (Gleason scores≤7) (25% vs.72%, P=0.034), the existence of positive Lymph node (78% vs. 40%, P=0.032), the existence of visceral metastasis (80% vs. 44%, P=0.041) and baseline blood HGB value≤120 g/L (30% vs. 74%, P=0.024) were associated with chemotherapy effectiveness. CONCLUSION: High Gleason score, lymph node metastasis, visceral metastasis and normal HGB level may predict PSA response after docetaxel-based chemotherapy.

[Risk factors for the development of postoperative paralytic ileus after radical cystectomy: a report of 740 cases].

OBJECTIVE: To identify the risk factors that would aid in the identification of patients at the greatest risk of developing postoperative paralytic ileus. METHODS: In the retrospective study, 749 patients who received radical cystectomy from January 2005 to August 2014 were reviewed, of whom, 9 who received orthotopic ileal neobladder were excluded. Of the 740 patients, 82 (11.1%) developed postoperative paralytic ileus. The correlation between the clinical characters and the occurrence of post-operative paralytic ileus was identified. RESULTS: The postoperative paralytic ileus was significantly correlated with the patient's age (68 vs. 67, P=0.025), body mass index (23.0 kg/m2 vs.24.1 kg/m2, P=0.008), different urinary diversion reconstruction methods [13.2% (66/500) for ileal conduit and 7.3%(16/240) for cutaneous ureterostomy, P=0.008] and pelvic lymph node dissection [12.2% (77/632) vs.4.6% (5/108), P=0.021].The postoperative paralytic ileus caused a prolonged hospital stay and delayed recovery (24 d vs. 17 d, P=0.000). There was no significant correlation between the postoperative paralytic ileus and the patients' gender, previous abdominal operations, preoperative hemoglobin and creatinine, American Society of Anesthesiologists score, operative time, estimated blood loss, transfusion requirement, laparoscopic and open surgery, ICU admission or tumor staging. On multivariate analysis, age (hazard ratio 1.185, 95% confidence interval 1.036-1.355, P=0.013), body mass index (hazard ratio 0.605, 95% confidence interval 0.427-0.857, P=0.005), different urinary diversion reconstruction methods (hazard ratio 2.422, 95% confidence interval 1.323-4.435, P=0.004) and pelvic lymph node dissection (hazard ratio 2.798, 95% confidence interval 1.069-7.322, P=0.036) were significantly correlated with the presence of the postoperative paralytic ileus. CONCLUSION: Increasing age, decreasing BMI, ileal conduiturinary diversion and pelvic lymph node dissection were significantly correlated with the presence of postoperative paralytic ileus in patients undergoing radical cystectomy.

[A head-to-head comparison of contemporary indolent prostate cancer screen protocols in Chinese].

OBJECTIVE: To compare the diagnostic accuracy of five internationally used indolent prostate cancer screen protocols in Chinese prostate cancer patients. METHODS: Retrospective analysis was made of the consecutive cohort of 314 patients, from Jan. 2006 to Apr. 2014, who had both prostate biopsy and radical prostatectomy in Peking University First Hospital. The Gleason score≤6, pT2, tumor volume≤0.5 mL, margin negative and lymph nodes negative were defined as indolent prostate cancer. The predictive value of five indolent screen criteria including Epstein, Memorial Sloan-Kettering Cancer Center (MSKCC), Prostate Cancer Research International: Active Surveillance (PRIAS), University of California, San Francisco (UCSF), and University of Miami (UM) were evaluated in Chinese prostate cancer patients. Measures of diagnostic accuracy and areas under the receiver-operating curve (AUC) were calculated for each protocol and compared. RESULTS: A total of 16% (49 cases) of the patients met the inclusion criteria of at least one protocol, including 24 cases in Epstein, 33 cases in MSKCC, 28 cases in PRIAS, 34 cases in UCSF, and 22 cases in UM. Three percent were eligible for all the studied criteria. UCSF and MSKCC protocols had the highest sensitivity and specificity than the others. The Epstein and PRIAS protocols demonstrated acceptable positive predictive value, but the specificity and sensitivity were inefficient. The UM protocol was performed unsatisfiedly on sensitivity, positive predictive value and AUC. A strict limited protocol which contained all the five protocols could not improve the predictive accuracy. CONCLUSION: The UCSF protocol had better diagnostic accuracy than the others, but the results were not satisfied. A further investigation on indolent prostate cancer screening in Chinese patients is needed.

Prevalence of baseline chronic kidney disease in 2,769 Chinese patients with renal cancer: nephron-sparing treatment is still underutilized.

PURPOSE: To evaluate the prevalence of baseline chronic kidney disease (CKD) in a large cohort of patients with renal masses in a single Chinese institution. Estimated glomerular filtration rate (eGFR) and CKD stage are more clinically relevant to predict the risk of morbidity and mortality in patients after nephrectomy. But, sCr reflects renal function poorly. METHODS: We retrospectively identified patients undergoing kidney surgery between January 2002 and June 2012. eGFR was calculated using the modification of diet in renal disease formulas modified based on Chinese people. CKD stages I­V were defined using the National Kidney Foundation definitions. RESULTS: A total of 2769 patients had adequate data available to calculate a preoperative eGFR (mL/min/1.73m2) with renal cancer confirmed by pathology. Of all patients, 97.7 % awaiting surgery at our institution had a "normal" baseline sCr (≤1.4 mg/dL), and 3.2 % of patients had CKD stage III or worse. Of the 401 patients ≥70 years old, 16.7 % (67/401) had CKD stage III. CONCLUSION: Many patients with a seemingly normal sCr have CKD stage III or worse, especially in patients over 70 years old. Given the high prevalence of baseline CKD in patients with renal cancer, it is important to preserve renal parenchyma when treating them surgically.

Pattern and risk factors of intravesical recurrence after nephroureterectomy for upper tract urothelial carcinoma: a large Chinese center experience.

BACKGROUND/PURPOSE: There is currently no consensus about the pattern and risk factors of bladder recurrence after nephroureterectomy, especially in the Chinese population. We evaluated the pattern and risk factors based on data from a large Chinese center. METHODS: The clinical and pathological data of 438 patients with upper tract urothelial carcinoma (UTUC), who underwent nephroureterectomy at Peking University First Hospital, Beijing, China between 2000 and 2010, was retrospectively analyzed. Univariate analysis by log-rank test and multivariate analysis by Cox proportional hazards regression model were used to determine the independent risk factors. RESULTS: A total of 135 patients (30.8%) developed intravesical recurrence within a median follow-up of 45 months (range: 12-144 months). The median interval of bladder recurrence was 15 months (range: 2.0-98.0 months), and the two peaks for recurrence were 4-6 months and 17-19 months. Lower tumor grade, tumor multifocality, concomitant carcinoma in situ (CIS) and tumors located in the lower ureter were significant risk factors by univariate and multivariate analysis. A risk-scoring system was developed and a significant difference was found between different risk evaluations. Patients with concomitant CIS tended to develop a late bladder recurrence. One hundred and eighteen patients (87.4%) received transurethral resection after bladder tumor recurrence. CONCLUSION: Lower tumor grade, tumor multifocality, concomitant CIS and tumors located in the lower ureter tend to be predictive for bladder recurrence after nephroureterectomy, although the underlying mechanism is not fully elucidated, and the scoring system could help risk stratification. Most recurrent tumors could be treated by transurethral resection and there were two peaks for recurrence, which is probably related to the mechanisms and may be unique to the Chinese population.

[Clinical pathological features of small renal cell cancer: a single-center experience on 1 267 cases].

OBJECTIVE: To study the characteristics of histopathologic features of small renal carcinoma. METHODS: This retrospective study collected the data of renal cell carcinoma from the patients who underwent surgery from January 2002 to June 2012. They were all preoperatively diagnosed as renal cancer by CT scan, and pathologically diagnosed as renal cell carcinoma after surgery with the diameter ≤ 4 cm. We recorded and analyzed the tumor size, histologic subtype, Fuhrman grading, TNM stage, the existence of tumor vascular invasion, sarcomatoid differentiation, and whether it was multifocal, and then grouped them for comparison. RESULTS: A total of 1 276 patients were included in the study and were analyzed, of whom 306 (24.0%) had small renal cell carcinoma less than 2.0 cm, 526 (41.2%) 2.0-3.0 cm, and 444 (34.8%) bigger than 3.0 cm. Of all the subjects, 1 158 (90.7%) suffered from clear cell carcinoma, 49 (3.8%) papillary carcinoma, 32 (2.5%) chromophobe cell carcinoma, whose distribution was not related with tumor size. Of the ≤ 2.0 cm and >2.0 cm groups, Furmann grades of G3/4 were 15 (4.9%), 98 (10.1%), respectively (P=0.007). T3a + stage and above were 1 (0.3%), and 32 (3.3%), respectively (P=0.004). Synchronous distant metastases occurred in 6 patients, all in group >2.0 cm. Tumor sarcomatoid differentiation (0.3% vs. 0.9%), vascular invasion (0.6% vs. 2.1%) and multifocal (1.3% vs. 2.7%) had no significant difference between the two groups. CONCLUSION: Small renal cell carcinoma with diameter over 2.0 cm are more aggressive, suggesting that renal cancer bigger than 2.0 cm in diameter should not select a non-surgical treatment.

[Long-term outcome of isolated local recurrence following radical nephrectomy].

OBJECTIVE: To characterize the long-term outcome of surgical extirpation for local recurrence after radical nephrectomy of renal cell carcinoma (RCC) and identify prognostic factors for locally recurrent RCC. METHODS: Peking University First Hospital urologic database was queried for all patients with isolated local recurrence following radical nephrectomy for localized RCC. According to previous literature, local recurrence included relapse in the renal fossa, ipsilateral adrenal gland and ipsilateral retroperitoneal lymph nodes. The median follow up was 62 months. The cancer specific survival and relapse patterns were estimated using the Kaplan-Meier method. RESULTS: In our institutional database,1 045 patients were treated with nephrectomy for localized RCC from January 1994 to December 2011.With a postoperative follow-up of (62.7 ± 36.2) months, 15 patients (1.44%) experienced local recurrence, 9 of which were managed by surgical resection, and the rest 6 did not receive operation. The patients who received surgical resection had a 1-year cancer specific survival rate of 87%, compared with 60% of the patients without receiving surgical treatment. The 4-year cancer specific survival rate was 72% vs. 30%.The survival time was(51.8 ± 7.4) months vs. (28.4 ± 9.2) months. The recurrence interval was (39.4 ± 29.5) months vs. (29.3 ± 23.9) months. CONCLUSION: Surgical resection for local recurrence of RCC in selected patients is a feasible management and may prolong the survival time.

[A prospective randomized control study: new rigid cystoscopy technology to improve patients' comfort].

OBJECTIVE: To determine whether the extruded irrigation solution bag during passage of rigid cystoscope will reduce the patient's discomfort. METHODS: In the study, 378 male patients undergoing rigid cystoscopies were randomized into "Institute of Urology Peking University (IUPU)" technique group (n = 193) and routine manipulation group (n = 185). All the patients had received 10 mL oxybuprocaine gel before manipulation. In the IUPU technique group, irrigation solution bag was connected with cystoscope sheath and obturator. As the scope passed through the bulbar urethra, a nurse was instructed to extrude the irrigating fluid bag. A 10-point visual analog pain scale assessment was completed by the patient after the procedure. RESULTS: The visual analog pain score was 2 (1-2) in the IUPU technique group and 4 (3-6) in the routine manipulation group (P < 0.001, Mann-Whitney U test). All the procedure indications had no effect on the findings. CONCLUSION: This study has shown that a simple IUPU technique can significantly reduce the patient's discomfort during outpatient rigid cystoscopy. We strongly recommend this technique for all male patients undergoing rigid cystoscopy.

Predictive factors for worse pathological outcomes of upper tract urothelial carcinoma: experience from a nationwide high-volume centre in China.

OBJECTIVES: To analyse the predictive factors for worse pathological outcome (muscle invasive pT2+, non-organ-confined pT3+ or N+ and histological Grade 3) of upper tract urothelial carcinoma (UTUC) in a Chinese population from a nationwide high-volume centre in China. PATIENTS AND METHODS: Predictors were studied by retrospectively reviewing the clinicopathological data of 729 consecutive patients with UTUC treated in our centre from January 2002 to December 2010. Univariate and multivariate logistic regression analyses were used. RESULTS: There were more female patients (56.4%) than males and more tumours were located in the ureter (52.7%) than in the pelvis. In multivariate analysis, male gender (hazard ratio [HR] 1.898, P = 0.001), sessile architecture (HR 3.249, P < 0.001), high grade (HR 5.007, P < 0.001), ipsilateral hydronephrosis (HR 4.768, P < 0.001), renal pelvis location (HR 2.620, P < 0.001) and tumour without multifocality (HR 1.639, P = 0.028) were predictive factors for muscle-invasive UTUC. Male gender (HR 2.132, P < 0.001), renal pelvis location (HR 3.466, P < 0.001), tumour without multifocality (HR 2.532, P = 0.001), sessile tumour architecture (HR 3.274, P < 0.001), and high grade (HR 3.019, P < 0.001) were predictive factors for non-organ-confined disease. Chronological old age (HR 1.047, P < 0.001), sessile tumour architecture (HR 25.192, P < 0.001), ipsilateral hydronephrosis (HR 1.689, P = 0.024), and positive urinary cytology (HR 1.997, P = 0.006) were predictive factors for histological Grade 3 UTUC. CONCLUSIONS: There was a predominance of female patients and ureteric tumours in UTUCs of this Chinese population. Male gender, sessile architecture, tumour location, tumour without multifocality, high histological grade and preoperative ipsilateral hydronephrosis were independent predictive factors for worse pathological outcome of UTUCs.

Prophylactic intravesical chemotherapy to prevent bladder tumors after nephroureterectomy for primary upper urinary tract urothelial carcinomas: a systematic review and meta-analysis.

INTRODUCTION: Intravesical recurrence after treatment of primary upper urinary tract urothelial carcinomas (UUT-UCs) is common. While intravesical instillation is widely used to prevent recurrence after transurethral resection for primary bladder tumors, there is still no consensus on the prophylactic capability of intravesical chemotherapy in preventing bladder tumor recurrence after surgery for UUT-UCs. METHODS: A meta-analysis of the published results of clinical trials was performed to compare radical surgery alone or surgery plus postoperative intravesical chemotherapy. The primary end point was to determine the percentage of patients with recurrence in the different groups. RESULTS: Our study includes five trials with recurrence information on 614 patients. During follow-up, 55 of 268 (20.5%) patients who received postoperative instillation had bladder recurrence compared to 127 of 346 (36.7%) patients who had no adjuvant treatment--a decrease of 41% in the odds of recurrence with chemotherapy (odds ratio 0.48, 95% confidence interval 0.33-0.69, p = 0.0001). No serious adverse events were reported. Subgroup analyses were temporarily unavailable. CONCLUSIONS: Postoperative intravesical chemotherapy significantly decreases the risk of bladder recurrence after nephroureterectomy for primary UUT-UCs. Postoperative intravesical instillation is considered the treatment of choice after nephroureterectomy.

[Surgical management and long-term outcomes of patients with renal cell carcinoma accompanied with venous tumor thrombus].

OBJECTIVE: To evaluate the surgical management and long-term outcomes of patients with renal cell carcinoma and venous tumor thrombus. METHODS: From Aug. 2000 to Dec. 2011, 140 patients underwent radical nephrectomy and thrombectomy in our hospital, of whom, 80 were with renal vein tumor thrombus, 41 with inferior vena caval (IVC), level I tumor thrombus (below hepatic vein), 13 with IVC level II tumor thrombus (above hepatic vein but below diaphragm) and 6 with IVC level III tumor thrombus (above diaphragm). The overall and cancer-specific survival rates were analyzed with Kaplan-Meier survival curve method. RESULTS: The follow-up information of the 114 patients was gained. The median follow-up period for all the patients was 20.5 months (1-96). In the last follow-up, 47 patients died. The median survival time for all the patients was 51 months. The median survival time for the patients with renal vein tumor thrombus and IVC level Ito III tumor thrombus were 57, 43, 40 and 27 months. The 5 year overall survival (OS) and cancer-specific survival (CSS) rates for all the patients were 40.1% and 47.2%, respectively. The survival time of the patients with early tumor thrombus (below hepatic vein) was significantly longer than that of the patients with advanced tumor thrombus (above hepatic vein) (54.1±4.8 months vs. 26.9±5.7 months, P=0.049). CONCLUSION: Radical nephrectomy and thrombectomy are effective therapies for RCC patients with venous extension. The patients can obtain a relatively promising long-term outcome, which is comparable to previous western studies. Long-term outcome of the early tumor thrombus patients is significantly better than that of the advanced tumor thrombus patients.

[Prognostic and long term follow-up analysis of sporadic bilateral renal cell carcinoma].

OBJECTIVE: To investigate the pathological feature, therapy and prognosis of bilateral sporadic renal cell carcinoma. METHODS: The data of 59 bilateral sporadic renal cell carcinoma patients diagnosed from Apr. 1986 to Dec. 2009 were collected. We retrospectively analyzed the treatment, pathological features, long term survival and prognosis factors of the disease. RESULTS: We found 59 patients with bilateral sporadic renal cell carcinoma (RCC) in the database diagnosed from Apr. 1986 to Dec. 2009. The median age was 56 years. Of all the cases, 37 were bilateral synchronous sporadic renal cell carcinoma and 22 bilateral metachronous sporadic renal cell carcinoma. Forty-three patients underwent bilateral surgeries, 11 unilateral surgery, and 5 no treatment. There were 122 masses in the 59 patients and 109 masses had pathological reports. All the 59 cases were RCC, and clear cell carcinomas was the main subtype (96.6%). The median follow-up time was 62.1 months (range 4-277 months). Thirty-nine patients (66.1%) survived without tumor recurrence, 4 survived with tumors recurrence, and 16 (27.1%) died. Kaplan-Meier curve revealed that the 3-year and 5-year overall survival rates were 83.5% and 81.1%, respectively; the 3-year and 5-year cancer special survival rates were 73.1% and 64.8%, respectively. The disease-free survival rates of bilateral synchronous and bilateral metachronous RCC were similar. Multivariate regression suggested that post-operative application of interferon-α and bilateral surgeries were related with a better prognosis. CONCLUSION: The main subtype of bilateral sporadic renal cell carcinoma was clear cell carcinoma (96.6%). Bilateral synchronous and bilateral metachronous RCC both had a long time disease-free survival. Interferon-α application after surgery and bilateral surgeries were related with a better prognosis.

[Urachal carcinoma: experience of a clinical center within 30 years].

OBJECTIVE: To summarize more than thirty years of experience with urachal carcinoma and to discuss the clinical features of urachal carcinoma. METHODS: The clinical data of 22 patients with urachal carcinoma, 18 males and 4 females, their median age at diagnosis was 52 years (range: 31-77 years), were analyzed retrospectively. RESULTS: Twenty-one cases were urachal adenocarcinoma, and 1 was small cell carcinoma. The first common symptom was gross hematuria in the urachal carcinoma patients (20/22, 90.9%), and CT showed calcification in 18.75% of them (3/16). The cystoscopic finding was a mass seen at the dome of the bladder or anterior wall in all. Twenty cases were followed up (90.9%), with the median follow-up 28 months (range: 3-184 months). The overall 5-year cancer-specific survival rate was 49.5%. It was significantly different in survival between T2 and T3 or more in the urachal carcinoma patients by survival analysis (P=0.026). CONCLUSION: The results indicate that the most important predictor of prognosis is tumor stage, and it is critical for diagnosis of urachal carcinoma by CT scan and cystoscopy. Extended partial cystectomy is the main surgery of patients with urachal carcinoma. Active multimodal treatments may improve the survival of patients with recurrent and metastatic disease.

Anti-SARS-CoV-2 spike immunoglobulin G and immunoglobulin M titers decline as interval from the second inactivated vaccine dose to the onset of illness is prolonged in breakthrough infection patients.

BACKGROUND: Understanding of the early immune response in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) breakthrough infections is limited. METHODS: Ninety-eight patients with coronavirus disease 2019 (COVID-19) breakthrough infections were divided into two groups, with intervals from receiving the second dose of inactivated vaccine to the onset of illness <60 or ≥60 days. RESULTS: The median lymphocyte count and the median anti-SARS-CoV-2 spike immunoglobulin G (IgG) and immunoglobulin M (IgM) titers were higher in the <60-day interval group compared with the corresponding medians in the ≥60-day interval group (p = 0.005, p = 0.001, and p = 0.001, respectively). The median interleukin-6 (IL-6) level in the <60-day interval group was significantly lower than the median IL-6 level in the ≥60-day interval group (p < 0.001). CONCLUSIONS: Our results highlight the different anti-SARS-CoV-2 spike IgG and IgM antibody titers among patients with different intervals from receiving the second dose of inactivated vaccine to the onset of illness.