Shilin Zhang

Efficacy of sorafenib on metastatic renal cell carcinoma in Asian patients: results from a multicenter study.

BackgroundThe effects of sorafenib in the treatment of advanced renal cell carcinoma (RCC) have been confirmed in an international collaborative phase III trial. This study aims to confirm similar efficacy and treatment-induced toxicities of sorafenib in the treatment of metastatic RCC in ethnic Chinese patients.MethodsNinety-eight consecutive and non-selected patients with pathologically confirmed metastatic RCC were treated according to an institutional treatment protocol. All patients were treated with 400 mg of sorafenib orally twice daily on a continuous basis until disease progression or intolerance to treatment occurred. Dose reduction to 400 mg once daily was required if grade 3 or 4 toxicities occurred. All patients except for 7 received nephrectomy in the course of their disease. All patients were assessed for tumor response, progression-free survival (PFS), overall survival (OS), and treatment-induced toxicities.ResultsThe median follow-up time was 76 weeks (range 2–296 weeks) for the entire group of patients. Radiologically confirmed complete response (CR), partial response (PR), stable disease (SD) of more than 4 months, and disease progression as best objective responses were observed in 1 (1%), 23 (23.5%), 62 (63.3%), and 12 (12.2%) patients, respectively. The tumor control rate (CR+PR+SD of >4 months) was 87.8%. The 1-year estimated PFS and OS were 58.4% and 64.6%, respectively. The median progression-free survival (PFS) time was 60 weeks (95% CI 41–79); and the median overall survival (OS) time was not reached with a follow-up of 76 weeks. Reduction of sorafenib dose was required in 26 patients who developed grade 3 or 4 treatment-cause adverse-effects. An additional 9 patients discontinued sorafenib treatment due to severe adverse-effects. No grade 5 toxicity occurred.Multivariate analysis revealed that independent predictive factors for tumor response to sorafenib treatment included ECOG status, presence of lymph node metastasis, and nephrectomy prior to the development of metastasis.ConclusionSorafenib produced an 87.8% disease control rate for metastatic renal cell carcinoma in Chinese patients, with acceptable rates of toxicity. The medication dosed at 400 mg twice daily is both efficacious and safe in the treatment of metastatic renal cell carcinoma in Chinese patients.

Lower skeletal muscle index and early complications in patients undergoing radical cystectomy for bladder cancer

BackgroundRadical cystectomy (RC) is the standard treatment for patients with muscle-invasive bladder cancer (BC), and it is also a valid option for selected patients with high-risk non-muscle-invasive BC. The purpose of this study was to evaluate the effect on the lower skeletal muscle index (SMI) of short-term postoperative complications of radical cystectomy (RC) in patients with bladder cancer (BC).MethodsA total of 247 patients who received RC for BC and 204 age-matched healthy population-based controls were retrospectively assessed. SMI was measured by preoperative computed tomography scans at the L4 to L5 level. Early complications were graded by Clavien-Dindo classification; severity of grade III or greater was identified as a severe complication. Logistic regression was utilized to determine the relationships between covariables and severe complications.ResultsA total of 125 (50.61%)/19 (7.69%) patients exhibited overall/severe complications during the early postoperative period. SMI was strongly associated with gender (P <0.01), but not age and body mass index (BMI), among patients with BC. Compared with the matched control group, BC patients exhibited lower SMI. The difference was statistically significant in the subgroup of male patients (Pu2009=u20090.03). In the multivariate analysis, SMI was an independent predictor of developing severe complications. Each 1 cm2/m2 increase in SMI was associated with a decrease in the odds of morbidity by 4.8%.ConclusionsA lower SMI is frequently observed in bladder cancer patients undergoing RC and is shown to be strongly associated with early complications following surgery.

Reconstruction with scrotal skin fl aps after wide local resection of penoscrotal extramammary Paget ' s disease

Study Type – Therapy (case series)

Role of KIT expression in the prognosis of clear cell renal cell carcinomas in Chinese patients

ObjectivesTo investigate the expression of KIT in clear cell renal cell carcinomas, and to reveal the relationships between KIT status and clinicopathological features and survival of clear cell renal cell carcinomas.MethodsThe expression of KIT was tested immunohistochemically in 119 specimens of clear cell renal cell carcinoma. Their correlations to clinicopathological parameters were compared and discussed. Kaplan–Meier method was used to determine the survival between KIT-positive and KIT-negative patients. Multivariate analysis was performed using the Cox-regression model for overall survival.ResultsA total of 13 out of 119 cases of clear cell renal cell carcinomas (10.9%) were demonstrated consistent overexpression of KIT. There was statistical significance in the correlation between KIT expression and tumor size (Pxa0<xa00.01), pathological stage (Pxa0<xa00.01), tumor grade (Pxa0<xa00.01) and P53 (0.01xa0<xa0Pxa0<xa00.05). On multivariate analysis, positive KIT expression presented an independent predictive factor for decreased overall survival (hazard ratio 17.26, Pxa0=xa00.005). The estimated mean survival time was 25.6xa0months for KIT-positive patients and 56.9xa0months for KIT negative patients, Pxa0<xa00.001.ConclusionsThe expression of KIT was significantly associated with tumor size, pathological stage, tumor grade and P53 in clear cell renal cell carcinomas. The expression of KIT is an important survival predicting factor for patients with clear cell renal cell carcinoma.

774 VARIATION OF CIRCULATING ESTROGEN AND ANDROGEN LEVELS IN PROSTATE CANCER PATIENT WITH COMBINED ANDROGEN BLOCKADE: OBSERVATION AND IMPLICATION

a study to evaluate which, the moment and the severity of appearance of these modifications. METHODS: Unique institution prospective and descriptive study. IRB approval. Study population: High risk PC patients submitted to radiotherapy and long period adjuvant hormonotherapy with LHRHa. Included consecutively from September 2009 to January 2011. To evaluate the symptoms 5 validated questionnaires were administered: baseline and 3, 6, 12, 24 and 36 months after therapy start: 1. International Index Erectile Function (IIEF): sexual modifications; 2. Aging Males’ Symptoms Scale (AMSS): androgenic deficit, 3. Minimental test (MM): Cognitive area, 4. Short Form Health Survey SF-12 : Quality of life; 5. Beck Depression Inventory (BDI) Mental status and depression. Data were analyzed with the Wilcoxon test with a statistical significance p value 0,05. RESULTS: 61 patients were available at 6 months at least evaluation. The IIEF shows: a dramatic decrease since the first evaluation (p 0,05). AMSS test shows a progressive worsening (28, 32, 33 points at 6 months) (p 0,05). The MM test (cognitive area) does not demonstrate any significant alteration. SF-12 test (mental health area) shows a deterioration after 6 months (p 0,03). The rest of evaluated parameters do not present modifications. A deterioration in the BDI test (depresion area) is observed from the baseline (3,5 points) to the 3 months evaluation (4,9 points) (p 0,08), that consolidates at the 6 months (5,8 points) (p 0,030). CONCLUSIONS: Treatment with LHRHa shows from initial stages (3 months) deleterious effects, fundamentally in the sexual sphere. At 6 months a slight deterioration of the mental status appears, which is confirmed in the paragraph of mental health when we evaluate the quality of life. Neither the cognitive capacity, nor the rest of quality parameters of global life seem to be diminished at this early period of time.