Yichun Wang

Optimal biopsy strategy for prostate cancer detection by performing a Bayesian network meta-analysis of randomized controlled trials

Objective: With the increasing recognition of the over-diagnosis and over-treatment of prostate cancer (PCa), the choice of a better prostate biopsy strategy had confused both the patients and clinical surgeons. Hence, this network meta-analysis was conducted to clarify this question. Methods: In the current network meta-analysis, twenty eligible randomized controlled trials (RCTs) with 4,571 participants were comprehensively identified through Pubmed, Embase and Web of Science databases up to July 2017. The pooled odds ratio (OR) with 95% credible interval (CrI) was calculated by Markov chain Monte Carlo methods. A Bayesian network meta-analysis was conducted by using R-3.4.0 software with the help of package “gemtc” version 0.8.2. Results: Six different PCa biopsy strategies and four clinical outcomes were ultimately analyzed in this study. Although, the efficacy of different PCa biopsy strategies by ORs with corresponding 95% CrIs had not yet reached statistical differences, the cumulative rank probability indicated that overall PCa detection rate from best to worst was FUS-GB plus TRUS-GB, FUS-GB, CEUS, MRI-GB, TRUS-GB and TPUS-GB. In terms of clinically significant PCa detection, CEUS, FUS-GB or FUS-GB plus TRUS-GB had a higher, whereas TRUS-GB or TPUS-GB had a relatively lower significant detection rate. Meanwhile, TPUS-GB or TRUS-GB had a higher insignificant PCa detection rate. As for TRUS-guided biopsy, the general trend was that the more biopsy cores, the higher overall PCa detection rate. As for targeted biopsy, it could yield a comparable or even a better effect with fewer cores, compared with traditional random biopsy. Conclusion: Taken together, in a comprehensive consideration of four clinical outcomes, our outcomes shed light on that FUS-GB or FUS-GB plus TRUS-GB showed their superiority, compared with other puncture methods in the detection of PCa. Moreover, TPUS or TRUS-GB was more easily associated with the over-diagnosis and over-treatment of PCa. In addition, targeted biopsy was obviously more effective than traditional random biopsy. The subsequent RCTs with larger sample sizes were required to validate our findings.

Prognostic significance of microRNA‑200c in various types of cancer: An updated meta‑analysis of 34 studies

Previous studies have indicated that miR-200c is a promising cancer biomarker. However, different studies have presented conflicting results. Therefore, the aim of the present study was to perform a meta-analysis of miR-200c based on 34 relevant studies. The Materials and methods sections of papers were carefully identified using the databases PubMed, Web of Science and Embase for publications up to December 4, 2015. Pooled hazard ratios (HRs) and 95% confidence intervals (95% CIs) were systematically calculated to investigate the association between the expression of miR-200c and cancer prognosis. The results demonstrated that elevated expression levels of miR-200c indicated significantly worse overall survival rates (HR=1.37, 95% CI: 1.01, 1.85), and a high level of miR-200c was considered an indicator of an unfavorable prognosis in patients from Europe and America (HR=1.85, 95% CI: 1.27, 2.69). Furthermore, overexpression of miR-200c was significantly associated with progression of the disease in the subgroups of tissue and blood samples (HR=0.68 and 2.45, respectively), and inferior overall survival rates for the blood subgroup were revealed (HR=2.21, 95% CI: 1.04, 4.72). In addition, miR-200c was of prognostic value in several disease subgroups. Taken together, high expression levels of miR-200c are of significant prognostic value in various human malignancies.

Testis Tumor of Ovarian Epithelial Type: A Rare Case

Ovarian epithelial type tumors of the testis have been a rare clinical entity. Its awareness and management remain a clinical challenge. We described the case of an 18-year-old, obese male patient who presented with scrotal enlargement. He underwent eversion of tunica vaginalis and resection of epididymal mass. The histology of the resected sample showed an ovarian epithelial type borderline tumor. We believe our case helps to strengthen awareness and management of this rare disease.

The C.L.A.M.P. Nephrometry score: A system for preoperative assessment of laparoscopic partial nephrectomy with Segmental Renal Artery Clamping

Laparoscopic partial nephrectomy with segmental renal artery clamping is associated with a less warm ischemic injury and better postoperative affected renal function compared with main renal artery clamping. However, its indication remains unclear. We established a standardized nephrometry scoring system (The C.L.A.M.P. Nephrometry Score) to evaluate its flexibility in preoperative assessment. This scoring system based on 5 components. The ranking (C)oefficient of each score and the (L)ocation of the clamping position of the target artery and areas of the target artery entering the renal sinus: (A)nterior boundary, (M)ulti-boundary and (P)osterior boundary. We applied this system to analyze data from 106 consecutive patients who underwent SRAC during LPN and divided these patients into 3 groups based on their C.L.A.M.P. scores. The rate of conversion to main renal artery clamping and clamping success rate and the affected side GFR reduction showed significant differences among the groups (Pu2009<u20090.001). However, parameters such as blood loss, Warm ischemia time and postoperative hospitalization were not significantly different. The C.L.A.M.P. nephrometry score shows strong ability in distinguishing different complexities of artery characteristics and plays a promising role in identifying patients who are suitable for the SRAC technique.

Robotic renal cyst decortication with calyceal diverticulectomy in a toddler – technical practicalities: a case report

BackgroundIncidence of simultaneous renal cyst with calyceal diverticula in contralateral kidney is rare in children. A minimally invasive procedure in different sittings is often recommended.Case presentationA Chinese 15-month-old boy presented to the Urology department of a tertiary care center with right flank pain. He was subjected to magnetic resonance urography and was diagnosed as having right renal cyst and contralateral calyceal diverticula. He underwent robotic cyst decortication and calyceal diverticulectomy using da Vinci robot. His postoperative period was uneventful. He was discharged on fifth postoperative day. Histopathology was consistent with simple renal cyst.ConclusionsRobotic combined cyst decortication and contralateral diverticulectomy is feasible in selected small children. However, it demands adequate technical skill and experience.

Different Chemotherapy Regimens in the Management of Advanced or Metastatic Urothelial Cancer: a Bayesian Network Meta-Analysis of Randomized Controlled Trials

Background/Aims: Urothelial cancer (UC) as a chemotherapy-sensitive tumor, has achieved remarkable progresses in therapeutic paradigm, particularly in the advanced/metastatic stages. However, both clinicians and patients are confused when it comes to choosing the optimal chemotherapy. Hence, this article was aimed to conduct a comprehensive comparison of different chemotherapy regimens for advanced or metastatic UC in terms of survival benefits or adverse events. Methods: The online databases PubMed, EMBASE and Web of Science were searched systematically and comprehensively for randomized controlled trials (RCTs) up to September 15, 2017. The pooled hazard ratios (HRs) or odds ratios (ORs) with 95% credible interval (CrI) were calculated by Markov chain Monte Carlo methods. The effectiveness and safety of included regimens were conducted to provide a hierarchy by means of rank probabilities with the help of “R-3.4.0” software and the “gemtc-0.8.2” package. The surface under the cumulative ranking curve (SUCRA) was also incorporated in our analysis for ranking the corresponding chemotherapy regimens. Results: Ten different chemotherapy regimens involved in this article were predominantly of trials in a first-line setting, and eight clinical outcomes were ultimately analyzed in this study. In terms of Overall response rate (ORR), Overall survival (OS) or Progression-free survival (PFS)/Time to progression (TTP), the rank probabilities and SUCRA indicated that Paclitaxel/cisplatin/gemcitabine (PCG) was superior to gemcitabine/cisplatin (GC) or methotrexate/vinblastine/doxorubicin/cisplatin (MVAC), the traditional first-line treatment for advanced/metastatic UC. In the case of ORR or PFS/TTP, GC+sorafenib also displayed its superiority in comparison with GC or MVAC. Despite their survival benefits, PCG or GC+sorafenib presented a relatively higher incidence of adverse events. Conclusion: Our results revealed that by adding a paclitaxel or sorafenib into the first-line GC, it could yield a better survival benefit, but also worsen adverse events for advanced/ metastatic UC. Clinically, physicians should weigh the merits of these approaches to maximize the survival benefits of eligible patients.

Microdissection testicular extraction for a patient with transverse testicular ectopia and testicular fusion

absence of vas deferens (CAVD). Microdissection testicular sperm extraction (micro-TESE) is an effective treatment option for patients with azoospermia. Herein, we present a case of application of Micro-TESE in an infertile patient with TTE. A 29-year-old infertile male who had not taken any contraceptive measures during 5 years of marriage visited our clinic. Sperm analysis showed azoospermia. Blood tests showed a serum testosterone level of 287 ng dl−1, luteinizing hormone 4.3 mIU ml−1, and follicle-stimulating hormone 4.98 mIU ml−1, all within normal limits. Physical examination revealed a testis-like mass in the right hemiscrotum and an empty left hemiscrotum. Scrotal ultrasonography showed hydrocele in the left testis and no testis on the left side, with right testicular volume slightly larger than that of a normal testis. Two fused testicles were revealed when we opened the left groin, one testis with epididymis and vas deferens and another with unilateral CAVD, both having a rich blood supply (Figure 1a). Micro-TESE was applied to the testis with CAVD (Figure 1b). A midline incision Dear Editor, Transverse testicular ectopia (TTE) is a rare condition whereby both testes migrate toward the same hemiscrotum. Most of the cases (65%) are diagnosed intraoperatively during an inguinal hernia repair; only few are diagnosed preoperatively.1 On the basis of various anomalies, TTE is classified into three types: Type 1, accompanied only by inguinal hernia (40%–50%); Type 2, accompanied by persistent Müllerian duct structures (30%); Type 3, accompanied by genitourinary anomalies, such as hypospadias (20%).2 In the case of TTE, the spermatic vessels of the ectopic testis pass through the midline and the inguinal canal adjacent to the spermatic cord of the normal opposite testis.3 To date, fewer than 150 cases of TTE have been reported in the literature,4 mostly in children. Adult patients with TTE consult doctors mainly because of oligoasthenozoospermia or infertility. To date, there have been no reports in the literature about TTE in infertile males with fused testicles and unilateral congenital LETTER TO THE EDITOR

Prognostic evaluation of microRNA-210 in various carcinomas: Evidence from 19 studies

Background: We performed this meta-analysis to provide a comprehensive evaluation of the role of MicroRNA-210 (miR-210) expression on the overall survival (OS) rate of cancers. Methods: We searched for relevant available literatures on miR-210 and cancer until November 1st, 2016 on the databases PubMed, EMBASE, Cochrane Library, and Science Direct database. We calculated the pooled hazard ratio (HR) with 95% confidence intervals (CIs) for OS, which compared the high and low expression levels of miR-210 in patients of the available studies. Subgroup analysis was performed to evaluate the specific role of miR-210 in ethnicity and the type of cancers. Publication bias was evaluated using Begg funnel plots and Egger regression test. Results: Overall, 19 studies were involved in this meta-analysis. The result indicated that upregulated miR-210 might be associated with poor OS outcome in various carcinomas, with the pooled HR of 1.80 (95% CI: 1.29–2.51). When stratified by disease, significant results were detected in breast cancer (HRu200a=u200a2.67, 95% CI: 1.24–5.76) and glioma (HRu200a=u200a2.42, 95% CI: 1.32–4.43). Besides, in the subgroup analysis by ethnicity, significant results were detected only in Asian populations (HRu200a=u200a2.14, 95% CI: 1.37–3.34). Conclusion: The present meta-analysis suggests that high expressed miR-210 is significantly associated with OS in cancer patients, which has the potential to be a prognostic marker in cancers.

The role of radical prostatectomy for the treatment of metastatic prostate cancer: a systematic review and meta-analysis

The recommended therapy by EAU guidelines for metastatic prostate cancer (mPCa) is androgen deprivation therapy (ADT) with or without chemotherapy. The role of radical prostatectomy (RP) in the treatment of mPCa is still controversial. Hence, a meta-analysis was conducted by comprehensively searching the databases PubMed, EMBASE and Web of Science for the relevant studies published before September 1st, 2017. Our results successfully shed light on the relationship that RP for mPCa was associated with decreased cancer-specific mortality (CSM) (pooled HR = 0.41, 95%CI = 0.36–0.47) and enhanced overall survival (OS) (pooled HR = 0.49, 95%CI = 0.44–0.55). Subsequent stratified analysis demonstrated that no matter how RP compared with no local therapy (NLT) or radiation therapy (RT), it was linked to a lower CSM (pooled HR = 0.36, 95%CI = 0.30–0.43 and pooled HR = 0.56, 95%CI 0.43–0.73, respectively) and a higher OS (pooled HR = 0.49, 95%CI = 0.44–0.56 and pooled HR = 0.46, 95%CI 0.33–0.65, separately). When comparing different levels of Gleason score, M-stage or N-stage, our results indicated that high level of Gleason score, M-stage or N-stage was associated with increased CSM. In summary, the outcomes of the present meta-analysis demonstrated that RP for mPCa was correlated with decreased CSM and enhanced OS in eligible patients of involved studies. In addition, patients with less aggressive tumors and good general health seemed to benefit the most. Moreover, no matter compared with NLT or RT, RP showed significant superiority in OS or CSM. Upcoming prospective randomized controlled trials were warranted to provide more high-quality data.

Extraperitoneal laparoscopic resection for retroperitoneal lymphatic cysts: initial experience

BackgroundTo assess the safety and efficacy of laparoscopic retroperitoneal resection for retroperitoneal lymphatic cysts.MethodsA retrospective analysis was conducted based on clinical data from eight patients with hydronephrosis caused by retroperitoneal lymphatic cysts. All patients underwent laparoscopic retroperitoneal lymphatic cyst resection and received postoperative follow-up. A follow-up ultrasound was performed postoperatively every 6–12xa0months to evaluate the recovery of the hydronephrosis.ResultsAll operations were successful, and their postoperative pathological results revealed lymphatic cyst walls. The operation time ranged from 43 to 88xa0min (mean: 62xa0min), with a blood loss of 20 to 130xa0mL (mean: 76xa0mL), and the length of hospital stay was 3 to 6xa0days (mean: 4.5xa0days). Within the follow-up of 12 to 36xa0months (mean: 28.5xa0months), great relief was detected in all eight cases, and no recurrence was found. Moreover, complications such as renal pedicle or renal pelvis injury were not observed.ConclusionsLaparoscopic retroperitoneal lymphatic cyst resection is an effective treatment for retroperitoneal lymphatic cysts and has the advantages of being minimally invasive, producing less intraoperative blood loss and leading to a quick recovery. This treatment thus deserves further studies.