Zheng Zhang

Coexpression of erythopoietin and erythopoietin receptor in sporadic clear cell renal cell carcinoma.

Clear cell renal cell carcinoma (CCRCC) is the most common renal carcinoma and it is often associated with von Hippel-Lindau disease (VHL) gene mutations. CCRCCs with VHL mutations demonstrate hypoxia-inducible factor (HIF) overexpression as well as increased expression of vascular endothelial growth factor (VEGF). Recently, the erythropoietin (Epo) has been found to be upregulated in renal and other tumors associated with VHL disease. Furthermore, Epo and Epo receptor (EpoR) coexpression has also been reported in these tumors. The results provided strong evidence that an autocrine loop is involved in tumorigenesis in VHL disease. We investigated whether Epo and EpoR coexpression also occurs in sporadic CCRCC. Fifty-four sporadic CCRCCs were analyzed. VHL gene mutations were detected in 30 out of 54 tumors. Coexpression of Epo and EpoR was detected in 50 out of 54 tumors regardless of their VHL mutation status. The results suggest that coexpression of Epo and EpoR plays an important role in tumorigenesis of sporadic CCRCC.

Laparoscopic total pelvic exenteration for pelvic malignancies: the technique and short-time outcome of 11 cases

BackgroundPrevious reports about laparoscopic total pelvic exenteration (LTPE) are still limited. In the present study, we described our single-center experience of the initial 11 cases.MethodsBetween April 2011 and September 2015, eight males and three females diagnosed as pelvic malignancies underwent LTPE by the same operation team. We retrospectively collected all cases’ parameters about surgical technique. Thirty-seven patients who received open surgery were also retrospectively collected. A comparison between LTPE and open surgery was performed to evaluate the feasibility and safety of LTPE.ResultsEleven cases successfully underwent the LTPE without any intraoperative complication. No open conversion was required. Eight patients underwent Bricker’s procedure. Three patients were performed with the cutaneous ureterostomy. Anus preservation operation was performed in three patients. Compared with open surgery, LTPE had longer mean operative time (565.2 vs 468.2xa0min, pu2009=u20090.004) but less mean blood loss (547.3 vs 1033.0xa0ml, pu2009<u20090.001) and shorter postoperative hospitalization time (15.3 vs 22.4xa0days, pu2009=u20090.004). One patient died of pulmonary embolism in the 7th month of follow-up time. One patient died of recurrence in the 12th month of follow-up time. Nine patients are still alive without recurrence and metastasis. The mean follow-up time was 11.1xa0months.ConclusionsThe technique of LTPE seems to be feasible and safe in the treatment of carefully selected patients of pelvic malignancies. LTPE can also decrease the blood loss, the recovery time, and the hospital stay. But the oncological safety and long-term outcome of LTPE still need to be explored.

Fluorescence in situ hybridization status of voided urine predicts invasive and high-grade upper tract urothelial carcinoma.

Here, we assessed the diagnostic accuracy of fluorescence in situ hybridization (FISH) for detecting aggressive upper tract urothelial carcinoma (UTUC). A total of 210 UTUC patients from a single hospital in China were enrolled in this retrospective study between 2012 and 2016. Patients were classified as FISH-positive or -negative based on FISH analysis of voided urine, and the clinicpathological characteristics of these two patient groups were compared. Patients with positive FISH results had more advanced tumor stages and higher tumor grades than those with negative results. The overall sensitivity of FISH for detecting advanced UTUC was 62.4% (131/210). The sensitivity and positive predictive values of positive FISH results were 76.5% and 59.5% for high-grade UTUC and 71.7% and 58.0% for muscle-invasive UTUC. These data suggest that voided urine FISH results accurately predict advanced UTUC and might help distinguish patients with aggressive disease from those who might benefit from conservative management.

Comparison between completely and traditionally retroperitoneoscopic nephroureterectomy for upper tract urothelial cancer

BackgroundTo evaluate the safety and efficacy of the completely retroperitoneoscopic nephroureterectomy (CRNU), a retrospectively comparative study between completely and traditionally retroperitoneoscopic nephroureterectomy (TRNU) was done in a single center.MethodsFrom January 2014 to December 2014, 107 patients with upper tract urothelial cancer (UTUC) underwent CRNU. The kidney was retroperitoneoscopically dissected and the bladder cuff was cut by endoscopic gastrointestinal automatic stapler, and the specimen was removed from a 6-cm incision by posterior axillary line. Demographic, perioperative, and follow-up data were collected and compared retrospectively with 110 patients undergoing TRNU.ResultsThe patients’ characteristics between the two groups were not statistically different (pu2009>u20090.05), and all patients successfully received the procedure. The mean operative time (106u2009±u200937.9 versus 199u2009±u200969.1xa0min, pu2009<u20090.0001), the mean estimated blood loss (47.2u2009±u200982.4 versus 166.9u2009±u2009250.9xa0ml, pu2009=u20090.002), and the mean hospital stay (6.1u2009±u20093.5 versus 8.1u2009±u20093.3xa0days, pu2009=u20090.03) of the CRNU group decreased significantly compared to the traditional group. The operative time was not affected by gender. No open conversion and major complications occurred. The surgical margin of the ureter was all negative. The mean follow-up time was 13.4xa0months for the CRNU group and 37.5xa0months for the TRNU group. All follow-up patients in the CRNU group were alive without local recurrence. No cases of port site metastasis and local recurrence were observed in both groups. Bladder tumor recurrence occurred in 4 patients of the CRNU group and 21 patients of the TRNU group.ConclusionsThe CRNU using an endoscopic gastrointestinal automatic stapler to manage the bladder cuff is feasible and advantageous in decreasing the operative time, the blood loss, and the hospital stay. However, a larger sample and longer follow-up time will be still required.

Renal cell carcinoma with infrahepatic vena caval tumor thrombus treated with a novel combined retroperitoneal and transperitoneal pure laparoscopic procedure.

A 61-year-old male patient presented with intermittent gross hematuria. A right renal mass with infrahepatic vena caval tumor thrombus was found using magnetic resonance imaging. We undertook a novel combined retroperitoneal and transperitoneal pure laparoscopic nephrectomy with vena caval thrombectomy for this patient. The patient recovered well after surgery and discharged on day 6. A clear cell renal cell carcinoma with venous extension was confirmed by pathologic assay. To our knowledge, this is the first report of such a novel hybrid surgical strategy.

The Influence of Tumor Size on Oncologic Outcomes for Patients with Upper Tract Urothelial Carcinoma after Radical Nephroureterectomy

Previous studies have reached diverse conclusions about the influence of tumor size on the oncologic outcomes in patients with upper tract urothelial carcinoma (UTUC). In this study, we retrospectively analyzed the records of 687 patients and evaluated how tumor size affected the prognosis of patients with UTUC after surgery. Clinicopathologic characteristics and oncological outcomes were compared according to tumor size (≤3u2009cm versus >3u2009cm). During a median follow-up period of 65 months (range 3-144 months), 225 patients (32.8%) died from UTUC and 228 patients (33.2%) experienced intravesical recurrence (IVR). Patients with a larger tumor size tended to have a significantly higher percentage of being male (p = 0.011), tobacco consumption (p = 0.036), lack of preoperative ureteroscopy history (p = 0.003), renal pelvic location (p < 0.001), tumor necrosis (p = 0.003), advanced tumor stage (p < 0.001), higher tumor grade (p = 0.003), and lymph node metastasis (p = 0.018). Univariate analysis revealed that a tumor size >3u2009cm was significantly associated with worse cancer-specific survival (p = 0.002) and IVR (p = 0.011). However, the influence was not statistically significant after controlling for other factors in the multivariate analysis (hazard ratio [HR] 1.124, p = 0.414 and HR 1.196, p = 0.219). In conclusion, UTUC patients with a larger tumor present aggressive biological characteristics and tend to have a worse prognosis.

AB116. Research of efficacy of brachytherapy for localized prostate cancer

Objective To investigate the efficacy of brachytherapy for patients with localized prostate cancer and the influence factors. Methods A total of 61 patients with localized prostate cancer were treated with brachytherapy between 2001 and 2011, including 11 patients who received combined external beam radiotherapy. The mean age was 75.2 yr (range, 57-84 yr). Clinical stage was T1c in 12 patients, T2a in 18 patients, T2b in 17 patients, and T2c in 14 patients. Long-term follow-up was carried on all patients for PSA and adverse effects. Kaplan-Meier survival curves, Log-rank test and univariate Cox proportional hazard regression analysis was used to examine the factors associated with the treatment efficacy. Results The median follow-up was 49 months (range, 9-126 months). The mean PSA before treatment and the mean nadir PSA after operation were 17.80 and 1.16 μg/L, respectively. The PSA of 58 patients (95.1%) reached a nadir below 4 μg/L, which was even below 1 μg/L in 37 patients (60.7%). The mean time to reach the nadir PSA was 11.6 months after operation. The short-term adverse events after operation included fever in 4 patients, hematuria in 7 patients, and hematochezia in 4 patients. The most common long-term adverse event was urinary irritation (31%); other long-term adverse events were rare, including hematochezia, hematuria, urinary incontinence, urinary retention, mild diarrhea and radiation enteritis. The estimated mean biochemical recurrence-free survival after brachytherapy was 41.0 months (95% CI: 31.05-50.94 months). The mean nadir PSA after operation were 1.32 μg/L in the 11 patients who received combined external beam radiotherapy, and their estimated mean biochemical recurrence-free survival was 38 months. Patients with nadir PSA below 1 μg/L had a significant longer biochemical recurrence-free survival than those with nadir PSA between 1 and 4 μg/L (42.9 vs. 32.0 months, χ2=4.445, P=0.035). Conclusions Brachytherapy is an effective treatment strategy for localized prostate cancer, with relatively low rate of severe adverse events. After brachytherapy, a nadir PSA below 1 μg/L might indicate a better prognosis.

AB118. Feasibility and safety evaluation of pure laparoscopic radical nephrectomy and thrombectomy for renal tumor patients with venous tumor thrombus

Objective To evaluate the feasibility and safety of pure laparoscopic radical nephrectomy and thrombectomy for renal tumor patients with venous tumor thrombus. Methods From Jan 2013 to Dec 2014, records of patients with renal tumor and venous thrombus treated in our institute were retrospectively reviewed. Thirteen patients underwent pure laparoscopic radical nephrectomy and thrombectomy, including seven patients with renal vein (RV) thrombus and six patients with inferior vena cava (IVC) thrombus. Retroperitoneal approach was undertaken for RV thrombus patients, while transperitoneal approach or combined retroperitoneal and transperitoneal approach for IVC thrombus patients. During the combined approach surgery, renal artery and lumbar vein were controlled through retroperitoneal approach, and the thrombectomy procedure was completed through transperitoneal approach. Results There were nine male patients and four female patients. All patients ranged from 30 to 78 years old (median, 55 years old). Seven patients were diagnosed by routine medical examination, while six patients had clinical symptoms, including four with gross hematuria and two with flank pain. All patients underwent operations successfully. Operation time ranged from 84 to 456 minutes (median 195 minutes). The blood loss ranged from 50 to 150 mL (median, 50 mL) for RV tumor thrombus patients, and 100 to 2,500 mL (median, 325 mL) for IVC tumor thrombus patients. All patients recovered well after surgery without major complications. With the postoperative pathological examination, the average tumor maximum diameter was 7.9±2.5 cm. Eleven cases of clear cell renal cell carcinoma, one case of chromophobe renal cell carcinoma and one case of renal metastatic osteosarcoma were showed in our study. Median follow-up time was 13 months (2-22 months). No decease was observed at the last follow-up. Three patients experienced distant metastasis after surgery, including two patients with multiple pulmonary metastases and one patient with lumbar vertebral metastasis. Conclusions Pure laparoscopic radical nephrectomy and thrombectomy is feasible and safe, with promising oncological prognosis. Combined retroperitoneal and transperitoneal procedures can take both the advantages of these two approaches and simplify operative manipulations.

Comparison of laparoscopic and open cystectomy for bladder cancer: A single center of 110 cases report

Purpose We compared the operative time, complications, blood loss, total cost, and hospital days of laparoscopic cystectomy vs. open cystectomy for bladder cancer. Materials and methods This retrospective, nonrandomized study was conducted between January 2004 and March 2011 on 110 patients (17 women and 93 men) who underwent radical cystectomy for bladder cancer. A total of 45 cystectomies were performed laparoscopically and 65 by open surgery. Mean patient age was 62.9±10.4 years. The age, gender, American Society of Anesthesiologists score, histopathological results etc. were reviewed in this article. Results Intraoperative blood loss was significantly lower in the laparoscopic surgery group (821±776 vs. 1112±706 mL, P=0.044) while operative time was significantly lower in the open surgery group (376±90 vs. 445±119 min, P=0.001). The total costs were also significantly lower in the open surgery group 51,726±13,589 yuan (about

Predictive role of preoperative hydronephrosis on poor pathological outcomes and prognosis in upper tract urothelial carcinoma patients: Experience from a nationwide high-volume center in China

8000) vs. 63,053±19,378 yuan (about