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Recurrent renal cell carcinoma(reRCC) is associated with poor prognosis and the underlying mechanism is not yet clear. A comprehensive understanding of tumor microenvironment (TME) of reRCC may aid in designing effective anticancer therapies, including immunotherapies. Single-cell transcriptomics holds great promise for investigating the TME, however, this technique has not been used in reRCC. Here, we aimed to explore the difference in the TME and gene expression pattern between primary RCC (pRCC) and reRCC at single-cell level.We performed single-cell RNA sequencing analyses of 32,073 cells from 2 pRCC, 2 reRCC, and 3 adjacent normal kidney samples. 41 pairs of pRCC and reRCC samples were collected as a validation cohort to assess differences observed in single-cell sequencing. The prognostic significance of related cells and markers were studied in 47 RCC patients underwent immunotherapy. The function of related cells and markers were validated via in vitro and in vivo experiments.reRCC had reduced CD8We delineated the heterogeneity of reRCC and highlighted an innovative mechanism that CAFs acted as a suppressor of CD8

Background: At present, China has more than 11 million patients with stable coronary heart disease, becoming a major public health problem. The pathological changes of coronary heart disease can lead to dysfunction of cardiac autonomic nervous system, which increases the risk of complications such as malignant arrhythmia (ventricular flutter, ventricular fibrillation, etc.), heart rate, systolic blood pressure, and rate-pressure-product (RPP), which is highly correlated with myocardial oxygen consumption and indirectly reflects myocardial blood supply and oxygen consumption. Although the guidelines recommend that such patients take drugs to reduce heart rate and myocardial oxygen consumption, the clinical control of heart rate is still not ideal. Thus, in this trial, we will use voluntary breathing exercises as the strategy of exercise rehabilitation patients with Stable coronary artery disease（SCAD）, in order to increase the vagus nerve activity and/or reduce the sympathetic nervous activity, help maintain or rebuild the balance of plant nerve system, improve the time domain index of heart rate variability, reduce the burden on the heart, relieve patients' anxiety and other negative emotions. Methods: This is a 6 months single-blind, randomized controlled clinical trial that will be conducted in the First Affiliated Hospital of Soochow University. 140 patients who fill out the Informed Consent Form are registered and randomized 1:1 into the Voluntary Breathing Exercises（VBE）-based clinical trial monitoring group (n = 70) or the Routine follow-up group (n = 70). The VBE-based clinical trial monitoring group is given VBE training on the basis of conventional treatment and health education, while the control group received conventional health education and follow-up. The primary outcome will be measured heart rate variability(HRV) and rate-pressure product (RPP). Secondary outcomes will include changes in self-rating anxiety ccale (SAS), total cholesterol(TC),triglyceride(TG), high density lipoprotein (HDL-C),low density lipoprotein(LDL-C), weight and body mass index (BMI). Discussion: This trial will carry out scientific respiratory exercise for patients with stable coronary heart disease, which belongs to the category of active secondary prevention for patients, and changes from remedial to pre-protective. VBE is easy to operate, and is not limited by time and place. It is very important and meaningful to carry out VBE for patients with SCAD. This study will provide considerable evidence for further large-scale trials and alternative strategies for the rehabilitation nursing of patients with SCAD. Trial registration: This study is registered at Chinese Clinical Trials Registry.gov, ID:1900024043.Registered on 23 June 2019. Keywords: Breathing, Stable coronary artery disease, Heart rate variability, Blood pressure , Myocardial oxygen consumption

Yang Yang,1 Feng Xiao,1 Jin Wang,1 Bo Song,1 Xi-Hui Li,1 Jian Li,2 Zhi-Song He,3 Huan Zhang,4 Ling Yin5 1Department of Cardiac Surgery, 2Department of Thoracic Surgery, 3Department of Urology Surgery, 4Department of General Surgery, 5Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, People’s RepublicofChina Background: To investigate the possibility and feasibility of simultaneous cardiac and noncardiac surgery.Methods: From August 2000 to March 2015, 64 patients suffering from cardiac and noncardiac diseases have been treated by simultaneous surgeries.Results: Two patients died after operations in hospital; thus, the hospital mortality rate was 3.1%. One patient with coronary heart disease, acute myocardial infarction, and a recurrence of bladder cancer accepted emergency simultaneous coronary artery bypass grafting (CABG), bladder cystectomy, and ureterostomy. He died of acute cerebral infarction complicated with multiple organ failure on the 153rd day after operation. The other patient with chronic constrictive pericarditis and right lung cancer underwent pericardial stripping and right lung lower lobectomy, which resulted in multiple organ failure, and the patient died on the tenth day postoperatively. The remaining 62 patients recovered and were discharged. The total operative morbidity was 17.2%: postoperative hemorrhage (n, % [1, 1.6%]), pulmonary infection and hypoxemia (2, 3.1%), hemorrhage of upper digestive tract (1, 1.6%), incisional infection (3, 4.7%), subphrenic abscess (1, 1.6%), and postoperative acute renal failure and hemofiltration (3, 4.7%). Of the 62 patients discharged, 61 patients were followed up. Eleven patients died with 10 months to 10 years during the follow-up. The mean survival time is 116.2±12.4months. The cumulative survival rate is 50.8%.Conclusion: Simultaneous surgeries in patients suffering from both cardiac and noncardiac benign or malignant diseases are safe and possible with satisfactory short-term and long-term survival. Keywords: cardiac surgery, noncardiac surgery, coronary artery bypass grafting (CABG), tumor resection, simultaneous surgery

The aim of this study was to analyze the results of major non-cardiac surgery in patients with severe coronary arterial disease who underwent concomitant vs. previous myocardial revascularization (MR) in terms of operative complications and hospital stay. Between June 1999 and October 2008, 37 patients with coronary arterial disease underwent neoplastic resection at our hospital. Fourteen patients with a curable left-main or multiple-vessel disease received surgical MR concomitantly, while 23 patients previously underwent surgical or transluminal MR. Univariate analysis determined the impact of the timing of MR on operative complications and hospital stay. The overall mortality and morbidity rates were 3% and 65%, respectively. Compared with simultaneous MR, neoplastic surgery with previous MR had shorter postoperative hospital stay. Occurrence of postoperative complications was influenced by surgical duration (P=0.014). Postoperative length of hospital stay was affected by the timing of revascularization (P=0.008) and surgical duration (P=0.007). Previous MR can shorten postoperative hospital length of stay for current major non-cardiac surgeries in patients with severe coronary artery disease (CAD). For patients with concomitant severe CAD and clinically rapidly progressive malignant neoplasm, simultaneous neoplastic resection and MR is associated with acceptable operative mortality.

To compare the diagnostic accuracy of five internationally used indolent prostate cancer screen protocols in Chinese prostate cancer patients.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.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.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.

To investigate the factors that may predict the effectiveness of metastatic castration resistant prostate cancer (mCRPC) patients who received docetaxel plus prednisone treatment.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.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.High Gleason score, lymph node metastasis, visceral metastasis and normal HGB level may predict PSA response after docetaxel-based chemotherapy.

To identify the risk factors that would aid in the identification of patients at the greatest risk of developing postoperative paralytic ileus.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.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.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.

Objective To evaluate two treatment methods for bilateral upper urinary tract transitional cell carcinomas (TCCs). Methods Clinical data of 43 patients with bilateral upper urinary tract TCCs treated in our hospital from 1994 to 2006 were analyzed retrospectively. Of them, 13 patients underwent bilateral nephroureterectomy and the rest 30 patients received unilateral nephroureterectomy and contralateral organ-preserving surgery, including partial nephrectomy, partial pelvectomy, partial ureterectomy＋end-to-end ureteral anastomosis, distal ureterectomy＋reimplantation and endoscopic resection. The data were analyzed and compared between the two groups using SPSS software. Results There were no statistical differences between two groups in age, gender, incidence of hematuria, low back pain and abdominal pain, smoking, number of tumor, tumor stage, tumor grade, recurrence time, recurrence rate, survival time, survival rate, or taking aristolochic acid drugs (P>0.05). Significantly higher post-surgical costs and lower survival condition satisfaction score were found among the patients undergoing bilateral nephroureterectomy, showing a significant statistical difference between the two groups (P < 0.001). Conclusions For synchronous or metachronous bilateral upper urinary tract TCCs, bilateral nephroureterectomy results in similar clinical outcomes compared with that of unilateral nephroureterectomy + contralateral organ-preserving surgery, but the latter costs lower postoperative expenses and higher life quality, therefore it is worthy to be popularized.

To study the characteristics of histopathologic features of small renal carcinoma.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.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 and2.0 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 group2.0 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.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.

To determine whether the extruded irrigation solution bag during passage of rigid cystoscope will reduce the patient's discomfort.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.The visual analog pain score was 2 (1-2) in the IUPU technique group and 4 (3-6) in the routine manipulation group (P0.001, Mann-Whitney U test). All the procedure indications had no effect on the findings.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.

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.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.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.Surgical resection for local recurrence of RCC in selected patients is a feasible management and may prolong the survival time.

To summarize more than thirty years of experience with urachal carcinoma and to discuss the clinical features of urachal carcinoma.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.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).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.

To investigate the pathological feature, therapy and prognosis of bilateral sporadic renal cell carcinoma.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.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.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.

To evaluate the surgical management and long-term outcomes of patients with renal cell carcinoma and venous tumor thrombus.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.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).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.

Sunitinib has been proved an effective new option for treatment of metastatic renal cell carcinoma (mRCC). Analysis of clinical data of 22 patients, who were exposed to sunitinib for at least 1 year, was conducted to evaluate the long-term efficacy and safety of sunitinib for the treatment of mRCC.A total of 54 patients with mRCC were treated with sunitinib malate, 50 mg/d orally, on a 4-weeks-on and 2-weeks-off dosing schedule in Peking University First Hospital. Treatment continued until disease progression, unacceptable adverse events (AEs), or death. Among them, 22 patients continued treatment for at least 1 year. The clinical data of these 22 patients were prospectively collected for analysis. AEs were assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 3.0. Tumor response was evaluated in accordance with the Response Evaluation Criteria in Solid Tumors.Median progression-free survival was 19.5 months until last follow-up. The best efficacy results achieved were complete response, partial response, and stable disease for 2, 9, and 11 patients, respectively. Objective response rate was 50%. The most common AEs were hand-foot syndrome (95%) and hypertension (91%). Other common AEs were thyroid-stimulating hormone elevation (82%), platelet decrease (77%), and loss of appetite (77%). Only one patient withdrew from treatment for cardiac infarction. Another nine patients experienced dose modifications or short-term suspensions.Long-term exposure to sunitinib malate showed encouraging efficacy in the treatment of mRCC. At the same time, the tolerability was good.

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.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.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, P0.001), high grade (HR 5.007, P0.001), ipsilateral hydronephrosis (HR 4.768, P0.001), renal pelvis location (HR 2.620, P0.001) and tumour without multifocality (HR 1.639, P = 0.028) were predictive factors for muscle-invasive UTUC. Male gender (HR 2.132, P0.001), renal pelvis location (HR 3.466, P0.001), tumour without multifocality (HR 2.532, P = 0.001), sessile tumour architecture (HR 3.274, P0.001), and high grade (HR 3.019, P0.001) were predictive factors for non-organ-confined disease. Chronological old age (HR 1.047, P0.001), sessile tumour architecture (HR 25.192, P0.001), 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.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.

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.

To analyze the clinicopathologic features of 10 Chinese prostate adenocarcinoma patients under 50 years.Between January 2007 and April 2012, 10 cases of prostate adenocarcinoma patients under 50 years (age: 36-49) were diagnosed at our institution through prostate biopsy. The indications of biopsy were abnormal digital rectal examination (7 cases) and/or a total prostate specific antigen (PSA) over 4.0 μg/L (4 cases). The clinicopathological data of these patients were reviewed. The results of biopsy were 1 case with Gleason score (GS) 6, 4 cases with GS 7 and 5 cases with GS 9. In the study, 7 patients were diagnosed with cT4. Lymph node metastasis and bone metastasis were found in 5 and 4 cases, respectively. The treatments were hormonal therapy in 5 cases, radical prostatectomy in 2 cases and combination therapy in 3 cases.During the follow-up, 6 patients were in progression within 3 to 7 months, 1 patient died after 3 years, and 4 patients were lost of the follow-up.These findings suggest that the Chinese prostate adenocarcinoma patients with age under 50 years are likely to have more aggressive tumor and combination therapy might be appropriate.

To investigate and analyze the treatment and Long-term follow-up results of adult Wilms' tumor.Medical records for diagnosed Wilms' tumor in patients aged more than 15 years from Jan. 1970 to Dec. 2011 were reviewed retrospectively. The clinical presentations, stages, operative details, pathologic findings, adjuvant therapies and outcomes were analyzed. All the patients received regular follow-up, and particular attention was paid to the median follow-up period and tumor specific survival time.The records revealed the 10 patients with a median age of 33.5 year. Male and female were each 5. Left was 4 and right was 6. In the study, 80% of the patients had clinical presentations, and 30% of the patients presented with abdominal mass, and 30% of the patients had distant metastasis at the time of diagnosis. The number of the patients with tumor stages I,II, III, and IV were 2, 1, 4, and 3. One patient just underwent fine needle biopsy due to advanced tumor stage, and the others underwent surgical operations. The range of the follow-up time was 12 to 187 months, and the median follow-up period was 20 months. One patient lost the follow up , 5 patients died, 2 patients survived with tumor recurrence, and 2 patients survived without tumor recurrence. The median survival period was 42 months, and one patient lost the follow-up.The Long-term follow-up data demonstrated the poor prognosis of adult Wilms' tumor. Early tumor stage and the combination of operation, radiotherapy and chemotherapy are key factors to improve the outcomes.

To evaluate the changes in perioperative outcomes that might refect progress along the learning curving by a single-surgeon's experience in our institution with laparoscopic radical cystectomy (LRC).This report was conducted between May 2004 and January 2012 in 60 patients (9 women and 51 men) who underwent LRC for bladder cancer. The mean patient age was (60.8±11.4) years, and mean BMI was (23.9±2.7) kg/m(2). We divided the patients into 3 groups (group A, group B, and group C; each group had twenty patients) by the time, and compared the operative time, intraoperative blood loss, hospital stay among the three groups.The mean intraoperative blood loss was (799.2±717.8) mL, the mean operative time was (420.2±119.8) minutes, and the mean hospital stay was (15.7±11.0) d; There was no statistically significant difference in age, American Society of Anesthesiologists (ASA) scores and BMI among the three groups (P0.05). Their operative time was (497.5±131.2), (413.6±75.6) and (349.4±100.2) minutes, respectively, for each group, P0.001. The intraoperative blood loss was (1 080.0±1 028.8), (862.5±510.6) and (455.5±262.3) mL, for each group, P=0.018. The hospital stay was (20.8±13.5), (16.4±10.6) and (9.8±4.4) d, for each group, P=0.005. However, there was no statistically significant difference in postoperative complications among the three groups.Our experience of LRC appears to be favorable with reduction in blood loss, operative time and hospital stay with increasing experience. The curving shows a significant decline at 2 different breakpoints: after the first 20 cases, and after 40 cases.

To investigate the predictive value of prostate-specific antigen (PSA) and Gleason sum for results of radionuclide bone scintigraphy in prostate cancer patients, in order to determine when to perform a radionuclide bone scintigraphy in Chinese patients with newly diagnosed prostate cancer.We retrospectively reviewed the charts of 624 consecutive patients with a pathology diagnosis of prostate cancer hospitalized in Department of Urology, Peking University First Hospital between Jan. 1994 and Dec. 2005, and evaluated the relationships between results of bone scintigraphy and serum tPSA, and between bone scintigraphy and Gleason sum. The receiver operating characteristics (ROC) curves were analyzed to determine the cut-off values of tPSA and Gleason sum for predicting positive results of bone scintigraphy.In the study, 443 patients underwent both a radionuclide bone scan and a serum PSA test prior to treatment, of whom, 216 (48.8%) got positive results, and 338 also possessed the Gleason sum for pathological evaluation. The serum tPSA levels were significantly higher in patients with positive results of the bone scan ( median: 71.00 μg/L; range: 1.30-2 400.00 μg/L) than those with negative results ( median: 60.00 μg/L; range: 0.60-201.00 μg/L; rank P0.001), and the Gleason sums were also significantly higher in positive-bone-scan patients than in negative-bone-scan patients (7.7±1.5 vs. 6.7±1.8, P0.001). Linear regression analysis suggested significant positive correlation between the results of the bone scan and the two afore-mentioned parameters, respectively (lg[PSA]: r=0.933, B=0.352, P=0.001; Gleason sum: r=0.971, B=0.096, P0.001). The incidence of a positive bone scan result was 9.0% in patients with tPSA10 μg/L and 3.8% in patients with Gleason sum5. When the indication for bone scan was established as tPSA15 μg/L or Gleason sum≥7,its sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for positive results were 97.5%, 24.7%, 54.4%, 91.5% and 60.0%, respectively.In patients with prostate cancer, their positive results of the bone scan are significantly positively correlated to their higher PSA levels and higher Gleason sums, respectively. Our analyses suggest that a patient with newly diagnosed prostate cancer would not need to undergo radionuclide bone scintigraphy when the PSA level is lower than 10 μg/L and Gleason sum is less than 5, and that a prostate cancer patient with tPSA15 μ g/L or Gleason sum≥7 should take a bone scintigraphy.

To summarize the clinical outcome and adverse events of estrogen therapy for hormone refractory prostate cancer.A total of 32 patients with hormone refractory prostate cancer received diethylstilbestrol (DES) 2 mg daily at our institute. The data of PSA (prostate-specific antigen) change, time to progression, overall survival rate, disease-specific survival rate and adverse events were collected and analyzed.The data of 29 patients were complete. The mean duration of DES dosing was 8.6 ± 0.9 months. Among them, 8 (27.5%) patients achieved a PSA response with a 50% decrement of PSA or more. Seven (24.1%) patients had a stable level of PSA (50%PSA125%) while 14 of 29 (48.3%) maintained a PSA progression with a 25% increment of PSA or more. The overall median time to progression was 4 (1 - 12) months. And the median time to progression was 6 (5-12) months in the PSA response group. The overall survival rate was 48.3% and disease-specific survival rate 55.2%. The main adverse events were gynecomastia (10/29, 34.5%) and deep vein thrombosis (3/29, 10.3%).When used for the treatment of hormone refractory prostate cancer, diethylstilbestrol at a daily dose of 2 mg can achieve a PSA response in 27.5% patients and a PSA stability in 24.1% patients. And the median time to progression is 4 months. Estrogen is efficacious for the patients with hormone refractory prostate cancer.

The tyrosine kinase inhibitors (TKIs) sunitinib, the first targeted agent for the first line treatment of metastatic renal cell carcinoma (RCC), targets the vascular endothelial growth factor (VEGF) pathway. The objective of this study was to investigate the efficacy and safety of sunitinib in treating metastatic clear-cell RCC and to confirm if hypertension is an effective predictive factor.A total of 36 patients with metastatic RCC were enrolled between June 2008 and December 2010. Among them 29 cases were first line therapy and 7 cases were in progression on first-line cytokine or sorafinib therapy. The pathology of all patients was confirmed predominant in clear cell type. Sunitinib mono-therapy was administered in repeated 6-week cycles of daily oral therapy for 4 weeks, followed by 2 weeks off in 34 patients; and 3 patients were administered with 37.5 mg/d continuously until disease progression or unacceptable toxicities occurred. Overall response rate and safety were evaluated. We divided patients into Group A and Group B according to the blood pressure level.The median follow-up was 15 months (10 cycles, range 1.5 - 30.0 months (1 - 20 cycles)). Ten patients (29.4%) achieved partial responses (PR); 23 patients (67.6%) demonstrated stable disease (SD) lasting ≥ 2 cycles. Seventeen patients (50%) developed progressive disease (PD) during follow-up. The median progression-free survival (PFS) was 15 months (range 3.0 - 28.5) months. A total of 9 patients died; the overall survival has not been reached; the median survival time of the deceased patients was 13 months (range 7 - 24) months. The most common adverse events were hand-foot syndrome (77.8%), thrombocytopenia (75.0%), hypertension (61.1%) and diarrhea (46.0%). Most adverse events were reversible by treatment interruption. Twenty-two patients (61.1%) developed hypertension; and hypertension was associated with a long time to disease progression and long overall survival (P = 0.004, 0.000, respectively).The results of this study demonstrate the efficacy and manageable adverse event profile of sunitinib as a single agent in first- or second-line therapy for patients with metastatic clear cell RCC. Further, sunitinib-associated hypertension may be a strong predictive marker for treatment efficacy in metastatic RCC.

To discuss the surgical skills and clinical value of complete transperitoneal laparoscopic nephroureterectomy.We collected and analyzed the clinical data of 25 patients (14 renal pelvic carcinoma and 11 carcinoma of ulreter, right side 15 and left side 10) who underwent complete transperitoneal laparoscopic nephroureterectomy for the upper urinary tract urothelial carcinoma (UUT-UC) in Peking University First Hospital from May 2010 to April 2011.All the operations were successfully done by one surgeon with standard 4 or 5 trocars technique. The mean operative time was 150 min (120-180 min), the blood loss about 20-100 mL (mean 40 mL) and no severe complications observed. The postoperative hospital stay was 4-6 days with an average length of 5.5 days. The mean follow-up was 5.5 (1-11) months. One of 19 patients underwent trans urethral resection of bladder tumour (TURBT) for recurrent non-muscle invasive bladder tumor.Complete transperitoneal laparoscopic nephroureterectomy is a minimally invasive, safe and effective way to treat UUT-UC. The patients recover soon and have a shorter length of stay.

To discuss the feasibility and safety of laparoscopic transperitoneal and transmesenteric pyeloplasty for recurrent ureteropelvic junction obstruction (UPJO).From May 2006 to June 2008, we admitted 5 cases of recurrent UPJO who had received open retroperitoneal pyeloplasty with 3 males and 2 females. They were 19 to 32 years old with the average of 24.5 years and suffered from recurrent UPJO 3 to 16 years with the average of 7.8 years after operation. They felt discomfort in the lumbar region to different extent and their intravenous pyelography (IVP) or computerized tomography for urinary system (CTU) showed typical UPJO. The nucleotide renal scan (NRS) revealed that the renal excretion was slow, even after intravenous injection of diuretics. The laparoscopic transperitoneal and transmesenteric pathway was done in such a way that the incision was longitudinal at the mesentery of small intestine near the affected ureteropelvic junction (UPJ). The UPJ was isolated to avoid injuring the intestine and the mesenteric blood vessels. The UPJO was removed with the routine Anderson-Hynes technique and the anastomosis between pelvis and ureter was carried out by 2 separate and running sutures.The operating time was 105-230 min with the average of 165 min and the estimated blood loss was 50 to 120 mL with the average of 75 mL. Patients left bed on the first day and the drainage tube was taken out on the 4th to 5th day after the operation. There were no other injuries and complications. By October of 2008, they had been followed up for 33 to 49 months with the average of 37.5 months and IVP or CTU and the diuretic NRS showed smooth excretion of the operated UPJ.As for experienced hands, the laparoscopic transperitoneal and transmesenteric pyeloplasty is feasible and safe for recurrent UPJO, but it's not recommended to the beginners of laparoscopic procedures.

To assess the clinical utility of a fluorescence in situ hybridization (FISH) assay as a non-invasive method for diagnosing and monitoring urothelial carcinoma (UC) in the upper urinary tract (UUT).Urine specimens from 63 consecutive patients with UUT-UC and 69 controls with benign disease were analyzed by means of cytology and FISH. For FISH analysis, labeled probes specific for chromosomes 3, 7, and 17 and for the p16 (9p21) gene were used to assess chromosomal abnormalities indicative of malignancy.Sensitivity and specificity of both techniques were determined and compared. The frequency of chromosomal aberrations of malignant cells from UUT-UC was also determined.Of 63 patients with UUT-UC, FISH affords an overall sensitivity of 84.1% (53/63), the figure being 71.4% (20/28) for PTa and PT1 tumors,94.3% (33/35) for PT2-4 tumors. The sensitivities of urine cytology were 35.7% (10/28) for PTa and PT1 tumor,45.7% (16/35)for PT2-4 tumors,with an overall sensitivity of 41.3% (26/63). The sensitivities of the two methods for the low grade tumors were 80% (20/25) and 44% (11/25), and for high grade tumors were 86.8% (33/38) and 39.5% (15/38), respectively. Specificities for FISH and urine cytology were 91.3% (63/69) and 94.2% (65/69)respectively.According to the results,the sensitivity of FISH for the detection of UUT-UC is superior to that of urine cytology and the specificities of FISH and urine cytology are not significantly different. FISH can promote the diagnosis of UUT-UC, especially for the low stage and low grade cases,it may be a new promising non-invasive method for the diagnosis of UUT-UC.

To investigate the effect of intermittent hormonal therapy (IHT) for patients with different stage/grade prostate cancer (PCa).The number of cycles and the duration of ON/OFF therapy for 45 PCa patients receiving IHT were observed. Maximal androgen blockade (MAB) therapies were used for six to nine months, and then stopped until the serum prostate specific antigen (PSA) was decreased below 0.2 microg/L, which lasted for three months. It was decided whether MAB went on according to the level of PSA.The average follow-up time was 40.7+/-13.4 months. Forty-one patients started the second cycle of treatment, of whom, 8 became androgen-independent and 7 were at T3-4M0 or M1 stages and the Gleason scores were above 8. Sixteen patients entered the third cycle, of whom, 14 were at lower than stage III and 13 had the Gleason scores below 7. From the first to the fourth courses of treatment, the average intervals were 8.7+/-5.4 (47.1%), 8.4+/-4.9 (49.3%), 7.0+/-3.4 (43.7%), and 3.7+/-0.6(42.5%) months respectively. Five patients developed bone metastasis. No one died up to now. According to the evaluation criteria, patients were divided into tolerance (n=16) and intolerance groups (n=29). Compared with the intolerance group, the patients who tolerated the treatment well had lower Gleason scores (P=0.002), lower PSA levels (P=0.053) and lower tumor stages (P=0.001). There was no evidence that age, lymph node metastasis, bone metastasis and the state of recurrence were associated with an increased risk of the outcome. Non-conditional Logistic regression analysis showed that the proportion of patients at stage IV was the only independent risk factor for the tolerance of the treatment (OR=12.113, 95%CI 1.330-110.312, P=0.027).Intermittent hormonal therapy is more effective and proper for the patient with highly differentiated tumor and at lower stages (or = III). The patients who progressed to hormone-independence are mostly at stage IV with poorly differentiated tumor. Intermittent hormone therapy could be more adaptive for the patients at lower than stage III.

To describe our diagnostic and therapeutic experience of patients with urinary tract endometriosis.We performed a retrospective analysis of 22 cases of urinary tract endometriosis with histopathological results from 2001 to 2007.The mean patient age was 36.0 years. Of the 22 patients, 4 had bladder involvement and 18 ureteral involvement. In those with bladder endometriosis, the diagnosis was made by cystoscopy and biopsy in 4 patients. The treatments consisted of partial cystectomy in 3 patients and transurethral resection of the bladder in 1 patient. One of the patients who underwent transurethral resection of the bladder experienced 1 relapse. The relapse was treated with partial cystectomy. In the patients with ureteral endometriosis, the diagnosis was mainly established by ultrasound (18 cases), intravenous urography (11 cases), retrograde pyelography (7 cases), CT (14 cases) and MRI (5 cases). The treatments consisted of ureterolysis in 1 patient,ureteroneocystostomy in 4, and ureteral resection and end-to-end anastomosis in 13 of them. All the patients pathologic results were of endometriosis.Urinary tract endometriosis is an uncommon disease. Partial cystectomy should be considered as the therapeutic option for bladder endometriosis . For cases of ureteral endometriosis, the first technique depends on the location, extent and depth of the lesion.

To investigate changes of the stage, age of onset, and prostate specific antigen (PSA) level of prostate cancer with socioeconomic development and medicare promotion.The medical records of 784 inpatients with prostate cancer were analyzed retrospectively, who were diagnosed in Peking University First Hospital from 1997 to 2007. According to the time of diagnosis, all the patients were sorted into three groups: earlier group (1997-2001), intermediate group (2002-2004), and contemporary group (2005-2007). The tumor stages, ages, Gleason scores, and PSA levels of each group and of the three groups were compared to determine whether the discrepancies were significant.The discrepancies of ages, Gleason scores, and stages between earlier and intermediate groups were not significant. The differences of ages and stages between intermediate and contemporary groups were not significant, but the change of Gleason scores was significant. The discrepancies of Gleason scores and stages between earlier and contemporary groups were meaningful, but the change of ages was not significant.As time passes, PSA levels and tumor stages of prostate cancer patients show a descending trend, but the discrepancy of ages between the three groups is meaningless. The weight of low risk and intermediate risk groups in localized prostate cancer is becoming heavy.

To compare the safety and efficacy of laparoscopic and open partial nephrectomy for small renal cell carcinoma.To collect and analyze the data such as operation time, warm ischemia time, complications, recovery and surgical margins of 110 patients of small renal carcinoma (T1aN0M0) from January 2004 to March 2009, 52 of which underwent laparoscopic partial nephrectomy (LPN) and the other 58 patients underwent open partial nephrectomy (OPN).The mean operation time of LPN group and OPN group were 177.8 min and 126.7 min (t = 3.973, P0.01), respectively. The warm ischemia time of the two groups were 28.3 min and 21.9 min (t = 4.627, P0.05), respectively. Two cases in LPN group and 1 case in OPN group (3.8% vs 1.7%, chi(2) = 0.010, P0.05) needed blood transfusion. The increment of creatine after operation were 4 micromol/L in LPN group and 6 micromol/L in OPN group (t = -2.018, P0.05). Six cases (11.5%) in LPN group and 8 cases (13.8%) in OPN group needed collection system repairing (chi(2) = 0.130, P0.05)and the same data of hematuria after operation was observed. There was no urinary fistula or other severe complications in all patients. The hospital stay after operation was 10.6 d and 12.9 d (t = -3.244, P0.01) in the two groups, respectively. All surgical margins were negative.LPN and OPN have the same safety and efficacy, LPN primary treatment can be used for selected patients of T1aN0M0 renal cell carcinoma because of its fast recovery.

To evaluate the efficacy and safety of Sunitinib in the treatment of metastatic renal clear cell carcinoma in our institution.A total of 23 patients with metastatic clear cell RCC were enrolled from June 2008 to June 2009, male 16, female 7, median age 52 years. Twenty cases were treated by using Sunitinib as first-line therapy and 3 cases as second-line therapy. All pathological diagnosis was clear cell carcinoma. Sunitinib monotherapy was administered in repeated 6-week cycles of daily oral for 4 weeks, followed by 2 weeks off, until disease progression or intolerable toxicities occurred. Overall response rate and safety were evaluated.The median follow-up were 7.5 months (5 cycles). Four of 23 patients (17.4%) were treated with Sunitinib achieved partial responses (PR); 18 patients (78.3%) demonstrated stable disease (SD); 1 patient (4.3%)developed progressive disease (PD) during the study. Seventeen patients received treatment over 6 months (5 cycles). The 6 months' overall survival rate was 100%, 6 months' progression-free survival rate was 88.2%. The most commonly reported grade 3 adverse events included hand-foot syndrome (13.0%), thrombocytopenia(8.7%), diarrhea (4.3%)and fatigue (4.3%). Most grade 3 adverse events were ameliorated by dose-adjustment or treatment interruption.The results of this study demonstrate the efficacy and manageable adverse-event profile of Sunitinib as a single therapy in first-line or second-line therapy for patients with metastatic clear cell RCC.

To determine the diagnostic value of multislice CT urography (MSCTU) in patients with transitional cell carcinoma (TCC) of upper urinary tract by comparing other imageology methods used.Two hundred and thirty four cases of transitional cell carcinoma of upper urinary tract, in which 82 cases were diagnosed pathologically with pelvic carcinoma and 152 cases with ureteral carcinoma, between June 2004 and September 2006 in our institute were enrolled in a retrospective study. Most of them underwent urological ultrasound, intravenous urogram (IVU), retrograde pyelography and MSCTU. We compared the positive rate (PR) and diagnostic rate (DR) of these methods used by chi-square test.Among the 234 cases, 215 patients underwent urologic ultrasound, in which 152 cases were detected to be abnormal, with the PR of 70.7%; Meanwhile, 58 cased were diagnosed by this examination, with the DR of 27.0%. IVU was performed in 193 patients and 132 cases were found to be abnormal, and the PR was 68.4%, 65 cases were diagnosed by IVU and the DR was 33.7%. And 132 patients underwent retrograde pyelography, by which 115 cases of lesion were detected, with the PR of 87.1%; In the meantime, 93 cases were diagnosed, with the DR of 70.5%. MSCTU was performed in 226 cases and 220 cases were found to be abnormal, and the PR was 97.3%; 214 cases were diagnosed by MSCTU, with the DR of 94.7%. The DR of detecting TCC of retrograde pyelography had statistically significant difference with that of ultrasound and IVU (P0.001). As compared with retrograde pyelography, MSCTU had statistically significant superiority (P0.001).To shorten the diagnosis time and mitigate the sufferings, patients with hematuria supposed to be TCC of upper urinary tract should be recommended to undergo MSCTU first.

To evaluate and improve the diagnosis and surgical treatment of the retroperitoneal fibrosis (RPF).The medical records of 26 patients with the RPF (21 men and 5 women with mean age 54 years) were analyzed retrospectively. They were been treated from January 1996 to May 2007. Fourteen cases received double-J inter-ureter drainage or pricking pyelostomy and 9 of 15 cases who received open surgery were performed bilateral ureterolysis with their ureters translocated intraperitoneally.For masses in retroperitoneal space, the diagnostic rate of B mode ultrasonography, CT and MRI was 12% (3/26), 86% (18/21) and 57% (8/14) respectively. The patients were followed up from 1 to 106 months. After drained by double-J inter-ureter stent or pricking pyelostomy, the mean serum creatinine level decreased from 373.9 micromol/L to 157.1 micromol/L of 14 patients. Those patients who underwent ureterolysis with ureteral intraperitoneal translocation had good results and their mean serum creatinine level decreased from 171.0 micromol/L before operation to 139.6 micromol/L after operation. Four patients had normal B-ultrasound and intravenous urogram findings with at least 24 months of follow-up.CT scan has better accuracy for diagnosis of the RPF than B mode ultrasonography and MRI. Prompt and appropriate relief of urinary obstruction with surgical intervention can effectively protect the renal function in patients with the RPF, and the ureterolysis with ureteral intraperitoneal translocation is an effective surgical procedure to treat this disease.

A 35-year-old woman patient, complained of intermittent pain in the left flank for a week. Abdominal ultrasound and computed tomography scan revealed a left renal mass. Nephrectomy was performed, and a final diagnosis of adult Wilms' tumor was made based on histopathology and immunohistology. Chemotherapy was conducted for 4 times with dactinomycin D, vincristine and doxorubicin after surgery. At the time of the last recheck, the patient was alive with no evidence of disease. Adult Wilms' tumor is the exceptional malignant renal tumor. Only 1%-2% of Wilms' tumor is diagnosed in adult patients. Because of unspecific tumor symptoms in adults, the diagnosis is frequently made by histology. The diagnosis of adult Wilms' tumor is difficult to make preoperatively because diagnostic imaging only confirms the presence of a renal mass. Stage and histology are the clinical factors guiding the selection of postsurgical treatment and prognosis. Having retrospected 6 cases of adult Wilms' tumor between 1950 and 2007 and reviewed related reports, we conclude that the proper strategies of adjuvant treatment as applied to childhood Wilms' tumor patients after surgery can conspicuously improve the outcome in adult patients.

To evaluate the prognostic factors of ureter transitional cell carcinoma (TCC).Between January 2001 and December 2005 133 TCC patients were treated. And the data was retrospectively analyzed.A mean age of the 133 patients was 68 years (range 43 - 87 years) at diagnosis. Altogether the non-invasive ureter TCC was found in 42 patients (31.6%) and the invasive ureter TCC in 91 patients (68.4%). Invasive ureter TCC growth was more common in distally located tumors (82.5%) compared to mid (62.5%) and proximal ureter (47.1%). Tumor stage, grade and location of the tumor were all correlated with disease specific survival in a univariate analysis. In a multivariate Cox analysis, tumor stage and grade were significantly associated with disease specific survival.More invasive tumors are found in ureter than in bladder. Ureter cancer is more frequently found in the distal part. Distally located ureteral tumors are more likely invading into the muscular cell layers compared to proximally located tumors. Tumor stage and grade are still the more important prognostic factors for ureter TCC.

To investigate the expression of nucleosomal binding protein 1 (NSBP1) in normal prostate (NP), benign prostate hyperplasia (BPH), and prostate cancer (PCa) and significance thereof.Western blotting was used to detect the expression of NSBP1 in 10 specimens of NP from voluntary donors who died of accidents, and 15 specimens of PCa resected during operation. Immunohistochemistry was used to detect the NSBP1 expression in 19 specimens of NP resected during complete cystectomy from patients with bladder carcinoma, and 26 specimens of BPH and 40 specimens of PCa, all resected during operation.Western blotting showed that the relative optical density (OD) of NSBP1 in the PCa tissue was 0.66 +/- 0.02, significantly higher than that of the NP tissue (0.26 +/- 0.03, t = 37.308, P0.01). Immunohistochemistry showed that the positive and weak positive rates of protein expression of NSBP1 in the PCa tissue was 80.0% (32/40), significantly higher than those of the NP tissue (36.8%, 7/19) and BPH (34.6%, 9/26) (t = -3.569 and t = -4.152, both P0.01). The NSBP1 expression level in the PCa tissue was not correlated with the pathological staging, grade, and serum prostate-specific antigen (P = 0.911, 0.666, and 0.779).Highly expressed in the PCa tissue, NSBP1 protein is may be involved in the carcinogenesis of PCa.

To investigate the prognosis of surgical treatment for renal cell carcinoma with renal vein or inferior vena cava tumor thrombus.Between August 1994 and July 2004, 33 patients with renal cell carcinoma with renal vein or inferior vena cava tumor thrombus underwent radical nephrectomy and thrombectomy. The study population included 26 male and 7 female. The median age was 60 years (20 - 82). Level of tumor thrombus was renal vein in 15 patients, infrahepatic (level I) in 9, intrahepatic (level II) in 5, suprahepatic (level III) in 1, and right atrial extension (level IV) in 3. Survival analysis was made with Kaplan-Meier method.Twenty-nine patients can be followed up. Fourteen patients were lost with a mean survival time of (16.4 +/- 2.9) months (1 - 42 months). Fifteen patients were survival with a mean follow-up of (17.3 +/- 4.6) months (3 - 67 months). One patient was lost on the second postoperative day. Three patients can not be followed up. The 5-year Kaplan-Meier survival rate was 16%. The mean survival time of patients with renal vein involvement [(49.9 +/- 9.8) months] versus level I [(16.7 +/- 1.9) months] was significantly different (P0.05).Radical nephrectomy plus thrombectomy is a valuable method for the treatment of renal cell carcinoma with renal vein or inferior vena cava involvement. Patients with renal vein tumor thrombus appear to have better survival compared to patients with inferior vena cava tumor thrombus.

To explore the method of predicting the stage of prostate cancer with serum prostate-specific antigen (PSA) and pathological grade.One hundred and eighty-seven patients were studied retrospectively with prostate cancer diagnosed by systemic biopsy in our hospital. The rank correlation analysis, rank sum test and stepwise discriminant multivariate analysis were used to assess the correlation of serum PSA level, ratio of free PSA to total PSA (FPSA/TPSA ratio) with Gleason score (GS) and stage.Serum PSA level increased with GS for prostate cancer patients (r = 0.369, P0.001). With increasing stage, serum PSA level and GS increased (r = 0.398, 0.530, P0.001). Overall, FPSA/TPSA ratio was not correlated with stage (P0.70), but a significant negative correlation was demonstrated between them when serum PSAor = 10 microg/L (r = -0.600, P0.05). When serum PSA20 microg/L, 67% - 87% patients with prostate cancer may be stage C or D. The equation using serum PSA and GS to predict the stage of patients with prostate cancer was: x = -3.488 + 0.041 x PSA + 0.428 x GS.Serum PSA level is positively correlated with GS for prostate cancer patients. Serum PSA level and GS are positively correlated with stage. A negative correlation between FPSA/TPSA ratio and stage is demonstrated when serum PSAor = 10 microg/L. The combination of serum PSA and GS may predict the stage of patients with prostate cancer.

To summarize the experience of ultrasound guided percutaneous aspiration and sclerotherapy for peripelvic cysts and investigate the clinical effect.A total of 169 cases of peripelvic cyst patients were evaluated, of whom 36 cases (21.3%) had hydronephrosis secondary to peripelvic cysts, 8 cases (4.7%) had renal calculus. All patients underwent ultrasound and intravenous phelography (IVP) examination, 59 patients also had CT scan. Hydatid fluid was analyzed by amine test. Percutaneous aspiration was guided by ultrasound, 95% alcohol was used to sclerosis the peripelvic cysts when amine test was negative or positive but did not have communication with pelvis through opacification. Ultrasound were done at 1, 3, 6 months and every 1 year thereafter, follow-up period were 6 months to 5 years.One hundred and sixty-five peripelvic cysts (97.6%) were cured by once sclerotherapy, the diameter of another 4 cases (2.4%) diminished to less than 1.5 cm by once sclerotherapy. Thirty-six cases of hydronephrosis were all resolved after sclerotherapy. Eight cases had renal calculus, of whom 4 cases underwent extracorporeal shockwave lithotripsy, 2 cases underwent percutaneous nephrolithotomy, and 2 cases did not treat the stone. Five patients had gross hematuria after aspiration, but all diminished in 3-5 d.Ultrasound guided percutaneous aspiration and sclerotherapy for peripelvic cysts had the superiority of safety, effectiveness micro-invasion and low complication.