The role of tumor size,ultrasonographic findings,and serum tumor markers in predicting the likelihood of malignant testicular histology

The clin ical predictive factors for maligna nt testicular histology remain unclear because of the low prevale nee.Therefore,the aim of this study was to investigate predictors of malignant histology for testicular masses and decide more testis-sparing surgeries before surgery.This retrospective study enrolled 325 consecutive testicular mass patients who underwent radical orchiectomy(310/325)or testicular preserving surgery(15/325)from January 2001 to June 2016.The clinicopathological factors,including tumor diameter,cryptorchidism history,ultraso und fin dings,serum alpha-fetoprotein,and human chorio nic gonadotropin(HCG)levels,were collected retrospectively for statistical an alysis.A predictive no mogram was also gen erated to evaluate the qua ntitative probability.Among all patients,247(76.0%)were diagnosed with a malignant testicular tumor and 78(24.0%)with benign histology.Larger tumor diameter(percm increased,hazard ratio[HR]=1.284,P=0.036),lower ultrasound echo(HR=3.191,P=0.001),higher ultrasound blood flow(HR=3.320,P<0.001),and abnormal blood HCG(HR=10.550,P<0.001)were significant predictive factors for malignant disease in all testicular mass patients?The nomogram generated was well calibrated for all predicti ons of malig nant probability,and the accuracy of the model no mogram measured by HarrelTs C statistic(C-in dex)was 0.92.According to our data,the proportion of patients who underwent radical orchiectomy for benign tumors(24.0%)was much larger tha n gen erally believed(10.0%).Our results in dicated that the diameter,ultras onic echo,ultras onic blood flow,and serum HCG levels could predict the malignancy in testicular mass patients.

Validation of the Pretreatment Neutrophil-to-Lymphocyte Ratio as a Prognostic Factor in a Large Cohort of Chinese Patients with Upper Tract Urothelial Carcinoma

Background：The pretreatment neutrophil-to-lymphocyte ratio （NLR） has been reported to be a prognostic factor in various types of carcinomas.The aim of this study was to investigate the prognostic value of pretreatment NLR in a large cohort of Chinese patients with upper tract urothelial carcinoma （UTUC）.Methods：We retrospectively analyzed the medical data of 656 UTUC patients who underwent radical nephroureterectomy （RNU） from 2001 to 2011 at Peking University First Hospital.Receiver operating characteristic （ROC） curve analysis was performed to calculate the optimal cutoffpoint of pretreatment NLR.Uni-and multi-variate analyses were used to identify the prognostic factors for cancer-specific survival （CSS） and intravesical recurrence-free survival （IVRFS）.Results：The optimal cutoff point of pretreatment NLR was 2.40 by ROC curves,by which patients with high NLR （NLR 〉2.40） and low NLR （NLR 〈2.40） accounted for 314 （47.9%） and 342 （52.1%） patients,respectively.Patients with a high pretreatment NLR tended to have high tumor grades （x2 =15.725,P〈 0.001）,high tumor stages （x2 =25.416,P〈 0.001）,tumor sizes 〉5 cm （x2 =8.213,P=0.005）,ipsilateral hydronephrosis （x2 =4.624,P =0.033）,and concomitant carcinoma in situ （CIS） （x2 =9.517,P =0.003）.A high pretreatment NLR （hazard ratio [HR] =1.820,P=0.001）,main tumor diameter 〉5 cm （HR =1.789,P =0.009）,lymph node metastasis （HR =1.863,P =0.024）,and high tumor stage （HR =1.745,P 〈 0.001） independently predicted poor CSS after surgery,while only concomitant carcinoma in situ （CIS） （HR =2.164,P =0.034）,ureteroscopy before surgery （HR =1.701,P =0.015）,and high tumor grade （HR =1.645,P =0.018） were independent predictors of IVRFS after RNU.Conclusions：The pretreatment NLR was related to some adverse clinicopathological features and was an independent predictor of CSS,although not IVRFS,in Chinese UTUC patients.