以累积和分析法研究保留耻骨后间隙机器人辅助根治性前列腺切除术的学习曲线

目的通过应用累积和分析(CUSUM)法,探讨保留耻骨后间隙机器人辅助根治性前列腺切除术(RsRARP)的学习曲线,评估手术者的学习过程。方法回顾性分析2016年10月至2021年9月1日由单术者连续进行的161例RsRARP患者的临床资料。应用CUSUM法以手术时间作为衡量指标分析RsRARP学习曲线。根据CUSUM分析结果,确定手术学习曲线的拐点,利用学习曲线变化的拐点划分学习阶段,比较学习曲线各阶段的术中失血量、手术时间、并发症、切缘阳性率和术后尿控等指标。并采用Kaplan-Meier曲线计算术后尿控情况。结果161例患者手术均顺利完成,无中转开放。根据CUSUM分析,学习曲线可分为三个阶段:早期学习37例,技能提高71例,熟练掌握53例。随着手术例数的增加,手术时间明显缩短(P<0.001),术中出血明显减少(P<0.001),术后住院时间明显缩短(P<0.001)。熟练掌握阶段中位手术时间为185 min,术后即刻尿控率为64.2%,pT_(2)期患者切缘阳性率为11.3%,pT_(2)期患者的1年无生化复发率为96.7%。三个阶段的即刻尿控率、并发症发生率、切缘阳性率、生化复发率差异无统计学意义。结论通过应用CUSUM分析方法,对RsRARP的学习曲线进行了量化评估,为该手术的培训和推广提供了重要参考。

Environmental microcystin exposure triggers the poor prognosis of prostate cancer: Evidence from case-control, animal, and in vitro studies

Microcystin-leucine-arginine(MC-LR)is positively linked with multiple cancers in humans.However,the association between MC-LR and the risk and prognosis of prostate cancer has not been conducted in epidemiological studies.No reported studies have linked MC-LR exposure to the poor prognosis of prostate cancer by conducting experimental studies.The content of MC-LR was detected in most of the aquatic food in wet markets and supermarkets in Nanjing and posed a health risk for consumers.MC-LR levels in both prostate cancer tissues and serum were significantly higher than controls.The adjusted odds ratio(OR)for prostate cancer risk by serum MC-LR was 1.75(95%CI:1.21-2.52)in the whole subjects,and a positive correlation between MC-LR and advanced tumor stage was observed.Survival curve analysis indicated patients with higher MC-LR levels in tissues exhibited poorer overall survival.Human,animal,and cell studies confirmed that MC-LR exposure increases the expression of estrogen receptor-α(ERα)and promotes epithelial-mesenchymal transition(EMT)in prostate cancer.Moreover,MC-LR-induced decreased E-cadherin levels,increased vimentin levels,and increased migratory and invasive capacities of prostate cancer cells were markedly suppressed upon ERαknockdown.MC-LR-induced xenograft tumor growth and lungmetastasis in BALB/c nude mice can be effectively alleviated with ERαknockdown.Our data demonstrated that MC-LR upregulated vimentin and downregulated E-cadherin through activating ERα,promoting migration and invasion of prostate cancer cells.Our findings highlight the role of MC-LR in prostate cancer,providing new perspectives to understand MC-LR-induced prostatic toxicity.

Indications,strategies,and development on prostate targeted biopsy:Report of the Panjiayuan Consensus Conference 2022

Prostate biopsy is the gold standard for diagnosing prostate cancer(PCa).Prostate targeted biopsy(TB)having a higher rate of detecting clinically significant PCa(csPCa)than traditional systematic biopsy(SB)is supported by high-quality evidence.However,the TB indications and strategies are controversial.The National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences,invited a panel of recognized urology experts in PCa to address these topics at the Panjiayuan Consensus Conference 2022.The conference results on prostate TB are presented herein.The National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences identified 10 key areas of prostate biopsy:(1)selection of imaging examination;(2)indications of TB;(3)transperineal and transrectal prostate biopsy;(4)TB pathways;(5)TB and SB;(6)three techniques of TB;(7)the number of TB cores needed for one lesion;(8)core number for SB;(9)free-hand TB;(10)future development of TB/prostate diagnosis.Thus,a panel of 25 recognized urologists and 2 radiologists from China were invited to attend this conference.The panel voted anonymously on 14 predetermined questions.Voting was based on the panelists'clinical practice and opinion,rather than high-level evidence.The voting outcomes were supported by the panel unequally,and details of the voting results were reported.The voting results can help clinicians to decide on biopsy timing and proper strategies,for which guidelines are sparse.We also focused on the future development of TB and SB,such as the combined pathway of TB and SB,techniques of TB,biopsy cores,free-hand TB,and prostate-specific membrane antigen positron emission tomography/computed tomography.

Efficacy and safety of LY01005 versus goserelin implant in Chinese patients with prostate cancer: A multicenter, randomized, open-label, phase III, non-inferiority trial

Background:LY01005(Goserelin acetate sustained-release microsphere injection)is a modified gonadotropin-releasing hormone(GnRH)agonist injected monthly.This phase III trial study aimed to evaluated the efficacy and safety of LY01005 in Chinese patients with prostate cancer.Methods:We conducted a randomized controlled,open-label,non-inferiority trial across 49 sites in China.This study included 290 patients with prostate cancer who received either LY01005 or goserelin implants every 28 days for three injections.The primary efficacy endpoints were the percentage of patients with testosterone suppression≤50 ng/dL at day 29 and the cumulative probability of testosterone≤50 ng/dL from day 29 to 85.Non-inferiority was prespecified at a margin of-10%.Secondary endpoints included significant castration(≤20 ng/dL),testosterone surge within 72 h following repeated dosing,and changes in luteinizing hormone,follicle-stimulating hormone,and prostate specific antigen levels.Results:On day 29,in the LY01005 and goserelin implant groups,testosterone concentrations fell below medical-castration levels in 99.3%(142/143)and 100%(140/140)of patients,respectively,with a difference of-0.7%(95%confidence interval[CI],-3.9%to 2.0%)between the two groups.The cumulative probabilities of maintaining castration from days 29 to 85 were 99.3%and 97.8%,respectively,with a between-group difference of 1.5%(95%CI,-1.3%to 4.4%).Both results met the criterion for non-inferiority.Secondary endpoints were similar between groups.Both treatments were well-tolerated.LY01005 was associated with fewer injection-site reactions than the goserelin implant(0%vs.1.4%[2/145]).Conclusion:LY01005 is as effective as goserelin implants in reducing testosterone to castration levels,with a similar safety profile.Trial registration:ClinicalTrials.gov,NCT04563936.

Crosstalk between IL-15Rα^(+)tumor-associated macrophages and breast cancer cells reduces CD8+T cell recruitment

Background:Interleukin-15(IL-15)is a promising immunotherapeutic agent owing to its powerful immune-activating effects.However,the clinical benefits of these treatments are limited.Crosstalk between tumor cells and immune cells plays an important role in immune escape and immunotherapy drug resistance.Herein,this study aimed to obtain in-depth understanding of crosstalk in the tumor microenvironment for providing potential therapeutic strategies to prevent tumor progression.Methods:T-cell killing assays and co-culture models were developed to determine the role of crosstalk between macrophages and tumor cells in breast cancer resistant to IL-15.Western blotting,histological analysis,CRISPR-Cas9 knockout,multi-parameter flow cytometry,and tumor cell-macrophage co-injection mouse models were developed to examine the mechanism by which IL-15Rα^(+)tumor-associated macrophages(TAMs)regulate breast cancer cell resistance to IL-15.Results:We found thatmacrophages contributed to the resistance of tumor cells to IL-15,and tumor cells induced macrophages to express high levels of theαsubunit of the IL-15 receptor(IL-15Rα).Further investigation showed that IL-15Rα^(+)TAMs reduced the protein levels of chemokine CX3C chemokine ligand 1(CX3CL1)in tumor cells to inhibit the recruitment of CD8^(+)T cells by releasing the IL-15/IL-15Rαcomplex(IL-15Rc).Administration of an IL-15Rc blocking peptide markedly suppressed breast tumor growth and overcame the resistance of cancer cells to anti-programmed cell death protein 1(PD-1)antibody immunotherapy.Interestingly,Granulocyte-macrophage colony-stimulating factor(GMCSF)inducedγchain(γc)expression to promote tumor cell-macrophage crosstalk,which facilitated tumor resistance to IL-15.Additionally,we observed that the non-transcriptional regulatory function of hypoxia inducible factor-1alpha(HIF-1α)was essential for IL-15Rc to regulateCX3CL1 expression in tumor cells.Conclusions:The IL-15Rc-HIF-1α-CX3CL1 signaling pathway serves as a crosstalk between macrophages and tumor cells in the tumormicroenvironment of breast cancer.Targeting this pathway may provide a potential therapeutic strategy for enhancing the efficacy of cancer immunotherapy.