Although several models have been developed to predict the probability of Gleason sum upgrading between biopsy and radical prostatectomy specimens,most of these models are restricted to prostatespecific antigen screen...Although several models have been developed to predict the probability of Gleason sum upgrading between biopsy and radical prostatectomy specimens,most of these models are restricted to prostatespecific antigen screening-detected prostate cancer.This study aimed to build a nomogram for the prediction of Gleason sum upgrading in clinically diagnosed prostate cancer.The study cohort comprised 269 Chinese prostate cancer patients who underwent prostate biopsy with a minimum of 10 cores and were subsequently treated with radical prostatectomy.Of all included patients,220(81.8%) were referred with clinical symptoms.The prostate-specific antigen level,primary and secondary biopsy Gleason scores,and clinical T category were used in a multivariate logistic regression model to predict the probability of Gleason sum upgrading.The developed nomogram was validated internally.Gleason sum upgrading was observed in 90(33.5%) patients.Our nomogram showed a bootstrap-corrected concordance index of 0.789 and good calibration using 4 readily available variables.The nomogram also demonstrated satisfactory statistical performance for predicting significant upgrading.External validation of the nomogram published by Chun et al.in our cohort showed a marked discordance between the observed and predicted probabilities of Gleason sum upgrading.In summary,a new nomogram to predict Gleason sum upgrading in clinically diagnosed prostate cancer was developed,and it demonstrated good statistical performance upon internal validation.展开更多
Several prediction models have been developed to estimate the outcomes of prostate biopsies. Most of these tools were designed for use with Western populations and have not been validated across different ethnic group...Several prediction models have been developed to estimate the outcomes of prostate biopsies. Most of these tools were designed for use with Western populations and have not been validated across different ethnic groups. Therefore, we evaluated the predictive value of the Prostate Cancer Prevention Trial （PCPT） and the European Randomized Study of Screening for Prostate Cancer （ERSPC） risk calculators in a Chinese cohort. Clinicopathological information was obtained from 495 Chinese men who had undergone extended prostate biopsies between January 2009 and March 2011. The estimated probabilities of prostate cancer and high-grade disease （Gleason 〉6） were calculated using the PCPT and ERSPC risk calculators. Overall measures, discrimination, calibration and clinical usefulness were assessed for the model evaluation. Of these patients, 28.7% were diagnosed with prostate cancer and 19.4% had high-grade disease. Compared to the PCPT model and the prostate-specific antigen （PSA） threshold of 4 ng m1-1, the ERSPC risk calculator exhibited better discriminative ability for predicting positive biopsies and high-grade disease （the area under the curve was 0.831 and 0.852, respectively, P〈O.01 for both）. Decision curve analysis also suggested the favourable clinical utility of the ERSPC calculator in the validation dataset. Both prediction models demonstrated miscalibration： the risk of prostate cancer and high-grade disease was overestimated by approximately 20% for a wide range of predicted probabilities. In conclusion, the ERSPC risk calculator outperformed both the PCPT model and the PSA threshold of 4 ng ml- z in predicting prostate cancer and high-grade disease in Chinese patients. However, the prediction tools derived from Western men significantly overestimated the probability of prostate cancer and high-grade disease compared to the outcomes of biopsies in a Chinese cohort.展开更多
Based on the results of TAX 327, a nomogram was developed to predict the overall survival of metastatic castration-resistant prostate cancer （mCRPC） after first-line chemotherapy. The nomogram, however, has not been...Based on the results of TAX 327, a nomogram was developed to predict the overall survival of metastatic castration-resistant prostate cancer （mCRPC） after first-line chemotherapy. The nomogram, however, has not been validated in an independent dataset, especially in a series out of clinical trials. Thus, the objective of the current study was to validate the TAX 327 nomogram in a community setting in China. A total of 146 patients with mCRPC who received first-line chemotherapy （docetaxel or mitoxantrone） were identified. Because clinical trials are limited in China's Mainland, those patients did not receive investigational treatment after the failure of first-line chemotherapy. The predicted overall survival rate was calculated from the TAX 327 nomogram. The validity of the model was assessed with discrimination, calibration and decision curve analysis. The median survival of the cohort was 21 months （docetaxel） and 19 months （mitoxantrone） at last follow-up. The predictive c-index of the TAX 327 nomogram was 0.66 （95% CI： 0.54-0.70）. The calibration plot demonstrated that the 2-year survival rate was underestimated by the nomogram. Decision curve analysis showed a net benefit of the nomogram at a threshold probability greater than 30%. In conclusion, the present validation study did not confirm the predictive value of the TAX 327 nomogram in a contemporary community series of men in China, and further studies with a large sample size to develop or validate nomograms for predicting survival and selecting therapies in advanced prostate cancer are necessary.展开更多
BACKGROUND Horseshoe kidney(HK)with renal stones is challenging for urologists.Although both retroperitoneal and transperitoneal laparoscopic approaches have been reported in some case reports,the therapeutic outcome ...BACKGROUND Horseshoe kidney(HK)with renal stones is challenging for urologists.Although both retroperitoneal and transperitoneal laparoscopic approaches have been reported in some case reports,the therapeutic outcome of retroperitoneal compared with transperitoneal laparoscopic lithotripsy is unknown.AIM To assess the efficacy of laparoscopic lithotripsy for renal stones in patients with HK.METHODS This was a retrospective study of 12 patients with HK and a limited number(n≤3)of 20-40 mm renal stones treated with either retroperitoneal or transperitoneal laparoscopic lithotripsy(June 2012 to May 2019).The perioperative data of both groups were compared including operation time,estimated blood loss,postoperative fasting time,perioperative complications and stone-free rate(SFR).RESULTS No significant difference was observed for age,gender,preoperative symptoms,body mass index,preoperative infection,hydronephrosis degree,largest stone diameter,stone number and isthmus thickness.The mean postoperative fasting time of the patients in the retroperitoneal group and the transperitoneal group was 1.29±0.49 and 2.40±0.89 d,respectively(P=0.019).There was no significant difference in operation time(194.29±102.48 min vs 151.40±39.54 min,P=0.399),estimated blood loss(48.57±31.85 m L vs 72.00±41.47 m L,P=0.292)and length of hospital stay(12.14±2.61 d vs 12.40±3.21 d,P=0.881)between the retroperitoneal and transperitoneal groups.All patients in both groups had a complete SFR and postoperative renal function was within the normal range.The change in estimated glomerular filtration rate(e GFR)from the preoperative stage to postoperative day 1 in the retroperitoneal group and the transperitoneal group was-3.86±0.69 and-2.20±2.17 m L/(min·1.73 m2),respectively(P=0.176).From the preoperative stage to the 3-mo follow-up,the absolute change in e GFR values for patients in the retroperitoneal group and the transperitoneal group was-3.29±1.11 and-2.40±2.07 m L/(min·1.73 m2),respectively(P=0.581).CONCLUSION Both retroperitoneal and transperitoneal laparoscopic lithotripsy seem to be safe and effective for HK patients with a limited number of 20-40 mm renal stones.展开更多
BACKGROUND Sarcomatoid renal cell carcinoma(SRCC)is a rare variant of renal cell carcinoma associated with an unfavorable prognosis.The efficacy of conventional chemo-therapy and targeted therapies are limited,whereas...BACKGROUND Sarcomatoid renal cell carcinoma(SRCC)is a rare variant of renal cell carcinoma associated with an unfavorable prognosis.The efficacy of conventional chemo-therapy and targeted therapies are limited,whereas the emergence of immune checkpoint inhibitor has introduced new avenues for managing advanced SRCC.CASE SUMMARY A 77-year-old female patient was referred to our hospital following the incidental detection of a right kidney tumor without specific symptoms.The tumor was successfully resected,and subsequent pathological examination confirmed SRCC.She experienced both local recurrence and distant metastasis eight months after the initial laparoscopic resection.Following six cycles of toripalimab combined with pirarubicin chemotherapy,the patient achieved a partial response.Subse-quently,the patient attained an almost-complete continuous response to toripa-limab monotherapy maintenance for an additional six cycles.She has not experienced disease progression for 15 months,and her overall survival has reached 24 months thus far.CONCLUSION Combination therapy with programmed death 1 antibodies and cytotoxic agents may be a recommended first-line treatment approach for SRCC.展开更多
The present study aimed to investigate the relationship between histopathological subtype and the probability of inguinal lymph node metastasis （ILNM） in patients with penile squamous cell carcinoma （PSCC）. The cl...The present study aimed to investigate the relationship between histopathological subtype and the probability of inguinal lymph node metastasis （ILNM） in patients with penile squamous cell carcinoma （PSCC）. The clinical records of 198 consecutive patients with PSCC were analyzed retrospectively. Primary lesions were reevaluated according to the 2016 World Health Organization （WHO） histopathological classification. We retrieved the clinicopathological factors from the medical records including age, clinical lymph node stage, pathological tumor stage, lymphatic invasion, and nerve invasion. Uni- and multivariate logistic regression analyses were used to explore the risk factors of ILNM. Multivariate analyses identified clinical lymph node stage （P = 0.000）, pathological tumor stage （P = 0.016）, histologic grade （P = 0.000）, and risk group of histological subtypes （P = 0.029） as independent predictors for ILNM. Compared with the low-risk group of PSCC subtypes, the intermediate- （HR： 3.66, 95% CI. 1.30-10.37, P = 0.021） and high-risk groups （HR： 28.74, 95% Ch 2.37-348.54, P = 0.008） were significantly associated with ILNM. In conclusion, the histopathological subtype of the primary lesion is a significant predictor for ILNM in patients with PSCC.展开更多
基金supported by the Grants for International Cooperation and the Exchange of Science and Technology Commission of Shanghai Municipality (No.12410709300)a grant from the Guide Project of Science and Technology Commission of Shanghai Municipality (No.124119a7300)
文摘Although several models have been developed to predict the probability of Gleason sum upgrading between biopsy and radical prostatectomy specimens,most of these models are restricted to prostatespecific antigen screening-detected prostate cancer.This study aimed to build a nomogram for the prediction of Gleason sum upgrading in clinically diagnosed prostate cancer.The study cohort comprised 269 Chinese prostate cancer patients who underwent prostate biopsy with a minimum of 10 cores and were subsequently treated with radical prostatectomy.Of all included patients,220(81.8%) were referred with clinical symptoms.The prostate-specific antigen level,primary and secondary biopsy Gleason scores,and clinical T category were used in a multivariate logistic regression model to predict the probability of Gleason sum upgrading.The developed nomogram was validated internally.Gleason sum upgrading was observed in 90(33.5%) patients.Our nomogram showed a bootstrap-corrected concordance index of 0.789 and good calibration using 4 readily available variables.The nomogram also demonstrated satisfactory statistical performance for predicting significant upgrading.External validation of the nomogram published by Chun et al.in our cohort showed a marked discordance between the observed and predicted probabilities of Gleason sum upgrading.In summary,a new nomogram to predict Gleason sum upgrading in clinically diagnosed prostate cancer was developed,and it demonstrated good statistical performance upon internal validation.
文摘Several prediction models have been developed to estimate the outcomes of prostate biopsies. Most of these tools were designed for use with Western populations and have not been validated across different ethnic groups. Therefore, we evaluated the predictive value of the Prostate Cancer Prevention Trial （PCPT） and the European Randomized Study of Screening for Prostate Cancer （ERSPC） risk calculators in a Chinese cohort. Clinicopathological information was obtained from 495 Chinese men who had undergone extended prostate biopsies between January 2009 and March 2011. The estimated probabilities of prostate cancer and high-grade disease （Gleason 〉6） were calculated using the PCPT and ERSPC risk calculators. Overall measures, discrimination, calibration and clinical usefulness were assessed for the model evaluation. Of these patients, 28.7% were diagnosed with prostate cancer and 19.4% had high-grade disease. Compared to the PCPT model and the prostate-specific antigen （PSA） threshold of 4 ng m1-1, the ERSPC risk calculator exhibited better discriminative ability for predicting positive biopsies and high-grade disease （the area under the curve was 0.831 and 0.852, respectively, P〈O.01 for both）. Decision curve analysis also suggested the favourable clinical utility of the ERSPC calculator in the validation dataset. Both prediction models demonstrated miscalibration： the risk of prostate cancer and high-grade disease was overestimated by approximately 20% for a wide range of predicted probabilities. In conclusion, the ERSPC risk calculator outperformed both the PCPT model and the PSA threshold of 4 ng ml- z in predicting prostate cancer and high-grade disease in Chinese patients. However, the prediction tools derived from Western men significantly overestimated the probability of prostate cancer and high-grade disease compared to the outcomes of biopsies in a Chinese cohort.
文摘Based on the results of TAX 327, a nomogram was developed to predict the overall survival of metastatic castration-resistant prostate cancer （mCRPC） after first-line chemotherapy. The nomogram, however, has not been validated in an independent dataset, especially in a series out of clinical trials. Thus, the objective of the current study was to validate the TAX 327 nomogram in a community setting in China. A total of 146 patients with mCRPC who received first-line chemotherapy （docetaxel or mitoxantrone） were identified. Because clinical trials are limited in China's Mainland, those patients did not receive investigational treatment after the failure of first-line chemotherapy. The predicted overall survival rate was calculated from the TAX 327 nomogram. The validity of the model was assessed with discrimination, calibration and decision curve analysis. The median survival of the cohort was 21 months （docetaxel） and 19 months （mitoxantrone） at last follow-up. The predictive c-index of the TAX 327 nomogram was 0.66 （95% CI： 0.54-0.70）. The calibration plot demonstrated that the 2-year survival rate was underestimated by the nomogram. Decision curve analysis showed a net benefit of the nomogram at a threshold probability greater than 30%. In conclusion, the present validation study did not confirm the predictive value of the TAX 327 nomogram in a contemporary community series of men in China, and further studies with a large sample size to develop or validate nomograms for predicting survival and selecting therapies in advanced prostate cancer are necessary.
基金the National Natural Science Foundation of China,No.81572507。
文摘BACKGROUND Horseshoe kidney(HK)with renal stones is challenging for urologists.Although both retroperitoneal and transperitoneal laparoscopic approaches have been reported in some case reports,the therapeutic outcome of retroperitoneal compared with transperitoneal laparoscopic lithotripsy is unknown.AIM To assess the efficacy of laparoscopic lithotripsy for renal stones in patients with HK.METHODS This was a retrospective study of 12 patients with HK and a limited number(n≤3)of 20-40 mm renal stones treated with either retroperitoneal or transperitoneal laparoscopic lithotripsy(June 2012 to May 2019).The perioperative data of both groups were compared including operation time,estimated blood loss,postoperative fasting time,perioperative complications and stone-free rate(SFR).RESULTS No significant difference was observed for age,gender,preoperative symptoms,body mass index,preoperative infection,hydronephrosis degree,largest stone diameter,stone number and isthmus thickness.The mean postoperative fasting time of the patients in the retroperitoneal group and the transperitoneal group was 1.29±0.49 and 2.40±0.89 d,respectively(P=0.019).There was no significant difference in operation time(194.29±102.48 min vs 151.40±39.54 min,P=0.399),estimated blood loss(48.57±31.85 m L vs 72.00±41.47 m L,P=0.292)and length of hospital stay(12.14±2.61 d vs 12.40±3.21 d,P=0.881)between the retroperitoneal and transperitoneal groups.All patients in both groups had a complete SFR and postoperative renal function was within the normal range.The change in estimated glomerular filtration rate(e GFR)from the preoperative stage to postoperative day 1 in the retroperitoneal group and the transperitoneal group was-3.86±0.69 and-2.20±2.17 m L/(min·1.73 m2),respectively(P=0.176).From the preoperative stage to the 3-mo follow-up,the absolute change in e GFR values for patients in the retroperitoneal group and the transperitoneal group was-3.29±1.11 and-2.40±2.07 m L/(min·1.73 m2),respectively(P=0.581).CONCLUSION Both retroperitoneal and transperitoneal laparoscopic lithotripsy seem to be safe and effective for HK patients with a limited number of 20-40 mm renal stones.
基金The Health Research Program of Anhui Province,China,No.AHWJ2022b048The Research Foundation of Anhui Medical University,China,No.2021xkj164The Clinical Scientific Research Cultivation Project of the Second Affiliated Hospital of Anhui Medical University,China,No.2021LCZD04.
文摘BACKGROUND Sarcomatoid renal cell carcinoma(SRCC)is a rare variant of renal cell carcinoma associated with an unfavorable prognosis.The efficacy of conventional chemo-therapy and targeted therapies are limited,whereas the emergence of immune checkpoint inhibitor has introduced new avenues for managing advanced SRCC.CASE SUMMARY A 77-year-old female patient was referred to our hospital following the incidental detection of a right kidney tumor without specific symptoms.The tumor was successfully resected,and subsequent pathological examination confirmed SRCC.She experienced both local recurrence and distant metastasis eight months after the initial laparoscopic resection.Following six cycles of toripalimab combined with pirarubicin chemotherapy,the patient achieved a partial response.Subse-quently,the patient attained an almost-complete continuous response to toripa-limab monotherapy maintenance for an additional six cycles.She has not experienced disease progression for 15 months,and her overall survival has reached 24 months thus far.CONCLUSION Combination therapy with programmed death 1 antibodies and cytotoxic agents may be a recommended first-line treatment approach for SRCC.
基金This study was supported by the Natural Science Foundation of Anhui Province （No. 1608085QH173） and the Research Foundation of Anhui Medical University （No. 2015xkj025）.
文摘The present study aimed to investigate the relationship between histopathological subtype and the probability of inguinal lymph node metastasis （ILNM） in patients with penile squamous cell carcinoma （PSCC）. The clinical records of 198 consecutive patients with PSCC were analyzed retrospectively. Primary lesions were reevaluated according to the 2016 World Health Organization （WHO） histopathological classification. We retrieved the clinicopathological factors from the medical records including age, clinical lymph node stage, pathological tumor stage, lymphatic invasion, and nerve invasion. Uni- and multivariate logistic regression analyses were used to explore the risk factors of ILNM. Multivariate analyses identified clinical lymph node stage （P = 0.000）, pathological tumor stage （P = 0.016）, histologic grade （P = 0.000）, and risk group of histological subtypes （P = 0.029） as independent predictors for ILNM. Compared with the low-risk group of PSCC subtypes, the intermediate- （HR： 3.66, 95% CI. 1.30-10.37, P = 0.021） and high-risk groups （HR： 28.74, 95% Ch 2.37-348.54, P = 0.008） were significantly associated with ILNM. In conclusion, the histopathological subtype of the primary lesion is a significant predictor for ILNM in patients with PSCC.
