Who needs further evaluations to diagnose upper urinary tract urothelial cancers among patients with abnormal findings by enhanced CT?

Objective:We evaluated who would need further evaluations such as retrograde pyelography(RP)and/or ureteroscopy to diagnose upper urinary tract urothelial cancers(UUTUCs)when abnormal findings for the upper urinary tract(UUT)were detected by enhanced computed tomography(CT).Methods:We retrospectively analyzed 125 patients who underwent enhanced CT for various reasons and had abnormal findings for the UUT.Patients whose tumors were suspected to be of extraureteral origin were excluded.All patients received RP and/or ureteroscopy to evaluate the UUTUCs.Results:The median age of the 125 patients was 70 years and gross hematuria(26.4%)was the most frequently observed symptoms.RP,ureteroscopy and both were performed for 121,59 and 55 patients,respectively.CT revealed tumor-like lesions in 58 patients and the other patients had non-tumor-like lesions.UUTUCs were found in 43(34.4%)of the 125 patients.All of them had tumor-like lesions on CT.In 58 patients who had tumor-like lesions on CT,univariate and multivariate analyses revealed that tumor diameter and tumor enhancement were significant predictive factors for UUTUCs.ROC curve analysis of enhanced CT to diagnose UUTUCs revealed that a tumor diameter of 18 mm was the best cutoff point.The sensitivity,specificity and accuracy were 90.0%,98.8% and 92.7% for RP and 95.5%,100% and 97.1%for ureteroscopy,respectively.Both of them had high sensitivity,specificity and accuracy.Conclusion:We should decide to evaluate the UUT according to the tumor diameter on enhanced CT.When we evaluate the UUT in patients with tumor diameters of less than 20 mm,ureteroscopy is recommended.

Prognostic value of T cell immunoglobulin and mucin-domain containing-3 expression in upper gastrointestinal tract tumors:A meta-analysis

BACKGROUND There is a lack of robust prognostic markers for upper gastrointestinal(GI)tract cancers,including esophageal,gastric,and esophagogastric junction cancers.T cell immunoglobulin and mucin-domain containing-3(TIM3)plays a key immunomodulatory role and is linked to the prognosis of various cancers.However,the significance of TIM3 in upper GI tract tumors is still uncertain.AIM To investigate the prognostic value of TIM3 expression in upper GI tract tumors.METHODS A literature search was conducted on the PubMed,Embase,and Web of Science databases for relevant studies published until June 2023.After screening and quality assessment,studies that met the criteria were included in the metaanalysis.Statistical methods were used for the pooled analysis to assess the association of TIM3 expression in upper GI tract tumors with the prognosis and clinicopathological parameters.The results were reported with the hazard ratio(HR)and 95%confidence interval(CI).RESULTS Nine studies involving 2556 patients with upper GI tract cancer were included.High TIM3 expression was associated with a worse prognosis in upper GI tract cancer(HR:1.17,95%CI:1.01-1.36).Positive expression of TIM3 in gastric cancer was correlated with the T and N stage,but the difference was not statistically significant.However,TIM3 overexpression was significantly correlated with the TNM stage(odds ratio:1.21,95%CI:0.63-2.33;P<0.05).TIM3 expression showed no association with the other clinicopathological parameters.CONCLUSION High expression of TIM3 in the upper GI tract cancer is associated with a worse prognosis and advanced T or N stages,indicating its potential value as a prognostic biomarker.These findings may provide a basis for the personalized treatment of upper GI tract cancers.

Poor visualization of renal collecting system in intravenous urography as an indicator of invasive transitional cell carcinoma in the upper urinary tract

Background Transitional cell carcinoma of the upper urinary tract （UUT-TCC） accounts for 5% to 10% of all renal tumours and 5% to 6% of all urothelial tumours all over the world. In China, the proportion of UUT-TCC to all urothelial tumours may be 26%, which is higher than that in the western world. The early diagnosis of UUT-TCC is difficult and the present study elucidates the diagnostic value of poor or nonvisualization （PNV） in intravenous urography in patients with UUT-TCC and its correlations with pathological findings and clinical characteristics. Methods The data of 172 consecutive patients between January 1997 and January 2005 with UUT-TCC who underwent nephroureterectomy in our departments were selected and analyzed retrospectively. Results Of our sample, 144 cases presented with gross haematuria （83.7%） and 12 with microscopic haematuria （7.0%）. Forty-six cases （26.7%） were detectable by cytology. Filling defect identified 36 positive cases of 172 patients （20.9%）, PNV was present in the images of 105 of 172 patients （61.0%）. The detection rate by PNV （61.0%） was significantly different from that by cytology （26.7%） or by filling defect （20.9%） （P=-0.031, P=-0.001, respectively）. Univariate logistic regression analysis for PNV showed that tumour stage, grade and size were significant predictors （P=0.028; P=-0.031; P=-0.006, respectively）. Tumour stage and size were identified as independent risk factors in the multivariate logistic regression model （P=-0.042; P=-0.014）.Conclusions Except for suspected urolithiasis, urinary tuberculosis or congenital abnormalities, UUT-TCC should be considered if PNV exists in intravenous urography especially of old patients. The value of PNV is much more significant than filling defect in intravenous urography in the diagnosis of UUT-TCC. It is supposed that PNV carries more risk of higher stage and larger tumour size in UTT-TCC.

Follow-Up Upper Tract Imaging Post-Nephroureterectomy for TCC: Need for a Protocol Driven Approach?

Objectives: We present a retrospective analysis of follow-up strategy adapted by different clinician in managing UTUC cases. Methods: Case notes of 83 patients undergoing nephroureterectomy for UTUC at our institute were selected. Their follow-up pattern and any imaging protocols for upper tract surveillance were studied retrospectively. Results: Our study highlighted diversity in clinicians’ overall approach at a time when no approved guidelines or standardised protocols were available. Conclusions: This study clearly highlighted the need for a protocol driven approach;which has lately been addressed with the introduction of EAU guidelines on this subject matter and majority of practising Urologists will adhere to it.

Potential of metastin and metastin receptor as biomarkers for urological cancers

AIM: To investigate the current state of the research of metastin and metastin receptor in the urological cancer field.METHODS: For analyzing the value of metastin and metastin receptor as molecular biomarkers for the patients with urological cancer, MEDLINE database searches were performed using these terms: metastin, KISS1, kisspeptin, renal(cell) carcinoma(RCC), kidney cancer or urothelial cancer or bladder cancer or prostate cancer or testicular cancer(tumor). Since the articles were evaluated by the validity of the articlesbased on plausibility, credibility, and evidence levels, the articles were graded according to their level of evidence, using the grading system defined by the Oxford Centre for Evidence-based Medicine. RESULTS: A total of six clinical studies published by individual institutions between 2003 and 2013 were included in this review. The article numbers for each of the evidence levels 2a and 2b were three(50%) and three(50%), respectively. Immunohistochemistry and reverse transcriptase-polymerase chain reaction using tumor tissues were performed to analyze in five articles(83%) and in one article(17%). The value of metastin and/or metastin receptor as molecular biomarkers in clear cell RCC, upper tract urothelial carcinoma, and bladder cancer was evaluated by multivariate analysis. Low expression of metastin receptor in clear cell RCC and low expression of metastin in upper tract urothelial carcinoma were significant risk factors for metastasis, and low metastin expression was an independent prognostic factor in bladder cancer. CONCLUSION: Metastin and metastin receptor have potential as suitable molecular biomarkers for urological cancers. However, future studies of metastin and metastin receptor should undergo external validation to ensure consistency across different patient series, since individual institutional studies lack generalization.

Clipping the extremity of ureter prior to nephroureterectomy is effective in preventing subsequent bladder recurrence after upper urinary tract urothelial carcinoma

Background Bladder recurrent disease is still a challenge in the treatment of upper tract urothelial carcinoma （UTUC）. This controlled study aims to investigate the efficacy of early clipping of the distal ureter prior to nephroureterectomy （NU） to prevent bladder recurrence after UTUC.

Transitional cell carcinoma associated with aristolochic acid nephropathy： most common cancer in chronic hemodialysis patients in China

Background The research of cancer in patients on hemodialysis （HD） in China has not been reported. The aim of this study was to investigate the clinical and histological features and outcomes of cancer in Chinese HD patients. Methods The study subjects were 49 cancer patients （1.4%） out of 3448 end stage renal disease （ESRD） patients maintained on HD at China-Japan Friendship Hospital from October 1997 to July 2011. Results Urinary tract cancer （74%） was the most common followed by gastrointestinal tract cancer （12%）, breast cancer （6%）, lung cancer （4%）, thyroid cancer （2%）, and hematologic cancer （2%）. Thirty-three patients （67%） had urinary tract transitional cell carcinoma （TCC） and 29 of them had aristolochic acid nephropathy （AAN） as underlying disease. Death occurred in eight patients out of 49, and the survival rate of HD patients with cancer was similar to those without cancer （P=0.120）. Conclusion The urinary tract TCC is the most common cancer in HD patients with AAN in one of the centers of northern China.

完全腹腔镜下肾输尿管全切除术(附9例报告)

目的探讨完全腹腔镜下肾输尿管全切除的手术方法.方法该组9例.男6例,女3例.采用完全腹腔镜手术方法行肾输尿管全切除术.气管内插管全麻,侧卧位.首先采用3、4个套管经腹入路行腹腔镜下肾及肾周脂肪囊整块切除.然后将体位转成45°斜卧位,用超声刀将输尿管向下分离至膀胱壁外,提拉输尿管末段,绕其根部2 cm切除膀胱壁及输尿管开口.用2-0 Dexon线缝合膀胱切口.将肾输尿管放入标本袋内取出.结果该组病例全部顺利完成手术.手术时间180～240min,平均210min.出血量150～250ml,平均180ml,无明显围手术期并发症.术后随访2～34个月,未见肿瘤种植转移及膀胱肿瘤发生.结论完全腹腔镜肾输尿管全切除术可进一步减少手术创伤,更加符合肿瘤根治原则,减少并发症.随着腹腔镜技术及设备的不断完善,该术式将越来越广泛地应用于临床.

影像学检查诊断上尿路移行细胞癌的比较及临床意义(附234例分析)

目的:比较各种影像学检查对输尿管肿瘤的检出情况,探讨多层螺旋CT泌尿系统成像(MSCTU)在输尿管肿瘤诊断中的优越性。方法:2004年6月至2006年9月手术病理诊断的上尿路移行上皮癌患者234例,其中肾盂癌82例、输尿管癌152例,多数患者行泌尿系B超、静脉尿路造影(IVU)、逆行造影及MSCTU。各项检查的阳性率和符合诊断率的比较采用多重卡方检验。结果:行B超检查者215例,发现异常152例,检查阳性率70.7%,明确诊断58例,符合诊断率为27.0%;行IVU检查者193例,发现异常132例,检查阳性率68.4%,明确诊断65例,符合诊断率33.7%;行逆行造影者132例,发现异常115例,检查阳性率87.1%,明确诊断93例,符合诊断率70.5%;行MSCTU检查者226例,发现异常220例,检查阳性率97.3%,明确诊断214例,符合诊断率94.7%。逆行造影对输尿管肿瘤的符合诊断率显著优于B超和IVU检查(P<0.001),MSCTU的符合诊断率显著优于逆行造影(P<0.001)。结论:血尿患者行B超检查后怀疑为上尿路移行细胞癌患者,宜首先考虑行MSCTU检查,以缩短诊断时间并减轻患者痛苦。

肾移植受者上尿路尿路上皮癌术后膀胱复发的预后因素

目的：评价肾输尿管全长切除术治疗肾移植受者原发上尿路尿路上皮癌（upper tract urothelial carcinoma,UTUC）术后膀胱复发的独立危险因素。方法：回顾2006年4月至2013年3月临床诊断为肾移植后局限性UTUC并且排除既往或同期合并膀胱肿瘤的病例共38例,均接受后腹腔镜下肾输尿管全长切除术。采用Kaplan-Meier方法对临床病理特征、危险因素和术后膀胱无复发生存率进行单因素分析。采用单因素和多因素Cox比例风险回归模型分析影响膀胱肿瘤复发的独立危险因素。结果：本组患者随访时间12~104个月,中位随访时间38个月,其间膀胱复发率42.1%（16/38）,其中75.0%复发于术后2年内,手术与复发间隔时间6~48个月,中位复发时间15.5个月。单因素分析显示,原肾为马兜铃酸肾病（aristolochic acid nephropathy,AAN）、肿瘤为多中心和累及输尿管下段可增加膀胱复发风险。术后2年膀胱复发率,原肾AAN组为62.5%（5/8）,肿瘤多中心发病组为46.2%（12/26）。多因素分析结果表明,肿瘤多中心发病（HR=2.603,95%CI=1.529~8.906,P=0.019）和原肾马兜铃酸肾病（HR=2.179,95%CI=1.085~8.093,P=0.038）是术后膀胱复发的独立预后危险因素。结论：肾移植受者UTUC经腹腔镜肾输尿管全长切除术后膀胱复发率高,大多数病例于术后2年内复发,多因素分析显示,肿瘤多中心发病和原肾AAN是术后膀胱复发的独立预后危险因素。

膀胱癌合并上尿路上皮癌的诊断与外科治疗

目的探讨膀胱癌合并上尿路上皮癌的诊治方法。方法本组膀胱癌合并输尿管癌13例,膀胱癌合并肾盂癌5例。用B超、静脉尿路造影(IVU)、CT、膀胱镜检查及输尿管镜检查进行诊断。对上尿路癌予切除患侧肾及全长输尿管或切除含肿瘤的下段输尿管后行再种术;对膀胱癌行扩大范围的管口周围膀胱切除术,或管口周围+膀胱部分切除术,或管口周围切除+经尿道膀胱肿瘤电切术。结果IVU诊断上尿路梗阻最好,检出率为100%;CT对上尿路癌定位诊断符合率最高(87.5%),膀胱肿瘤诊断符合率为93.75%;膀胱镜发现膀胱癌比率为100%;输尿管镜发现输尿管癌比率为100%。采用各种手术方法均一期完成手术,无明显并发症。术后随访6～24个月,各手术方法间疗效无明显差别。结论多种检查方法相结合有利于减少膀胱癌合并上尿路上皮癌的漏诊率。对该疾病的治疗应根据具体病情采用个体化的方案。

尿路移行上皮细胞的培养鉴定

为建立尿路上皮细胞分离、培养、扩增的常规 ,获得构建组织工程学泌尿系器官所需的大量尿路移行上皮细胞 ,分别采用刮削法和组织块法分离出尿路上皮细胞 ,在角化细胞培养基 (Keratinocyte_SFM)中培养 ,观察细胞形态、扩增情况 ,并用免疫组化方法检测细胞类型特异性蛋白质。结果 :尿路移行上皮细胞生长良好 ,呈现出典型的移行上皮形态特征。细胞经10次传代后仍扩增迅速 ,免疫组化染色显示CKAE1/AE3 阳性、CK34βE12 阴性。提示该常规中细胞分离方法可靠 ,传代顺利 ,扩增迅速 ;尿路上皮细胞经10次传代仍保持其固有生物学特性 。

NMP22肿瘤标志物诊断尿路上皮癌的初步评价

目的 :探讨核基质蛋白 (NMP2 2 )对尿路上皮癌临床诊断的价值。方法 :应用酶联免疫法检测 2 8例尿路上皮癌及 4例非尿路上皮肿瘤术前尿液的NMP2 2的含量。结果 :尿路上皮癌NMP2 2的阳性率为 71.4% ,其与病理分级、分期无明显相关性 ,而尿细胞学阳性率为 32 .1% ;4例非尿路上皮癌患者尿NMP2 2含量检测结果均为阴性。结论 :尿液NMP2 2含量的测定有助于尿路上皮癌的诊断 ,且快速方便。

改良经腹入路全腹腔镜下上尿路上皮癌根治术的临床研究

目的评价改良的经腹入路腹腔镜下上尿路上皮癌根治术的手术技巧及临床效果。方法对郑州大学附属洛阳中心医院2013年9月-2018年4月收治的104例上尿路上皮癌患者随机分为两组。51例侧卧位行经腹入路腹腔镜下切肾后,改平卧位下腹部切口处理输尿管膀胱连接部并取出标本(标准组);53例行改良经腹入路全腹腔镜下上尿路上皮癌根治术(改良组)。比较两组患者的手术时间、术中出血量、术后疼痛程度、住院时间,术后引流量和术后短期并发症发生率等临床指标。术后疼痛程度评估采用疼痛数字评定量表(NRS)。结果改良组手术时间及住院时间明显少于标准组,差异均有统计学意义(P<0.05),改良组术后疼痛程度较标准组轻,术后引流量少,差异均有统计学意义(P<0.05)。改良组术中出血量虽较标准组少,但两组比较,差异无统计学意义(P>0.05)。标准组术后出现短期并发症11例(21.6%),改良组4例(7.5%),改良组明显少于标准组(P<0.05)。结论改良经腹入路全腹腔镜下上尿路上皮癌根治术是一种安全有效的手术方法,值得临床推广。

上尿路上皮细胞癌42例分析

为探讨上尿路上皮细胞癌的临床特点和诊治方法 ,回顾分析 4 2例经病理证实的上尿路上皮细胞癌。 4 2例中多器官同时发病者 1 1例 ,4 0例手术治疗 ,术后随访 34例。结果 :尿细胞学检查阳性率 6 6 .7% ,灌洗后肾盂尿检阳性率 92 .9% ,2 8例行CT检查者阳性率 85 .7% ,术后再发膀胱癌 6例。提示 :尿细胞学检查是特异性的定性诊断方法 ,灌洗肾盂尿可提高阳性率 ;CT检查对肿瘤的定位、分期有重要价值。肿瘤的多器官发病倾向应高度重视 ,治疗以肾、输尿管全长及膀胱袖套状切除为主 ,膀胱镜检查应列为常规。

上尿路移行细胞癌12例误诊分析

目的探讨上尿路移行细胞癌的误诊原因。方法回顾性分析12例上尿路移行细胞癌患者在诊治过程中的误诊情况。误诊为肾炎4例,上尿路结石3例,泌尿系感染3例,肾结核1例,前列腺增生1例。结果 12例患者均经手术治疗,术后病理证实肾盂移行细胞癌9例,输尿管移行细胞癌3例,伴膀胱移行细胞癌2例。通过B超、静脉尿路造影（IVU）、逆行肾盂造影、CT、输尿管镜及膀胱镜等检查均提示发现肿瘤病灶。8例患者随访6个月~15年,3例死于肿瘤进展,2例术后出现膀胱移行细胞癌。结论对长期血尿病史患者需进一步病因检查,B超、IVU、CT等影像学检查具有重要的诊断价值,同时应提高对检查结果的正确分析和判读能力。

上尿路肿瘤术后再发膀胱癌的危险因素分析

目的:探讨上尿路肿瘤术后再发膀胱癌的因素。方法:采用回顾性研究对上尿路肿瘤76例进行总结。结果:术后膀胱癌再发率36%(27/76),70%(19/27)发生于术后2年。多器官性肿瘤者的再发率69%(11/16)高于单发肿瘤者的27%(16/60)。输尿管下段肿瘤者的再发率50%(8/16)高于肾盂输尿管上段者的18%(8/44)。Ⅱ～Ⅲ级、T3者再发率高。未切除患侧输尿管口周围膀胱壁的再发率49%(21/43),高于肾输尿管膀胱部分切除术的18%(6/33)。结论:上尿路肿瘤的部位、多器官性、病理分级、分期是术后膀胱癌再发的危险因素,切除输尿管口周围膀胱壁是防止再发的关键。

腹腔镜联合等离子电切镜治疗上尿路肿瘤的临床观察

目的探讨应用腹腔镜联合等离子电切镜治疗上尿路肿瘤的临床疗效。方法于2007年1月至2011年6月间应用腹腔镜联合等离子电切镜对34例肾盂肿瘤患者及9例输尿管肿瘤患者进行了上尿路肿瘤根治性切除手术。结果 5例患者在处理下半部输尿管时因剥脱失败而需切口辅助手术,其余38例手术均获得成功,术后患者体表仅存有一约5 cm手术切口及两个穿刺孔。平均手术时间150min。平均出血量150 mL。平均住院时间7.8 d,围手术期无手术并发症。术后病理检查为低级别乳头状尿路上皮癌13例,高级别乳头状尿路上皮癌16例,浸润性尿路上皮癌14例。平均随访13个月未见肿瘤复发及转移。结论腹腔镜联合等离子电切镜治疗浅表性上尿路肿瘤手术方式安全可行,切除肿瘤彻底,创伤小,恢复快,值得临床推广使用。

ICC样细胞在正常豚鼠上尿路的分布及对平滑肌收缩的影响

目的研究正常豚鼠上尿路不同部位起搏细胞(interstitial cells of Cajal,ICCs)的分布及其对局部平滑肌收缩的影响。方法取10只豚鼠分别取肾盂输尿管交界处、上、中、下段输尿管组织,经全层铺片处理后,行ICCs特异性标志物KIT免疫荧光染色,对各段组织进行细胞计数,单因素方差分析各段ICCs的分布及其差异;再于上述部位(除输尿管壁内段外)分别剪取2mm×6mm肌条进行张力测定实验,比较各部位肌条收缩频率及幅度的变化,分析其与ICCs密度变化的相关性。结果KIT染色阳性、形态与胃肠道起搏细胞ICCs相似的细胞(ICCs样细胞)存在于豚鼠上尿路的各段中,上尿路ICC样细胞密度在肾盂肾盏交界处、输尿管上、中、下段分别为(5.20±0.98)、(3.90±0.98)、(3.03±0.98)、(2.50±0.81)个/视野;各部位肌条收缩频率及幅度不同,但肾盂输尿管交界处、输尿管上段的肌条收缩频率及幅度较输尿管中段和下段明显增大,差异显著(P<0.05),输尿管中段和下段之间没有显著区别(P>0.05);相关性分析结果表明局部平滑肌肌条收缩频率和幅度与ICCs密度呈显著正相关性(P<0.05)。结论豚鼠上尿路平滑肌中存在ICCs,肾盂输尿管各部位ICCs的分布有显著差异,其与上尿路平滑肌局部肌条收缩有密切关系。

PTBP1通过EMT途径促进肝癌细胞的迁移与侵袭

目的:基于上皮-间充质转化(epithelial-mesenchymal transition,EMT)途径研究多聚嘧啶区结合蛋白1(polypyrimidine tract-binding protein 1,PTBP1)促进肝癌细胞迁移与侵袭的分子机制。方法:通过qPCR与Western blot实验筛选不同细胞中差异表达的剪接蛋白,生物信息学分析肝癌与正常肝组织中PTBP1的表达差异。划痕及侵袭实验研究过表达或敲减PTBP1对肝癌细胞迁移与侵袭能力的影响,Western blot检测过表达或敲减PTBP1对EMT通路蛋白的影响。结果:高转移肝癌细胞系HCCLM3中PTBP1的表达显著升高(P<0.05),且肝癌组织中PTBP1的表达水平明显高于正常组织(P<0.05)。过表达PTBP1可显著提高HCCLM3细胞的迁移与侵袭能力(P<0.05),并增加间充质标志物N-cadherin和vimentin等的表达(P<0.05),促进肝癌细胞的EMT进程。结论:PTBP1可通过促进肝癌细胞的EMT途径而促进肝癌细胞的迁移与侵袭。