Purpose: This study aimed to evaluate the safety and efficacy of gemcitabine and cisplatin (GP) regimen in combination with immune checkpoint inhibitor sintilimab as neoadjuvant therapy for muscle-invasive bladder cancer (MIBC) patients and the feasibility of the following selective bladder sparing surgery. Materials and Methods: Patients with histopathologically confirmed urothelial carcinoma without distant metastases (T2-4a, N ≤ 1, M0, American Joint Committee of Cancer 8th) and with adequate organ function will be enrolled. The therapeutic regimen was sintilimab 200 mg once on day 8, gemcitabine 1,000 mg/m2 and cisplatin 35 mg/m2 once on days 1 and 8, every 21 days for four cycles. The primary endpoint was pathologic complete response (pCR, pT0N0) rate. The secondary end points were ypT < 2 rate, R0 resection rate, event-free survival, and safety. Results: From May 4, 2020, to May 20, 2023, 55 patients were enrolled. Forty-six patients were evaluated for efficacy. Among the 42 patients who underwent surgery, 16 patients (38.0%) achieved pCR. Thirty-three patients (78.6%) achieved pT < 2. With a median follow-up of 15.7 months, the 1-year event-free survival was 91.3%. Notwithstanding the poor pathological baseline characteristic of a high T3-T4a proportion (39.1%), a promising bladder preservation (including 22 patients transurethral resection of bladder tumor, 5 patients partial cystectomy, and 4 surveillances) rate was achieved (67.4%). The most common grade ≥ 3 treatment-related adverse events was neutropenia (n=15, 27.3%), which was related to chemotherapy. There were no grade 3 immune-related adverse events. Conclusion Neoadjuvant GP plus sintilimab is a promising regimen for MIBC patients, with relatively high pT < 2 rate and triggering the emerging roles for the multi-disciplinary team decision-making for bladder sparing surgery.

Multiple endocrine neoplasia type 2 (MEN2) is an autosomal dominant hereditary neuroendocrine cancer syndrome characterized by medullary thyroid carcinoma, in combination or not with pheochromocytoma, hyperparathyroidism and extra-endocrine features, and two forms subtyped as MEN2A and MEN2B. Based on the correlation between RET proto-oncogene mutation and MEN2 phenotype, MEN2 could be prevented through prenatal diagnosis and preimplantation genetic testing. Integrating the detection of RET mutation with measurement of serum calcitonin, plasma or urinary metanephrine/normetanephrine, and serum parathyroid hormone levels could accurately predict the progression of MEN2, and then facilitating implementation of personalized precision treatment. In addition, increased awareness of MEN2 is needed, which requires participation of physicians, patients/family members, and relevant organizations, supplemented by psychological support, which could promote the comprehensive management of MEN2. The "5P" strategies for MEN2 represents a paradigm of precision medicine, which could effectively avoid or reduce the clinical adverse outcomes, improve the prognosis and quality of life of MEN2 patients.
Humans ; Multiple Endocrine Neoplasia Type 2a/therapy* ; Quality of Life ; Proto-Oncogene Proteins c-ret/genetics* ; Early Detection of Cancer ; Thyroid Neoplasms/genetics* ; Adrenal Gland Neoplasms/therapy*

Objective To detect the expression of peripheral blood free prostate specific antigen (fSPA),total prostate specific antigen (tSPA),prostate specific antigen density (PSAD) and prostate cancer gene 3 (PCA3) in prostate disease,and the significance of combined detection of fSPA,tSPA and PCA3.Methods 67 patients with prostate cancer,75 patients with prostatic hyperplasia and 70 healthy male were selected as the research objects from Dec.2014 to Jul.2016.The serum level of fSPA and tSPA was detected by chemiluminescence immune staining method.The prostate volume was tested by ultrasonic sound and PSAD value was calculated.The total RNA was extracted by Trizol,and the serum PCA3 mRNA expression was detected by RT-PCR.The specificity and sensitivity of combined detection of fSPA,tSPA and PCA3 were analyzed.Results The serum levels of fSPA,tSPA,PSAD and PCA3 in prostate cancer were significantly higher than those in patients with prostatic hyperplasia and healthy male,and they were higher in patients with hyperplasia of prostate than in healthy male,and the differences had statistical significance (P＜0.01).The serum levels of fSPA,tSPA,PSAD and PCA3 were higher in patients with Gleason score ≥7 points and in T3-T4 stage than in patients with Gleason score ＜7 and in T1-T2 stage,and the difference had statistical significance (P＜0.01).The serum levels of fSPA,tSPA,PSAD and PCA3 were positively correlated with Gleason score and TMN pathological stage,and the difference had statistical significance (P＜0.01).The AUC value of fSPA,tSPA,PSAD and PCA3 in diagnosis of prostate cancer was 0.53,0.57,0.63 and 0.75,and the AUC value of combined detection was 0.92.The combined detection efficiency was higher than the single index.The specificity of fSPA,tSPA,PSAD and PCA3 was 67.16％,68.66％,73.13％ and 85.07％,and the sensitivity was 71.64％,70.15％,74.63％ and 82.09％ respectively.The specificity of combined detection was 97.01％,the sensitivity was 92.54％,and the difference had statistical significance (P＜0.01).Conclusion The serum level of fSPA,tSPA,PSAD and PCA3 is increased in prostate disease,and is negatively correlated with Gleason score and TMN pathological stage.The combined detection of fSPA,tSPA,PSAD and PCA3 can improve the sensitivity and specificity of prostate disease diagnosis,and is of high clinical value.

Objective To analyze the related factors that influence the stone free rate ( SFR) in flexible ureteroscopic lithotripsy ( FURL ) and develop a stone free index ( SFI ) model to estimate and predict the outcome of FURL.Methods A total of 393 patients receiving FURL were included in this study from May 2013 to August 2014.All patients′and calculous characteristics were recorded.It was evaluated the correlation of one-stage SFR with body mass index, the degree of hydronephrosis, the sterile urine, the renal insufficiency, the stone location, the stone number, the cumulative stone diameter ( CSD) , the stone density, the average of CT values, the minimum angle of pelvis ureter long axis with lamp long axis, the average length of stone located calyx-neck, and the minimum ratio of stone located calyx-neck′width with calyx′width.Multivariate regression analysis was used to analyze the relationship between preoperative characteristics and the SFR.Results The one-stage postoperative SFR in our study was 92.4% ( 363/393).We found that the staghorn stone, bacteriuria, CSD, average of CT values, the average length of stone located calyx-neck, the minimum ratio of stone located calyx-neck′width with calyx′width were significantly correlated with the postoperative SFR ( P <0.05 ) .We used logistic regression analysis to determine statistical significant variables and to create predictable mathematical model.The SFI system was consist of four stone characteristics, including the staghorn stone, the cumulative stone diameter, the average length of stone located calyx-neck, and the minimum ratio of stone located calyx-neck′width with calyx′width.The SFI had a high ROC curve (AUC=0.867) for predicting the one-stage postoperative stone free outcome.SFI score >7.5 meant a relatively high SFR ( SFR>85%) of FURL.Conclusions A SFI model using preclinical data was developed to predict the postoperative outcome of FURL, as well as the one-stage SFR.This model needs further prospective studies in the future.

OBJECTIVETo assess the effect of bladder neck preservation (BNP) on postoperative continence during laparoscopic radical prostatectomy.

METHODSOne hundred and forty-five patients with localized prostate cancer (Tlb-T2c) underwent laparoscopic radical prostatectomy in our center from July 2006 to May 2010, including 59 cases treated with bladder neck preservation (BNP group) and 86 cases with bladder neck resection (non-BNP group). All cases were diagnosed as prostate cancer by transrectal ultrasonography-guided prostate biopsy preoperatively, in which localized tumors were confirmed by CT or MRI and distant metastases were ruled out by ECT bone scan. All patients had no history of incontinence and no radiation therapy preoperatively. All the 145 operations were performed by the same surgeon. The bladder neck preservation was defined as a procedure of direct suturing of the bladder neck on the urethra without repair and reconstruction of the bladder neck. Both procedures of neurovascular bundle preservation and external striated urethral sphincter preservation were carried out on all cases. Urinary continence was evaluated using the International Continence Society questionnaire at 1, 3 and 6 months postoperatively. Positive surgical margins rates were compared between the two groups. Postoperative continence was defined as the absence of need for pads or the use of one pad daily.

RESULTSAt 1, 3 and 6 months, the urinary continence rates were 42.4%, 74.6% and 86.4% in BNP group, respectively, while 25.6%, 58.1% and 80.2% in non-BNP group, respectively. There were statistically significant differences in continence at 1 and 3 months between two groups (P <0.05), while no significant differences were observed at 6 months postoperatively (P=0.331). There were no significant differences in overall rate of positive surgical margins between two groups (10.1% Compared with 10.4% P=0.954) and both groups had one case with positive surgical margins at bladder neck.

CONCLUSIONBladder neck preservation during laparoscopic radical prostatectomy is helpful for postoperative continence without increase of positive surgical margins rate.

Adult ; Aged ; Aged, 80 and over ; Humans ; Laparoscopy ; Male ; Middle Aged ; Prostatectomy ; methods ; Prostatic Neoplasms ; surgery ; Retrospective Studies ; Urinary Bladder ; surgery ; Urinary Incontinence ; prevention & control

cuses tumors. Survivin seems to be a promising marker for analyzing clinical stages and predicting the prognosis of TCC.

Objective To compare the clinical features and results between transperitoneal laparoscopic radical prostatectomy and extraperitoneal laparoscopic radical prostatectomy.Methods Thirty-three prostate cancer patients treated with laparoscopic radical prostatectomy. Among them,21 cases had been done transperitoneally and 12 cases had been done extroperitoneally. The two different approaches were evaluated and compared in respects of operating time, estimated blood loss, complications during surgery, postoperative complications, intestinal function recovery time, catheterization time and length of hospital stay.Results All the surgeries had completed successfully without conversion to open surgery. For transperitoneal approach and extraperitoneal approach, the operating time was (299±46)min and (309±64)min, blood loss was (618±448)ml and (677±469)ml. There were 3 cases with severe blood loss, 2 cases with bladder injuries and 1 case with ureteral injury in transperitoneal approach group. There were 1 case with severe blood loss, 1 case with obturator never injury, 1 case with cysto-ureteral injury and 1 case with peritoneum injury in extraperitoneal approach group. For transperitoneal approach and extraperitoneal approach,the catheterization time was(14.6±3.8)d and (12.3±2.9)d, intestinal function recovery time was (2.7±0.7)d and (2.1±0.5)d, length of hospital stay was (17.0±3.6)d and (11.2±3.5)d, respectively.Conclusions Laparoscopic radical prostatectomy is feasible and safe in clinical practice. Extraperitoneal approach has better vision, less impact on abdominal organs, faster recovery and shorter hospital stay comparing to transperitoneal approach.

Objective To investigate the characteristics and mechanism of W-shaped orthotopic ileal neobladder. Methods A total of 20 patients with W-shaped orthotopic ileal neobladder after total cystectomy were evaluated by urodynamic examinations (questionnaire of urination,uroflowmetry,post-voiding(PVR) residual urine volume measurement,enterocystometry and resting urethral pressure profilometry);meanwhile cystourethrography,B-ultrasound,renal function test and IVU were performed. Results Of the 20 cases,2 suffered from daytime incontinence and 6,nocturnal incontinence.The maximum capacity of neobladder was (492.9?177.8)ml,and maximum pressure within the reservoir was (32.1?8.6 )cm H 2O (1 cm H 2O=0.098 kPa).The urine flow curve showed continual type in 12 cases and intermittent type in 8,with maximum uroflow rates of (14.9?2.5 )ml/s,(7.7?2.8)ml/s;capacity of neobladders of (409.0?96.1)ml,(622.1?197.7)ml;PVR of (9.2?11.8)ml,(69.0?38.4)ml,respectively,in the 2 type groups.These values were significantly different between the 2 groups (P