前列腺小细胞神经内分泌癌诊治特点分析

Objective To review the clinical features of small cell neuroendocrine carcinoma of the prostate (SCPCa). Methods The ages of 4 cases were 25-77 years. Four cases had progressive dysuria with 2 cases had chronic urinary retention and 2 had upper urinary tract hydronephrosis. On admission, all cases were palpated a hard prostate mass in digital rectal examination. Serum tPSA were 0. 57-6.36 ng/ml with a ratio f/t PSA 0. 26-0.63. B ultrasound, CT and MRI detected 3.9 cm×3. 9 cm×1.6 cm-11.3 cm×7. 9 cm×9. 5 cm irregular shape mass in prostate. 2 cases had seminal vesicle involved, 2 cases had rectum involved, 2 had unilateral ureter involved, and 1 case had sacrum involved. Pelvic lymphonodes metastasis were seen in 3 cases. Bone scan detected multiple bone metastasis in 3 patients. Results The final diagnoses were accomplished by prostate biopsy. Under light microscope, tumor cells were orbivular-ovate or fusiform shape, small volume, and had little cytoplasm. The margin of tumor cells was not clear. Caryokinesis phase could be found with hyperchromatic chromatin. Immunohistochemistry showed positive ChA staining in 4 eases, positive NSE expression in 2 patients and negative PSA in 4 cases. 3 cases were given cisplatin-based chemotherapy, pelvic radiation, or chemotherapy plus radiotherapy. All patients appeared widespread metastasis quickly and died or lost visit within one year. Conclusions SCPCa is a rare, poor prognosis malignancy with early extensive metastasis. The diagnosis is based on pathology.     

前列腺小细胞神经内分泌癌诊治特点分析

Objective To review the clinical features of small cell neuroendocrine carcinoma of the prostate (SCPCa). Methods The ages of 4 cases were 25-77 years. Four cases had progressive dysuria with 2 cases had chronic urinary retention and 2 had upper urinary tract hydronephrosis. On admission, all cases were palpated a hard prostate mass in digital rectal examination. Serum tPSA were 0. 57-6.36 ng/ml with a ratio f/t PSA 0. 26-0.63. B ultrasound, CT and MRI detected 3.9 cm×3. 9 cm×1.6 cm-11.3 cm×7. 9 cm×9. 5 cm irregular shape mass in prostate. 2 cases had seminal vesicle involved, 2 cases had rectum involved, 2 had unilateral ureter involved, and 1 case had sacrum involved. Pelvic lymphonodes metastasis were seen in 3 cases. Bone scan detected multiple bone metastasis in 3 patients. Results The final diagnoses were accomplished by prostate biopsy. Under light microscope, tumor cells were orbivular-ovate or fusiform shape, small volume, and had little cytoplasm. The margin of tumor cells was not clear. Caryokinesis phase could be found with hyperchromatic chromatin. Immunohistochemistry showed positive ChA staining in 4 eases, positive NSE expression in 2 patients and negative PSA in 4 cases. 3 cases were given cisplatin-based chemotherapy, pelvic radiation, or chemotherapy plus radiotherapy. All patients appeared widespread metastasis quickly and died or lost visit within one year. Conclusions SCPCa is a rare, poor prognosis malignancy with early extensive metastasis. The diagnosis is based on pathology.     

浸润性和转移性膀胱癌的诊断和评价

一、膀胱癌的分级与分期 1.膀胱癌的组织学类型:尿路被覆的上皮统称为尿路上皮(urothelium).传统上将尿路上皮称为移行上皮(transitional epithelium).目前在文献和习惯上这两个名词常常被交替使用.膀胱癌的组织学类型包括尿路上皮癌、鳞状细胞癌和腺癌,其次还有较少见的转移性癌、小细胞癌和癌肉瘤等.     

《膀胱癌诊断治疗指南》解读——膀胱癌的治疗

本篇《膀胱癌诊断治疗指南》（以下简称“指南”）中,治疗部分分为非肌层浸润性膀胱癌的治疗、肌层浸润性膀胱癌的治疗、尿流改道术以及膀胱癌的化疗与放疗4个部分,对膀胱癌的治疗原则与方法做了全面的论述,以下分别就指南中有关膀胱癌治疗的各部分做一介绍。     

超声引导侧方穿刺和头端穿刺在经皮肾镜碎石术中应用的比较

目的比较在经皮肾镜碎石术中超声引导侧方穿刺和头端穿刺的技术特点。 方法回顾性分析2017年4月至2019年7月北京大学首钢医院就诊的肾中组后盏无积水完全或部分鹿角型肾结石行经皮肾镜手术治疗的30例患者的临床资料，采用侧方穿刺和头端穿刺技术穿刺肾中组后盏的患者各15例。采用t检验比较2组患者在寻找穿刺盏拟定穿刺路径时间、穿刺成功时间、穿刺成功所需次数的差异，并观察2组患者有无严重并发症发生。 结果在寻找穿刺盏拟定穿刺路径的时间方面，侧方穿刺组所需的时间比头端穿刺组短［（37.82±8.94）s vs（51.83±13.16）s］；而在穿刺成功的时间方面，侧方穿刺组所需的时间比头端穿刺组长［（51.36±24.10）s vs（29.20±12.35）s］，差异均具有统计学意义（t=2.712、4.122，P=0.019、0.001）。在穿刺成功所需次数方面，侧方穿刺组和头端穿刺组分别为（2.13±0.74）次和（1.73±0.70）次，差异无统计学意义（t=1.382，P=0.189）。2组患者均未出现重要脏器损伤和术后大出血。 结论在经皮肾镜超声定位穿刺操作中，侧方穿刺和头端穿刺技术各有优缺点；无论掌握哪一种穿刺技术，都可以做到精准穿刺。     

西施泰与吡柔比星联合灌注减少膀胱灌注化疗所致膀胱并发症的多中心临床研究

目的 验证西施泰膀胱灌注减少非肌层浸润性膀胱癌TURBt术后灌注化疗并发症的疗效和安全性.方法 对120例符合入选/排除标准患者进行多中心、随机、空白对照的疗效和安全性临床研究.患者均先行TURBt,之后观察组联合灌注吡柔比星和西施泰,对照组仅灌注吡柔比星.以膀胱疼痛直观模拟分级(VAS)评分为主要疗效指标,以血尿、膀胱刺激症状为次要疗效指标,严密观察不良事件、实验室检查、治疗前后生命体征的变化,评价其疗效和安全性. 结果 2组患者人口学特征与基线资料相似,具有可比性.观察组治疗前后VAS评分差值和改善率分别为2.24±1.70与(92.92±14.76)%,对照组分别为0.70±1.82与(20.59±87.34)%,2组比较差异均有统计学意义(P＜0.01);2组VAS总分变化值差异也有统计学意义,并且2组VAS评分灌注前后改善率的比较从访视2开始差异就有统计学意义.观察组尿频次数从治疗前的(9.06±4.09)次减少至(6.69±2.89)次,对照组从(8.85±3.32)次增加至(10.15±4.40)次,组间比较差异有统计学意义(P＜0.01).观察组夜尿次数从治疗前的(2.88±1.74)次减少至(1.47±1.62)次,对照组从(3.22±2.30)次减少至(2.91±1.73)次,差异亦有统计学意义(P＜0.01).2组治疗前后尿急、排尿困难及血尿方面的改善不明显,未发现与西施泰有关的不良事件. 结论西施泰与化疗药物联合灌注能明显改善膀胱灌注化疗患者VAS评分状况,迅速、持续缓解患者的膀胱疼痛,并改善患者尿频与夜尿症状,提高患者生活质量.VAS评分高的患者改善效果更明显.西施泰与化疗药联合灌注安全性与临床耐受性良好.

Abstract：

Objective To verify the efficacy and safety of intravesical instillation of Cystistat in reducing complications caused by intravesical chemotherapy after TUR-BT in non-muscle invasive bladder cancer patients. Methods One hundred and twenty patients who met the inclusion/exclusion criteria were enrolled into this multi-centered, randomized and blank controlled clinical study. Selected patients were randomized into the observation group and control group. TUR-BT was carried out in both groups followed by pirarubicin (THP) and Cystistat intravesical instillation in the observation group, and THP intravesical instillation alone in control group. Visual analog scale (VAS) was used as the primary efficacy variable. The secondary efficacy variables were assessments of hematuria and bladder irritation symptoms. Adverse events, laboratory tests and changes of vital signs before and after treatment were strictly observed during observation to evaluate the efficacy and safety of Cystistat.Results Demographics and baseline characteristics were comparable in both groups. The differences and the improvement rate of VAS score in the 2 groups were significant, both P＜0.01. The changes of VAS score and the improvement rate before and after treatment were (2. 24±1.70) and (92. 92±14.76) % in observation group and (0. 70±1.82) and (20. 59±87.34)% in control group respectively. According to the covariance analysis, there were significant differences in changes of VAS score between the observation group and the control group. Also, the improvement rate of VAS score was significant from visit 2. The urine frequency decreased from 9.06±4.09 to 6. 69±2.89 in observation group and increased from 8. 85±3. 32 to 10. 15±4.40 in control group, P＜0.01. There were also significant differences in changes of nocturia before and after treatment between these two groups (P＜0.01), the nocturia decreased from 2. 88±1.74 to 1. 47±1.62 in observation group and 3. 22±2.30 to 2.91±1.73 in control group, respectively. The changes of WHO assessment for hematuria,urgency and dysuria were not significantly different between the 2 groups. No Cystistat related adverse event was observed. Conclusions Cystistat combined instillation can significantly improve the VAS score of patients with chemotherapeutic agent instillation. Relief of bladder pain, frequency and nocturia are more rapidly and more durable in Cystistat combined instillation group. The improvement is more effective in patients with a high VAS score. Cystistat instillation with chemotherapeutics agents is both well tolerated and safe.     

MT1-MMP与DEK蛋白在前列腺增生和前列腺癌组织中的表达

目的研究Ⅰ型膜型基质金属蛋白酶(MT1-MMP)与DEK在前列腺增生(BPH)和前列腺癌(PCa)组织中表达的意义。方法用免疫组织化学SABC法研究MT1-MMP蛋白与DEK蛋白在13例BPH和22例PCa组织中的表达,并用基因芯片技术分析DEK mRNA在雄激素依赖性PCa细胞系C4和雄激素非依赖性PCa细胞系C4-2中的表达水平。结果在BPH中无MT1-MMP表达,而在50%PCa中MT1-MMP的表达为阳性,PCa组织呈阳性染色而癌旁正常组织呈阴性染色。不同Gleason评分、临床分期的PCa组织中MT1-MMP的表达无统计学差异。DEK在BPH和PCa中阳性率没有差异。在BPH组织中阳性表达位于基底细胞,PCa组织中癌细胞为阳性染色。50%的T1+T2期PCa和92.6%的T3+T4期PCa中DEK表达为阳性,二者有统计学差异。Gleason评分5~7分和8~10分PCa的表达无差异。92.9%转移PCa中DEK表达阳性而无转移PCa中DEK表达阳性率为50%,二者有统计学差异。C4-2中DEK mRNA的表达水平明显高于C4的水平。结论 MT1-MMP和DEK的高表达可能在PCa的发生、临床发展及转移中起重要作用,DEK在前列腺不同上皮细胞表达可能决定BPH或者PCa的发生。DEK的高表达可能与PCa的雄激素非依赖化有关。     

体外冲击波碎石对高密度输尿管结石治疗效果的影响因素分析

目的探讨影响体外冲击波碎石（ESWL）治疗高密度输尿管结石疗效（CT值＞1000 HU）的影响因素。 方法回顾性收集2015年6月至2020年6月在北京大学首钢医院诊断CT值＞1000 HU的单发输尿管结石,同时行ESWL治疗患者的临床资料,分析第一次体外碎石后的疗效和影响因素。 结果65例患者纳入研究,平均结石大小为（10.63±3.24）mm,平均结石密度（CT值）1202±126 HU,碎石成功率为63.1%,结石大小是影响ESWL治疗效果的独立影响因素（OR=1.586,95%CI=1.162~2.166,P=0.004）。ROC曲线分析显示,预测ESWL疗效的结石大小临界值是1 cm。 结论对于CT值＞1000 HU的输尿管结石,结石大小是影响ESWL疗效的独立预测因素,其中≤1 cm结石的碎石成功率达84.8%。     

比卡鲁胺150 mg单药与单独药物去势治疗局部晚期前列腺癌的随机对照研究

论 比卡鲁胺150 mg单药治疗局部晚期前列腺癌的安全性和耐受性良好,患者PSA下降程度和前列腺体积缩小程度与单独药物去势治疗相似,是一种新的治疗局部晚期、无远处转移前列腺癌安全、有效的方法.