Prognostic Significance of C-reactive Protein in Urological Cancers: a Systematic Review and Meta-analysis

Background: C-reactive protein (CRP), considered as a prototypical inflammatory cytokine, has beenproposed to be involved in tumor progression through inflammation. Recent studies have indicated CRP asa progostic predictor for urological cancers, but the results remain controversial. Materials and Methods: Asystematic search of Medline, Scopus and the Cochrane Library was performed to identify eligible studiespublished between Jan 1, 2001 and Sep 1, 2013. Outcomes of interest were collected from studies comparingoverall survival (OS), cancer-specific survival (CSS) and relapse-free survival (RFS) in patients with elevatedCRP levels and those having lower levels. Studies were pooled, and combined hazard ratio (HR) of CRP withits 95% confidence interval (CI) for survival were used for the effect size estimate. Results: A total of 43 studies(7,490 patients) were included in this meta-analysis (25 for RCC, 10 for UC, and 8 for PC). Our pooled resultsshowed that elevated serum CRP level was associated with poor OS (HR: 1.26, 95%CI: 1.22-1.30) and RFS (HR:1.38 95%CI: 1.29-1.47), respectively. For CSS the pooled HR (HR: 1.33, 95%CI: 1.28-1.39) for higher CRPexpression could strongly predict poorer survival in urological cancers. Simultaneously, elevated serum CRPwas also significantly associated with poor prognosis in the subgroup analysis. Conclusions: Our pooled resultsdemonstrate that a high serum level of CRP as an inflammation biomarker denotes a poor prognosis of patientswith urological cancers. Further large prospective studies should be performed to confirm whether CRP, as abiomarker of inflammation, has a prognostic role in urological cancer progression.     

离断性肾盂成形术治疗肾盂输尿管连接部狭窄32例

目的:探讨肾盂输尿管连接部(ureteropelvic junction,UPJ)狭窄的手术治疗方法。方法:32例均采用离断性肾盂成形术,术中置双J管引流,术后6~8周拔除双J管,3~6个月复查。结果:32例手术均获成功,排泄性尿路造影检查肾盂积水好转,狭窄解除,吻合口通畅。随访6个月,未出现吻合口再狭窄、肾积水加重等并发症。结论:离断性肾盂成形术是治疗UPJ狭窄的有效方法,使用有引流作用的支架管可减少术后再狭窄的发生。     

Impact of sarcopenia in the management of urological cancer patients

Introduction: Sarcopenia, the degenerative and systemic loss of skeletal muscle mass, develops as a consequence of the progression of cancer cachexia. Recent studies suggest that sarcopenia may be used as a biomarker in the management of patients with several cancers.

Areas covered: In this article, the authors review 1) the methods to simply and optimally evaluate and define sarcopenia using computed tomography images in daily clinical practice and 2) the impact of sarcopenia in the management of urological cancers, specifically focusing on the usefulness in predicting treatment-related complications and prognosis. The authors also discuss the prognostic importance of changes in skeletal muscle mass in the course of treatment and the potential roles of nutritional support and exercise to prevent progression of sarcopenia.

Expert commentary: Sarcopenia is associated with treatment-related complications and unfavorable prognosis in urological cancer patients. Nutritional support and exercise might be helpful in improving sarcopenia. The impact of these interventions on clinical outcomes would be elucidated by ongoing or future clinical studies.     

输尿管镜技术在泌尿外科的临床应用（附1333例报告）

目的：探讨输尿管镜技术在泌尿外科疾病诊治中的临床应用价值。方法：2002年9月至2008年9月应用经尿道输尿管镜技术诊断和治疗泌尿系疾病患者1333例。其中行输尿管镜治疗者1200例,包括输尿管结石1010例,其中上段结石146例、中段344例、下段520例;输尿管狭窄18例;医源性双J管滞留38例;男性尿道狭窄38例;膀胱尿道结石41例;肾盂结石8例;输尿管阴道漏5例;小儿逆行输尿管插管20例;内支架管置入22例。其中用于诊断的患者133例。结果：治疗1010例输尿管结石,成功865例,成功率为85.6%,其中治疗输尿管上、中、下段结石的成功率分别为68.5%、81.7%及93.1%;输尿管狭窄、尿道狭窄、膀胱尿道结石、输尿管阴道漏及小儿逆行输尿管插管均疗效满意。用于诊断的133例患者中,发现肿瘤4例,阴性结石48例,息肉8例,输尿管结核9例,输尿管狭窄30例,无阳性发现34例。手术失败24例。发生严重手术并发症37例,其中死亡1例,感染性休克2例,黏膜撕脱4例,穿孔15例、假道12例,严重出血3例。结论：输尿管镜技术由于其适应于泌尿系统腔道的独特特点,可应用于泌尿外科的许多疾病的诊治,尤其对输尿管下段结石可作为首选治疗措施;只要仔细操作,随着经验的积累,并发症发生率会越来越低。     

Clinical Evaluation of Parapelvic Renal Cysts: Do These Represent Latent Urological Malignant Disease?

Purpose: The parapelvic renal cyst is a relatively common finding on routine urological examination, butonly rarely needs treatment. We here examined all parapelvic renal cyst patients who consulted our Departmentbetween April 1998 and December 2004 with the focus on potential for malignant development. Materials andMethods: A total of 73 patients were diagnosed as having parapelvic renal cysts by ultrasonography, incombination with computed tomography, and/or drip infusion urography in our Department. The backgroundto diagnosis was suspicion of hydronephrosis in 15, flank and/or back pain in 15, and macroscopic hematuriaand/or occult blood urine in 12. Results: There were 3 patients with renal pelvic cancer, and one patient withureteral cancer. Nephro-ureterectomy was performed for all of these 4 cases. There were 10 patients with renalstones, three of which were given extracorporeal shock wave lithotripsy and one pyelonephrolithotomy. A furtherthree underwent parapelvic renal cyst puncture, performed to preserve renal function or obtain release fromsymptoms. The remaining 3 cases were symptomless, diagnosed after routine examinations, and were simplyfollowed up, as with the other 59 cases with no stones or cancer. Conclusions: Unless a parapelvic renal cystcauses pyelonephritis, symptomatic renal stones, or back discomfort, treatment is not indicated. However, thepossibility that urological malignant disease may be encountered should be borne in mind and appropriatediagnostic measures should be performed. Furthermore, careful follow up of parapelvic renal cyst patients maybe required.     

尿沉渣工作站对血尿定位的诊断价值

目的:探讨Diasys R/S2003尿沉渣工作站在鉴别血尿来源中的应用价值.方法:用Diasys R/S2003尿沉渣工作站检测110例不同来源血尿样本的红细胞.结果:应用Diasys R/S2003尿沉渣工作站检测尿红细胞对肾小球性血尿诊断的敏感性为88.7%,对非肾小球性血尿诊断的敏感性为80.7%.结论:用Diasys R/S2003尿沉渣工作站检测非均一性尿红细胞以诊断肾小球性血尿的敏感性高,可作为鉴别肾小球性与非肾小球性血尿的筛选方法.     

Gemcitabine chemotherapy for the treatment of metastatic bladder carcinoma

What’s known on the subject? and What does the study add? Metastatic bladder cancer is a devastating disease that often proves fatal. Systemic chemotherapy with MVAC (methotrexate, vinblastine, adriamycin, cisplatin) has been the first choice of treatment for many years but toxicity can be severe and overall survival poor. The search for more effective drug combinations continues. Clinical data indicate that gemcitabine has activity in this disease in terms of tumour response and overall survival. This systematic review comprehensively presents the available clinical evidence on gemcitabine chemotherapy for the management of metastatic bladder cancer. Limited data from randomized trials suggest that cisplatin plus gemcitabine may be considered a viable first‐line option for this disease and that the less toxic combination of gemcitabine plus carboplatin may be suitable for patients with poor renal function or low performance status. Data from observational studies highlight the wide variation in drug combinations and schedules used and the need for a systematic approach to clinical research with gemcitabine.

OBJECTIVE

? To systematically review the literature on gemcitabine chemotherapy for advanced or metastatic bladder cancer.

MATERIALS AND METHODS

? The Medical Literature Analysis and Retrieval System Onlinedatabase (MEDLINE), the Excerpta Medicadatabase (EMBASE), the Cumulative Index to Nursing and Allied Health Literature database(CIHNAL), the Cochrane database of randomized trials, the Literatura Latino‐Americana e do Caribe emCiências da Saúdedatabase (LILACS), and Web of Science were searched to identify trials of gemcitabine for metastatic bladder cancer. Also searched were international guidelines on metastatic prostate cancer, trial registries, and recent systematic reviews. Data on trial design, survival, tumour response and toxicity outcomes were extracted from relevant studies.

RESULTS

? This review identified six randomized trials of combined chemotherapy with gemcitabine for the management of unresectable, locally advanced or metastatic bladder cancer. ? One trial compared gemcitabine plus cisplatin (GCis) with methotrexate/vinblastine/doxorubicin/cisplatin(MVAC) and found no difference in overall survival (OS; hazard ratio 1.09) but a better safety profile with GCis, which was suggested as the treatment of choice. ? A second trial evaluated GCis against gemcitabine plus carboplatin (GCarbo) and reported similar median OS (12.8 vs 9.8 months), disease progression (8.3 vs 7.3 months) and tumour response rates (66% vs 56%) for the two patient groups. ? A third trial compared GCis with GCis plus paclitaxel (GCisPac) and showed no significant difference in median OS (12.3 vs 15.3 months) and response rates (44% vs 43%) but greater toxicity with GCisPac. ? A fourth trial assessed GCarbo against methotrexate plus carboplatin plus vinblastine in patients unfit for cisplatin‐based chemotherapy and found similar tumour response rates for each regime (38% vs 20%) but the triplet regime was more toxic. ? Two other randomized studies compared a 2‐weekly maintenance regime of gemcitabine plus paclitaxel with a 3‐weelky regime given for a maximum of six cycles and found that the maintenance schedule did not confer any additional survival benefit. ? In all, 53observational studies of gemcitabine chemotherapy were identified that varied considerably in the drug combinations used and schedules. Overall response rates (17–78%) and median OS (6.4–24.0 months) were variable with no combination being clearly superior.

CONCLUSIONS

? Gemcitabine combined chemotherapy is active in the management of metastatic bladder cancer. ? GCis may be considered an alternative regime to MVAC. ? GCarbo should be considered for patients unfit for cisplatin‐based therapy.     

Binding indocyanine green to human serum albumin potentially enhances the detection of sentinel lymph nodes. An initial step for facilitating the detection of first-station nodes in penile and other urological cancers

IntroductionSurgical oncology strives to remove the primary cancer tumor together with its local lymphatic tissue. One of the techniques improving the staging of lymph nodes is sentinel node biopsy. The most common agent used in SNB is indocyanine green (ICG). Indocyanine green is characterized by its high affinity for human serum albumin (HSA). In practice, the visualization of the sentinel node is enhanced by attaching a relatively large carrier to the ICG molecule. The aim of this study was to investigate whether the covalent linking of ICG to a nanocolloid would extend the time of detection of the dye as it binds to HSA, assessed by fluorescence measurements in vitro.Material and methodsThe influence of the molar concentration of ICG on its ability to form a complex with HSA was investigated. The dye luminescence was measured, with an increasing amount of dye in the presence of a constant concentration of HSA. The stability of the ICG:HSA complex was also investigated.ResultsThe binding of ICG and human protein in a solution ratio of 3 : 1 made it possible to detect the ICG luminescence with better and prolonged visibility. In the case of the two lowest ratios, complex formation was not observed. The use of ICG bound to a nanocolloid based on human serum albumin increases the luminescence of the HSA : ICG complex up to 98%.ConclusionsProperly selected proportions of human albumin protein and ICH allowed higher and longer luminescence to be achieved. Nevertheless, further studies are necessary to establish the optimal concentration ratio.