Succinate dehydrogenase (SDH) defective renal cell carcinoma (RCC) is a new subtype of renal carcinoma newly identified by WHO(2016). Until now, only a few samples and a few cases have been reported retrospectively. This article reported a young female patient who was found to have a small tumor in the left kidney by physical examination and underwent left partial nephrectomy. The postoperative pathological result was SDH-RCC. There was no recurrence and metastasis of the tumor 3 months after operation.

目的 分析3D腹腔镜下前列腺癌根治术切缘阳性的影响因素.方法 收集146例3D腹腔镜下前列腺癌根治术患者的病历资料,分析术后病理切缘阳性情况及其影响因素.结果 146例患者中,手术切缘阳性(PSM)患者65例,切缘阳性部位(有部分样本具有多个部位切缘阳性):尖部及尿道26例,环周切缘及部分环周切缘24例,上切缘13例,下切缘13例,侧切缘10例,膀胱颈基底切缘4例,后切缘1例.PSM与非PSM前列腺癌患者的危险分级比较,差异有统计学意义(P＜0.01).危险分组是3D腹腔镜下前列腺癌根治术PSM的影响因素(P＜0.05).高危患者PSM风险是中低危患者的3.859倍.结论 危险分组是3D腹腔镜下前列腺癌根治术切缘阳性的独立影响因素,术前明确的危险分组应引起足够重视.

Objective:To investigate the long-term survival and safety in patients with muscle-invasive bladder cancer (MIBC) who experienced a noninvasive down-staging (≤pT 1)after transurethral resection of bladder tumor (TURBT) plus systemic chemotherapy and received bladder-sparing treatment. Methods:The records of patients with MIBC who underwent maximal TURBT plus systemic chemotherapy-guided bladder-sparing treatment were reviewed retrospectively from Dec 2013 to Dec 2020. Eventually, 22 patients who achieved noninvasive down-staging underwent conservative management. The total patient cohort contained 10 males and 12 females. A majority of patients had single lesion and stage T2 disease. The median age of the patients was 66 years and the median tumor size was 3.0 cm. All patients underwent maximal TURBT to resect all visible diseases and followed by 3-4 cycles platinum-based systemic chemotherapy. After achieving noninvasive down-staging, 14 patients received concurrent chemoradiotherapy, and the other 8 patients underwent surveillance. Overactive bladder symptom score (OABSS) was used to assess the bladder function after treatment.Results:Twelve patients achieved pT 0 and 10 patients were down-staged to cT a-T 1. At a median follow-up of 36.7 months, 90.9%(20/22) patients retained their bladder function successfully. Among the 14 patients who received concurrent chemoradiotherapy, 4 had grade 3 or 4 adverse events. Among the 8 patients who underwent surveillance, 3 had grade 3 or 4 adverse events after systemic chemotherapy.Nine patients experienced tumor recurrence in the bladder, and 2 patients died of bladder cancer. Seven (31.8%) patients experienced Ⅲ/Ⅳ grade complications. The 5-year recurrence-free survival (RFS) and overall survival (OS) in patients achieved pT0 were 66.7% and 100.0%, respectively. The 5-year RFS and OS in patients achieved cTa-T1 were 40% and 72%, respectively. The OABSS score of 20 patients who retained their bladder successfully was (1.00±1.03). Conclusions:MIBC patients who achieved noninvasive down-staging might be candidates for the bladder-sparing treatment with maximum TURBT followed by systemic chemotherapy.The patients who achieved pT 0 might have better prognosis with functional bladder.

目的:观察吉西他滨联合顺铂(GC)方案新辅助治疗肌层浸润性膀胱癌(MIBC)患者的疗效性及安全性.方法:回顾性分析2015年1月-2019年3月于中国医学科学院北京协和医学院肿瘤医院经病理证实的87例T2～4N0M0期行新辅助化疗(NAC)的MIBC患者的临床资料.予吉西他滨1000 mg/m2,第1、8天静脉滴注,顺铂70 mg/m2,分2～3 d静脉滴注,共3～4个疗程,观察疗效及毒性反应,并根据化疗效果行根治性膀胱切除术(RC)或经尿道膀胱肿瘤电切术(TURBt)+放化疗同步等不同的治疗方式.结果:87例患者均完成NAC,平均疗程为3个,客观缓解率65.52％(57/87),疾病控制率为96.55％(84/87),其中完全缓解6例,部分缓解51例,疾病稳定27例,疾病进展3例;主要不良反应为骨髓抑制及消化道反应,未出现化疗相关性死亡.成功保留膀胱59例,其中行TURBt+膀胱灌注17例,TURBt+同步放化疗27例,TURBt+化疗3例,膀胱部分切除12例;行膀胱全切除术28例.结论:MIBC术前NAC有较高的反应率,且毒副作用小、具有较好的安全性及耐受性,可积极推广,并可联合手术、放疗等治疗措施保留膀胱,需要更大样本及更长时间随访进一步验证.

管状囊性肾细胞癌(tubulocystic renal cell car-cinoma,TRCC)是近年来人们逐渐认知的一种罕见的预后良好的低度恶性肿瘤,2016版世界卫生组织泌尿系统和男性生殖器官肿瘤分类中将其正式命名,列为一种独立的肾细胞癌亚型[1].本文对2014年4月和2014年7月中国医学科学院肿瘤医院采用后腹腔镜肾部分切除术治疗的2例TRCC患者的临床及预后资料进行分析,探讨该术式治疗TRCC的安全性和长期疗效.

目的:探究磁共振(MRI)-经直肠超声(TRUS)认知融合引导下经会阴前列腺靶向穿刺活检与经会阴前列腺系统穿刺活检对前列腺癌的检出率的差异性,并分析检出率的影响因素.方法:回顾性分析中国医学科学院肿瘤医院2017年12月～2019年12月规范的影像数据系统第2版评分≥3分的行经会阴前列腺穿刺活检的患者资料.同时行2～4针靶向穿刺活检和12针系统穿刺活检,比较二者在前列腺癌检出率方面的差异性.结果:共127例证实为前列腺癌,其中经认知融合靶向穿刺检出前列腺癌105例,系统穿刺检出前列腺癌117例,两者在前列腺癌检出率方面差异无统计学意义(x2 = 1.229,P = 0.268).在以PSA高低的分组中,两者在PSA＜4 ng/mL、4ng/mL≤PSA ＜ 10 ng/mL、10 ng/mL≤PSA＜20 ng/mL及PSA≥20 ng/mL4组的检出率差异均无统计学意义(P＞0.05),以PSA密度分组中,两者检出率差异无统计学意义(P＞0.05).二者联合检出率为54.04％,均高于两者单独的检出率,且检出率的高低与PSA水平及PSA密度相关.结论:MRI-TRUS认知融合引导的经会阴靶向穿刺活检与系统的前列腺穿刺活检在前列腺癌的检出率方面差异无统计学意义,经会阴前列腺靶向穿刺活检仍不能代替系统前列腺穿刺活检,二者的结合可提高前列腺癌的检出率.

Objective: To investigate the feasibility and safety of minimally invasive radical prostatectomy for prostate cancer patients without preoperative prostate biopsy in the new era of the continuous development of comprehensive new imaging diagnostic mode and minimally invasive surgery technology. Methods: From August 2018 to October 2019, 17 patients with prostate cancer were enrolled in this study in the Cancer Hospital, Chinese Academy of Medical Sciences. All patients were highly suspected of prostate cancer by PSMA-PET/CT-based imaging diagnostic techniques and underwent 3D laparoscopic radical prostatectomy without prostate biopsy. The perioperative data, postoperative pathology, postoperative complications and follow-up results were recorded and analyzed. Results: The average age of 17 patients with prostate cancer was (65±7) years. The body mass index (BMI) average was (24.4±3.0) kg/m(2). The American Society of Anesthesiologists (ASA) score was 1 (1-2) and the Charlson comorbidity index (CCI) score was 1 (0-4). The preoperative value of PSA was (19±11) μg/L. The PSMA PET/CT showed abnormally high expression foci and the great possibility of prostate cancer for all the 17 patients. Prostate puncture biopsy: the results of prostate biopsy were negative in 3 cases. The digital rectal examination found that the prostate volume was Ⅰ or Ⅱ degree large, 10 cases touched hard and the nodule was touched in two cases. Three patients had undergone a previous prostate biopsy, but prostate cancer was not found. All the 17 operations were successfully performed without conversion to open surgery. The surgery time was (85±21) (range from 45 to 120) min, the estimated blood loss was (25±18) (range from5 to 100) ml, the time of intake of liquid diet was (14.3±4.4) h, the intestinal recovery time was (23±10) h, the postoperative activity time was (22±7) h, the drainage duration was (3.7±0.8) d, the postoperative hospital stay was (4.9±1.2) days, and the catheter removal time was (7.4±1.5) days. In the early postoperative period (within 30 days after surgery), no obvious complications occurred. The postoperative final pathology confirmed that all the 17 specimens were prostate cancer. After a median follow-up of 6.5 months, the patient's urinary control rate reached 81.3% at postoperative 1 month, 92.3% at postoperative 3 months after surgery, and the urinary control rate reached 100% at postoperative 6 months. Postoperative PSA value was (0.08±0.08) μg/L, significantly lower than preoperative PSA level (P<0.001). There was significant difference between the preoperative and postoperative QOL (Quality of life) score (57±5 and 47±5 respectively, P<0.001) which indicated that the patients' postoperative quality of life was greatly improved. Conclusions: It is safe and feasible to perform minimally invasive radical prostatectomy without preoperative prostate biopsy for patients with highly suspected prostate cancer by comprehensive diagnostic mode based on modern new imaging technology.

目的:探讨临床分期为T1期(cT1)的肾癌患者行肾部分切除术后,病理升期为T3a期(pT3a)的临床特点及预后情况.方法:回顾性分析2009年1月～2019年12月中国医学科学院肿瘤医院泌尿外科临床诊断为T1期肾癌,行肾部分切除术的患者的临床资料,记录年龄、性别、肿瘤大小、临床分期、病理类型、Fuhrman分级等情况.结果:肾部分切除术肾癌患者共计1168例,T1a期618例,T1b期550例,男733例,女435例;年龄20～72岁,中位年龄50岁;均成功行肾部分切除术,腹腔镜手术801例,开放性手术367例.病理升期为pT3a期的肾癌占2.2％(26/1168),26例术后经病理检查证实均存在肾周脂肪或肾窦脂肪受侵.年龄、性别、肿瘤大小、临床分期、肿瘤侧别、病理类型等因素与病理升期无明显相关性(P＞0.05),而Fuhrman分级与升期相关(P=0.005),pT1期和pT3a期两组无复发生存期及总生存期无明显差异(P=0.973,P=0.321).结论:cT1的肾癌肾部分切除术后升期为pT3a期的患者比例不高,CT等影像学检查无法精确判断,但术中完整切除周围脂肪,整体预后良好,但需要积攒病例进一步研究.

Objective To investigate the dose of docetaxel appropriate for patients with metastatic castration-resistant prostate cancer and its affects to the prognosis.Methods A retrospective analysis was performed on the clinical data of 75 patients with metastatic castration-resistant prostate cancer admitted from March 2010 to July 2016 who received docetaxel combined with prednisone chemotherapy.The patients were divided into the low-dose group (n =43,docetaxel ＜ 65 mg/m2),the middle-dose group (n =21,docetaxel 65-70 mg/m2) and the high-dose group (n =11,docetaxel ＞ 70 mg/m2).The median age in the low-dose group,middle-dose group and high-dose group was 67 (53-80),66 (56-78) and 61 (47-76) years old,respectively.Among 75 patients with bone metastasis,2 patients had no evidence of bone metastasis in the low-dose group.The lymph node metastasis was found in 26,13 and 6 cases in each group,respectively.And visceral and other metastasis were founded in 11,4 and 2 cases,respectively.The Gleason score in the low-dose group was≤7 points in 15 cases,≥8 points in 22 cases and no score in 6 cases.The Gleason score inthe middle-dose group was ≤7 points in 4 cases,≥8 points in 13 cases and no score in 4 cases.The Gleason score in the high-dose group was ≤7 points in 3 cases,≥8 points in 5 cases and no score in 3 cases.The number of patients with pain in the low-dose group,middle-dose group and high-dose group was 36,12 and 9,respectively,there were no significant differences in the above indicators (P ＞ 0.05),except age,which showed relatively more aged patients in the low-dose group,(P =0.045).Kaplan-Meier method was used to compare the overall survival (OS),progression-free survival (PFS) and the incidence of ≥CTCAE-4 grade 3 adverse reactions between the two groups.The Cox regression model was adopted to analyzed the factors that might affect patient prognosis,including the effective time of first-line endocrine therapy,hemoglobin level,ECOG score,pain score,number of cycles of chemotherapy,age,dose of docetaxel and alkaline phosphatase (ALP).Kaplan-Meier method was used to analyze the effect of dose of docetaxel on the prognosis,and log-rank method was used to test the significance of the results.Results The median OS was respectively 24.1,18.5 and 23.5 months in the low-dose group,middle-dose group and high-dose group,respectively.The median PFS was 5.3 months in all three groups,which didn't show statistically significant differences.The incidence of grade 3/4 adverse reactions in the low-dose group,middle-dose group and high-dose group was 15 cases (34.9％),8 cases (38.1％) and 5 cases (45.5％) respectively.It showed an increasing trend,but no statistically significant difference.The single factors related to OS mainly include the effective time of first-line endocrine therapy,hemoglobin level,ECOG score,pain score,number of cycles of chemotherapy,there was no significant correlation with age,docetaxel dose,ALP and PSA value.Conclusions It is common to receive lower doses of docetaxel in clinical practice for patients with metastatic castration-resistant prostate cancer in China.The efficacy of low-dose docetaxel is similar to that of high doses (standard dosage).There was no significant correlation between the OS and the actual dose of docetaxel in the tolerable range.

目的 探讨肾脏黏液小管状和梭形细胞癌(MTSCC)患者的临床特征、诊断及治疗情况,提高对该疾病的认知.方法 回顾性分析5例肾脏MTSCC患者的临床资料,并结合文献进行讨论.结果 术前诊断乳头状肾细胞癌3例,诊断肾嫌色细胞癌2例.5例患者均接受了手术治疗,其中行根治性肾切除术2例,行肾部分切除术3例.B超提示肿物均呈低回声,界限较清楚;彩色多普勒血流成像(CDFI)未见明显血流信号或见少许血流信号.术后标本大体观察表现为类圆形实性肿瘤,切面呈灰黄色或灰白色,质软或质韧.肿瘤切片经HE染色、光镜观察,见5例肿瘤组织形态相似,主要由梭形细胞、小管状结构和黏液样基质构成.其中,3例患者的肿瘤伴有坏死(1例同时伴有出血),2例伴有钙化.免疫组织化学染色结果显示,配对盒基因2(PAX2)阳性3例,配对盒基因8(PAX8)阳性3例,细胞角蛋白7(CK7)阳性4例,CD10阳性2例,上皮膜抗原(EMA)阳性2例,细胞角蛋白18(CK18)阳性2例,细胞角蛋白19(CK19)阳性2例,波形蛋白(vimentin)阳性4例,高分子质量角蛋白34βE12(CK34βE12)阳性3例;CD117染色均为阴性,共5例.上述病例经病理诊断均为肾脏MTSCC,T1a期2例,T1b期3例.术后随访7～60个月,中位随访36个月,患者均未发现肿瘤复发与转移.结论 MTSCC影像学表现为肾脏低血供病变,界限清楚.术前可被误诊为乳头状肾细胞癌、肾嫌色细胞癌,最终依赖术后病理确诊,手术为其首选治疗方式,预后良好,但若存在复发和转移,需进一步积累经验以评价其预后.

目的 探讨在多学科团队综合诊治模式下,采用肾部分切除术治疗75岁以上T1期肾癌患者的安全性与疗效.方法 回顾性分析2014年2月至2017年8月在本院经多学科(泌尿外科、麻醉科、影像诊断科、肿瘤内科、放疗科、病理科、介入治疗科、重症医学科等)团队会诊后,采取保留肾单位手术治疗的16例75岁以上高龄肾癌患者的病例资料.其中行开放肾部分切除术2例,后腹腔镜肾部分切除术14例,均采用加速康复外科理念行术中、术后管理.结果 16例患者手术均顺利完成,术中肾脏热缺血时间15～29min,平均20.6min.术中出血量10～100ml,平均37.5ml.术后病理结果:透明细胞癌12例,嫌色细胞癌2例,乳头状肾细胞癌2例.病理分期T1a期14例,T1b期2例.肿瘤切缘均为阴性.按照Clavien-Dindo系统评分,2例出现Ⅰ级术后并发症,均为发热,经对症治疗后好转,其余14例均无并发症.患者术后5～7d(平均6.4d)出院,无术后30d内再次入院.术后3个月复查同位素肾动态显像,结果显示患肾肾小球滤过率与术前比较差异无显著性.术后随访10～48个月,中位随访时间35个月,所有患者均无瘤存活.结论 多学科团队综合诊治模式下行肾部分切除术治疗高龄T1期肾癌患者,有利于严格掌握手术指征,充分术前评估及准备,在此基础上由经验丰富的术者行肾部分切除术安全有效,对于预期寿命较长的患者,可获得良好的预后.加速康复外科理念有助于减少术后并发症、促进患者恢复.

Objective To improve the accuracy of preoperative diagnosis of renal vein tumor thrombus in renal cell carcinoma (RCC),the clinical characteristics of RCC with misdiagnosis of renal vein tumor thrombus (RVTT) were analyzed.Methods Clinical data of 128 patients with RCC accompanied with RVTT from January 2000 to September 2015 were studied retrospectively.According to whether RVTT failed to be detected preoperatively,all patients were divided into 39 cases of misdiagnosis group and 89 cases of no misdiagnosis group.Forty cases of RCC with pathologically confirmed no RVTT were selected as no tumor thrombus group from January 2015 to June 2015.Misdiagnosis group included 29 males and 10 females,with age of (61.4 ± 11.1) years old,body mass index of (26.74 ±3.12) kg/m2,KPS ＜80 in 2 cases,paraneoplastic syndrome and Mayo grade 0 in 1 case.No misdiagnosis group consisted of 74 males and 15 females,with age of (60.2 ± 9.7) years old,body mass index of (25.12 ± 1.93) kg/m2,KPS ＜ 80 in 5 cases,paraneoplastic syndrome and Mayo grade 0 in 7 cases.No tumor thrombus group comprised of 31 males and 9 females,with age of (59.5 ± 10.7) years old,body mass index of (24.48 ± 2.56) kg/m2,KPS ＜ 80 in 3 cases,and paraneoplastic syndrome in 3 cases.There was no significant difference in general clinical data between misdiagnosis group and no misdiagnosis group,and misdiagnosis group and no tumor thrombus group (P ＞ 0.05).The tumor location,tumor diameter and imaging data were compared between misdiagnosis group and no misdiagnosis group,and misdiagnosis group and no tumor thrombus group.Results There was no significant difference in term of tumor locating in the middle pole [56.4％ (22/39) vs.38.2％ (34/89)],tumor with collateral vessels [33.3％ (13/39) vs.31.5％ (28/89)] and renal vein contrast agents filling defect [42.9％ (9/21) vs.61.8％ (21/34)] between misdiagnosis group and no misdiagnosis group (P ＞ 0.05).The proportion of renal tumor locating in the middle pole,tumor with collateral vessels and renal vein contrast agents filling defect in misdiagnosis group was significantly higher than that of no tumor thrombus group [30.0％ (12/40),P =0.018;10.0％ (4/40),P =0.012;16.7％ (4/24),P =0.002].Conclusions RVTT is vulnerable of misdianosis in RCC.It should be alert to the possibility of complicating tumor thrombus in the presence of renal tumor locating in the middle pole,renal tumor with collateral vessels and renal vein contrast agents filling defect.The clinical understanding of these features should be improved.

Objective To expLore the Long‐term efficacy and safety of 125 I brachytherapy com‐bined with androgen deprivation therapy (ADT ) for the treatment of intermediate to high‐risk LocaL‐ized prostate cancer . Methods T hirty‐six cases of LocaLized prostate cancer treated with 125 I brachytherapy combined with ADT were retrospectiveLy anaLyzed .T he median age of the patients was 65 years .T he pathoLogicaL diagnosis of prostate biopsy was confirmed as adenocarcinoma ,and the GLeason score was 7‐8 .CLinicaL staging showed :9 cases in T2a ,17 cases in T2b ,and 10 cases in T2c stage.Serum PSA vaLue ranged from 5 .8 ng／mL to 26 .2 ng／mL with a median of 12 .8 ng／mL . According to the risk cLassification of prostate cancer ,20 cases were in the intermediat‐risk group and 16 cases in the high‐risk group .T he prescription dose of 125 I radioactive particLes was 145 Gy , and combined androgen bLockade using L HRH agonist and bicaLutamide were performed .T he inter‐mediate‐risk group received adjuvant therapy for 6 months and the high‐risk group for 12 months . ALL patients were foLLowed up for 60‐72 months ,with a median period of 60 months . ResuLts PSA vaLue of these patients decreased to beLow 0 .2 ng／mL ,and the Lowest vaLue was 0 .003 ng／mL with the median of 0 .01 ng／mL in 6 months .Two cases of biochemicaL recurrence occurred in the intermediate‐risk group and 1 case in the high‐risk group ,and effective endocrine therapy was administered again .LocaL recurrence occurred in 1 case in the high‐risk group ,and the PSA decreased to 0 .003 ng／mL after saLvage radicaL prostatectomy being performed .No patient died during foLLow‐up.T he 5‐year overaLL survivaL rate is 100%,and the 5‐year tumor progression‐free survivaL rate was 90 .0% in the intermediate‐risk group and 87 .5% in the high‐risk group .T here was no significant difference between the two groups (P＝0 .816).Adjacent treatment adverse reactions :u‐rinary tract symptoms :grade Ⅰ 22%(8／36) ,grade Ⅱ 6%(2／36) ;rectaL symptoms :grade Ⅰ 8%(5／36 ).ALL the above adverse reactions disappeared within one year .Endocrine therapy adverse reactions :Loss of Libido 100%(36／36) ,erectiLe dys‐function 100%(36／36) ,hot fLash 50%(18／36) ,fatigue 33%(12／36) ,breast sweLLing 25%(9／36) ,nausea 14%(5／36) ,a‐nemia 5%(2／36) ,depression 3%(1／36).The symptoms aLL disappeared after stopping the drug . ConcLusions 125 I brachy‐therapy combined with ADT for the treatment of intermediate to high‐risk LocaLized prostate cancer is effective and safety .T he 6‐month adjuvant ADT in the moderate‐risk group and the 12‐month adjuvant ADT in the high‐risk group showed a simiLar tumor prognosis .

目的 探讨中国肿瘤登记地区肾细胞癌(RCC)的死亡趋势.方法 收集整理全国肿瘤登记中心1998—2008年登记的RCC数据,包括RCC死亡率及年龄标化死亡率.分别按性别及城乡差异进行统计,分析中国男性与女性、城市与农村RCC的死亡趋势.结果 1998—2008年,中国肿瘤登记地区RCC的死亡率总体呈增长趋势,死亡率年均增长率为7.63％.男性RCC死亡率年均增长率(7.95％)略高于女性(7.13％);城市地区RCC死亡率年均增长率(6.97％)低于农村地区(7.67％).1998—2001年,中国RCC死亡率呈现较快速增长,死亡率年均增长率为19.33％;2001年以后,RCC死亡率增长趋于放缓,2001—2008年的死亡率年均增长率降至2.98％.中国男性、女性、城市地区及农村地区RCC死亡率年均增长率在1998—2001年分别为18.09％、21.50％、18.21％和20.34％,在2001—2008年分别为3.87％、1.50％、2.49％和2.65％.结论 中国RCC死亡率在一段时间的快速增长后,自2001年开始趋于稳定.总体上,中国RCC死亡率的增长男性略高于女性,城市地区低于农村地区.

目的 探索经会阴认知融合MRI前列腺靶向穿刺活检与系统前列腺穿刺活检对前列腺癌诊断率的差异性.方法 选择怀疑前列腺癌未曾行前列腺穿刺、前列腺特异性抗原(PSA)≤50.0ng/ml、多参数磁共振成像(mpMRI)检查发现前列腺结节且PI-RADS V2≥3分的患者71例.均同时进行前列腺结节经会阴认知融合MRI前列腺靶向穿刺+系统前列腺穿刺,即先进行前列腺结节2针的经会阴认知融合MRI前列腺靶向穿刺;再进行12针的经会阴系统前列腺穿刺;比较两者在前列腺癌诊断阳性率方面的差异性.结果 共发现前列腺癌42例[59.15％(42/71)],经会阴认知融合MRI前列腺靶向穿刺发现前列腺癌36例[50.70％(36/71)],系统前列腺穿刺发现前列腺癌39例[54.93％(39/71)];认知融合靶向前列腺穿刺对前列腺癌的诊断率与系统前列腺穿刺差异无显著性(χ2=0.44,P=0.508).经会阴认知融合MRI前列腺靶向穿刺和系统前列腺穿刺分别诊断低危前列腺癌1例(1.4％)和3例(4.2％).根据前列腺特异性抗原(PSA)将71例患者分为PSA<10ng/ml组29例和10ng/ml≤PSA<50ng/ml组42例,分层分析显示,在PSA<10ng/ml组患者中,经会阴认知融合MRI前列腺靶向穿刺和系统前列腺穿刺的阳性诊断率分别为37.93％和48.28％(χ2=0.25,P=0.625);在10ng/ml≤PSA<50ng/ml组患者中,经会阴认知融合穿刺和系统前列腺穿刺的阳性诊断率分别为59.52％和66.67％(χ2=0,P=0.618),差异均无显著性.结论 在PSA≤50ng/ml,mpMRI提示前列腺结节且PI-RADS V2≥3分的患者,认知融合穿刺阳性诊断率并不优于系统前列腺穿刺.

Objective To study associated single nucleotide polymorphisms (SNPs) with testicular germ cell tumors (TGCTs) patients in China,expect to find the different risk SNPs of domestic TGCTs.Methods Selecting 37 SNPs from foreign genome-wide association study about TGCTs as candidate SNPs in this experiment.76 TGCTs patients and 148 healthy men blood samples from three hospitals of China are genotyping in iMLDRTM for case-control.Results rs4624820,rs6897876,rs4324715,rs12699477,rs10463352,rs4888262,rs4617646,rs210138,rs8046148,rs2839186,rs3805663,rs4635969 are associated with TGCTs in China.rs10463352,rs12699477,rs755383,rs6897876,rs4624820,rs2900333,rs4617646,rs4324715 are related to seminoma.And rs10463352,rs12699477,rs210138,rs6897876,rs4617646,rs4624820,rs4324715 are related to non-seminoma.Conclusion The positive SNPs sites of TGCTs patients in the studied area of China are different from that of foreign TGCTs patients.There are also differences of positive SNPs sites between seminoma and non-seminoma.

目的 探讨中国肿瘤登记地区肾细胞癌(RCC,以下简称肾癌)的发病趋势.方法 收集整理中国肿瘤登记中心1998-2008年的肾癌登记数据,包括肾癌发病率及年龄别发病率.分别按照性别及城乡差异进行统计,分析中国男性与女性、城市与农村肾癌的发病趋势.结果 1998-2008年,中国肿瘤登记地区肾癌的发病率逐年增长,年均增长率为7.89％.男性发病的年均增长率为8.13％,高于女性的7.51％.城市地区肾癌发病的年均增长率为7.04％,低于农村地区的9.15％.35岁以前的肾癌年龄别发病率处于较低水平,35岁以后的肾癌年龄别发病率呈现较快增长的趋势,75～79岁达到高峰.结论 中国属于肾癌发病中等水平的国家之一.但近10年间,不论是男性还是女性,城市还是农村,肾癌的发病率均呈明显增长的趋势,应引起广泛重视.

Objective:To identify genetic susceptibility genes and the loci of their single nucleotide polymorphisms (SNPs) in patients with testicular germ cell tumor (TGCT) and provide some new ideas for the prediction, diagnosis and treatment of TGCT.METHODS:We identified 41 SNP loci of TGCT-related genetic susceptibility genes from the literature published abroad. Using the iMLDRTM genotyping technique, we examined the SNP loci of the genetic susceptibility genes in the blood samples from 76 TGCT patients (aged 16－68 years) and 148 healthy men (aged 22－61 years) in China and analyzed their correlation with TGCT.RESULTS:In China, TGCT was found to be correlated with the SNP loci rs2978381, rs10146204, rs12435857 and rs1256063 of the ESR2 gene, rs9397080 of the ESR1 gene, rs11202586 of the PTEN gene, rs2606345 and rs4646903 of the CYP1A1 gene, and rs1456432 of the CYP19A1 gene.CONCLUSIONS:The results of our study indicated some difference in the positive SNP loci of the TGCT patients between Chinese and foreign cohorts as well as in different groups in China.

目的 探讨肾上皮样血管平滑肌脂肪瘤(EAML)的诊断与治疗.方法 回顾性分析19例肾EAML患者的临床及预后资料.患者术前经CT、MRI等影像学检查,术前诊断血管平滑肌脂肪瘤(AML)4例,其中EAML 2例;诊断肾癌15例.所有病例均首先接受手术治疗,其中行根治性肾切除术12例,行肾部分切除术7例.结果 术后标本病理切片经光镜观察及选用HMB45、Melan-A、SMA、S100、Vim、CD-10、EMA、CK-7、CK-8、CK18和Ki-67等免疫组化染色分析,均诊断为EAML.其中病理确诊恶性1例,提示肿瘤具有恶性倾向,建议密切随访5例.术后随访6～144个月,中位随访67个月,出现肿瘤复发、转移4例.行全身化疗2例,行酪氨酸激酶抑制药治疗1例.1例行雷帕霉素靶蛋白(MTOR)抑制剂依维莫司治疗,疗效评价为部分缓解(PR),缓解时间超过5个月,目前带瘤生存中.结论 肾EAML可表现为恶性生物学行为,术后很快出现复发和远处转移,并可导致患者死亡.但病理学上EAML尚无明确的良恶性鉴别标准,免疫组化染色Ki-67表达水平与肿瘤侵袭性有关.对于局限性EAML,手术治疗是首选治疗方法.对于转移性EAML,常规化疗效果不确定,而MTOR抑制剂依维莫司有望成为有效治疗手段.

Objective To evaluate the efficacy and safety of the modified docetaxel plus prednisone scheme for the metastatic castration resistant prostate cancer patients who got poor tolerance to chemotherapy.Method The clinical data of 50 metastatic castration resistant prostate cancer who received docetaxel + prednisone chemotherapy from March 2010 to October 2015 were analyzed retrospectively.23 cases received the modified DP regimen (modified group),27 cases received the standard DP regimen (standard group).The median age of the modified group and the standard group were 69 years (47-80 years) and 63 years (52-77 years) (P =0.005).There were 19 and 24 cases with pain in modified group and standard group respectively;10 and 19 cases with lymph node metastasis respectively;3 and 4 cases of visceral metastasis respectively;all of the 50 patients were complicated with bone metastasis.For the pathological Gleason score,there were 7 cases scored ≤7 points,13 cases scored ≥ 8 points and 3 cases unscored in the modified group;7 cases scored ≤7 points,15 cases scored ≥8 points and 5 cases unscored in standard group.There was no significant difference of the pain,metastasis,and Gleason score between the two groups (P ＞ 0.05).Progression free survival (PFS),overall survival (OS)and adverse events were analyzed using Kaplan-Meier curves,and the differences were assessed using the log-rank test.Results In the modified group and standard group,the median follow-up times were 11.0 months and 14.0 months respectively,the median chemotherapy cycles were 4.5 cycles and 5.0 cycles respectively;OS were 18.0 months and 27.5 months respectively (P =0.746).The PFS of the two groups were 6.0 months and 5.2 months,respectively (P =0.822).The PSA response were 13 cases and 17 cases in the modified group and standard group respectively (P =0.615),and the pain response were 8 cases and 7 cases (P =0.927),grade 3 to 4 adverse events were 3 cases and 14 cases (P =0.003).The main adverse events were blood toxicity,neutrophils,gastrointestinal reaction,edema,fatigue and oral mucositis etc.Conclusions Compared with the standard DP scheme,the modified DP scheme had no significant difference in OS,PFS,pain response rate and PSA response rate,while the incidence of grade 3 to 4 adverse events was significantly reduced.Modified DP scheme may be a better choice for patients with metastatic castration resistant prostate cancer who get poor tolerance to chemotherapy.