PURPOSE:To explore the genomic profiles of Chinese patients with castration sensitive prostate cancer and those with metastatic castration resistant prostate cancer via germline and circulating tumor DNA sequencing.MATERIALS AND METHODS:A hybridization capture based next-generation sequencing assay was used to identify germline and somatic alterations in 50 genes including androgen receptor pathway genes, DNA damage repair pathway genes, TP53 and RB1.RESULTS:We successfully sequenced DNA from 396 blood samples and 32 matched tumor tissue samples from 396 patients. We observed a similar frequency of deleterious germline alterations between patients with castration sensitive prostate cancer and metastatic castration resistant prostate cancer (8.9% vs 9.8%, p >0.05). There was a high consistency (90.9%) between metastatic tumor tissue and matched circulating tumor DNA. Among patients who were circulating tumor DNA positive we observed significantly higher alteration frequencies of CDK12 (27.2% vs 6.4%, p <0.001) and FOXA1 (36.8% vs 15.3%, p <0.001) in our metastatic castration resistant prostate cancer cohort compared with the SU2C-PCF (Stand Up to Cancer-Prostate Cancer Foundation) cohort. Alteration frequencies of DNA damage repair pathway genes (66.7% vs 41.5%, p=0.015) and androgen receptor pathway genes (71.9% vs 48.8%, p=0.018) in patients with metastatic castration resistant prostate cancer were higher than in patients with de novo metastatic castration sensitive prostate cancer. Androgen receptor alteration was selectively enriched in metastatic castration resistant prostate cancer.CONCLUSIONS:Through genomic profiling of prostate cancer across clinical states we identified a similar frequency of deleterious germline alterations between patients with castration sensitive prostate cancer and metastatic castration resistant prostate cancer. We explored the genomic diversity of androgen receptor and DNA damage repair pathway genes between patients with metastatic castration sensitive prostate cancer and metastatic castration resistant prostate cancer. Higher alteration frequencies of CDK12 and FOXA1 were observed in our metastatic castration resistant prostate cancer cohort than in the SU2C-PCF cohort. Our findings support the view that circulating tumor DNA sequencing could guide clinical treatment for metastatic prostate cancer.

目的 观察精索静脉显微结扎术治疗原发性精索静脉曲张的疗效.方法 随机选取2013年5月至2016年5月上海交通大学医学院附属仁济医院诊治的原发性精索静脉曲张23例患者作为研究对象.依据治疗方法将这些患者分为精索静脉显微结扎术组(显微组,13例)和腹膜后精索静脉高位结扎术组(腹膜组,10例)两组,对两组患者的术中术后指标、术后切口疼痛程度、精子数量、密度、活力、活率、睾丸动脉识别、精液质量改善、静脉曲张复发情况、术后并发症发生情况、临床疗效进行统计分析.结果 显微组患者的手术时间显著长于常规腹膜组患者,差异具有统计学意义(P＜0.05),术中出血量显著少于腹膜组,差异具有统计学意义(P＜0.05),术后胃肠功能恢复时间、住院时间均显著短于腹膜组,差异具有统计学意义(P＜0.05),住院费用、术后切口疼痛程度评分均显著低于腹膜组,差异具有统计学意义(P＜0.05),精子数量、活力、活率均显著高于腹膜组,差异具有统计学意义(P＜0.05),睾丸动脉识别率、精液质量改善率100.0％ (13/13)、69.2％ (9/13)均显著高于腹膜组50.0％ (5/l0)、30.0％ (3/10),差异具有统计学意义(P＜0.05),静脉曲张复发率15.4％ (2/13)显著低于腹膜组30.0％ (3/10),差异具有统计学意义(P＜0.05),术后并发症发生率7.7％(1/13)显著低于腹膜组30.0％(3/10),差异具有统计学意义(P＜0.05),治疗的总有效率92.3％(12/13)显著高于腹膜组60.0％(6/10),差异具有统计学意义(P＜0.05).结论 精索静脉显微结扎术治疗原发性精索静脉曲张的疗效较腹膜后精索静脉高位结扎术显著.

Objective To investigate the application effects of solifenacin combined with tamsulosin in mild and moderate benign prostatic hyperplasia with overactive bladder.Methods A total of 160 patients with mild and moderate benign prostatic hyperplasia and overactive bladder were chosen as experimental subjects,mild patients were divided into research group one and control group one,moderate patients were divided into re-search group two and control group two,each group were 40 cases,patients in research group were treated with solifenacin(5 mg each time,once per day)combined with tamsulosin(0.2 mg each time,once per day), patients in control group were treated with tamsulosin(0.2 mg each time,once per day),after 12 weeks'treat-ment,residual urine,Qmax,Voiding symptom score(VSS),Urine storage period symptom score(USPSS), Overactive bladder symptom score(OABSS),International Prostate Symptom Score(IPSS)and adverse reac-tions were compared.Results Before treatment,IPSS,USPSS,OABSS,residual urine and Qmax between re-search group one and control group one had no significant differences(t=0.333,0.448,0.269,0.081,0.384, P>0.05).After treatment,IPSS,USPSS,OABSS of research group one were lower than those in the control group one,Qmax was higher than that in the control group one,the differences were statistically different(t=8.692,8.095,9.264,6.065,P<0.05).Residual urine between two groups had no significant difference(t=0.081,0.456,P> 0.05).Before treatment,IPSS,VSS,OABSS,residual urine and Qmax between research group two and control group two had no significant difference(t=1.253,0.139,0.092,0.006,0.619,P>0. 05).After treatment,IPSS,VSS,residual urine and Qmax between the two groups had no significant differ-ences(t=0.096,1.678,0.478,0.456,P>0.05).OABSS of research group two was lower than that in the control group,the difference was statistically different(t=4.222,P<0.05).In mild and moderate patients, adverse reaction rate between research group one and control group one(12.50% vs.7.50%),research group two and control group two(10.00% vs 7.50%)had no significant differences(χ2=0.556,0.157,P>0.05). Conclusion Solifenacin combined with tamsulosin could effectively improve the clinical symptom of mild and moderate benign prostatic hyperplasia with overactive bladder,and with good safety,worthy of clinical promo-tion.

Objective To determine the influence of abiraterone acetate (AA) on neuroendocrine differentiation (NED) in metastatic castration-resistant prostate cancer (mCRPC) and the prognostic predicting value of the serum NED markers in mCRPC patients treated with AA.Methods We conducted an analysis in 115 chemotherapy-naive mCRPC patients who were treated with chemotherapy in Renji hospital from 2013 to 2017.The median age was 70,ranged from 65 to 76 years old.The median CgA,NSE and PSA levels were 101.1 ng/ml (78.5-150.0 ng/ml),13.4 ng/ml (10.5-17.6 ng/ml) and 38.8 ng/ml (11.2-123.2 ng/ml),respectively.Among them,48 cases were classified as the group without AA treatment.The other 67 cases were classified as group after AA failure.In group without AA treatment,the median CgA,NSE and PSA levels were 109.1 ng/ml(80-151.5 ng/ml);13.8 ng/ml(10.8-18.2 ng/ml) and 39.2 ng/ml (8.6-200 ng/ml),respectively.In group after AA failure,the median CgA,NSE and PSA levels were 105.4 ng/ml(78.8-175.5 ng/ml),13.8 ng/ml(10.8-17.6 ng/ml) and 39.0 ng/ml(8.4-219.8 ng/ml),respectively.In the group with serial evaluation of NED markers during AA treatment,the median serum CgA,NSE levels at baseline were 115.9 ng/ml(90.1-201.5 ng/ml),13.3 ng/ml (10.4-18.1 ng/ml),respectively.The endpoints were PSA PFS(progression-free survival) and radiographic PFS (rPFS).Results In 34 patients with serial evaluation,serum NED markers level in 19 patients increased after the failure of AA treatment.Median serum CgA and NSE levels were 115.9 ng/ml(90.1-201.5 ng/ml)and 13.25 ng/ml (10.37-18.14 ng/ml) at baseline.Median serum CgA and NSE levels were 129.6ng/ml (75.5-230.5 ng/ml) and 14.7 ng/ml (11.8-19.1 ng/ml) after 6 months treatment,respectively.The median serum CgA and NSE levels were 130.4 ng/ml (95.7-205.7 ng/ml) and 15.2 ng/ml(12.4-18.7 ng/ml) at the time of failure of AA treatment,respectively.There was no significant difference of NED markers between baseline and failure of AA treatment (P =0.243).In logistic univariate analysis,AA treatment and its duration were not independent factors influencing NED(P =0.30;P =0.52).Compared with the NED markers elevation group in the first 6 months of AA treatment and baseline supranormal NED markers group,the NED markers decline group(PSA PFS(17.1 vs.10.4 months,P ＜ 0.001) and rPFS (17.0 vs.10.4 months,P =0.003)) and baseline normal NED markers group(PSA PFS(14.1 vs.9.5 months,P =0.001) and rPFS(16.4 vs.10.5 months,P ＜ 0.001)) has a longer median PSA PFS and rPFS respectively.In multivariate Cox analysis,baseline NED markers level and NED markers variation during the first 6 months of AA treatment remained significant predictors of rPFS(P ＜ 0.05),and PSA-PFS (P ＜ 0.05).Conclusions We found there was heterogeneity in changes of NED markers in different mCRPC patients during AA treatment,and AA might not significantly lead to progression of NED of mCRPC in general.Serial CgA and NSE evaluation might help clinicians guide clinical treatment of mCRPC patients.Serum NED markers elevation during the first 6 months of AA treatment and elevated baseline NED markers levels indicated poor prognosis in mCRPC treated with AA.

Objective: To investigate the efficacy and drug related adverse reactions of sorafenib and sunitinib as first-line tyrosine-kinase inhibitors (TKIs) for patients with metastatic renal cell carcinoma (mRCC) and analyze the clinical prognostic factor for survival. Methods: The data of 271 patients with metastatic renal cell carcinoma who had complete clinicopathological data were retrospectively analyzed, including 174 cases in sorafenib group and 97 cases in sunitinib group, to access patients' overall survival (OS) and progression-free survival (PFS). Prognostic values of all characteristics were determined by using univariate and multivariate Cox regression models. Results: The objective response rates (ORR) of the sorafenib and sunitinib groups were 14.9% and 19.6%, respectively, and the disease control rates (DCR) were 85.1% and 88.6%, respectively. No significant difference was found between the sorafenib and sunitinib group in ORR (P=0.325) or DCR (P=0.408). The most common grade 3 to 4 adverse events in the sorafenib group were hand-foot syndrome (6.7%), diarrhea (2.3%), and rash (2.3%). The most common grade 3 to 4 adverse events in the sunitinib group were neutropenia (6.2%), hand-foot syndrome (6.2%), and thrombocytopenia (4.6%). During the follow-up, 97 cases death occurred and 81 cases disease progression occurred in sorafenib group. The median PFS was 12 months (95% CI: 9-15 months), and the median OS was 25 months (95% CI: 21-29 months) in sorafenib group. While 74 cases death occurred and 40 cases disease progression occurred in sunitinib group, the median PFS was 12 months (95% CI: 10-12 months) and the median OS was 23 months (95% CI: 20-32 months) in sunitinib group. No significant difference was found between the sorafenib and the sunitinib group in PFS (P=0.771) or OS (P=0.548). Multivariate analysis showed Fuhrman grades (HR=1.358, 95%CI: 1.004-1.835), number of metastatic sites (HR=1.550, 95%CI: 1.143-2.101) and MSKCC risk grade (Intermediate risk group: HR=1.621, 95%CI: 1.117-2.232; Poor risk group: HR=2.890, 95%CI: 1.942-4.298) were independent prognostic factors for PFS. Fuhrman grades (HR=2.135, 95%CI: 1.533-2.974), number of metastatic sites (HR=1.774, 95%CI: 1.279-2.461) and MSKCC risk grade (Intermediate risk group: HR=1.415, 95%CI: 1.002-1.998; Poor risk group: HR=3.161, 95%CI: 2.065-4.838) were independent prognostic factors for OS. Conclusions: The results of this study indicate that sorafenib and sunitinib are both effective as the first-line TKIs for mRCC patients and sorafenib has comparable efficacy to sunitinib. But they have differences in the incidence of adverse effects. Fuhrman grades, number of metastatic sites and MSKCC risk grade are independent prognostic factors for mRCC patients.

To evaluate the efficacy and safety of abiraterone acetate (AA) plus prednisone compared with prednisone alone in Asian patients with chemotherapy-naive metastatic castration-resistant prostate cancer (mCRPC), and to identify predictive factors.

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) III1 Apr 2018MP52-05 PROGNOSTIC NUTRITIONAL INDEX PREDICTS PRIMARY RESISTANCE TO TREATMENT AND PROGNOSIS IN METASTATIC CASTRATION-RESISTANT PROSTATE CANCER ATIENTS REATED WITH ABIRATERONE Liancheng Fan, Baijun Dong, Jiahua Pan, Chenfei Chi, Yinjie Zhu, Lixin Zhou, and Wei Xue Liancheng FanLiancheng Fan More articles by this author , Baijun DongBaijun Dong More articles by this author , Jiahua PanJiahua Pan More articles by this author , Chenfei ChiChenfei Chi More articles by this author , Yinjie ZhuYinjie Zhu More articles by this author , Lixin ZhouLixin Zhou More articles by this author , and Wei XueWei Xue More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1656AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Debate exists in regarding whether the observed PSA decline is a true surrogate for overall survival(OS) in patients with mCRPC. In addition, PSA flare phenomenon during Abiraterone (AA) treatment, which consists of an early and transient rise in the PSA level followed by a decline, had been reported by sevaral previous studies. So only PSA monitoring seems to be not reliable for evaluating the response to AA treatment of mCRPC patients. prognostic nutritional index (PNI), which is calculated on the basis of serum albumin levels and peripheral lymphocyte counts, may represent the nutritional and immunological status which could affect the survival rate of patients. Owing to this, higher baseline PNI level and PNI level elevation during AA treatment might indicate response to treatment and good clinical outcome of mCRPC. So we determined if PNI and its variation could predict initial resistance to treatment and prognosis in metastatic castration-resistant prostate cancer (mCRPC) patients treated with AA. METHODS 112 chemotherapy pretreated or chemotherapy-naive patients were scheduled for systemic treatment with AA. PNI levels were measured before and after one month of AA treatment. Univariate and multivariate logistic regression analyses were used to identify predictive factors of initial response to AA treatment. Univariable and multivariable Cox regression analyses were performed to determine prognostic factors that were associated with PSA progression-free survival (PSA-PFS), radiographic PFS (rPFS) and OS. The Harrell concordance index with variables only or combined PNI data were used to evaluate the prognostic accuracy. RESULTS 81(72.3%) of 112 patients showed initial response to AA treatment, in which 15 experienced PSA flare during AA treatment. In multivariate logistic regression analyses, high baseline PNI level, PSA level decrease during the first month of AA treatment and PNI level elevation during the first month of AA treatment were significantly correlated with initial response to AA treatment. In multivariate Cox regression analysis, low PNI level remained significant predictors of OS, rPFS and PSA-PFS. The estimated c-index of the multivariate model for OS increased from 0.82 without PNI to 0.83 when PNI added. CONCLUSIONS Independent of PSA level variation, PNI level elevation during the first month of AA treatment and high baseline PNI level were significantly correlated with initial response to AA treatment. In addition, low pretreatment PNI level is a negative independent prognosticator of survival outcomes in mCRPC treated with AA and also increases the accuracy of established prognostic model. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e696 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Liancheng Fan More articles by this author Baijun Dong More articles by this author Jiahua Pan More articles by this author Chenfei Chi More articles by this author Yinjie Zhu More articles by this author Lixin Zhou More articles by this author Wei Xue More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

ObjectiveTo determine if prognostic nutritional index (PNI) and its variation could predict initial response to treatment and prognosis in metastatic castration-resistant prostate cancer (mCRPC) patients treated with Abiraterone (AA). Patients and MethodsOne-hundred-twelve chemotherapy pretreated or chemotherapy-naive patients were scheduled for systemic treatment with AA. PNI levels were measured before and after one month of AA treatment. Univariate and multivariate logistic regression analyses were used to identify predictive factors of initial response to AA treatment. Univariable and Multivariable Cox regression analyses were performed to determine prognostic factors that were associated with PSA progression-free survival (PSA-PFS), radiographic PFS (rPFS) and overall survival (OS). The Harrell concordance index with variables only or combined PNI data were used to evaluate the prognostic accuracy. ResultsEighty-one (72.3%) of 112 patients showed initial response to AA treatment, in which 15 experienced PSA flare during AA treatment. In multivariate logistic regression analyses, high baseline PNI level, PSA level decrease during the first month of AA treatment and PNI level elevation during the first month of AA treatment were significantly correlated with initial response to AA treatment. In multivariate Cox regression analysis, low PNI level remained significant predictors of OS, rPFS and PSA-PFS. The estimated c-index of the multivariate model for OS increased from 0.82 without PNI to 0.83 when PNI added. ConclusionIndependent of PSA level variation, PNI level elevation during the first month of AA treatment and high baseline PNI level were significantly correlated with initial response to AA treatment. In addition, low pretreatment PNI level is a negative independent prognosticator of survival outcomes in mCRPC treated with AA and also increases the accuracy of established prognostic model.

Hypoalbuminemia adversely affects the clinical outcomes of various cancers. The purpose of this study was to estimate the prognostic value of hypoalbuminemia 3–5 weeks after treatment in patients with metastatic renal cell carcinoma (mRCC) who received sorafenib or sunitinib as first-line treatment.

Objective· To assess the efficacy of abiraterone acetate (AA) plus prednisone treating metastatic castration-resistant prostate cancer (mCRPC) patients and analyze the prognostic factors for this treatment. Methods · The medical history of 112 patients with mCRPC treated in Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine, including 70 patients in the chemotherapy-na?ve setting and 42 in the post-chemotherapy setting, were retrospectively reviewed. Coprimary end points were prostate specific antigen progression-free survival (PSA PFS), radiographic PFS (rPFS) and overall survival (OS). Univariable and multivariable Cox analyses were performed to determine prognostic factors that were associated with PSA PFS, rPFS and OS. Results · At a median follow-up of 20.2 months, 59 (52.7%) patients had died. The median PSA PFS, rPFS and OS were 8.9 (7.8~10.0) months, 9.7 (9.0~10.4) months, and 22.2 (20.3~24.1) months, respectively. In multivariate analysis, previous chemotherapy, neutrophil lymphocyte ratio(≥3 vs<3),serum lactate dehydrogenase level(≥196 U/L vs<196 U/L)and ECOG PS(≤?1 vs 2)were independent predictors for PSA PFS and rPFS,and previous chemotherapy,ECOG PS(≤?1 vs 2)remained significant predictors for OS. Conclusion·These results further support the favourable profile of AA plus prednisone in patients with mCRPC in China.Previous chemotherapy,ECOG PS(≤?1 vs 2)remained significant predictors for OS.

BackgroundTo determine the influence of abiraterone Acetate (AA) on neuroendocrine differentiation (NED) in patients with chemotherapy-naive metastatic castration-resistant prostate cancer (mCRPC). MethodsWe conducted an analysis in 115 chemotherapy-naive mCRPC patients who would be treated with chemotherapy. The serum levels of chromogranin A (CgA), neurone-specific enolase (NSE) were measured in 67 mCRPC patients without AA treatment and 48 patients after the failure of AA treatment, in which these markers were also measured in 34 patients before and after 6 months of AA treatment. Comparative t-test was used to evaluate the serial changes of serum NED markers during AA treatment and univariate and multivariate analyses were performed to test the influence of AA treatment on NED. ResultsSerum CgA were NSE were evaluated to be above the upper limit of normal (ULN) in 56 (48.7%) and 29 (25.2%) patients before chemotherapy. In 34 patients with serial evaluation, serum CgA level of 14 patients and NSE of 14 patients increased after the failure of AA treatment. There was no significant difference of NED markers (CgA or NSE variation (P=0.243) between at baseline and after the failure of AA treatment. Compared with the CgA elevation group in the first 6 months of AA treatment and baseline supranormal CgA group, the CgA decline group, and baseline normal CgA group has a much longer median PSA PFS (14.34 vs 10.00 months, P<0.001, and 14.23 vs 10.30 months, P=0.02) and rPFS, respectively (18.33 vs 11.37 months, P<0.001, and 17.10 vs 12.07 months, P=0.03). In logistic univariate analysis, AA treatment and its duration were not independent factors influencing NED. ConclusionsWe hypothesized that AA might not significantly lead to progression of NED of mCRPC in general. Furthermore, we found there was heterogeneity in changes of NED markers in different mCRPC patients during AA treatment. Serial CgA and NSE evaluation might help clinicians guide clinical treatment of mCRPC patients.

To compare the antitumor effect of abiraterone (AA) followed by docetaxel‐prednisone (DP) or vice versa in metastatic castration‐resistant prostate cancer (mCRPC) patients, and explored factors that might predict combined PSA‐PFS, combined rPFS and OS.

Background: Sorafenib and sunitinib are widely used as first-line targeted therapy for metastatic renal cell carcinoma (mRCC) in China. This study aimed to compare the efficacy, safety, and quality of life (QoL) in Chinese mRCC patients treated with sorafenib and sunitinib as first-line therapy. Methods: Clinical data of patients with mRCC who received sorafenib (400 mg twice daily; 4 weeks) or sunitinib (50 mg twice daily; on a schedule of 4 weeks on treatment followed by 2 weeks off) were retrieved. Primary outcomes were overall survival (OS), progression-free survival (PFS), adverse events (AEs), and QoL (SF-36 scores), and secondary outcomes were associations of clinical characteristics with QoL. Results: Medical records of 184 patients (110 in the sorafenib group and 74 in the sunitinib group) were reviewed. PFS and OS were comparable between the sorafenib and sunitinib groups (both P > 0.05). The occurrence rates of leukocytopenia, thrombocytopenia, and hypothyroidism were higher in the sunitinib group (36.5% vs. 10.9%, P < 0.001; 40.5% vs. 10.9%, P < 0.001; 17.6% vs. 3.6%, P = 0.001), and that of diarrhea was higher in the sorafenib group (62.7% vs. 35.2%, P < 0.001). There was no significant difference in SF-36 scores between the two groups. Multivariate analysis indicated that role-physical and bodily pain scores were associated with the occurrence rate of grade 3 or 4 AEs (P = 0.017 and 0.005). Conclusions: Sorafenib has comparable efficacy and lower toxicity profile than sunitinib as first-line therapy for mRCC. Both agents showed no significant impact on QoL of patients.

This is a retrospective study on medical records of patients with metastatic renal cell carcinoma to study the prognostic importance of pretreatment prealbumin by evaluating the overall survival (OS) and progression-free survival (PFS), given the scarcity of such data till date. Results found that the pretreatment prealbumin group is an independent prognosticator of risk and survival outcomes, which attenuated the PFS and OS compared with the normal pretreatment prealbumin group. Background: Although serum prealbumin is a sensitive marker to assess malnutrition, its prognostic impact in patients with metastatic renal cell carcinoma (mRCC) remains elusive. Methods: Patients' data were retrospectively retrieved from the medical records of Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from March 2006 to July 2015 to access overall survival (OS) and progression-free survival (PFS). The survival outcomes of patients with low pretreatment prealbumin (< 200 mg/L) and high pretreatment prealbumin (>= 200 mg/L) were compared using a log-rank test and Cox proportional hazard regression model. Prognostic accuracy was determined using the Harrell concordance index (c-index). Results: The median PFS and OS for 143 patients were 11 months (95% confidence interval [CI], 9-14 months) and 27 months (95% CI, 22-39 months), respectively. The low pretreatment prealbumin group had significantly shorter median PFS (6 vs. 14 months, P<.001) and OS (10 vs. 34 months, P <.001) than the normal pretreatment prealbumin group. Multivariate analysis showed that pretreatment prealbumin was an independent predictor of OS (hazard ratio [HR] 1.963; 95% CI, 1.140-3.381; P=.015) and also an independent predictor of PFS (HR 2.021; 95% CI, 1.227-3.329; P=.006). Further, addition of pretreatment prealbumin to the Heng model enhanced the predictive accuracy of PFS and OS (c-index: 0.70 and 0.74) compared with the Heng model alone (c-index: 0.69 and 0.72). Conclusion: Low pretreatment serum prealbumin is an independent prognosticator of risk and survival outcomes in patients with mRCC receiving tyrosine kinase inhibitors as first-line treatment and also increases the accuracy of established prognostic models. (C) 2017 Elsevier Inc. All rights reserved.

Objective To determine the prognostic utility of serum pre-albumin in metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone (AA).Patients and Methods 112 chemotherapy pretreated or chemotherapy-naive patients were scheduled for systemic treatment with AA.Serum pre-albumin levels were measured before and after 3 months of AA treatment.Univariate and multivariate analyses were performed to determine prognostic factors that were associated with PSA progression-free survival (PSA-PFS), radiographic PFS (rPFS) and overall survival (OS).The Harrell concordance index with variables only or combined pre-albumin data were used to evaluate the prognostic accuracy. ResultsThe group of patients with baseline pre-albumin value ≥20mg/dL had a longer OS, PSA-PFS, rPFS than those with pre-albumin value <20mg/dL.Based on the values of pre-albumin before and after 3 months of AA treatment, we divided these patients into 4 groups: high-high, high-low, low-high and low-low group.High-high group showed a significantly better OS, PSA-PFS, rPFS than other 3 groups.In multivariate analysis, low pre-albumin level remained significant predictors of OS (HR, 13.2; P<0.001), rPFS (HR, 3.7; P=0.003) and PSA-PFS (HR, 8.7; P<0.001).The estimated c-index of the multivariate model for OS increased from 0.814 without pre-albumin to 0.845 when pre-albumin added.Conclusion Low pretreatment serum pre-albumin is a negative independent prognosticator of survival outcomes in mCRPC treated with AA and also increases the accuracy of established prognostic model.Serial pre-albumin evaluation might help clinicians guide clinical treatment of mCRPC patients.

目的 探究动态心电图与常规心电图诊断冠心病的临床应用效果.方法 择取2013年8月-2015年8月至我院进行疾病诊疗的冠心病患者82例纳入本次实验研究,对所有患者实施计算机随机分组方案,共分为每组患者均占据41例的常规组与实验组,其中对常规组患者实施常规心电图诊断方式,对实验组患者实施动态心电图诊断方式,对两组患者的诊断结果进行分析比较.结果 经过心电图诊断后,显示实验组与常规组冠心病患者的心肌缺血阳性检出率分别为87.80%与60.98%,比较组间数据差异显著,P<0.05.结论 对冠心病患者来说,给予动态心电图诊断方式的阳性检出率明显高于常规心电图诊断,值得在今后的临床工作中推荐采纳.

Prognostic nutritional index (PNI) is a recognized indicator of both immune and nutritional status. It was firstly used as a preoperative prognostic indicator, and its role in the prognosis of patients with metastatic renal cell carcinoma (mRCC) has not yet been investigated in large-scale study. The purpose of this work was to investigate the prognostic role of pretreatment PNI in patients with mRCC with sorafenib or sunitinib as first-line targeted therapy.

下尿路功能障碍主要表现为尿频、尿急、尿失禁、排尿困难和尿潴留等,其中神经源性下尿路功能障碍采用传统保守治疗往往不能取得很好的疗效,手术治愈率低且并发症较多.近年来,随着生物反馈电刺激疗法在临床上的应用,在尿失禁、膀胱过度活动症及下尿路症状的治疗上取得了较好的疗效,为泌尿科医师提供了一种有效的方法.该文对膀胱内电刺激在下尿路功能障碍治疗中的应用进展综述如下.

目的 探讨阴茎勃起功能障碍(Erectile Dysfunction,ED)与血液黏稠度相关指标的相关性,分析其临床意义.方法 对73例ED患者和35例阴茎勃起正常对照者血液黏稠度相关指标进行分析.结果 ED组患者全血高切黏度(η 100)全血低切黏度(η 10)、血浆黏度(η p)、红细胞聚集指数(CE)、总胆固醇(TC)及低密度脂蛋白(LDL-C)等明显高于对照组(P＜0.05),在不同病因ED组中,内分泌性ED组患者的CE、TC及LDL-C明显高于心因性、动脉性、静脉性、神经性ED组(P＜0.05).结论 ED患者相对于正常人血液黏稠度较高,可能是ED的潜在原因.

目的·评价阿比特龙联合泼尼松治疗未经化疗转移性去势抵抗性前列腺癌(mCRPC)患者的有效性和安全性.方法·回顾性分析2012年9月至2016年3月仁济医院收治的60例未经化疗mCRPC患者的临床资料.治疗组为阿比特龙(1 000 mg,每日1次)联合泼尼松(5 mg,每日2次)治疗,共43名;对照组为单纯泼尼松治疗,共17名.观察指标为前列腺特异性抗原无进展生存期(PSA PFS)、影像学无进展生存期(rPFS)和总体生存期(OS).结果·中位随访时间为14.0月,治疗组11人(25.58％)死亡,对照组8人(47.06％)死亡.治疗组相较对照组中位PSA PFS、rPFS及OS均显著延长.治疗组与对照组最常见三级或四级药物相关不良反应为谷丙转氨酶升高.研究中未发生导致药物无法继续治疗的严重不良反应.结论·阿比特龙联合泼尼松治疗显著延长未经化疗mCRPC患者PSA PFS、rPFS与OS,同时患者耐受性良好,是未经化疗mCRPC患者的有效治疗选择.