Background Bladder cancer (BLCA) is a highly heterogeneous malignancy, and accurate prognostic assessment remains challenging in clinical practice. Recent advances in multidimensional RNA sequencing, including bulk RNA-seq and single-cell RNA sequencing (scRNA-seq), have provided new opportunities to identify prognostic biomarkers. In this study, we integrated bulk RNA-seq and scRNA-seq data from BLCA to construct an immune microenvironment-related prognostic model for more accurate survival prediction. Methods Bulk RNA-seq and scRNA-seq datasets for BLCA were obtained from the GEO and TCGA databases to identify key genes and cell populations. After quality control of the scRNA-seq data, principal component analysis (PCA) and uniform manifold approximation and projection (UMAP) were used for dimensionality reduction and cell clustering. Cell types were annotated using previously reported markers and the CellMarker database. Core cell populations were identified by marker-gene analysis using Seurat and the MAST test, followed by single-sample gene set enrichment analysis (ssGSEA). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed using clusterProfiler. Differentially expressed genes (DEGs) were identified using DESeq2 and limma, and weighted gene co-expression network analysis (WGCNA) was used to identify BLCA-associated gene modules. Intersecting candidate genes were then evaluated by univariate Cox and LASSO-Cox regression analyses to establish a multigene prognostic risk model. Finally, gene set enrichment analysis (GSEA) and immune microenvironment analyses were performed to explore the model's potential association with immunotherapy response. Results scRNA-seq analysis identified 12 cell clusters and seven major cell types, of which five showed reduced enrichment in BLCA and were defined as core cell populations. Marker genes of these core cells were closely associated with immune responses, cell adhesion, and signal transduction. Differential analysis of bulk RNA-seq datasets identified 3,100 overlapping DEGs enriched in pathways related to the cell cycle, signal transduction, and immune regulation. WGCNA further identified key gene modules associated with BLCA progression. A five-gene prognostic model showed stable predictive performance for patient survival and was significantly associated with clinical features, including T stage, N stage, and M stage. GSEA and immune microenvironment analyses indicated that the high-risk group had a higher mutation frequency and was enriched for pathways related to immune cell infiltration and immune escape, suggesting a more immunosuppressive phenotype. Conclusions By integrating bulk RNA-seq and scRNA-seq data, we developed an immune microenvironment-related prognostic risk score model for BLCA. This model may serve as a useful tool for prognosis prediction and may help identify patients with BLCA who are more likely to benefit from immunotherapy.

Bladder cancer represents one of the most prevalent malignant tumors affecting the urinary system. As per data disclosed by the National Cancer Registration Center of China in 2019, the incidence of bladder cancer was 5.80 per 100,000 in 2015, placing it as the thirteenth most common systemic malignancy. Bladder cancer poses a substantial threat to public health in China, underlining the critical importance of standardizing diagnosis and treatment to enhance clinical outcomes. This clinical practice guideline for bladder cancer centers on the etiologies, clinical presentations, and diagnostic procedures for suspected bladder cancer, in addition to the histopathology and staging of urothelial bladder cancer.

Bladder cancer(BC)is an increasingly common malignancy in China,with an incidence rate of 5.80 per 100 000 in 2015,making it the thirteenth most common cancer in the country.This trend underscores the urgent need for standardized diagnosis and treatment protocols.In terms of treatment,approaches for bladder cancer vary based on the cancer's stage and pathology,as well as the patient's overall health.Notably,non-muscle-invasive BC(NMIBC)confined to the mucosa(Ta)and lamina propria(T1)without invading the muscle represents about 75％of all BC cases.Succeeding the first part of the guideline,this part of the clinical practice guideline focuses on NMIBC.It details risk classifications and treatment options,including both surgical procedures and posttransurethral resection of the bladder tumor intravesical instillations.Special attention is given to the treatment strategies for carcinoma in situ.The guideline also covers the recommended follow-up procedures for patients with NMIBC,underscoring the need for thorough and continuous care management.

Abstract Background Non-invasive, especially the urine-based diagnosis of prostate cancer (PCa) remains challenging. Although prostate cancer antigen (PSA) is widely used in prostate cancer screening, the false positives may result in unnecessary invasive procedures. PSA elevated patients are triaged to further evaluation of free/total PSA ratio (f/t PSA), to find out potential clinically significant PCa before undergoing invasive procedures. Genomic instability, especially chromosomal copy number variations (CNVs) were proved much more tumor specific. Here we performed a prospective study to evaluate the diagnostic value of CNV via urine-exfoliated cell DNA analysis in PCa. Methods We enrolled 28 PSA elevated patients (≥ 4 ng/ml), including 16 PCa, 9 benign prostate hypertrophy (BPH) and 3 prostatic intraepithelial neoplasia (PIN). Fresh initial portion urine was collected after hospital admission. Urine exfoliated cell DNA was analyzed by low coverage Whole Genome Sequencing, followed by CNV genotyping by the prostate cancer chromosomal aneuploidy detector (ProCAD). CNVs were quantified in absolute z-score (|Z|). Serum free/total PSA ratio (f/t PSA) was reported altogether. Results In patients with PCa, the most frequent CNV events were chr3q gain (n = 2), chr8q gain (n = 2), chr2q loss (n = 4), and chr18q loss (n = 3). CNVs were found in 81.2% (95% Confidence Interval (CI) 53.7–95.0%) PCa. No CNV was identified in BPH patients. A diagnosis model was established by incorporating all CNVs. At the optimal cutoff of |Z|≥ 2.50, the model reached an AUC of 0.91 (95% CI 0.83–0.99), a sensitivity of 81.2% and a specificity of 100%. The CNV approach significantly outperformed f/t PSA (AUC = 0.62, P = 0.012). Further analyses showed that the CNV positive rate was significantly correlated with tumor grade. CNVs were found in 90.9% (95% CI 57.1–99.5%) high grade tumors and 60.0% (95% CI 17.0–92.7%) low grade tumors. No statistical significance was found for patient age, BMI, disease history and family history. Conclusions Urine exfoliated cells harbor enriched CNV features in PCa patients. Urine detection of CNV might be a biomarker for PCa diagnosis, especially in terms of the clinically significant high-grade tumors.

Introduction: Prediction models are increasingly being used to predict outcomes after surgery, and such a model would be a precious tool for patients with clear cell renal cell carcinoma (ccRCC) after surgery.Aim: To develop a comprehensive model for predicting disease-free survival (DFS) in patients with localized ccRCC. Material and methods: In a retrospective analysis of 612 patients, least absolute shrinkage and selection operator (LASSO) Cox regression analysis was performed to identify significant predictors, and then risk factors were used to construct a prognostic model. Harrell's concordance index (C-index) was used to assess the accuracy of the model.Results: The lymphocyte-to-monocyte ratio (LMR), Mayo Clinic stage, size, grade, necrosis score (SSIGN), and Mayo adhesive probability score (MAPS) were the significant risk factors screened by LASSO Cox regression and recon-firmed by multivariate Cox regression analysis in 44 variables. Then a model was constructed by combining the LMR, SSIGN, and MAPS. The C-index of the LMR-SSIGN-MAPS model was greater than the SSIGN score alone. Kaplan -Mei-er survival analysis demonstrated a significant association between higher LMR-SSIGN-MAPS score and poorer DFS.Conclusions: The LMR-SSIGN-MAPS model, which consists of preoperative inflammation biomarkers, a perinephric adipose tissue image-based scoring system, and pathological features, showed the strengths of easy-to-use and high predictability and might also be used as a promising prognosis model in predicting DFS for patients with localized ccRCC.

Background: To develop a comprehensive model for predicting disease-free survival (DFS) in patients with localized clear cell renal cell carcinoma (ccRCC). Methods: A retrospective analysis of 612 patients was performed between 2010 and 2015.The least absolute shrinkage and selection operator (LASSO) Cox regression analysis was performed to identify significant predictors. Furthermore, the multivariate Cox regression analysis was performed to reconfirm risk factors, then the prognosis model was constructed. The Harrell’s concordance index (C-index) was conducted to assess the model’s accuracy for predicting DFS in localized ccRCC.Results: The lymphocyte-to-monocyte ratio (LMR) (HR: 1.04, P = 0.009), the Mayo Clinic stage, size, grade, and necrosis score (SSIGN) (HR: 1.36, P < 0.001) and Mayo adhesive probability score (MAPS) (HR: 1.99, P＜0.001) were the significant risk factors screened by LASSO Cox regression and reconfirmed by multivariate Cox regression analysis in 44 variables. The LMR-SSIGN-MAPS model was constructed by combining the LMR, SSIGN, and MAPS. In the training and validation cohorts, the Harrell’s C-index was larger for the LMR-SSIGN-MAPS model (0.854, 0.848) than the SSIGN score (0.782, 0.772). The Kaplan-Meier survival analysis demonstrated the significant association between higher LMR-SSIGN-MAPS score and poorer DFS (P < 0.001) in the overall cohorts.Conclusions: The LMR-SSIGN-MAPS model which consists of preoperative inflammation biomarkers, perinephric adipose tissue image-based scoring system, and pathological features showed the strengths of easy-to-use and high predictability and might be also used as a promising prognosis model in predicting DFS for patients with localized ccRCC.

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.

Background To explore the feasibility of single-position laparoscopic radical nephrectomy (LRN) and tumor thrombectomy for left renal cell carcinoma with high-risk Mayo 0 and 1 tumor thrombus (TT). Methods All patients with left renal cell carcinoma and venous TT (high-risk Mayo grade 0 and 1) who were performed single-position LRN and tumor thrombectomy were involved. After the renal artery was controlled by Hem-o-lok, the left renal vein was dissected through descending colon mesentery. The left renal vein was divided by EndoGIA for high-risk Mayo grade 0 TT. For Mayo grade 1 TT, part of the inferior vena cava was blocked by a bulldog clamp after milking the TT into the left renal vein and the inferior vena cava was sutured after complete excision of the TT. Results 3 patients were involved and operations were performed successfully without conversion to open surgery. The mean operation time was 136 min and the mean estimated blood loss was 60 mL. No postoperative complications occurred. Conclusions It is feasible to control left renal vein and partial inferior vena cava through descending colon mesentery in a single position during LRN and tumor thrombectomy for the treatment of high-risk Mayo grade 0 and 1 TT.

PURPOSE:Reduced quality of life after cystectomy has made bladder preservation a popular research topic for muscle-invasive bladder cancer (MIBC). Previous research has indicated significant tumor downstaging after neoadjuvant chemotherapy (NAC). However, maximal transurethral resection of bladder tumor (TURBT) was performed before NAC to define the pathology, impacting the real evaluation of NAC. This research aimed to assess real NAC efficacy without interference from TURBT and apply combined modality therapies guided by NAC efficacy.MATERIALS AND METHODS:Patients with cT2-4aN0M0 MIBC were confirmed by cystoscopic biopsy and imaging. NAC efficacy was assessed by imaging, urine cytology, and cystoscopy with multidisciplinary team discussion. Definite responders (≤ T1) underwent TURBT plus concurrent chemoradiotherapy. Incomplete responders underwent radical cystectomy or partial cystectomy if feasible. The primary endpoint was the bladder preservation rate.RESULTS:Fifty-nine patients were enrolled, and the median age was 63 years. Patients with cT3-4 accounted for 75%. The median number of NAC cycles was three. Definite responders were 52.5%. The complete response (CR) was 10.2%, and 59.3% of patients received bladder-sparing treatments. With a median follow-up of 44.6 months, the 3-year overall survival (OS) was 72.8%. Three-year OS and relapse-free survival were 88.4% and 60.0% in the bladder-sparing group but only 74.3% and 37.5% in the cystectomy group. The evaluations of preserved bladder function were satisfactory.CONCLUSION:After stratifying MIBC patients by NAC efficacy, definite responders achieved a satisfactory bladder-sparing rate, prognosis, and bladder function. The CR rate reflected the real NAC efficacy for MIBC. This therapy is worth verifying through multicenter research.

前列腺癌发病率、死亡率逐年升高,是肿瘤防治最受关注的恶性肿瘤之一.去势抵抗性前列腺癌(castration-resistant pros-tate cancer,CRPC)患者的规范化药物治疗是提高患者生存时间、改善生存质量的关键方法.本文将就近年来有关CRPC药物治疗的现状及最新进展进行综述.

Objective:To discuss the surgical techniques and clinical value of pure laparoscopic radical nephroureterectomy without changing patient’s position in the treatment of upper tract urothelial carcinoma(UTUC).Methods:The clinical data of 28 patients, who underwent pure laparoscopic radical nephroureterectomy with single patient’s position in the treatment of UTUC , were collected and analyzed, including 16 males and 12 females, with the median age of (68.3±9.7)(45-80)years.There were 20 renal pelvic carcinoma and 8 ureteral carcinoma with preoperative clinical TNM stage of T l-T 3N 0M 0. Among them, 9 tumors were located in right side, while 19 in left side. With the patient in a contralateral oblique position at 50°-70°. , an additional instrument hole is added at the midpoint between the umbilicus and pubic symphysis, besides the classical four holes. Nephrectomy was carried out routinely after the pneumoperitoneum was built, and then the ureter was dissected all the way down to bladder wall. The bladder was closed with 3-0 absorbable barbed suture following the bladder cuff being incised.The specimen were retrieved through the extended incision of the lower abdomen trocar or through vagina if suitable. There was no need to change patient’s positioning during operation. Results:All surgical procedures were successfully performed without conversion to open surgery. There was no serious bleeding or other operation related complications. The mean operative time was (136.3±48.7)(70-270)min, while the estimated blood loss was (46.3±38.3)(10-200)ml. The mean postoperative drainage volume (287.3±196.6)(30-910)ml, while the mean postoperative drainage time was 3.2(1-5)d. Their intestinal function recovered 1.5(1-4) d postoperatively. Their average postoperative hospital stay was(6.1±1.7)(3-12)d.Pathological results showed urothelial carcinoma in all cases, including 21 high grade and 7 low grade. Lymphovascular invasion was found in 7 cases of high-grade urothelial carcinoma. All the surgical margins were negative. The median follow-up was(9.2±4.8)(1-12)months, and there was neither tumor recurrence nor distant metastasis.Conclusions:Compared with the traditional operation method, single posture pure transperitoneal laparoscopic radical nephroureterectomy have the advantages of standardized operation method, simple procedure, less trauma, less bleeding and quick postoperative recovery. It is a safe and effective minimally invasive technology for the treatment of UTUC.

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.

Background Previous related studies have mainly focused on renal cell carcinoma (RCC) with venous tumor thrombus, specifically inferior vena cava tumor thrombus with renal vein tumor thrombus (RVTT). However, only a few studies have focused on postoperative long-term survival of RCC patients exclusively with RVTT. Our aim was to investigate the independent prognostic factors for locally advanced RCC with RVTT in China. Methods Patients with locally advanced RCC with RVTT were enrolled for the study from January 2000 to December 2015. All patients underwent radical nephrectomy. Survival analysis was estimated using Kaplan-Meier. Univariable and multivariable survival analyses were performed using COX. Patients were divided into high-risk, middle-risk, and low-risk groups based on independent prognostic factors and then analyzed for survival. Results One hundred twenty-eight consecutive patients (103 men & 25 women) were enrolled with a median age of 61 years. Thrombi were all graded 0 using the Mayo system, of which 23 were friable. None of the thrombi detached during surgery. 121 patients were successfully followed up, with a median follow-up period of 47 months. Median overall survival was 127 months (95%CI: 101–153). The 5-year and 10-year cancer-specific survival (CSS) rate was 67.9 and 57.0%. 59 patients had recurrence with median time of 40 months. Friable thrombus, paraneoplastic syndrome (PNS), modified Fuhrman grade 3/4 and perirenal fat invasion were independent prognostic factors ( p < 0.05). The 5-year CSS for the Low-risk group (no factors) was 100%, Middle-risk group (1–2 factors) was 68.6%, while the High-risk group (3–4 factors) was 0%. Conclusions After radical surgery, RCC patients with RVTT had a relatively fair prognosis except for patients with friable thrombus, PNS, higher modified Fuhrman grade and perirenal fat invasion.

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.

虽说“人在江湖,身不由己”,但男性最好尽量远离吸烟、喝酒,否则将付出高额健康成本. 无论是职场打拼,还是社交应酬,吸烟、喝酒是很多男性的重要生活习惯.很多人明知道烟酒不利健康,却还是“身不由己”.殊不知,不懂拒绝,就容易丢了自己的健康.

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.

目的 探讨无远处转移肾癌伴肾静脉瘤栓患者行开腹根治性肾切除联合瘤栓取出术的预后影响因素. 方法 回顾性分析2000年1月～2014年9月我院113例术后病理证实为肾癌伴肾静脉瘤栓的临床资料,均为May0 0级瘤栓,采用Kaplan-Meier生存分析,Cox比例风险模型评价肾癌伴肾静脉瘤栓的预后. 结果 106例获得随访,随访率93.8％(106/113),中位随访时间61个月(12～186个月),36例死亡,中位生存127个月(5～186个月),5年肿瘤特异性生存率(cancer-specific survival,CSS)为61.3％,10年CSS为50.4％.Cox比例风险模型结果显示副瘤综合征(β=2.457,P=0.000)、Fuhrman分级(G3/4) (β =2.617,P=0.000)和肾周脂肪受累(β=1.369,P=0.002)是肾癌伴肾静脉瘤栓患者的独立预后因素,同时伴有3项危险因素的患者中位生存仅14个月. 结论 术前无远处转移的肾癌伴肾静脉瘤栓患者行开腹根治性肾切除联合瘤栓取出术后预后良好,伴有副瘤综合征,高Fuhrman分级和肾周脂肪受累的患者预后差.

Objective To investigate the hyperthermia-induced heat shock protein 70 (HSP70) expression and its significance in bladder carcinoma cell line EJ. Methods The 106/ml EJ was placed in 1.5 ml Eppendorf tube for water bath of different temperatures, which were induced by hyperthermia for 2 h, 4 h, 6 h, and 8 h, and recovered in 5% CO2 incubator (37 ℃) for 2 h. The flow cytometry (FCM) and Western blot were used to determine HSP70. RT-PCR was used to determine HSP70 mRNA. The SPSS16.0 statistical software was used to process the data. Results The HSP70 expression in human bladder carcinoma cell line EJ was increased along with the increasing temperature, with significant difference (P<0.05). However, the cell mortality was increased when the temperature exceeded 43 ℃. The HSP70 expression was increased along with the increasing induction time, with significant difference ( P<0.05). The HSP70 expression no longer increased at 8 h. Conclusion The optimal condition of hyperthermia-induced HSP70 expression in human bladder carcinoma cell line EJ is 43 ℃ for 6 h, which provides a certain experimental foundation for the production of tumor vaccine based on HSP70 bladder carcinoma.