BACKGROUND:Molecular subtyping of bladder cancer (BCa) using bulk transcriptomic data is hindered by tumor microenvironment (TME) contamination and intra-tumoral heterogeneity. These factors also contribute to variable responses to immune checkpoint inhibitor (ICI) therapy. Single-cell RNA sequencing offers a high-resolution approach to overcome these limitations by enabling tumor-specific analysis and improving therapeutic target identification. MATERIALS AND METHODS:We constructed a large multicenter single-cell atlas of BCa by integrating nine cohorts comprising 123 samples and 842 127 cells. Tumor epithelial cells ( n = 265 962) were identified via copy number variation (CNV) analysis using inferCNV. Pseudobulk RNA profiles were generated to simulate conventional bulk samples (Pseudobulk all ) and purified tumor profiles (Pseudobulk tumor ), enabling systematic evaluation of bulk-based classifiers. Inter-tumoral and intra-tumoral heterogeneity programs were defined based on transcriptional profiles and validated through in vitro and in vivo experiments. Additionally, we cross-analyzed five immunotherapy datasets encompassing 13 immune response phenotypes to identify molecular features associated with therapeutic resistance and sensitivity. RESULTS:Unsupervised clustering identified 11 major cell types and 55 non-epithelial subtypes, with TME heterogeneity driven by tissue origin and malignancy status. Existing molecular classifiers UNC (University of North Carolina at Chapel Hill) showed compromised concordance between Pseudobulk all and Pseudobulk tumor , particularly in stroma-rich samples. We defined three inter-tumoral (GE inter 2-4) subtypes with distinct CNV and transcription factor signatures that remained stable even at low tumor purity. Seven intra-tumoral (GE intra ) programs captured key biological states, including an EMT/Stem-like module associated with immunosuppression and ICI resistance. Mechanistically, TGF-β1 induced expression of EMT/Stem-like genes (e.g., PTHLH ), while Pthlh knockdown synergized with anti-PD-L1 therapy in murine models by enhancing T cell cytotoxicity without altering T cell infiltration. CONCLUSIONS:This study provides a robust single-cell framework for resolving inter- and intra-tumoral heterogeneity in BCa, overcoming limitations of bulk-based subtyping. The TGF-β1-PTHLH axis contributes to ICI resistance, positioning PTHLH as a promising therapeutic target. These findings offer new insights for improving immunotherapeutic strategies in BCa.

Background:Digital rectal examination (DRE) is a straightforward, cost-effective, practical, and time-honored physical examination method that plays a valuable role in the detection of prostate cancer (PCa). Nevertheless, with the advent of the prostate-specific antigen (PSA) era, the necessity of performing DRE has become a subject of debate. Our aim was to investigate the diagnostic efficacy and adjunctive role of DRE in a population (Prostate Imaging Reporting and Data System (PI-RADS), PI-RADS ≥3 or PSA ≥4 ng/mL) suspected of PCa.Methods:Five hundred and ninety-seven patients with suspected PCa requiring referral for biopsy were prospectively enrolled consecutively from February 2020 to May 2021. All patients received DRE and corresponding clinical diagnosis by a urologist before biopsy. According to the collected clinical and pathological information, the diagnostic performance of DRE in different PSA stratifications, and its association with tumor location and Gleason score (GS) were statistically analyzed.Results:Among patients with suspected cancer, the diagnostic accuracy of DRE was 63.45%. Compared with central zone or transition zone tumors, the recall rate of peripheral zone PCa with DRE-positive results was higher (65.50% vs. 34.55%). DRE-positive results were significantly correlated with GS ≥7 PCa (P<0.001), and the average GS of DRE-positive PCa patients was significantly higher than that of DRE-negative (7.92 vs. 7.11, P<0.001).Conclusions:DRE may help physicians further judge the necessity of biopsy in patients with elevated PSA, and preliminarily estimate the location and invasiveness of the tumor. However, it is still necessary to explore the value of DRE in a normal PSA population.

Background:Urologists still encounter challenges when it comes to the surgical management of tumors located on the posterior lip and posterior renal hilar region. We propose a trans-retro-peritoneal (TRP) technique to address the difficulties associated with posterior hilar tumors during retroperitoneal laparoscopic partial nephrectomy (LPN). Its efficacy was evaluated in a retrospective case-control study.Methods:The patients with posterior hilar tumors (≤7 cm) that underwent retroperitoneal LPN were included. The TRP technique allowed the posterior hilar tumor completely visible by incising the ventral peritoneum and rotating kidney ventrally during retroperitoneal LPN, which was applied in 36 cases, while the conventional retroperitoneal LPN was performed in 22 cases. Perioperative data were analyzed to evaluate the efficacy of TRP-LPN.Results:In TRP-LPN group, the TRP technique was successfully performed in all the patients without converting to open surgery or radical nephrectomy. The warm ischemia time was significantly shorter in TRP-LPN group than conventional LPN group (20.3 vs. 28.5 min, P<0.001). Furthermore, the mean estimated blood loss in TRR-LPN group was significantly less than that in conventional LPN group (86.5 vs. 90.9 mL, P<0.05). The mean operation time and recovery time of gastrointestinal function were similar between two groups. No severe complications occurred, and no positive surgical margin was found. The rate of Trifecta achievement was 50.0% (18/36) and 31.8% (7/22) respectively for TRP-LPN and conventional LPN (P=0.175). After mean follow-up of 21 months, no recurrence or metastasis occurred in all cases.Conclusions:Our findings, as demonstrated by the Trifecta outcomes, support the feasibility and efficacy of TRP-LPN in managing posterior renal hilar tumors. This approach may be considered as an efficient option for surgical management of such tumors.

Abstract Objective:The epidemiological evidence regarding the causal relationship between hyperthyroidism, subacute thyroiditis (SAT), and tumors remains inconclusive. Therefore, we conducted a two-sample bidirectional Mendelian randomization (MR) study to establish the causal relationship between these conditions. Methods: We conducted a bi-directional MR study using publicly available GWAS summary statistics to explore the causality between genetically predicted hyperthyroidism, SAT and the risk of 20 common cancers. The analysis was performed using inverse-variance weighted (IVW), MR-Egger, weighted median, simple mode, and weighted mode methods. The primary results were based on the IVW (random effects), followed by sensitivity analysis. Furthermore, maximum likelihood, penalized weighted median and IVW (fixed effects) were used to confirm the robustness of the findings. Results:IVW analysis revealed a significant positive causal association between hyperthyroidism and breast cancer (OR = 2.20E+05, 95% CI: 7.7733–6.23E+09, P = 0.0187), ovarian cancer (OR =1.0949, 95% CI: 1.0250–1.1696, P = 0.0071), thyroid cancer (OR =3.05E+11, 95% CI: 1.06E+01–8.84E+21, P = 0.0314), and colorectal cancer (OR =1.1345, 95% CI: 1.0293–1.2505, P = 0.0110) ; while hyperthyroidism had an inverse association with bladder cancer (OR =0.9446, 95% CI: 0.9017–0.9896, P = 0.0164), prostate cancer (OR =0.6174, 95% CI: 0.4879–0.7813, P = 5.97E-05), liver and bile duct cancer (OR =0.9723, 95% CI: 0.9540–0.9910, P = 0.0038), brain cancer (OR =0.9699, 95% CI: 0.9460–0.9945, P = 0.0166), and malignant neoplasm of male genital organs (OR =0.8593, 95% CI: 0.7868–0.9385, P = 0.0007). Furthermore, the IVW analysis supported a positive causal relationship between SAT and endometrial cancer (OR =1.031, 95% CI: 1.0032–1.0596, P = 0.0288), while SAT had an inverse association with kidney cancer (OR =0.9015, 95% CI: 0.8255–0.9844, P = 0.0209) and thyroid cancer (OR =0.9143, 95% CI: 0.8390–0.9962, P =0.0407). However, we only observed an inverse association between malignant neoplasm of male genital organs and SAT in the reverse MR analyses. Conclusions: The current investigation offers genetic evidence that hyperthyroidism could potentially elevate the risk of developing breast, ovarian, thyroid, and colorectal cancers. Likewise, SAT is identified as a possible risk factor for endometrial cancer. In light of these findings, further studies are necessary to uncover the underlying mechanisms that establish causal links between hyperthyroidism, SAT, and malignancies.

BackgroundClear cell renal cell carcinoma (ccRCC) patients with venous tumor thrombus (VTT) have poor prognosis. We aimed to reveal features of ccRCC with VTT and develop a urine-based prognostic classifier to predict ccRCC prognosis through integrative analyses of transcriptomic landscape and urinary signature.MethodsRNA sequencing was performed in five patients with ccRCC thrombus-tumor-normal tissue triples, while mass spectrometry was performed for urine samples from 12 ccRCC and 11 healthy controls. A urine-based classifier consisting of three proteins was developed to predict patients’ survival and validated in an independent cohort.ResultsTranscriptomic analysis identified 856 invasion-associated differentially expressed genes (DEGs). Furthermore, proteomic analysis showed 133 differentially expressed proteins (DEPs). Integration of transcriptomic landscape and urinary signature reveals 6 urinary detectable proteins (VSIG4, C3, GAL3ST1, TGFBI, AKR1C3, P4HB) displaying abundance changes consistent with corresponding genes in transcriptomic profiling. According to TCGA database, VSIG4, TGFBI, and P4HB were significantly overexpressed in patients with shorter survival and might be independent prognostic factors for ccRCC (all p<0.05). A prognostic classifier consisting of the three DEPs highly associated with survival performed satisfactorily in predicting overall survival (HR=2.0, p<0.01) and disease-free survival (HR=1.6, p<0.001) of ccRCC patients. The ELISA analysis of urine samples from an independent cohort confirmed the satisfied predictive power of the classifier for pathological grade (AUC=0.795, p<0.001) and stage (AUC=0.894, p<0.001).ConclusionBased on integrative analyses of transcriptomic landscape and urinary signature, the urine-based prognostic classifier consisting of VSIG4, TGFBI, and P4HB has satisfied predictive power of ccRCC prognosis and may facilitate ccRCC molecular subtyping and treatment.

PurposeClear cell renal cell carcinoma (ccRCC) is the most common pathology type in kidney cancer. However, the prognosis of advanced ccRCC is unsatisfactory. Thus, early diagnosis becomes one of the most important research priorities of ccRCC. However, currently available studies about ccRCC lack urine-related further studies. In this study, we applied proteomics to search urinary biomarkers to assist early diagnosis of ccRCC. In addition, we constructed a prognostic model to assist judge patients' prognosis. Materials and methodsUrine which was used to perform 4D label-free quantitative proteomics was collected from 12 ccRCC patients and 11 non-tumor patients with no urinary system diseases. The urine of 12 patients with ccRCC confirmed by pathological examination after surgery was collected before operatoin. Bioinformatics analysis was used to describe the urinary proteomics landscape of these patients with ccRCC. The top ten proteins with the highest expression content were selected as the basis for subsequent validation. Urine from 46 ccRCC patients and 45 control patients were collected to use for verification by enzyme linked immunosorbent assay (ELISA). In order to assess the prognostic value of urine proteomics, a prognostic model was constructed by COX regression analysis on the intersection of RNA-sequencing data in The Cancer Genome Atlas (TCGA) database and our urine proteomic data. Results133 proteins differentially expressed in the urinary samples were found and 85 proteins (Fold Change, FC>1.5) were identified up-regulated while 48 down-regulated (FC<0.5). Top 10 proteins including S100A14, PKHD1L1, FABP4, ITIH2, C3, C8G, C2, ATF6, ANGPTL6, F13B were performed ELISA to verify. The results showed that PKHD1L1, ANGPTL6, FABP4 and C3 were statistically significant (P<0.05). We performed multivariate logistic regression analysis and plotted a nomogram. Receiver operating characteristic (ROC) curve indicted that the diagnostic efficiency of combined indicators is satisfactory (Aare under curve, AUC=0.835). Furthermore, the prognostic value of the urine proteomics was explored through the intersection between urine proteomics and TCGA RNA-seq data. Thus, COX regression analysis showed that VSIG4, HLA-DRA, SERPINF1, and IGLV2-23 were statistically significant (P<0.05). ConclusionOur study indicated that the application of urine proteomics to explore diagnostic biomarkers and to construct prognostic models of renal clear cell carcinoma is of certain clinical value. PKHD1L1, ANGPTL6, FABP4 and C3 can assist to diagnose ccRCC. The prognostic model constituted of VSIG4, HLA-DRA, SERPINF1, and IGLV2-23 can significantly predict the prognosis of ccRCC patients, but this still needs more clinical trials to verify.

Abstract Introduction: Choosing the appropriate urinary diversion method has always been a challenging decision for patients undergoing radical cystectomy (RC). Emerging data suggests that cutaneous ureterostomy (CU) has advantages over ileal conduit (IC) and orthotopic neobladder (ONB) in terms of reduced operation time, blood loss, and perioperative complications. However, traditional CU is associated with a high incidence of stoma stenosis (>50% or more). To address this issue, we have developed a new suture approach called CU-flap embedding approach. In this trial, we aim to investigate the incidence rate of ureteral stoma stenosis and other related complications associated with flap embedding approach. The goal is to determine whether the flap embedding approach is a safe and feasible suture technique. Methods and analysis：This study is a phase I, open-label study to investigate the safety and feasibility of the new suture approch of CU-flap embedding approch. Patients with indications for RC will be recruited. All enrolled patients will be sutured CU by flap embedding approch after RC. The primary objective is the incidence of ureteral stoma stenosis, the secondary objective is the incidence of other postoperative related complications of the approch. The postoperative complications will be assessed by Clavien-Dindo classification of surgical complications. Ethics and dissemination：This protocol was approved by the Institutional Review Board of Shanghai Changhai Hospital (ref. CHEC2023-107). The study will be performed in compliance with applicable local legislation and in accordance with the ethical principles developed by the World Medical Association in the Declaration of Helsinki 2013. Study results will be disseminated through conferences and peer-reviewed scientific journals. Trial registration number：ChiCTR2300073003

Protein kinase, membrane-associated tyrosine/threonine 1 (PKMYT1), which is associated with progression of tumor, is upregulated in a variety of cancers. However, its expression and the underlying molecular mechanisms in the context of bladder cancer (BLCA) remain elusive. Here we found that PKMYT1 expression was markedly higher expression in BLCA, which was correlated with poorer prognosis compared with low expression. Knockdown of PKMYT1 significantly inhibited the BLCA cells proliferation in vivo and in vitro, and migration and invasion, reduced G2/M phase in cell cycle and induced apoptosis. Mechanically, YAP and TEAD1 knockdown suppressed PKMYT1 expression in BLCA cells, whereas overexpression of YAP upregulated PKMYT1 expression and YAP prompted PKMYT1 transcriptional expression via TEAD1-mediated direct binding to PKMYT1 promotor. Collectively, these findings suggest that PKMYT1, functioning as a direct gene target regulated by YAP/TEAD1, could serve as a potential indicator of progression and prognosis in BLCA. Further, PKMYT1 could serve as a novel therapeutic target for BLCA.

Supplementary Figures and Figure Legends

Abstract Objective Previous observational studies have explored the correlation between testosterone and cancer risk. However, the causal association between testosterone and various cancer types in women remains inconclusive. The objective of this Mendelian randomization study is to evaluate the causal links between total testosterone (TT) and bioavailable testosterone (BT) with cancer risk in females. Methods Initially, a rigorous quality control process was employed to identify suitable instrumental single nucleotide polymorphisms (SNPs) associated with the exposure under investigation that exhibited a significant association. The genetic causal relationship between female testosterone levels and the risk of developing cancers was examined through a two-sample Mendelian randomization. Various analytical methods, including inverse-variance weighted (IVW), MR-Egger, weighted median, simple mode, and weighted mode, were applied in the investigation. Key findings were primarily based on the results obtained via IVW (random effects), and sensitivity analyses were conducted to assess the reliability of the obtained results. Furthermore, maximum likelihood, penalized weighted median, and IVW (fixed effects) methods were utilized to further validate the robustness of the results. Results Based on the results of IVW analysis, our study indicated a positive causal relationship between BT and breast cancer (OR = 1.1407, 95%CI: 1.0627–1.2244, P = 0.0015) and endometrial cancer (OR = 1.4610, 95%CI: 1.2695–1.6813, P = 1.22E-06). Moreover, our findings also showed a positive causal association between TT and breast cancer (OR = 1.1764, 95%CI: 1.0846–1.2761, P = 0.0005), cervical cancer(OR = 1.0020, 95%CI: 1.0007–1.0032, P = 0.0077), and endometrial cancer(OR = 1.4124, 95%CI: 1.2083–1.6511, P = 0.0001). Additionally, our results demonstrated a negative causal relationship between BT and ovarian cancer (OR = 0.8649, 95%CI: 0.7750–0.9653, P = 0.0320). However, no causal relationship was found between BT, TT and other types of cancer (corrected P > 0.05). Conclusions This study elucidates the role of testosterone on the development of breast cancer, endometrial cancer, ovarian cancer, and cervical cancer. It also hints at a potential but fragile link between testosterone and bladder cancer, as well as thyroid cancer. Nonetheless, it's worth noting that no statistically significant relationship between testosterone and various other types of cancer in females was identified.

Abstract FAPI PET/CT findings of renal tumors have been rarely reported. We describe 68Ga-FAPI-04 PET/CT findings in 1 case with lipid-poor renal angiomyolipoma and 1 case with high-grade clear cell renal cell carcinoma. Both tumors showed intense 68Ga-FAPI-04 uptake. These 2 cases indicate that lipid-poor renal angiomyolipoma should be included in the differential diagnosis of FAPI-avid renal tumors.

Background RING finger protein 7 (RNF7) is a highly conserved protein that functions as an E3 ubiquitin ligase. RNF7 overexpression is indicated in multiple human cancers, but its role in renal cell carcinoma (RCC) and the mechanisms underlying how it regulates the initiation and progression of RCC have not been explored. Methods Bioinformatics analysis, quantitative reverse-transcription polymerase chain reaction (RT-PCR), and Western blot were conducted to determine the expression of RNF7 in RCC tissues and cell lines. Knockdown and overexpression experiments were performed to examine the effects of RNF7 on cell viability, apoptosis, and glycolysis in vitro and on tumor growth in nude mice in vivo. Results The elevated RNF7 expression in tumor tissues of patients with RCC was correlated with poor survival. RNF7 overexpression inhibited apoptosis and promoted glycolysis in vitro and increased tumor growth in vivo by activating the JAK/STAT3 signaling pathway by ubiquitination of SOCS1. Moreover, RNF7 overexpression affected the sensitivity of RCC cells to sunitinib. Finally, STAT3 activation was necessary for transcriptional induction of RNF7. Conclusion These results demonstrate that RNF7 inhibited apoptosis, promoted glycolysis, and inhibited sunitinib sensitivity in RCC cells via ubiquitination of SOCS1, thus activating STAT3 signaling. These suggest the potential for targeting the RNF7-SOCS1/JAK/STAT3 pathway for RCC treatment.

Abstract Background Renal collecting duct carcinoma (CDC) is a rare and lethal subtype of renal cell carcinoma (RCC). The genomic profile of the Chinese population with CDC remains unclear. In addition, clinical treatments are contradictory. In this study, we aimed to identify the genomic mutation spectrum of CDC in the Chinese population. Methods Whole-exome sequencing was performed using the Illumina Novaseq™ 6000 platform. MuTect2 detects single-nucleotide variants (SNVs) and small scale insertions/deletions (INDELs). The identified mutations were annotated with ANNOVAR and validated by Sanger sequencing. Control-FREEC was used to detect copy number variation (CNV), and GISTIC was applied to detect frequently mutated altered regions. These data were compared with associated The Cancer Genome Atlas cohorts. Results Ten normal-matched CDC patients were included. The mean tumour mutation burden was 1.37 Mut/Mb. Six new recurrent somatic mutated genes were identified, including RBM14, MTUS1, GAK, DST, RNF213 and XIRP2 (20% and 2 of 10, respectively), and validated by Sanger sequencing. In terms of common mutated genes, SETD2 was altered in both CDC and other RCC subtypes but not in bladder urothelial carcinoma (BLCA); CDKN2A was a driver gene in both CDC (SNV: 10%, 1 of 10) and BLCA but not in other RCC subtypes. Next, 29 amplifications and 6 deletions of recurrent focal somatic CNVs were identified by GISTIC2.0, which displayed differences from kidney renal clear cell carcinoma (KIRC), kidney renal papillary cell carcinoma (KIRP) and BLCA cohorts. Of note, CDKN2A (CNV alteration: 30%, 3 of 10) and CDKN2A-AS1 were the only overlapping genes of these four cohorts. Importantly, the CDKN2A mutation in our cohort differed from previous studies in urinary carcinomas. Moreover, CDKN2A-altered cases had significantly worse overall survival than wild-type cases in both KIRC and KIRP cohorts. In addition, the most frequently altered genomic pathway of our CDC cohort was the CDKN2A-mediated p53/RB1 pathway. Conclusions Our study offers the first genomic spectrum of the Chinese population with CDC, which differs from that of the Western population. The altered CDKN2A-mediated p53/RB1 pathway might provide new insight into potential therapeutic targets for CDC patients.

Additional file 2: Table S2. The summary of the whole exosome sequencing data in patients with CDC.

1 临床资料 患者,女,71岁,因"间断性无痛性血尿4年,加重3周"入院.2015年10月无明显诱因出现无痛性全程血尿,无下尿路刺激症状,无腰痛及发热.予抗生素治疗后血尿消失,但仍有反复.尿脱落细胞学和抗酸杆菌检查均为阴性.肾动静脉增强CT检查(图1a)提示:右侧肾盂肾盏、右输尿管中上段轻度积水扩张,输尿管管壁增厚,以中段稍著,管腔稍狭窄,增强后管壁可见轻度强化,建议输尿管镜检查.2015年11月在我院行右侧输尿管镜检,距离输尿管开口约5 cm处见滤泡状增生伴管腔变细,长度约5 cm,予活检4处,病理提示为淀粉样变,遂留置F7双J管3个月.2016年1月再次行右侧输尿管镜检并取活检5处,病理同样为淀粉样变.随后3年余,肉眼血尿症状未再出现,肾积水较前改善.2019年5月,血尿复发.增强CTU检查(图lb)提示:右侧输尿管下段管壁不均匀增厚,部分结节样改变,增强后明显强化,伴管腔狭窄,上段输尿管、肾盂明显扩张积水.影像学诊断:右侧输尿管内病变,癌可能,请结合内镜检查.对比2015年10月影像学检查结果,病变输尿管长度未发生显著进展.

Background The tripartite motif (TRIM) family proteins exhibit oncogenic roles in various cancers. The roles of TRIM27, a member of the TRIM super family, in renal cell carcinoma (RCC) remained unexplored. In the current study, we aimed to investigate the clinical impact and roles of TRIM27 in the development of RCC. Methods The mRNA levels of TRIM27 and Kaplan–Meier survival of RCC were analyzed from The Cancer Genome Atlas database. Real-time PCR and Western blotting were used to measure the mRNA and protein levels of TRIM27 both in vivo and in vitro. siRNA and TRIM27 were exogenously overexpressed in RCC cell lines to manipulate TRIM27 expression. Results We discovered that TRIM27 was elevated in RCC patients, and the expression of TRIM27 was closely correlated with poor prognosis. The loss of function and gain of function results illustrated that TRIM27 promotes cell proliferation and inhibits apoptosis in RCC cell lines. Furthermore, TRIM27 expression was positively associated with NF-κB expression in patients with RCC. Blocking the activity of NF-κB attenuated the TRIM27-mediated enhancement of proliferation and inhibition of apoptosis. TRIM27 directly interacted with Iκbα, an inhibitor of NF-κB, to promote its ubiquitination, and the inhibitory effects of TRIM27 on Iκbα led to NF-κB activation. Conclusions Our results suggest that TRIM27 exhibits an oncogenic role in RCC by regulating NF-κB signaling. TRIM27 serves as a specific prognostic indicator for RCC, and strategies targeting the suppression of TRIM27 function may shed light on future therapeutic approaches.

Background To describe the techniques and outcomes of complete transperitoneal laparoscopic nephroureterectomy (CTLNU) for upper urinary tract urothelial carcinoma (UTUC) in a single position. Materials and methods Those patients with localized UTUC were included, among which 50 cases had CTLNU while 48 cases had laparoscopic nephroureterectomy with open bladder cuff excision (LNOBE). The clinical data were collected and analyzed retrospectively. Results All 98 patients underwent successful procedures of radical nephroureterectomy without transferring into open surgery. No significant difference was found among baseline clinical characteristics. Compared with the LNOBE group, the CTLNU group had a shorter operative time (98.5±40.3 min vs. 132.4±60.2 min), less blood loss (60.4±20.3 ml vs. 150.6±50.2 ml), shorter length of hospital stay (5.3±2.2 days vs. 8.1±2.3 days), and shorter incision (6.3±1.2 cm vs. 11.5±3.2 cm). The disease-related outcomes such as pathological stage, tumor grade, and recurrence rate were similar between the two groups. Conclusions The CTLNU in a single position had advantages of shorter operation time, less blood loss, and shorter incision length. This surgical technique is a more minimally invasive, simplified, and effective way to perform the radical nephroureterectomy.

肾癌是我国泌尿系统常见的恶性肿瘤,近年伴随国内腹腔镜技术和设备的快速发展,腹腔镜微创治疗已经基本取代开放手术成为肾癌根治性切除术的金标准.在肾癌的TNM分期中,临床分期T2b期(肿瘤直径>10 cm,局限在肾包膜内)的肿瘤巨大,对周围组织形成压迫或侵犯,因此行腹腔镜肾癌根治性切除术仍具有挑战性[1-2].2016年1月至2018年12月我科同一术者共完成临床分期T2b期经腹腹腔镜肾癌根治性切除术21例,现将手术经验及体会总结如下.

为探讨改良减Trocar法完全腹腔镜下肾盂输尿管癌根治术治疗上尿路尿路上皮癌(UTUC)的技术要点和临床效果,回顾性分析2016年6月～2018年12月我中心行该术式的36例UTUC患者的临床资料及进行随访数据分析.36例患者均先取90°健侧卧位,行经腹腹腔镜肾脏切除术,随后不重新铺单取45°健侧卧位,分离输尿管下段、袖状切除部分膀胱壁并连续缝合,术后予以吡柔比星40 mg即刻膀胱灌注.36例手术均获成功.随访时间6～30个月,术后每3个月复查膀胱镜,其中1例患者术后1年因膀胱肿瘤复发行经尿道膀胱肿瘤电切术(TURBT),1例患者术后3个月尿道复发,其余患者均无瘤生存,无死亡病例,效果满意.我中心认为,改良减Trocar法完全腹腔镜下肾盂输尿管癌根治术具有术中创伤小、出血少、术后恢复快、避免肿瘤播散等优点,且只需3个Trocar,是一种安全、有效且经济的治疗方法,是替代开放手术的理想术式.