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World Journal of Clinical Cases 2024年第3期12卷 551-559页

作者： Sami Berk Ozden Muhammed Fatih Simsekoglu Ipek Sertbudak Cetin Demirdag Iclal Gurses Istanbul University-Cerrahpasa Cerrahpasa School of Medicine Department of UrologyIstanbul 34100FatihTurkey Istanbul University-Cerrahpasa Cerrahpasa School of Medicine Department of PathologyIstanbul 34100FatihTurkey

BACKGROUND Epithelioid malignant peripheral nerve sheath tumor(EMPNST)of the bladder is a rare entity with devastating features.These tumors are thought to originate from malignant transformation of pre-existing schwannomas of pelvic autonomic nerve plexuses,and unlike the conventional malignant peripheral nerve sheath tumor(MPNST),are not associated with neurofibromatosis.The tumor has dis-tinctive morphological,immunohistochemical and molecular features.Addi-tionally,it tends to be more aggressive and have a higher mortality.This is the first case that presents with a synchronous urothelial carcinoma of the bladder and the epithelioid variant of MPNST in the literature.It’s also the second re-ported case of EMPNST originating from the bladder wall.CASE SUMMARY In this case report,we present the detailed clinical course of a 71-year-old patient with EMPNST of the bladder alongside a literature review.CONCLUSION During the management of EMPNST cases,offering aggressive treatment moda-lities to the patient,such as radical cystectomy,is appropriate for the best chance to contain the disease,regardless of the tumor stage and the extent of local disease at initial diagnosis.

关键词： Epithelioid Peripheral nerve sheath tumor Bladder Case report urothelial Cystoprostatectomy

The preoperative serum cystatin-C as an independent prognostic factor for survival in upper tract urothelial carcinoma

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Asian Journal of Andrology 2019年第2期21卷 163-169页

作者： Ping Tan Ming Shi Jie Chen Hang Xu Nan Xie Huan Xu Yong Jiang Jian-Zhong Ai Liang-Ren Liu Lu Yang Qiang Wei Department of Urology Institute of UrologyWest China HospitalSichuan UniversityChengdu 610041China Department of Radiology West China HospitalSichuan UniversityChengdu 610041China Department of Emergency West China HospitalSichuan UniversityChengdu 610041China Department of Pathology West China HospitalSichuan UniversityChengdu 610041China

Cystatin-C(Cys-C)has been reported as a valuable prognostic biomarker in various malignancies.However,its effect on upper tract urothelial carci noma(UTUC)patie nts has not bee n investigated before.Thus,to explore the impact of Cys-C on survival outcomes in patients undergoing radical nephroureterectomy(RNU),a total of 538 patients with UTUC who underwent RNU between 2005 and 2014 in our center(West China Hospital,Chengdu,China)were included in this study.Kaplan-Meier method and Cox regressi on an a lyses were performed to assess the relationship betwee n Cys-C and survival outcomes using SPSS versi on 22.0.The cutoff value of Cys-C was set as 1.4 mg I1 using the receiver operating characteristic(ROC)curves and Youden index.The mean age of patients included was 66.1±11.1 years,and the media n follow-up durati on was 38(interquartile ran ge:19-56)mon ths.Overall,162(30.1%)patients had elevated Cys-C,and they were much older and had worse renal function than those with Cys-C<1.4 mg I^-1(both P<0.001).Meanwhile,Kaplan-Meier analysis revealed that the group with elevated Cys-C had worse cancer-specific survival(CSS,P=0.001),disease recurrence-free survival(RFS,P=0.003),and overall survival(OS,P<0.001).Multivariable Cox analysis suggested that the elevated Cys-C was identified as an independent prognostic predictor of CSS(hazard ratio[HR]:1.997,95%confidential interval[CI]:1.331-2.996),RFS(HR:1.429,95%CI:1.009-2.023),and OS(HR:1.989,95%CI:1.366-2.896).In conclusion,our result revealed that the elevated preoperative serum Cys-C was significantly associated with worse outcomes in UTUC patients undergoing RNU.

关键词： cystatin-C prognosis radical nephroureterectomy upper tract urothelial carcinoma

Pretreatment elevated fibrinogen level predicts worse oncologic outcomes in upper tract urothelial carcinoma

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Asian Journal of Andrology 2020年第2期22卷 177-183页

作者： Hang Xu Jian-Zhong Ai Ping Tan Tian-Hai Lin Xi Jin Li-Na Gong Hao-Ran Lei Lu Yang Qiang Wei Department of Urology and Institute of Urology West China HospitalSichuan UniversityChengdu 610041China

This study aimed to further validate the prognostic role of fibrinogen in upper tract urothelial carcinoma(UTUC)in a large Chinese cohort.A total of 703 patients who underwent radical nephroureterectomy were retrospectively identified.Fibrinogen levels of≥4.025 g l?1 were defined as elevated.Logistic regression analysis was performed to determine the association between fibrinogen and adverse pathological features.Kaplan–Meier analysis and Cox regression models were used to assess the associations of fibrinogen with cancer-specific survival(CSS),disease recurrence-free survival(RFS),and overall survival(OS).Harrell c-index and decision curve analysis were used to assess the clinical utility of multivariate models.The median follow-up duration was 42(range:1–168)months.Logistic regression analysis revealed that elevated fibrinogen was associated with higher tumor stage and grade,lymph node involvement,lymphovascular invasion,sessile carcinoma,concomitant variant histology,and positive surgical margins(all P<0.05).Multivariate Cox regression analysis demonstrated that elevated fibrinogen was independently associated with decreased CSS(hazard ratio[HR]:2.33;P<0.001),RFS(HR:2.09;P<0.001),and OS(HR:2.09;P<0.001).The predictive accuracies of the multivariate models were improved by 3.2%,2.0%,and 2.8%for CSS,RFS,and OS,respectively,when fibrinogen was added.Decision curve analysis showed an added benefit for CSS prediction when fibrinogen was added to the model.Preoperative fibrinogen may be a strong independent predictor of worse oncologic outcomes in UTUC;therefore,it may be valuable to apply this marker to the current risk stratification in UTUC.

关键词： fibrinogen prognosis radical nephroureterectomy upper tract urothelial carcinoma

Chinese guidelines for diagnosis and treatment of urothelial carcinoma of bladder 2018 (English version)

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Chinese Journal of Cancer Research 2019年第1期31卷 49-66页

作者： National Health Commission of the People’s Republic of China National Health Commission of the People’s Republic of China

Contents1. Overview2. Risk factors for urothelial carcinoma of bladder3. Diagnosis of urothelial carcinoma of bladder3.1 Signs and symptoms of urothelial carcinoma of bladder3.1.1 Symptoms3.1.2 Signs3.2 Imaging examination3.2.1 Ultrasonography3.2.2 CT examination3.2.3 MRI examination3.2.4 IVU3.2.5 Chest plain X-ray film/CT plain scan3.2.6 Bone scintigraphy3.2.7 Positron emission tomography-CT (PET-CT).

关键词： Chinese guidelines diagnosis urothelial

WNT/β-catenin signaling in urothelial carcinoma of bladder

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World Journal of Nephrology 2019年第5期8卷 83-94页

作者： Minal Garg Niharika Maurya Department of Biochemistry University of Lucknow

urothelial carcinoma of bladder is the second most prevalent genitourinary disease.It is a highly heterogeneous disease as it represents a spectrum of neoplasms,including non-muscle invasive bladder cancer(NMIBC),muscle invasive bladder cancer(MIBC)and metastatic lesions.Genome-wide approaches and candidate gene analysis suggest that malignant transformation of the bladder is multifactorial and a multitude of genes are involved in the development of MIBC or NMIBC phenotypes.Wnt signaling is being examined to control and maintain balance between stemness and differentiation in adult stem cell niches.Owing to its participation in urothelial development and maintenance of adult urothelial tissue homeostasis,the components of Wnt signaling are reported as an important diagnostic and prognostic markers as well as novel therapeutic targets.Mutations/epigenetic alterations in the key molecules of Wnt/β-catenin canonical pathway have been linked with tumorigenesis,development of drug resistance and enhanced survival.Present review extends our understanding on the functions of key regulatory molecules of canonical Wnt/β-catenin pathway in urothelial tumorigenesis by inducing cancer stem cell phenotype(UCSCs).UCSCs may be responsible for tumor heterogeneity,high recurrence rates and complex biological behavior of bladder cancer.Therefore,understanding the role of UCSCs and the regulatory mechanisms that are responsible for high relapse rates and metastasis could help to develop pathway inhibitors and augment current therapies.Potential implications in the treatment of urothelial carcinoma of bladder by targeting this pathway primarily in UCSCs as well as in bulk tumor population that are responsible for high relapse rates and metastasis may facilitate potential therapeutic avenues and better prognosis.

关键词： Chemoresistance Therapeutic approaches urothelial carcinoma of bladder urothelial cancer stem cells Wnt/β-catenin

Segmental ureteroileal conduit resection for the treatment of distal upper urinary tract recurrence of bladder cancer fol lowing cystectomy

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Chinese Journal of Cancer 2016年第3期35卷 120-125页

作者： Shu‑Xiong Zeng Xin Lu Wei‑Dong Xu Zhen‑Sheng Zhang Hai‑Hang Li Ying‑Hao Sun Chuan‑Liang Xu Department of Urology Changhai HospitalSecond Military Medical UniversityShanghaiP.R.China Department of Burns Changhai HospitalSecond Military Medical UniversityShanghaiP.R.China.

Segmental ureterectomy is less invasive than radical nephroureterectomy and results in nephron preservation and satisfactory tumor control.This study was to determine the feasibility of segmental ureteroileal conduit resection(SUICR) for patients with distal upper urinary tract recurrence of bladder cancer following radical cystectomy.Four patients with high-grade distal upper urinary tract recurrence underwent SUICR 15-108 months after radical cystectomy.The surgical technique details of SUICR,operative results,and follow-up outcomes are reported.The median operation time was 280 min,and estimated blood loss was less than 100 ml One patient suffered from ileus 5 days after surgery and was managed conservatively.Histopathologic evaluation showed high-grade stages pTa-pT1 diseases for these patients,and ureteral margins were all negative.No patient suffered from tumor recurrence,with a median follow-up of 39 months.SUICR preserved the ipsilateral renal unit and conformed to oncological principles during surgery.The oncological outcome was satisfactory for these properly selected patients.This technique provides a valid alternative to nephroureterectomy for patients with imperative indications and high-grade upper urinary tract recurrence of bladder cancer following radical cystectomy.

关键词： Cystectomy, urothelial carcinoma, Upper urinary tract recurrence, Segmental resection

Bladder urothelial carcinoma extending to rectal mucosa and presenting with rectal bleeding

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World Journal of Gastrointestinal Endoscopy 2017年第6期9卷 282-295页

作者： Andrew M Aneese Vinayata Manuballa Mitual Amin Mitchell S Cappell Division of Gastroenterology and Hepatology Department of MedicineWilliam Beaumont Hospital Department of Pathology William Beaumont Hospital Oakland University William Beaumont School of Medicine

An 87-year-old-man with prostate-cancer-stage-T1cGleason-6 treated with radiotherapy in 1996, recurrent prostate cancer treated with leuprolide hormonal therapy in 2009, and bladder-urothelial-carcinoma in situ treated with Bacillus-Calmette-Guerin and adriamycin in 2010, presented in 2015 with painless, bright red blood per rectum coating stools daily for 5 mo. Rectal examination revealed bright red blood per rectum; and a hard, fixed, 2.5 cm × 2.5 cm mass at the normal prostate location. The hemoglobin was 7.6 g/d L(iron saturation = 8.4%,indicating iron-deficiency-anemia). AbdominopelvicCT-angiography revealed focal wall thickening at the bladder neck; a mass containing an air cavity replacing the normal prostate; and adjacent rectal invasion. Colonoscopy demonstrated an ulcerated, oozing, multinodular, friable, 2.5 cm × 2.5 cm mass in anterior rectal wall, at the usual prostate location. Histologic and immunohistochemical analysis of colonoscopic biopsies of the mass revealed poorly-differentiatedcarcinoma of urothelial origin. At visceral angiography, the right-superior-rectal-artery was embolized to achieve hemostasis. The patient subsequently developed multiple new metastases and expired 13 mo postembolization. Comprehensive literature review revealed 16 previously reported cases of rectal involvement from bladder urothelial carcinoma, including 11 cases from direct extension and 5 cases from metastases. Patient age averaged 63.7 ± 9.6 years(all patients male). Rectal involvement was diagnosed on average 13.5 ± 11.8 mo after initial diagnosis of bladder urothelial carcinoma. Symptoms included constipation/gastrointestinal obstruction-6, weight loss-5, diarrhea-3, anorexia-3, pencil thin stools-3, tenesmus-2, anorectal pain-2, and other-5. Rectal examination in 9 patients revealed annular rectal constriction-6, and rectal mass-3. The current patient had the novel presentation of daily bright red blood per rectum coating the stools simulating hemorrhoidal bleeding; the novel mechanism of direct bladder uroth

关键词：膀胱癌症 urothelial Uroepitheilal 过渡房间直肠穿入癌症传播了降低胃肠的流血 Colonoscopy

Long Noncoding RNA UCA1 Overexpression Is Associated with Poor Prognosis in Digestive System Malignancies: A Meta-analysis

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Current Medical Science 2019年第5期39卷 694-701页

作者： Fei-tao SHI Li-dong CHEN Lian-feng ZHANG Department of Gastroenterology the First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China

Long noncoding RNA(IncRNA)urothelial carcinoma associated 1(UCA1)has been reported to be highly expressed in many kinds of cancers.This meta-analysis summarized its potential prognostic value in digestive system malignancies.A meta-analysis was performed through a comprehensive search in PubMed,EMBASE,the Cochrane Library,Web of Science and Chinese National Knowledge Infrastructure(CNKI)for suitable articles on the prognostic impact of UCA1 in digestive system malignancies from inception to June 27,2019.Pooled hazard ratios(HRs)with 95% confidence interval(95%CI)were calculated to summarize the effect.Sixteen studies were included in the study,with a total of 1504 patients.A significant association was observed between UCA1 abundance and poor overall survival(OS),and shorter disease-free survival(DFS)for patients with digestive system malignancies,with pooled HR of 2.07(95%CI:1.74-2.47),and of 2.50(95%CI:1.62-3.86).Subgroup analysis and sensitivity analysis suggested the reliability of our findings.It is suggested that UCA1 abundance may serve as a reliable predictive factor for poor prognosis in patients with digestive system malignancies.

关键词： long noncoding RNAs urothelial carcinoma associated 1 prognosis digestive system tumor meta-analysis

Contemporary management of upper tract urothelial cell carcinoma

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World Journal of Clinical Urology 2017年第1期6卷 1-9页

作者： Kellen Choi Ryan McCafferty Samuel Deem Department of Urology Charleston Area Medical Center Department of Anesthesiology PGY-1 Larkin Community Hospital

Upper tract urothelial cell carcinoma(UTUCC),formerly known as transitional cell carcinoma of the upper urinary tract,is a rare oncologic disease in Western countries.Thus its disease process and its management are not as well defined as other urologic cancers. We are reviewing the current evidence based literature available to develop a plan for the treatment of UTUCC. A Pub Med search was completed using the key words "upper tract urothelial cell carcinoma","epidemiology","risk factor","treatment" and "prognosis". Six hundred fifty two articles were found. We narrowed our search to articles published between January 2004 and June 2016 for a more contemporary review of the topic. Four hundred seventy articles were then available for review. Further detailed search was performed for relevance on the topic and hundred one articles were selected for the review. Many risk factors have been found to be associated with the development of UTUCC,including tobacco use. Patients are often asymptomatic and may only present with microscopic or gross hematuria. Tumor grade and stage are pivotal in determining the treatment options for UTUCC. Advancements in endoscopic techniques have aided in the diagnosis,grading and treatment of this disease. Treatment options include topical therapy,with combinations of methotrexate,vinblastine,doxorubicin and cisplatin or gemcitibine or cisplatin,endoscopic resection,segmental ureterectomy and ureteral implantation,and nephroureterectomy,including bladder cuff. Treatment recommendations depend on tumor grade and stage,renal function,tumor location and the patient's prognosis. There are currently no tissue or blood-based biomarkers available to accurately monitor the disease. Further studies of gene expression and biomarkers may hopefully improve the management of this disease. Although rare in many countries,UTUCC is becoming more prevalent due to exposure to carcinogenic herbal remedies and other identifiable risk factors. Numerous treatment modalities,both surgical and chemotherapeutic

关键词： urothelial cell carcinoma Diagnosis Upper tract Epidemiology Risk factors Treatment Prognosis

Triplet chemotherapy with paclitaxel, gemcitabine, and cisplatin as second-line therapy for advanced urothelial carcinoma

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Modern Chemotherapy 2013年第1期2卷 1-7页

作者： Hideki Takeshita Koji Chiba Sachi Kitayama Shingo Moriyama Rika Omura Akira Noro Department of Pharmacy Saitama Red Cross Hospital Saitama Japan Department of Urology Saitama Red Cross Hospital Saitama Japan

Background: Methotrexate, vinblastine, doxorubicin, and cisplatin regimen, and gemcitabine and cisplatin regimen are widely used for advanced or metastatic urothelial carcinomas (UCs). However, a standard treatment for patients who fail these firstline chemotherapies is unavailable. We examined the efficacy and safety of secondline paclitaxel, gemcitabine, and cisplatin (PCG) chemotherapy in Japanese patients. Methods: Between 2004 and 2010, 25 patients with metastatic UCs who failed to respond to platinumbased regimens were treated with PCG. They received intravenous paclitaxel (60 mg/m2) and gemcitabine (1000 mg/m2) on days 1 and 8, and cisplatin (70 mg/m2) on day 2 of every 21 day course. We retrospectively collected patients’ clinical and pathological data and evaluated adverse effects and survivals. Results: Patients underwent 95 PCG cycles in all (average, 3.8 cycles per patient). One patient (4%) achieved complete response, 5 (20%) showed partial response, 8 (42%) had disease stabilization, and 5 (26%) had disease progression. Median overall survival was 8.5 months. Neutropenia and thrombocytopenia of grade ≥ 3 were observed in 68% and 56% of patients, respectively. No treatment related death occurred. Multivariate analysis revealed that hemoglobin levels 1.73 m2) were significant risk factors for overall survival. Conclusion: PCG chemotherapy in the secondline setting potentially contributed to good prognosis in selected patients with relatively significant but tolerable toxicity.

关键词： Metastatic urothelial Carcinoma Second-Line Paclitaxel Gemcitabine