Percent free prostatic-specific antigen （%fPSA） has been introduced as a tool to avoid unnecessary biopsies in patients with a serum PSA level of 4.0-10.0 ng ml^-1, however, it remains controversial whether %fPSA is...Percent free prostatic-specific antigen （%fPSA） has been introduced as a tool to avoid unnecessary biopsies in patients with a serum PSA level of 4.0-10.0 ng ml^-1, however, it remains controversial whether %fPSA is effective in PSA range of 10.1-20.0 ng ml^-1 in both Chinese and Western population. In this study, the diagnostic performance of %fPSA and serum PSA in predicting prostate cancer （PCa） and high-grade PCa （HGPCa） was analyzed in a multi-center biopsy cohort of 5915 consecutive Chinese patients who underwent prostate biopsy in 22 hospitals across China from January 1, 2010 to December 31, 2013. The indication for biopsy was PSA〉4.0 ng ml^-1 or/and suspicious digital rectal examination. Total and free serum PSA determinations were performed by three types of electrochemiluminescence immunoassays with recalibration to the World Health Organization standards. The diagnostics accuracy of PSA, %fPSA and %fPSA in combination with PSA （%fPSA ＋ PSA） was determined by the area under the receivers operating characteristic curve （AUC）. %fPSA was more effective than PSA in men aged ≥60 years old. The AUC was 0.584 and 0.635 in men aged ≥60 years old with a PSA of 4.0-10.0 ng ml^-1 and 10.1-20.0 ng ml^-1, respectively. The AUC of %fPSA was superior to that of PSA in predicting HGPCa in patients ≥60 years old in these two PSA range. Our results indicated that %fPSA is both statistically effective and clinical applicable to predict prostate biopsy outcome in Chinese patients aged ≥60 years old with a PSA of 4.0-10.0 ng ml^-1 and 10.1-20.0 ng ml^-1.展开更多
目的:探讨特发性非梗阻性无精子症患者中,睾丸穿刺活检对显微取精成功率的预测作用。方法:回顾性分析了从2014年1月至2017年8月在北京大学第三医院生殖医学中心接受显微取精术的特发性非梗阻性无精子症患者的临床资料,并对是否行诊断性...目的:探讨特发性非梗阻性无精子症患者中,睾丸穿刺活检对显微取精成功率的预测作用。方法:回顾性分析了从2014年1月至2017年8月在北京大学第三医院生殖医学中心接受显微取精术的特发性非梗阻性无精子症患者的临床资料,并对是否行诊断性穿刺活检、以及不同穿刺活检结果患者的精子获得率进行分析,探讨睾丸穿刺活检结果对显微取精成功率的预测作用。结果:共237例接受显微取精术的特发性非梗阻性无精子症患者入选研究,总体的精子获得率为25.7%。未行诊断性睾丸穿刺活检的103例患者与行诊断性睾丸穿刺活检的134例患者精子获得率分别为26.2%和25.4%,两组间比较差异没有统计学意义(P>0.05);两组睾丸体积和血清卵泡刺激素水平分别为(4.3±1.4)m L vs.(8.5±2.4)m L和(36.1±5.2)IU/L vs.(26.1±3.5)IU/L,组间比较差异具有统计学意义(P<0.05)。在睾丸穿刺活检的患者中,术中镜检及术后病理均偶见少量精子患者的精子获得率为100.0%(7/7),术中镜检或术后病理可见精子的患者,精子获得率为47.2%(17/36),术中镜检及术后病理均未见精子的患者,精子获得率为11.0%(10/91),3组间比较差异具有统计学意义(P<0.05)。结论:睾丸体积较小的特发性非梗阻性无精子症患者仍有一定机会通过显微取精术发现精子;睾丸穿刺活检结果(包括术中镜检及术后病理能否发现精子)对后期进行显微镜下睾丸切开取精有一定的预测作用,其中术中镜检及术后病理均未见精子的患者,显微取精术找到精子的概率较低。展开更多
This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma （PTL） patients. We retrospectively reviewed the clinical recor...This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma （PTL） patients. We retrospectively reviewed the clinical records of 32 patients from 1993 to 2017 diagnosed with PTL and included 22 patients for analysis. The Kaplan-Meier method, Log-rank test, and multivariate Cox proportional hazard regression analysis were applied to evaluate progression-free survival （PFS）, overall survival （OS）, and determine prognosis predictors. The median follow-up time was 30 months. Median OS and PFS were 96 months and 49 months, respectively. In univariate analysis, advanced Ann Arbor stage （Ill/IV） （P 〈 0.001）, B symptoms （P 〈 0.001）, and extranodal involvement other than testis （P = 0.001） were significantly associated with shorter OS and PFS. In multivariate analysis, Ann Arbor stage was significantly associated with OS （OR = 11.58, P = 0.049）, whereas B symptom was significantly associated with PFS （OR = 11.79, P = 0.049）. In the 10 patients with the systemic usage of rituximab, bilateral intervention could improve median OS from 16 to 96 months （P = 0.032）. The study provides preliminary evidence on bilateral intervention in testes in the rituximab era and validates common prognostic factors for Chinese PTL patients.展开更多
Background:Radical nephrectomy with thrombectomy is one of the most difficult and complicated urological operations.But the roles of renal tumor volume and thrombus level in surgical complexity and prognostic outcome ...Background:Radical nephrectomy with thrombectomy is one of the most difficult and complicated urological operations.But the roles of renal tumor volume and thrombus level in surgical complexity and prognostic outcome are not clear.This study aimed to evaluate the surgical complexity and prognostic outcome between the volume of renal cell carcinoma (RCC) and the level of venous tumor thrombus.Methods:The clinical data of 67 RCC cases with renal vein or inferior vena cava (IVC) tumor thrombus from January 2015 to May 2018 were retrospectively analyzed.Among these 67 cases,21 (31.3%) were small tumors with high-level thrombus (tumor ≤7 cm in diameter and thrombus Neves Level Ⅱ-Ⅳ),while 46 (68.7%) were large tumors with low-level thrombus group (tumor >7 cm in diameter and thrombus Level 0-Ⅰ).Clinical features,operation details,and pathology data were collected.Univariable and multivariable logistic regression analyses were applied to evaluate the risk factors for small tumor with high-level thrombus.Results:Patients with small tumors and high-level thrombus were more likely to have longer operative time (421.9 ± 135.1 min vs.282.2 ± 101.9 min,t=4.685,P < 0.001),more surgical bleeding volume (1200 [325,2900] mL vs.500 [180,1000] mL,U =270.000,P =0.004),more surgical blood transfusion volume (800 [0,1400] mL vs.0 [0,800] mL,U =287.500,P =0.004),more plasma transfusion volume (0 [0,800] mL vs.0 [0,0] mL,U =319.000,P =0.004),higher percentage of open operative approach (76.2% vs.32.6%,x2 =11.015,P =0.001),higher percentage of IVC resection (33.3% vs.0%,x2 =17.122,P < 0.001),and higher percentage of post-operative complications (52.4% vs.19.6%,x2 =7.415,P =0.010) than patients with large tumors and low-level thrombus.In multivariate analysis,decreased hemoglobin (Hb)(odds ratio [OR]:0.956,95 % confidence interval [CI]:0.926-0.986,P =0.005) and non-sarcomatoid differentiation (OR:0.050,95% CI:0.004-0.664,P =0.023) were more likely to form small tumors with high-level tumor thrombus rather than large tumor with s展开更多
目的:探讨乳头状肾细胞癌(papillary renal cell carcinoma,pRCC)的临床病理特征和预后特点。方法:回顾性分析2012年5月至2021年5月北京大学第三医院泌尿外科收治的114例pRCC患者的临床资料,包括91例男性和23例女性。所有病例均为手术患...目的:探讨乳头状肾细胞癌(papillary renal cell carcinoma,pRCC)的临床病理特征和预后特点。方法:回顾性分析2012年5月至2021年5月北京大学第三医院泌尿外科收治的114例pRCC患者的临床资料,包括91例男性和23例女性。所有病例均为手术患者,病理诊断明确,随访数据完整。采用Kaplan-Meier法绘制生存曲线并通过log-rank检验分析患者临床病理特征与生存时间的关系,使用Cox比例风险回归模型分析影响患者无进展生存率的因素。结果:114例患者平均年龄(57.3±12.6)岁。肿瘤位于左肾49例,右肾65例。48例行根治性肾切除术,66例行肾部分切除术。1型pRCC 42例,2型72例,肿瘤平均最大径为(5.5±3.6)cm。肿瘤分期pT1a期52例,pT1b期22例,pT2期4例,pT3期33例,pT4期3例。2016年世界卫生组织/国际泌尿病理学会(World Health Organization/International Society of Urological Pathology,WHO/ISUP)分级Ⅰ级13例,Ⅱ级44例,Ⅲ级51例,Ⅳ级6例。114例患者中34例伴有脉管癌栓,30例伴淋巴结转移,3例伴肾上腺转移。患者术后中位随访时间为22个月,3年无进展生存率为95.6%。1型和2型pRCC患者在年龄(P=0.046)、体重指数(P=0.008)、手术方式(P=0.001)、肿瘤最大径(P<0.001)、脉管癌栓(P<0.001)、淋巴结转移(P<0.001)、pT分期(P<0.001)和核分级(P<0.001)方面差异均有统计学意义。1型和2型pRCC的3年无进展生存率分别为100%和69.4%,1型预后明显优于2型(P=0.003)。2型pRCC患者的单因素分析结果显示,pT分期(P<0.001)、脉管癌栓(P<0.001)和淋巴结转移(P<0.001)与其预后紧密相关;多因素分析显示,脉管癌栓为2型pRCC无进展生存率的独立预后因素(P=0.001)。行根治性肾切除术的pRCC患者的单因素分析结果显示,pT分期(P=0.006)、脉管癌栓(P=0.001)和淋巴结转移(P=0.008)是影响其预后的显著因素,进一步多因素分析显示只有脉管癌栓是其无进展生存率的独立预后因素(P=0.006)。结论:2型pRCC比1型pRCC展开更多
Background:Positive surgical margins are independent risk factor for biochemical recurrence,local recurrence,and distant metastasis after radical prostatectomy.However,limited predictive tools are available.This study...Background:Positive surgical margins are independent risk factor for biochemical recurrence,local recurrence,and distant metastasis after radical prostatectomy.However,limited predictive tools are available.This study aimed to develop and validate a preoperative nomogram for predicting positive surgical margins after laparoscopic radical prostatectomy(LRP).Methods:From January 2010 to March 2016,a total of 418 patients who underwent LRP without receiving neoadjuvant therapy at Peking University Third Hospital were retrospectively involved in this study.Clinical and pathological results of each patient were collected for further analysis.Univariable and multivariable logistic regression(backward stepwise method)were used for the nomogram development.The concordance index(CI),calibration curve analysis and decision curve analysis were used to evaluate the performance of our model.Results:Of 418 patients involved in this study,142 patients(34.0%)had a positive surgical margin on final pathology.Based on the backward selection,four variables were included in the final multivariable regression model,including the percentage of positive cores in preoperative biopsy,clinical stage,free prostate specific antigen(fPSA)/total PSA(tPSA),and age.A nomogram was developed using these four variables.The concordance index(C-index)of the nomogram was 0.722 in the development cohort and 0.700 in the bootstrap validations.The bias-corrected calibration plot showed a limited departure from the ideal line with a mean absolute error of 2.0%.In decision curve analyses,the nomogram showed net benefits in the range from 0.2 to 0.7.Conclusion:A nomogram to predict positive surgical margins after LRP was developed and validated,which could help urologists plan surgical procedures.展开更多
文摘Percent free prostatic-specific antigen （%fPSA） has been introduced as a tool to avoid unnecessary biopsies in patients with a serum PSA level of 4.0-10.0 ng ml^-1, however, it remains controversial whether %fPSA is effective in PSA range of 10.1-20.0 ng ml^-1 in both Chinese and Western population. In this study, the diagnostic performance of %fPSA and serum PSA in predicting prostate cancer （PCa） and high-grade PCa （HGPCa） was analyzed in a multi-center biopsy cohort of 5915 consecutive Chinese patients who underwent prostate biopsy in 22 hospitals across China from January 1, 2010 to December 31, 2013. The indication for biopsy was PSA〉4.0 ng ml^-1 or/and suspicious digital rectal examination. Total and free serum PSA determinations were performed by three types of electrochemiluminescence immunoassays with recalibration to the World Health Organization standards. The diagnostics accuracy of PSA, %fPSA and %fPSA in combination with PSA （%fPSA ＋ PSA） was determined by the area under the receivers operating characteristic curve （AUC）. %fPSA was more effective than PSA in men aged ≥60 years old. The AUC was 0.584 and 0.635 in men aged ≥60 years old with a PSA of 4.0-10.0 ng ml^-1 and 10.1-20.0 ng ml^-1, respectively. The AUC of %fPSA was superior to that of PSA in predicting HGPCa in patients ≥60 years old in these two PSA range. Our results indicated that %fPSA is both statistically effective and clinical applicable to predict prostate biopsy outcome in Chinese patients aged ≥60 years old with a PSA of 4.0-10.0 ng ml^-1 and 10.1-20.0 ng ml^-1.
文摘目的:探讨特发性非梗阻性无精子症患者中,睾丸穿刺活检对显微取精成功率的预测作用。方法:回顾性分析了从2014年1月至2017年8月在北京大学第三医院生殖医学中心接受显微取精术的特发性非梗阻性无精子症患者的临床资料,并对是否行诊断性穿刺活检、以及不同穿刺活检结果患者的精子获得率进行分析,探讨睾丸穿刺活检结果对显微取精成功率的预测作用。结果:共237例接受显微取精术的特发性非梗阻性无精子症患者入选研究,总体的精子获得率为25.7%。未行诊断性睾丸穿刺活检的103例患者与行诊断性睾丸穿刺活检的134例患者精子获得率分别为26.2%和25.4%,两组间比较差异没有统计学意义(P>0.05);两组睾丸体积和血清卵泡刺激素水平分别为(4.3±1.4)m L vs.(8.5±2.4)m L和(36.1±5.2)IU/L vs.(26.1±3.5)IU/L,组间比较差异具有统计学意义(P<0.05)。在睾丸穿刺活检的患者中,术中镜检及术后病理均偶见少量精子患者的精子获得率为100.0%(7/7),术中镜检或术后病理可见精子的患者,精子获得率为47.2%(17/36),术中镜检及术后病理均未见精子的患者,精子获得率为11.0%(10/91),3组间比较差异具有统计学意义(P<0.05)。结论:睾丸体积较小的特发性非梗阻性无精子症患者仍有一定机会通过显微取精术发现精子;睾丸穿刺活检结果(包括术中镜检及术后病理能否发现精子)对后期进行显微镜下睾丸切开取精有一定的预测作用,其中术中镜检及术后病理均未见精子的患者,显微取精术找到精子的概率较低。
文摘This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma （PTL） patients. We retrospectively reviewed the clinical records of 32 patients from 1993 to 2017 diagnosed with PTL and included 22 patients for analysis. The Kaplan-Meier method, Log-rank test, and multivariate Cox proportional hazard regression analysis were applied to evaluate progression-free survival （PFS）, overall survival （OS）, and determine prognosis predictors. The median follow-up time was 30 months. Median OS and PFS were 96 months and 49 months, respectively. In univariate analysis, advanced Ann Arbor stage （Ill/IV） （P 〈 0.001）, B symptoms （P 〈 0.001）, and extranodal involvement other than testis （P = 0.001） were significantly associated with shorter OS and PFS. In multivariate analysis, Ann Arbor stage was significantly associated with OS （OR = 11.58, P = 0.049）, whereas B symptom was significantly associated with PFS （OR = 11.79, P = 0.049）. In the 10 patients with the systemic usage of rituximab, bilateral intervention could improve median OS from 16 to 96 months （P = 0.032）. The study provides preliminary evidence on bilateral intervention in testes in the rituximab era and validates common prognostic factors for Chinese PTL patients.
基金grants from the National Key Research and Development Program of China (No. 2017YFA0205600 and No. 2016YFA0201400)the National Natural Science Foundation of China (NSFC-81771842).
文摘Background:Radical nephrectomy with thrombectomy is one of the most difficult and complicated urological operations.But the roles of renal tumor volume and thrombus level in surgical complexity and prognostic outcome are not clear.This study aimed to evaluate the surgical complexity and prognostic outcome between the volume of renal cell carcinoma (RCC) and the level of venous tumor thrombus.Methods:The clinical data of 67 RCC cases with renal vein or inferior vena cava (IVC) tumor thrombus from January 2015 to May 2018 were retrospectively analyzed.Among these 67 cases,21 (31.3%) were small tumors with high-level thrombus (tumor ≤7 cm in diameter and thrombus Neves Level Ⅱ-Ⅳ),while 46 (68.7%) were large tumors with low-level thrombus group (tumor >7 cm in diameter and thrombus Level 0-Ⅰ).Clinical features,operation details,and pathology data were collected.Univariable and multivariable logistic regression analyses were applied to evaluate the risk factors for small tumor with high-level thrombus.Results:Patients with small tumors and high-level thrombus were more likely to have longer operative time (421.9 ± 135.1 min vs.282.2 ± 101.9 min,t=4.685,P < 0.001),more surgical bleeding volume (1200 [325,2900] mL vs.500 [180,1000] mL,U =270.000,P =0.004),more surgical blood transfusion volume (800 [0,1400] mL vs.0 [0,800] mL,U =287.500,P =0.004),more plasma transfusion volume (0 [0,800] mL vs.0 [0,0] mL,U =319.000,P =0.004),higher percentage of open operative approach (76.2% vs.32.6%,x2 =11.015,P =0.001),higher percentage of IVC resection (33.3% vs.0%,x2 =17.122,P < 0.001),and higher percentage of post-operative complications (52.4% vs.19.6%,x2 =7.415,P =0.010) than patients with large tumors and low-level thrombus.In multivariate analysis,decreased hemoglobin (Hb)(odds ratio [OR]:0.956,95 % confidence interval [CI]:0.926-0.986,P =0.005) and non-sarcomatoid differentiation (OR:0.050,95% CI:0.004-0.664,P =0.023) were more likely to form small tumors with high-level tumor thrombus rather than large tumor with s
文摘目的:探讨乳头状肾细胞癌(papillary renal cell carcinoma,pRCC)的临床病理特征和预后特点。方法:回顾性分析2012年5月至2021年5月北京大学第三医院泌尿外科收治的114例pRCC患者的临床资料,包括91例男性和23例女性。所有病例均为手术患者,病理诊断明确,随访数据完整。采用Kaplan-Meier法绘制生存曲线并通过log-rank检验分析患者临床病理特征与生存时间的关系,使用Cox比例风险回归模型分析影响患者无进展生存率的因素。结果:114例患者平均年龄(57.3±12.6)岁。肿瘤位于左肾49例,右肾65例。48例行根治性肾切除术,66例行肾部分切除术。1型pRCC 42例,2型72例,肿瘤平均最大径为(5.5±3.6)cm。肿瘤分期pT1a期52例,pT1b期22例,pT2期4例,pT3期33例,pT4期3例。2016年世界卫生组织/国际泌尿病理学会(World Health Organization/International Society of Urological Pathology,WHO/ISUP)分级Ⅰ级13例,Ⅱ级44例,Ⅲ级51例,Ⅳ级6例。114例患者中34例伴有脉管癌栓,30例伴淋巴结转移,3例伴肾上腺转移。患者术后中位随访时间为22个月,3年无进展生存率为95.6%。1型和2型pRCC患者在年龄(P=0.046)、体重指数(P=0.008)、手术方式(P=0.001)、肿瘤最大径(P<0.001)、脉管癌栓(P<0.001)、淋巴结转移(P<0.001)、pT分期(P<0.001)和核分级(P<0.001)方面差异均有统计学意义。1型和2型pRCC的3年无进展生存率分别为100%和69.4%,1型预后明显优于2型(P=0.003)。2型pRCC患者的单因素分析结果显示,pT分期(P<0.001)、脉管癌栓(P<0.001)和淋巴结转移(P<0.001)与其预后紧密相关;多因素分析显示,脉管癌栓为2型pRCC无进展生存率的独立预后因素(P=0.001)。行根治性肾切除术的pRCC患者的单因素分析结果显示,pT分期(P=0.006)、脉管癌栓(P=0.001)和淋巴结转移(P=0.008)是影响其预后的显著因素,进一步多因素分析显示只有脉管癌栓是其无进展生存率的独立预后因素(P=0.006)。结论:2型pRCC比1型pRCC
文摘Background:Positive surgical margins are independent risk factor for biochemical recurrence,local recurrence,and distant metastasis after radical prostatectomy.However,limited predictive tools are available.This study aimed to develop and validate a preoperative nomogram for predicting positive surgical margins after laparoscopic radical prostatectomy(LRP).Methods:From January 2010 to March 2016,a total of 418 patients who underwent LRP without receiving neoadjuvant therapy at Peking University Third Hospital were retrospectively involved in this study.Clinical and pathological results of each patient were collected for further analysis.Univariable and multivariable logistic regression(backward stepwise method)were used for the nomogram development.The concordance index(CI),calibration curve analysis and decision curve analysis were used to evaluate the performance of our model.Results:Of 418 patients involved in this study,142 patients(34.0%)had a positive surgical margin on final pathology.Based on the backward selection,four variables were included in the final multivariable regression model,including the percentage of positive cores in preoperative biopsy,clinical stage,free prostate specific antigen(fPSA)/total PSA(tPSA),and age.A nomogram was developed using these four variables.The concordance index(C-index)of the nomogram was 0.722 in the development cohort and 0.700 in the bootstrap validations.The bias-corrected calibration plot showed a limited departure from the ideal line with a mean absolute error of 2.0%.In decision curve analyses,the nomogram showed net benefits in the range from 0.2 to 0.7.Conclusion:A nomogram to predict positive surgical margins after LRP was developed and validated,which could help urologists plan surgical procedures.
