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Objective: To explore the effect of toxicity of sunitinib on the clinical outcome of patients with advanced renal cell carcinoma (RCC) ., Methods: A total of 136 patients with advanced RCC were treated with sunitinib from 2008 to 2011. There were 91 males and 45 females with an average age of 56 years. Their 6-week therapy cycle was 4 weeks of sunitinib 50 mg daily followed by 2-week off-treatment (schedule 4/2). The median follow-up time was 15 months. Correlation between toxicities and overall survival (OS) was evaluated in a Cox model using log-transformed levels after adjusting for MSKCC model.Log-rank test and Cox proportional hazard model were used to assess the value of drug toxicity as the prognostic factors., Results: The increased hemoglobin on cycle 1 day 14 (HR:0.950, 95%CI:0.923-0.978) and the increased lymphocytes on cycle 1 days 28 and 42 (HR:0.405, 95%CI:0.203-0.809, HR:0.394, 95%CI:0.179-0.867) were significantly associated with OS (P adj = 0.001, 0.014 and 0.022 respectively). Hypertension class III/IV (HR:0.066, 95%CI:0.008-0.582), and the number of neutrophils screening and lymphocyte count ratio (HR:2.537, 95%CI:1.182-5.404) were the survival prognosis independent predictors., Conclusion: Early hematopoietic toxicities may potentially predict the outcomes of advanced RCC after a therapy of sunitinib.

Objective: To explore the hematologic adverse effects in patients with renal cell carcinoma treated with sunitinib., Methods: A total of 136 patients with advanced renal cell carcinoma were treated with sunitinib at our hospital from 2008 to 2011. There were 91 males and 45 females with an average age of 55.5 years. They received sunitinib in repeated 6-week cycles consisting of 4 weeks of sunitinib 50 mg per day followed by 2 weeks of treatment (schedule 4/2). The hematologic toxicities, collected at baseline and 14, 28, 42 (after a 2-week rest period) days, were graded according to the National Cancer Institute common terminology criteria for adverse events version 3.0. The paired Wilcoxon test was used to evaluate the kinetics of hematologic adverse effects at days 14, 28, and 42 post-treatment., Results: The hematologic toxicities included leukopenia (n = 91, 66.9%), neutropenia (n = 95, 69.8%), lymphopenia (n = 58, 46.2%), thrombopenia (n = 89, 65.4%) and hypohemoglobinemia (n = 48, 35.3%). Among them, 31 cases (22.8%) had the high-grade (including grades 3 and 4) toxicity of thrombopenia. There were depressions in hematopoietic cell populations including leukocytes, neutrophils, and platelets at days 14, 28 and 42 versus the baseline level (all P < 0.05). The median hemoglobin level transiently increased at days 14 and 28 (both P < 0.01) and returned to the level of baseline at days 42 (P = 0.754)., Conclusions: The incidence of hematologic adverse effects of sunitinib slightly varies with what have been observed in previous studies. And the incidence of high-grade toxicity of thrombocytopenia is higher than that reported in studies conducted in the US and Europe.

Objective: To assess the efficacy of low dose ketoconazole therapy for Chinese patients with castration resistant prostate cancer (CRPC) and explore possible prognosis factors., Methods: From August 2006 to August 2011, 71 patients with CRPC were analyzed retrospectively, who received oral ketoconazole 200 mg, three times a day with prednisone 5 mg, twice a day. Prostate specific antigen (PSA) response rate was defined as the percentage of patients with PSA decline ≥ 50% compared to baseline PSA level during low dose ketoconazole therapy. Multivariate Logistic regression analysis and receiver operating characteristic curve were used to assess the prognostic factors and their accuracy., Results: The mean initial serum PSA level was (205 ± 38) ng/ml for these patients with mean age (69 ± 1) years old. After first androgen deprivation therapy failure, the prostate cancer progressed into castration resistant stage. The baseline PSA was (93 ± 24) ng/ml and the baseline serum testosterone was (0.13 ± 0.02) ng/ml. During the low dose ketoconazole therapy, 31 patients (43.7%) had PSA decrease and 22 cases (31.0%) were effective with PSA decline more than 50%. PSA doubling time and baseline serum testosterone were positive correlation with PSA response rate by multivariate Logistic regression analysis. Patients with PSA doubling time of ≥ 3.0 months had a PSA response rate of 64.3% and the PSA response rate in those with < 3.0 months decreased to 22.8%, hazard rate (HR) = 0.149 (95% confidence interval [CI] 0.029 - 0.766), P = 0.023, area under the curve (AUC) = 0.707. The PSA response rate for patients with baseline serum testosterone ≥ 0.1 and < 0.1 µg/L were 55.6% and 5.7%, respectively, HR = 0.068 (95%CI 0.012 - 0.380), P = 0.002, AUC = 0.749. The common adverse reactions included liver dysfunction (17.9%), renal dysfunction (16.4%), fatigue (11.9%), nausea (6.0%) and anorexia (4.5%) and so on., Conclusions: Low dose ketoconazole therapy was a moderate, low toxicity hormonal therapy option for patients with CRPC. PSA doubling time ≥ 3 months and baseline serum testosterone ≥ 0.1 µg/L were predictors of desired effect for low dose ketoconazole therapy.

Objective: To retrospectively analyze the clinical value of diffusion-weighted magnetic resonance imaging (MRDWI) in the detection of prostate cancer in suspected patients., Methods: Between January 2009 and December 2010, 141 patients with suspected prostate cancer underwent MRDWI and transrectal ultrasound (TRUS) guided prostate biopsy. They were divided into 4 groups by prostate surface antigen (PSA) < 10 µg/L, 10 µg/L ≤ PSA < 20 µg/L, 20 µg/L ≤ PSA < 50 µg/L and PSA ≥ 50 µg/L. Then the diagnostic accuracy of MRDWI was tested., Results: The diagnostic rate of patients with PSA < 10 µg/L, 10 µg/L ≤ PSA < 20 µg/L, 20 µg/L ≤ PSA < 50 µg/L and PSA ≥ 50 µg/L were 23.7%, 35.5%, 66.7% and 96.3% respectively. The sensitivity of MRDWI was significantly better than TRUS. In patients with PSA < 10 µg/L, 10 µg/L ≤ PSA < 20 µg/L, 20 µg/L ≤ PSA < 50 µg/L and PSA ≥ 50 µg/L, the patient-based sensitivities were 85.7%, 72.7%, 97.8%, 100.0% respectively; when based by segment of specimen, the sensitivities were 85.5%, 71.9%, 91.5% and 94.4% respectively., Conclusion: The sensitivity of MDWI is significantly better than TRUS in the diagnosis of prostate cancer. The combined use of MDWI and TRUS has the benefit of guiding the biopsy of cancer foci in patients with suspected prostate cancer.

Objective: There are many causative factors for the occurrence of post-prostatectomy incontinence. Objective clinical characteristics, surgical techniques and pelvic floor muscle therapy are the most important ones. The present study was to identify the risk factors associated with urinary incontinence after radical retropubic prostatectomy (RRP)., Methods: A total of 263 patients were recruited for this multivariate analysis. After a close follow-up, a series of pre-, peri- and post-operative factors were recorded and analyzed., Results: Urinary continence after radical prostatectomy was 14.8% at 4 weeks and 94.7% at 16 weeks. The most important recovery interval for urinary continence was 4 - 16 weeks post-operation. Multivariate analysis revealed that age (P = 0.015), blood transfusion (P = 0.017), previous TURP (transurethral resection of the prostate) (P = 0.006) and neoadjuvant hormonal therapy (P = 0.005) were the important risk factors for urinary incontinence., Conclusion: During RRP, optimized preservation of urethral rhabdosphincter length, nerve sparing and early postoperative functional exercises can improve the recovery of urinary continence. Age, blood transfusion and previous TURP are the independent prognostic factors. Neoadjuvant hormonal therapy may improve urinary continence through increasing the preoperative length of membranous urethra.

Objective: To establish the regression model predicting the probability of the capsular penetration according to the Chinese prostate cancer samples., Methods: Men enrolled in the Fudan University Shanghai Cancer Centre and undergoing radical prostatectomy between January 2006 and April 2010 were used to establish the predicting model. According to the pathology after radical prostatectomy, all cases were divided into two groups: organ confined disease group and locally advanced disease group, the difference of which were whether had the capsular penetration. The cases with regional lymph node metastasis were excluded. Serum prostate specific antigen level, Gleason grade, clinical stage were collected. Multiple Logistic regression model was established according to preoperative clinical data and postoperative pathological data to predict the incidence of capsular penetration. Receiver operating characteristic curve was used for the internal validation of the model., Results: 83 Chinese men were identified in the organ confined disease group with the age of 66.8 ± 5.8 years, and 36 in the locally advanced disease group with the age of 66.0 ± 6.8 years. The difference of the age between the two groups were of no statistic significance (t = 0.650, P = 0.517). The serum prostate specific antigen level (Wilcoxon W = 4562.0, P = 0.016), Gleason score (Wilcoxon W = 4586.5, P = 0.016), and clinical stage (Wilcoxon W = 4444.5, P = 0.001) of the locally advanced disease group were higher than the other group. The equation of the multiple Logistic regression model was Logit P = 0.488 × Gleason score + 0.104 × clinical stage -6.187, with the freedom degree of two and the likelihood ratio χ(2) test of 11.263 (P = 0.001). The area under the ROC curve (AUC) for capsular penetration was 0.696 (P = 0.001), with the 95% confidence interval of 0.598 - 0.793., Conclusion: The multiple Logistic regression model based on the Chinese population can accurately predict the probability of capsular penetration of the prostate cancer and work on well with high internal accuracy when clinical decisions are made.

Objective: To evaluate the effect of technical improvements of transperitoneal radical nephrectomy on the patients with large renal cell carcinoma., Methods: From May 2002 until May 2009, 45 patients with large (> 12 cm) renal cell carcinoma underwent transperitoneal radical nephrectomy. A subcostal incision was selected to expose the extraperitoneal area. The modified operative methods included exposing the operative field via a liver retractor and initially ligating renal artery to block the blood supply of kidney and tumor. The method of tumor-free tissue dissociation was applied. Hem-o-lock was employed for clipping so as to avoid hemorrhage. This modified technique was evaluated in respects of operating time, estimated blood loss, intra-operative complications, postoperative complications, length of hospital stay and pathological diagnoses., Results: The tumor diameter was from 12.2 cm to 28.3 cm with a mean of 14.5 cm. The mean operative time was (150 +/- 58) min and the average estimated blood loss (350 +/- 180) ml. Three cases received blood transfusion. The average length of hospital stay was (12 +/- 6) days. Three cases developed complications, including spleen injury in 2 and pancreatic injury in 1. The treatment modalities were splenectomy and resection of pancreatic tail respectively. The pathological diagnoses were all of renal cell carcinoma. The pathological stage included T(2)N(0 approximately 1)M(0 approximately 1)(n = 13), T(3)N(0 approximately 1)M(0 approximately 1)(n = 23), T(4)N(0 approximately 1)M(0 approximately 1)(n = 9). After a follow-up period of 3 - 63 months, 3 cases of tumor recurrence were found in primary renal clutch., Conclusion: Improved radical nephrectomy is feasible for large renal cell carcinoma. And it can reduce the volume of blood loss and decrease the occurrence of complications.