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Local retroperitoneal recurrence (RPR) after racial nephrectomy (RN) of renal cell carcinoma (RCC) remains a therapeutic challenge and has a poor prognosis. We aimed to compare the oncological outcomes of patients with RPR treated with RPR surgery or targeted therapy alone and assess the prognostic factors of these patients.This is a retrospective multi-center study of patients with RPR after prior RN treated with or without surgical treatment from 2008 to 2020. RPR of RCC is defined as an ipsilateral recurrence confined to the renal fossa, adrenal gland or retroperitoneal lymph nodes after prior nephrectomy, which was diagnosed by cross-sectional imaging. Clinical and pathological features, perioperative complications were reported using descriptive statistics. Cancer-specific survival (CSS) was evaluated by Kaplan-Meier method and studied using Cox proportional hazards model.Median follow-up period was 35 months (IQR 20-61) for the RPR surgery group and 23 months (IQR 9-40.5) for the targeted therapy group. No patients had distant metastatic disease at the time of RPR diagnosis. Treatment with RPR surgery resulted in significantly longer CSS than targeted therapy alone (P.001). In multivariable analysis, high Fuhrman grade, size of RPR tumor, mixed type of RPR, multiple recurrence lesions and the absence of RPR surgery were associated with a significantly increased risk of death from RCC.Aggressive surgical resection of RPR after RN represents a potentially curative treatment for selected RCC patients without synchronous metastases, resulting in significantly longer CSS than targeted therapy alone.

Background The aim of the present study was to explore the mechanism underlying the poor efficacy of pyrotinib, propose and validate a strategy for pyrotinib-combined therapy in patients with human epidermal growth factor receptor 2 (HER2)-positive gastric cancer (GC). Methods Human GC cell lines and patient-derived xenograft (PDX) models were used to evaluate the antitumor activity and mechanisms of pyrotinib. One pyrotinib-refractory PDX model was established to explore the potential mechanisms underlying drug resistance, propose an optimal therapeutic strategy, and further validate in a phase I clinical trial (NCT03480256). Results Pyrotinib exerted strong antitumor activity in HER2-positive GC cells and PDX models via suppressing the activation of the AKT/S6 signaling pathway. In addition, dysregulation of the cell cycle, represented by aberrant activation of the CCND1-CDK4/6-Rb axis, was found in the pyrotinib-refractory PDX model compared with the parental model. Then, combination therapy of pyrotinib with a CDK4/6 inhibitor (SHR6390) was proposed and its strong tumor growth inhibition was observed in the pyrotinib refractory-PDX model. Three HER2-positive GC patients after multiline therapies were subsequently enrolled in our clinical trial treatment with pyrotinib (400 mg/d for 28 days per cycle) combined with SHR6390 (100 mg/d for 21 days per cycle). After two cycles of therapy, two patients achieved a partial response (PR) and one patient achieved decreased stable disease (SD) with a progression-free survival of 120, 199, and 110 d, respectively. The common adverse events included leucopenia (grade 2 to 3), neutropenia (grade 2 to 4), anemia (grade 1 to 3), and thrombocytopenia (grade 1). Conclusions This representative translational study suggests that a combination treatment of pyrotinib with SHR6390 may serve as a promising strategy for patients with HER2-positive GC after systematic treatment failure. The optimal drug doses and tolerability of this combination treatment will be explored in future studies. Legal entity responsible for the study Zuhua Chen. Funding The National Key Research and Development Program of China (No. 2017YFC1308900, 2017YFC0908400). Disclosure All authors have declared no conflicts of interest.

Objective To describe a modified suture technique for transperitoneal laparoscopic dismembered pyeloplasty (TPLDP) that can be consistently replicated. Methods Between June 2010 and April 2014, 21 men and 7 women with primary pelviureteric junction obstruction underwent our modified TPLDP suture technique performed by the same surgeon. In our method, the dismembering should be performed after performing half of anastomosis to achieve the maintenance of correct orientation and the prevention of torsion of anastomosis. We defined the success criteria as complete clinical resolution of flank pain for the patients with flank pain and complete radiologic resolution for the asymptomatic patients. Results The mean overall operative time for our technique was 137.3 minutes. The mean operative time for procedures on the left side was longer than on the right side ( P = .02). The mean suture time was 37.2 minutes. The mean estimated blood loss was 29.4 mL, and the crossing vessel was found in 7 of 28 patients (25.0%). No open conversion was required. The mean follow-up time was 21.0 months. Only 1 patient still had frequent and intolerable flank pain after surgery whose treatment was unsuccessful. The rest of the patients got complete clinical or radiologic resolution. The success rate was 27 of 28 (96.4%). Conclusion Our modified TPLDP suture technique is feasible and seems to be safe and to allow high success rate for the treatment of pelviureteric junction obstruction. Sizable sample and further analysis about technique will be completed in the future.

Objective To evaluate the activity and safety of docetaxel plus cyclophosphomide (TC) compared with docetaxel, anthracycline and cyclophosphomide (TAC) in neoadjuvant treatment of triple negative or HER2 positive breast cancer, which may help us to determine the role of anthracycline in breast cancer treatment. Methods Clinical stage IIB or III breast cancer patients were treated with six cycles of TC (docetaxle 75 mg/m2 and cyclophosphomide 600 mg/m2) or TAC (docetaxle 75 mg/m2, anthracycline, and cyclophosphomide 500 mg/m2). Either epirubicin 60mg/m2 or adimycin 50mg/m2 was allowed as an anthracycline regimen. The primary end point was pathological complete remission (pCR), defined as no residual invasive cancer in breast and axillary lymph node. Seconday end points included safety, clinical response rate, event free survival (EFS), disease free survival (DFS), and overall survival (OS). Results 102 patients were randomized and 96 patients were available for analysis (TC: n = 45; TAC: n = 51). After surgery, pCR rate was 6.8% (3/45) and 17.6% (9/51) in TC and TAC group, respectively, P = 0.113. There was also no difference in clinical response rate. However, with mean follow up of 20 (3-36) months, TAC treatment, compared with TC, resulted in a significantly superior EFS (80.4% vs 60.0%, respectively; adjusted HR = 2.42 (95% CI: 1.11 to 5.30); P = 0.027), better DFS (84.3% vs 64.4%, respectively; adjusted HR = 2.85 (95% CI: 1.21 to 6.74); P = 0.017) and a trend towards less death (96.1% vs 86.7%, respectively; adjusted HR = 2.52 (95% CI: 0.41-15.38); P = 0.315). Patients treated with TAC had relative high rates of grade 3-4 neutropenia and leukopenia, and rates of other severe adverse events were similar and no patients died on treatment. Conclusions pCR rate was not significantly different between TAC and TC in neodajuvant treatment of triple negative or HER2 positive breast cancer. Adding anthracycline to TC can significantly improve patients' outcome, which deserves further investigation. (Sponsored by Sanofi; ClinicalTrials.gov number, NCT00912444.) Disclosure All authors have declared no conflicts of interest.