Shiwei Zhang

Background: In this study, we explored the diagnostic performances of multiparametric magnetic resonance imaging (mpMRI), ⁶⁸ Ga-PSMA-11 PET/CT and combination of ⁶⁸ Ga-PSMA-11 PET/CT and mpMRI (mpMRI + PET/CT) for extracapsular extension (ECE). Based on the analyses above, we tested the feasibility of using mpMRI + PET/CT results to predict T staging in prostate cancer patients. Methods: By enrolling 75 patients of prostate cancer with mpMRI and ⁶⁸ Ga-PSMA-11 PET/CT before radical prostatectomy, we analyzed the detection performances of ECE in mpMRI, ⁶⁸ Ga-PSMA-11 PET/CT and mpMRI + PET/CT on their lesion images matched with their pathological sample images layer by layer through receiver operating characteristics (ROC) analysis. By inputting the lesion data into Prostate Imaging Reporting and Data System (PI-RADS), we divided the lesions into different PI-RADS scores. The improvement of detecting ECE was analyzed by net reclassification improvement (NRI). The predictors for T staging were evaluated by using univariate and multivariable analysis. The Kappa test was used to evaluate the prediction ability. Results: One hundred three regions of lesion were identified from 75 patients. 50 of 103 regions were positive for ECE. The ECE diagnosis AUC of mpMRI + PET/CT is higher than that of mpMRI alone (ΔAUC = 0.101; 95% CI, 0.0148 to 0.1860; p < 0.05, respectively). Compared to mpMRI, mpMRI + PET/CT has a significant improvement in detecting ECE in PI-RADS 4–5 (NRI 36.1%, p < 0.01). The diagnosis power of mpMRI + PET/CT was an independent predictor for T staging (p < 0.001) in logistic regression analysis. In patients with PI-RADS 4–5 lesions, 40 of 46 (87.0%) patients have correct T staging prediction from mpMRI + PET/CT (κ 0.70, p < 0.01). Conclusion: The prediction of T staging in PI-RADS 4–5 prostate cancer patients by mpMRI + PET/CT had a quite good performance.

A positive surgical margin (PSM) is reported to have some connection to the occurrence of biochemical recurrence and tumor metastasis in prostate cancer after the operation. There are no clinically usable models and the study is to predict the probability of PSM after robot-assisted laparoscopic radical prostatectomy (RALP) based on preoperative examinations. It is a retrospective cohort from a single center. The Lasso method was applied for variable screening; logistic regression was employed to establish the final model; the strengthened bootstrap method was adopted for model internal verification; the nomogram and web calculator were used to visualize the model. All the statistical analyses were based on the R-4.1.2. The main outcome was a pathologically confirmed PSM. There were 151 PSMs in the 903 patients, for an overall positive rate of 151/903 = 16.7%; 0.727 was the adjusted C statistic, and the Brier value was 0.126. Hence, we have developed and validated a predictive model for PSM after RALP for prostate cancer that can be used in clinical practice. In the meantime, we observed that the International Society of Urological Pathology (ISUP) score, Prostate Imaging Reporting and Data System (PI-RADS) score, and Prostate-Specific Antigen (PSA) were the independent risk factors for PSM.

Background: Solitary fibrous tumors (SFT), most commonly found in the pleura, have a low incidence in the urinary and pelvic organs. This study aimed to discuss the diagnosis, treatment, and prognosis of urinary and pelvic SFT(UPSFT) as well as differences between benign and malignant UPSFTs. We aimed to gain a better understanding of this disease in the urinary and pelvic systems. Methods: Twenty-two patients with UPSFTs treated in our hospital between January 2004 and August 2021 were enrolled. General characteristics, clinical symptoms, imaging results, treatments, pathologies, and follow-up results were reviewed and analyzed. Results: Of the 22 patients, six (27.3%) showed non-specific clinical symptoms, including dysfunction of defecation, lower extremity weakness, urodynia, dysuria, frequent urination accompanied by changes in stool habits, low back pain, and abdominal wall mass with abdominal pain. Sixteen (72.7%) patients were asymptomatic. The median SFT diameter was 5.65 cm (range: 1.7–15 cm). All tumors were found to be space-occupying lesions on Doppler ultrasound, computed tomography, or magnetic resonance imaging. All patients were surgically treated, including nine, six, five, and two cases of robotic, open, laparoscopic, and transurethral resection of bladder tumor surgery, respectively. Pathology results revealed that frequent nuclear divisions, morphological variations, necrosis, and high expressions of Ki-67 were higher in malignant SFT compared with benign SFT. All patients were initially followed up 3 months post-surgery and every 6 months thereafter. Disease-free survival (DFS) in malignant SFT ranged from 5–63 months, with a median DFS of 37.0 months. Additionally, DFS was significantly longer in benign cases than that in malignant cases. Conclusions: UPSFTs do not typically present with specific clinical symptoms. Imaging exams were important in diagnosing UPSFT, with final diagnoses depending on histopathology results. In addition, surgical resection was the most common treatment with subsequent excellent prognoses, except in the case of malignancy.

Objectives: To investigate the causes of missed diagnosis in mpMRI/TRUS fusion-guided targeted prostate biopsy. Methods: The clinical data of 759 patients who underwent transperineal prostate biopsy from March 2021 to June 2021 at Nanjing DrumTower Hospital were retrospectively analyzed. Twenty-one patients had MRI contraindications. Ultimately, 738 patients completed mpMRI/TRUS fusion-guided targeted prostate biopsy + 12-core transperineal systematic biopsy after mpMRI and PI-RADS scoring. The pathological diagnoses from targeted and systematic biopsy were compared to evaluate and analyze the reasons for missed diagnoses in targeted biopsy. Results: A total of 388 prostate cancer patients were identified, including 37 (9%) missed diagnoses with targeted biopsy and 44 (11.34%) with systematic biopsy. Between the target biopsy missed diagnosis group and not missed diagnosis group, there was no significant difference in age (71.08 ± 7.11 vs. 71.80 ± 7.94), but PSA (13.63 ± 12.41 vs. 54.54 ± 177.25 ng/ml), prostate volume (61.82 ± 40.64 vs. 44.34 ± 25.07 cm³), PSAD (0.27 ± 0.28 vs. 1.07 ± 2.91), and ISUP grade [1(1) vs. 3(2)] were significantly different. The pathological results of the 37 targeted biopsy missed diagnoses were recompared with MRI: 21 prostate cancers were normal on MRI; 9 cancer areas were abnormal on MRI; and 7 cancer areas on MRI were PI-RADS 3. Conclusions: Early prostate cancer, large prostate, effect of local anesthesia, doctor–patient cooperation, MRI diagnosis, and operator technology were possible factors for missed diagnosis in targeted biopsy. Improvements imaging technology, greater experience, and personalized biopsy may lead to an accurate pathological diagnosis.

Background Response prediction is necessary for renal cell carcinoma (RCC) tumors. We aim to evaluate parameters derived from ⁶⁸ Ga-PSMA-11 PET/CT images for prediction of pathological VEGFR-2/PDGFR-β expression of primary RCC tumors. Methods Forty-eight RCC patients were retrospectively enrolled with preoperative ⁶⁸ Ga-PSMA-11 PET/CT scan and surgical specimen. Radiological parameters including tumor diameter, mean CT value, and maximal standard uptake value (SUV_max) were derived from PET/CT images and pathological VEGFR-2/PDGFR-β/PSMA expression were identified with immunohistochemistry. Mann–Whitney U test was performed for continuous variables and the chi-square test for categorical variables. ROC was used for determining the effectiveness of preoperative parameters in differentiating VEGFR-2/PDGFR-β expression. Univariate and multivariate logistic regression analyses were performed for significant parameters to predict VEGFR-2 & PDGFR-β co-expression. Results Of the 48 tumors, 25 (52.1%) harbored positive VEGFR-2 expression, 28 (58.3%) harbored positive PDGFR-β expression, and 24 (50%) were both VEGFR-2 positive and PDGFR-β positive. SUV_max significantly differed by subgroups of VEGFR-2/PDGFR-β expression (both P < 0.001). SUV_max demonstrated superior performance for differentiating VEGFR-2 & PDGFR-β co-expression (positive vs. negative), with area under the curve 0.87 (95% CI 0.78–0.96, P < 0.001), sensitivity 93% and specificity 78%. Moreover, SUV_max was identified as the significant predictor for VEGFR-2 & PDGFR-β co-expression (odds ratio 4.01, 95% CI 1.99–8.08, P < 0.001). Concordant with radiological findings with ⁶⁸ Ga-PSMA-11 PET/CT, pathological PSMA staining intensity was significantly higher in both VEGFR-2-positive tumor and PDGFR-β-positive tumor (P = 0.009 and P < 0.001, respectively). Conclusion ⁶⁸ Ga-PSMA-11 PET/CT could effectively identify pathological VEGFR-2/PDGFR-β expression of primary RCC tumors, which may help with selection of mRCC patients suitable for TKIs treatment.

Objective: To report perioperative outcomes in robot‐assisted radical cystectomy and laparoscopic radical cystectomy.Patients and Methods: Between January 2010 and July 2019, 298 patients with bladder cancer underwent robotic‐assisted radical cystectomy (RARC) (n = 172) and laparoscopic radical cystectomy (LRC) (n = 126) at our institution were enrolled in the retrospective study. The demographic, perioperative, and complication data were collected and analyzed.Results: The RARC group had less operative duration (P < .001), less blood loss (P < .001), lower transfusion rate (P < .05), and shorter hospital stay (P < .001) than the LRC group. The 90‐day readmission rate between the RARC and LRC group had no significant differences (P = .401). The 90‐day overall complication rates in the RARC group was much lower than the LRC group (P = .009). The 90‐day minor complication rates (Clavien‐Dindo grade ≤ IIA) between the RARC and LRC groups were similar (P = .274). The 90‐day major complication rates (Clavien‐Dindo grade ≥ IIIA) in the LRC group was higher than the RARC group (P = .022).Conclusions: The RARC approach appears to offer some operative and perioperative benefits compared with the LRC approach. Larger, randomized studies are required to confirm these findings.

Radical cystectomy (RC) with pelvic lymph node dissection (PLND) and urinary diversion (UD) is considered the standard treatment for muscle invasive bladder cancer (MIBC). In a part of patients, RC procedure is aborted due to unresectable disease, other followed treatment like systemic chemotherapy, radiotherapy or cryotherapy may be a better option. The aim of present study was to report the preliminary results of transperineal cryotherapy for unresectable muscle invasive bladder cancer. From January 2011 to August 2013, 7 male patients with pT4b unresectable bladder cancer underwent bilateral ureterocutaneostomy. Two performed a pelvic lymph node dissection (PLND). Then primary transperineal cryosurgery for preserved bladder at the guidance of transrectal ultrasound (TRUS) was performed. All patients underwent a dual freeze-thaw cycle using third-generation cryotechnology with ultrathin 17-gauge cryoneedles. Computer tomography (CT) and/or magnetic resonance image (MRI)were performed at 3 month intervals after cryosurgery to determine whether progression or recurrence occurred. All cryosurgery was performed successfully, mean operation time was 76.43 ± 25.12 min (range 50-120 min), mean blood loss was 19.29 ± 15.92 ml (range 5-50 ml). Mean hospital stay was 3.86 ± 1.68 day (range 2-7 days). No operative related deaths occurred. Four patients dead due to the metastasis disease at the follow up time of 8, 15, 18 and 37 months, respectively. Six patients received postoperative therapy, of whom 5 patients were treated with combined chemoradiation, and the other one received chemotherapy alone. The progression free survival (PFS) of the 7 patients was 22.00 ± 14.61 months (range 3-40 months). The one, two and three year overall survival (OS) was 85.7%, 57.1% and 42.9%, respectively. Our results suggest that cryosurgery combination with chemoradiotherapy provide a safe and effective alternative method for unresectable pT4b bladder cancer. Longer follow-up is necessary to determine the sustained efficacy.

Survivin (encoded by the gene BIRC5) plays an important role in the carcinogenesis of bladder cancer. Identifying miRNAs that target Survivin in the setting of bladder cancer will help to develop Survivin-based therapies for bladder cancer. The expression levels of miR-138-5p and Survivin protein were measured in 12 resected bladder cancer specimens. The correlation between miR-138-5p and Survivin was further examined by evaluating Survivin expression in human bladder cancer cell lines that either overexpressed or knocked down miR-138-5p. A luciferase reporter assay was performed to test the direct binding of miR-138-5p to the target gene BIRC5. We also investigated the biological role of miR-138-5p targeting to Survivin in bladder cancer cell lines both in vivo and in vitro. In this study, we found that the Survivin protein was either absent or weakly expressed in normal adjacent tissues and consistently up-regulated in bladder cancer tissues; however, the mRNA levels did not vary as much, suggesting that a post-transcriptional mechanism was involved. Because microRNAs are powerful post-transcriptional regulators of gene expression, we used bioinformatic analyses to search for microRNAs that could potentially target BIRC5 in the setting of bladder cancer. We identified 2 specific targeting sites for miR-138-5p in the 3′ untranslated region (3′-UTR) of BIRC5. We further identified an inverse correlation between miR-138-5p and Survivin protein levels in bladder cancer tissue samples. By overexpressing or knocking down miR-138-5p in bladder cancer cells, we experimentally confirmed that miR-138-5p directly recognizes the 3′-UTR of the BIRC5 transcript and regulates Survivin expression. Furthermore, the biological consequences of the targeting of BIRC5 by miR-138-5p were examined in vitro via cell proliferation and invasion assays and in vivo using a mouse xenograft tumor model. We demonstrated that BIRC5 repression by miR-138-5p suppressed the proliferative and invasive characteristics of bladder cancer cells and that miR-138-5p exerted an anti-tumor effect by negatively regulating BIRC5 in a xenograft mouse model. Taken together, our findings provide the first clues regarding the role of miR-138-5p as a tumor suppressor in bladder cancer by inhibiting BIRC5 translation.

Astaxanthin (ATX) is a powerful antioxidant that occurs naturally in a wide variety of living organisms. Previous studies have shown that ATX has effects of eliminating oxygen free radicals and can protect organs from ischemia/reperfusion (IR) induced injury. The present study was designed to further investigate the protective effects of ATX on oxidative stress induced toxicity in tubular epithelial cells and on IR induced renal injury in mice. ATX, at a concentration of 250 nM, attenuated 100 μM H2O2-inudced viability decrease of tubular epithelial cells. In vivo, ATX preserved renal function 12 h or 24 h post IR. Pretreatment of ATX via oral gavage for 14 consecutive days prior to IR dramatically prevented IR induced histological damage 24 h post IR. Histological results showed that the pathohistological score, number of apoptotic cells, and the expression of α-smooth muscle actin were significantly decreased by pretreatment of ATX. In addition, oxidative stress and inflammation in kidney samples were significantly reduced by ATX 24 h post IR. Taken together, the current study suggests that pretreatment of ATX is effective in preserving renal function and histology via antioxidant activity.