Background:Sarcomatoid carcinoma of the ureter(SCU)is a highly aggressive and relatively uncommon malignant tumor of the urinary tract.Its frequency is quite low,and its prognosis is very bad when compared to other ca...Background:Sarcomatoid carcinoma of the ureter(SCU)is a highly aggressive and relatively uncommon malignant tumor of the urinary tract.Its frequency is quite low,and its prognosis is very bad when compared to other cancers of the urinary system.SCU clinical reports are still hard to come by.MRI and PEI/CT imaging of ureteral sarcomatoid cancer is presented in this case to promote diagnostic awareness and comprehension of the imaging characteristics of this uncommon illness.Method:The patient had ureteral sarcomatoid cancer,which was verified by pathological investigation after ureteroscopic biopsy.The patient’s clinical information,imaging results,surgical outcomes,and pathological findings were gathered.A retrospective study was carried out in combinationwith pertinent national and international literature.Results:An 84-year-old female patient was admitted for“left flank discomfort lasting over one month.”MRI revealed an irregular soft tissue mass in the middle-lower segment of the left ureter.T2-weighted imaging showed an unevenly slightly hyperintense signal.Diffusion-weighted imaging demonstrated restricted diffusion.Contrastenhanced imaging exhibited heterogeneous enhancement.PET/CT demonstrated significantly increased fluorodeoxyglucose metabolism in the mass with secondary left upper urinary tract obstruction.Concurrent findings included a solitary metastatic lesion in hepatic segment S6 and multiple lymph node metastases along the left common iliac and external iliac arteries.Preoperative diagnosis suggested a malignant tumor of the ureter.The patient underwent left nephroureteroscopy with biopsy,and the postoperative pathological diagnosis was ureteral sarcomatoid carcinoma.Conclusion:Ureteral sarcomatoid carcinoma is a rare,highly malignant,and aggressive tumor with nonspecific imaging features,typically presenting as an invasively growing mass.Diagnosis relies on postoperative pathology and immunohistochemical examination.MRI and PET/CT scans are valuable for preoperative localization and characterization,tumor staging,treatment planning,and postoperative follow-up.The prognosis is extremely negative.The main treatment option is radical surgery,although constant monitoring is necessary since early recurrence and metastases are frequent after surgery.展开更多
晚期尿路上皮癌严重影响患者生存。长期以来,以顺铂为基础的化疗方案作为晚期转移性尿路上皮癌的一线标准治疗方案,患者中位生存期仅8~14个月[1-3]。随着免疫时代的到来,多个程序性死亡-受体1(programmed cell death protein 1,PD-1)/...晚期尿路上皮癌严重影响患者生存。长期以来,以顺铂为基础的化疗方案作为晚期转移性尿路上皮癌的一线标准治疗方案,患者中位生存期仅8~14个月[1-3]。随着免疫时代的到来,多个程序性死亡-受体1(programmed cell death protein 1,PD-1)/程序性死亡-配体1(programmed cell death ligand 1,PD-L1)抑制剂被美国食品药品监督管理局(Food and Drug Administration,FDA)和国家药品监督管理局(National Medical Products Administration,NMPA)批准用于治疗晚期尿路上皮癌[4-6]。另外,成纤维生长因子受体(fibroblast growth factor receptor,FGFR)抑制剂与抗体偶联(antibody-drug conjugate,ADC)药物的研究取得突破,并先后被批准用于临床[7-11]。展开更多
背景与目的：血小板／淋巴细胞比值（platelet to lymphocyte ratio，PLR）被认为是反映机体内炎性反应的重要指标，PLR在上尿路尿路上皮癌中的临床价值国内外尚没有相关研究。本研究旨在探讨术前PLR在判断上尿路尿路上皮癌临床分期及...背景与目的：血小板／淋巴细胞比值（platelet to lymphocyte ratio，PLR）被认为是反映机体内炎性反应的重要指标，PLR在上尿路尿路上皮癌中的临床价值国内外尚没有相关研究。本研究旨在探讨术前PLR在判断上尿路尿路上皮癌临床分期及预后的价值。方法：收集2007年1月至2012年3月单中心手术治疗的无远处转移的上尿路尿路上皮癌病例，术前、术后无瘤期及复发或转移期PLR。随访采用门诊与电话相结合。采用PLR=150：1为分界值将病例分为低PLR组和高PLR组，分析其与肿瘤分期、是否合并膀胱肿瘤、复发或转移、生存、肿瘤部位、术前血尿、术前肾积水、性别及年龄的关系。进一步分析不同PLR分组的无病生存时间、总生存时间。结果：共收集上尿路尿路上皮癌51例，术后中位随访时间21（9～51）个月，出现复发或转移20例（39．2％），中位无病生存时间15（2～51）个月，死亡9例（17．6％），中位生存时间21（9～51）个月。单因素分析显示术前PLR与肿瘤分期、生存率、血尿及性别具有相关性，P值分别为0．028、0．008、0．045、0．036。高PLR组更易发生器官非局限性肿瘤，术前PLR判断非器官局限性肿瘤的敏感性为57％、特异性为74％。Kaplan—Meier法生存分析显示，两组无病生存时间差异无统计学意义（P=0．155）、高PLR组总生存时间明显短于低PLR组（P=0．006）。Cox多因素生存分析显示仅肿瘤分期是总生存时间的独立影响因素（P=0．029）。结论：在上尿路尿路上皮癌中，术前PLR是判断非器官局限性肿瘤的潜在因素，高PLR组更易发生器官非局限性肿瘤。肿瘤分期是总生存时间的独立影响因素。展开更多
目的:研究针对中下段输尿管癌患者的保肾治疗策略中采用Boari膀胱肌瓣术治疗的疗效。方法:回顾性分析湘雅二医院泌尿外科从2002年7月至2007年6月采用Boari膀胱肌瓣术和输尿管癌根治术治疗中下段输尿管癌患者的临床资料及其随访情况,收...目的:研究针对中下段输尿管癌患者的保肾治疗策略中采用Boari膀胱肌瓣术治疗的疗效。方法:回顾性分析湘雅二医院泌尿外科从2002年7月至2007年6月采用Boari膀胱肌瓣术和输尿管癌根治术治疗中下段输尿管癌患者的临床资料及其随访情况,收集肿瘤大小、病理分级、分期、肾功能水平、住院时间等数据并结合患者生存情况进行统计学分析。结果:共有39例患者进行了手术治疗,包括Boari膀胱肌瓣术16例,输尿管癌根治术23例。中位随访时间为53个月(10~84个月),18名患者死亡,其中Boari膀胱肌瓣术组死亡6例,输尿管癌根治术组死亡12例。2组的5年无膀胱癌复发存活率分别为63%和59%(P>0.05),5年肿瘤特异性生存率分别为73.8%和73.5%(P>0.05),5年生存率分别为61%和57%(P>0.05),总体存活率分别为64.8%和58.1%(P>0.05)。2组间术前肾功能无明显差异[肌酐清除率57(32~104)mL/min vs 55(30~102)mL/min,P>0.05],术后Boari膀胱肌瓣术组肾功能优于输尿管癌根治术组[肌酐清除率55(35~102)mL/min vs 43(30~89)mL/min,P<0.05]。Cox比例风险回归模型多因素分析发现肾功能水平、肿瘤大小、病理分级和病理分期是影响肿瘤患者总生存期的独立因素(P<0.05),肿瘤越大、病理分级和分期越高,患者死亡风险越大,而术后高水平的肌酐清除率可以降低疾病的死亡风险。结论:Boari膀胱肌瓣术治疗中下段输尿管癌是可行的方式。相比输尿管癌根治术,Boari膀胱肌瓣术治疗后的生存率并无明显差别,而且能保护患者肾功能。展开更多
文摘Background:Sarcomatoid carcinoma of the ureter(SCU)is a highly aggressive and relatively uncommon malignant tumor of the urinary tract.Its frequency is quite low,and its prognosis is very bad when compared to other cancers of the urinary system.SCU clinical reports are still hard to come by.MRI and PEI/CT imaging of ureteral sarcomatoid cancer is presented in this case to promote diagnostic awareness and comprehension of the imaging characteristics of this uncommon illness.Method:The patient had ureteral sarcomatoid cancer,which was verified by pathological investigation after ureteroscopic biopsy.The patient’s clinical information,imaging results,surgical outcomes,and pathological findings were gathered.A retrospective study was carried out in combinationwith pertinent national and international literature.Results:An 84-year-old female patient was admitted for“left flank discomfort lasting over one month.”MRI revealed an irregular soft tissue mass in the middle-lower segment of the left ureter.T2-weighted imaging showed an unevenly slightly hyperintense signal.Diffusion-weighted imaging demonstrated restricted diffusion.Contrastenhanced imaging exhibited heterogeneous enhancement.PET/CT demonstrated significantly increased fluorodeoxyglucose metabolism in the mass with secondary left upper urinary tract obstruction.Concurrent findings included a solitary metastatic lesion in hepatic segment S6 and multiple lymph node metastases along the left common iliac and external iliac arteries.Preoperative diagnosis suggested a malignant tumor of the ureter.The patient underwent left nephroureteroscopy with biopsy,and the postoperative pathological diagnosis was ureteral sarcomatoid carcinoma.Conclusion:Ureteral sarcomatoid carcinoma is a rare,highly malignant,and aggressive tumor with nonspecific imaging features,typically presenting as an invasively growing mass.Diagnosis relies on postoperative pathology and immunohistochemical examination.MRI and PET/CT scans are valuable for preoperative localization and characterization,tumor staging,treatment planning,and postoperative follow-up.The prognosis is extremely negative.The main treatment option is radical surgery,although constant monitoring is necessary since early recurrence and metastases are frequent after surgery.
文摘晚期尿路上皮癌严重影响患者生存。长期以来,以顺铂为基础的化疗方案作为晚期转移性尿路上皮癌的一线标准治疗方案,患者中位生存期仅8~14个月[1-3]。随着免疫时代的到来,多个程序性死亡-受体1(programmed cell death protein 1,PD-1)/程序性死亡-配体1(programmed cell death ligand 1,PD-L1)抑制剂被美国食品药品监督管理局(Food and Drug Administration,FDA)和国家药品监督管理局(National Medical Products Administration,NMPA)批准用于治疗晚期尿路上皮癌[4-6]。另外,成纤维生长因子受体(fibroblast growth factor receptor,FGFR)抑制剂与抗体偶联(antibody-drug conjugate,ADC)药物的研究取得突破,并先后被批准用于临床[7-11]。
文摘背景与目的：血小板／淋巴细胞比值（platelet to lymphocyte ratio，PLR）被认为是反映机体内炎性反应的重要指标，PLR在上尿路尿路上皮癌中的临床价值国内外尚没有相关研究。本研究旨在探讨术前PLR在判断上尿路尿路上皮癌临床分期及预后的价值。方法：收集2007年1月至2012年3月单中心手术治疗的无远处转移的上尿路尿路上皮癌病例，术前、术后无瘤期及复发或转移期PLR。随访采用门诊与电话相结合。采用PLR=150：1为分界值将病例分为低PLR组和高PLR组，分析其与肿瘤分期、是否合并膀胱肿瘤、复发或转移、生存、肿瘤部位、术前血尿、术前肾积水、性别及年龄的关系。进一步分析不同PLR分组的无病生存时间、总生存时间。结果：共收集上尿路尿路上皮癌51例，术后中位随访时间21（9～51）个月，出现复发或转移20例（39．2％），中位无病生存时间15（2～51）个月，死亡9例（17．6％），中位生存时间21（9～51）个月。单因素分析显示术前PLR与肿瘤分期、生存率、血尿及性别具有相关性，P值分别为0．028、0．008、0．045、0．036。高PLR组更易发生器官非局限性肿瘤，术前PLR判断非器官局限性肿瘤的敏感性为57％、特异性为74％。Kaplan—Meier法生存分析显示，两组无病生存时间差异无统计学意义（P=0．155）、高PLR组总生存时间明显短于低PLR组（P=0．006）。Cox多因素生存分析显示仅肿瘤分期是总生存时间的独立影响因素（P=0．029）。结论：在上尿路尿路上皮癌中，术前PLR是判断非器官局限性肿瘤的潜在因素，高PLR组更易发生器官非局限性肿瘤。肿瘤分期是总生存时间的独立影响因素。
文摘目的:研究针对中下段输尿管癌患者的保肾治疗策略中采用Boari膀胱肌瓣术治疗的疗效。方法:回顾性分析湘雅二医院泌尿外科从2002年7月至2007年6月采用Boari膀胱肌瓣术和输尿管癌根治术治疗中下段输尿管癌患者的临床资料及其随访情况,收集肿瘤大小、病理分级、分期、肾功能水平、住院时间等数据并结合患者生存情况进行统计学分析。结果:共有39例患者进行了手术治疗,包括Boari膀胱肌瓣术16例,输尿管癌根治术23例。中位随访时间为53个月(10~84个月),18名患者死亡,其中Boari膀胱肌瓣术组死亡6例,输尿管癌根治术组死亡12例。2组的5年无膀胱癌复发存活率分别为63%和59%(P>0.05),5年肿瘤特异性生存率分别为73.8%和73.5%(P>0.05),5年生存率分别为61%和57%(P>0.05),总体存活率分别为64.8%和58.1%(P>0.05)。2组间术前肾功能无明显差异[肌酐清除率57(32~104)mL/min vs 55(30~102)mL/min,P>0.05],术后Boari膀胱肌瓣术组肾功能优于输尿管癌根治术组[肌酐清除率55(35~102)mL/min vs 43(30~89)mL/min,P<0.05]。Cox比例风险回归模型多因素分析发现肾功能水平、肿瘤大小、病理分级和病理分期是影响肿瘤患者总生存期的独立因素(P<0.05),肿瘤越大、病理分级和分期越高,患者死亡风险越大,而术后高水平的肌酐清除率可以降低疾病的死亡风险。结论:Boari膀胱肌瓣术治疗中下段输尿管癌是可行的方式。相比输尿管癌根治术,Boari膀胱肌瓣术治疗后的生存率并无明显差别,而且能保护患者肾功能。
