(Background) There is no consistent acknowledgment with the effects of the prolongation of survival for the advanced renal cell carcinoma (RCC) treated with interferon (IFN). Therefore, we tried to study on the effects of such prolongation of survival for the advanced RCC through the comparative analysis between the patients treated with IFN and the patients treated with other treatment modalities in the past years. (Patients and Methods) We differentiated the patients treated with IFN (recurrent patients after nephrectomy as Group I, and patients with stage 4B as Group II) from the patients treated with other modalities (recurrent patients after nephrectomy as Group III, and patients with stage 4B as Group IV). We compared the survival rate between the two groups (Groups I vs III, and Groups II vs IV). (Results) Regarding the various factors affecting prognosis of RCC, no significant difference was observed among these groups. 1) There observed a significantly favourable survival rate in the Group I compared with the Group III, and the same result was observed in the Group II compared with the Group IV. 2) In the patients with performance status (P. S.) 0 and low grade, there observed a significantly favourable survival rate in the Group I compared with the Group III, and the same result was observed in the Group II compared with the Group IV. Furthermore, in the patients with low stage, the Group I showed a significantly favourable survival rate compared with the Group III. 3) In the study on the number of metastatic organs (1, 2 and 3 organs or more), there observed a significantly favourable survival rate in the Group I compared with the Group III for all numbers of the metastatic organs. The same result was observed in the group II compared with the Group IV, except for the patients with 3 organs or more. Regarding the operative procedures for the metastatic side, the patients who did not receive the operative procedures showed a significantly favourable survival rate in the Group I compared with the Group III. The same result was observed in the Group II compared with the Group IV. 4) As to the survival rate based upon the response rate, only the patients with no change (N. C.) showed a significantly favourable survival rate in the Group I compared with the Group III. The same result was observed in the Group II compared with the Group IV. (Conclusion) We conclude that the treatment with IFN for the advanced RCC would much contribute to the prolongation of the survival in comparison with the previous patients who received other treatments.
(Purpose) The correlation between the serum soluble inerleukin-2 receptor (sIL-2R) levels and clinical stage is demonstrable in a variety of non-Hodgkin lymphomas. The prognostic significance of sIL-2R levels in the serum of patients with renal cell carcinoma (RCC) was investigated. (Method) sIL-2R were measured in patients with RCC (n=39) and normal control (n=6) by the enzyme immunoassay technique. Cases of RCC were classified according to the clinical stage, pathological grade and growth type. The IL-2R expression of RCC was evaluated by RT-PCR. (Result) The serum sIL-2R levels of patients with RCC showed significantly higher values than those of controls (p<0.05). The serum sIL-2R levels in RCC were closely associated with the stage, grade and growth type of disease. The patients with high serum sIL-2R level (≥1, 000U/L) exhibited a significantluy poorer prognosis than those with low serum sIL-2R level (<1, 000U/L). The band of IL-2R was detected only by using the template from the mRNA extracted from a resected tumor tissue of the RCC but not from the RCC cell lines. (Conclusion) It was suggested that the measurement of serum sIL-2R levels is useful for predicting the prognosis.
(Background) To estimate the usefulness of sextant systematic core biopsy or transrectal ultrasonography (TUBS) for performing radical prostatectomy. (Methods) The findings of sextant biopsy and TRUS were compared with 52 step-sectioned specimens obtained from radical prostatectomy. (Results) In 34 cases with no influence of hormonal therapy at the time of TRUS and biopsy, sextant systematic core biopsy provided tumor distribution rather precisely. In 33% of the cases who had received hormonal therapy, tumor cells were not detected by this sextant biopsy series. In these cases, majority of residual cancer existed in transition zone, paraurethral or fibromuscular stroma. Six cases showed small adenocarcinoma in only one biopsy tip obtained from sextant biopsy, while 4 cases were revealed well differentiated adenocarcinoma (Gleason score less than 4) by these core biopsies. Comparing with tumor mapping, Gleason score, PSA level and pT stage of the radical prostatectomy specimens, these tumors presented as, not clinically insignificant, but clinically significant prostate cancer. Playing special attention to distraction of normal ultrasound zonal configuration, TRUS detected neurovascular invasion with 94.7% sensitivity, 78.3% positive predictive value and 90.9% negative predictive value, while seminal vesicle invasion with 75.0% sensitivity, 50.0% positive predictive value, 90.9% negative predictive value. (Conclusions) Sextant biopsy tended to understimate the tumors located in the transition zone, paraurethral and fibromuscluar lesion. Additional or direct biopsies in transition zone are indispensable for accurate diagnosis. Findings of TRUS and distribution of positive core biopsy from sextant biopsy enable to extract stage C prostate cancer providing negative surgical margin.
(Background) Sexual dysfunction after transurethral resection of the prostate (TUR-P) depends on multiple factors including preoperative erectile function itself. Using the Sapporo Medical University-questionnaire, we analyzed background factors contributing to loss of sexual intercourse after the operation. (Patients and Methods) We sent the self-administered questionnaires to 1, 000 patients who had received TUR-P. Answers to questions were ranked as scores. Multiple regression analysis was used to identify factors significant for loss of sexual intercourse after TUR-P. (Results) The response rate was 63.5%. Patients with incomplete answers and those having diseases affecting voiding or sexual function and antiandrogen medication were excluded from the study. Leaving 536 patients for the final analysis. Scores for sexual desire and erectile function in the patients who received TUR-P were lower than those of age-matched healthy males. When we divided the patients according to frequency of sexual intercourse before and after TUR-P, there was distinct differences in age, scores for sensory disturbance, depression, the cooperative value of the sexual partner, sexual desire, erectile function, nocturia, residual sensation and urgency between those maintaining sexual intercourse and those having lost it. Multiple regression analysis using these factors indicated that the scores of erectile function was the most significant determinant for maintaining sexual intercourse after TUR-P in patients aged from 50 to 69 years, followed by the cooperative value of the sexual partner, residual sensation and sensory disturbance. In those 70 years old and older, the score for erectile function was the most significant determinant, followed by the cooperative value of the sexual partner. (Conclusion) Our results suggest that, irrespective of age, the cooperation of the patient's sexual partner as well as erectile function significantly influence the maintenance of sexual intercourse after TUR-P. In addition, voiding condition and psychological status after TUR-P may affect the maintenance of sexual intercourse in patients in their fifties and sixties.
(Background) In the evaluation of prostatic obstruction by using the pressure-flow study (PFS), we defined intravesical pressure at initiation of voiding as urethral opening pressure. This simple parameter could reflect the degree of compressive prostatic obstruction to some extent. The aim of this study is to analyze if a correlation exsists between clinical signs and urethral opening pressure, and if they bear any prognostic value in postoperative outcome of the patients. (Methods) We analyzed 46 patients with clinical benign prostatic hypertrophy who underwent urodynamic evaluations including PFS. They were divided into 2 groups according to their urethral opening pressure. The high opening pressure was defined as greater than 70cm water, which was noted in 24 patients (group A). Twenty-two patients had lower opening pressure (group B). Comparison of the clinical findings in these patients were reviewed. Medium-filling cystometry and PFS were performed transurethrally, by using a microtip transducer and rectal balloon. Cystoscopy was performed when possible, wherein we could examined the presence or absence of detrusor trabeculation. Transurethral prostatectomy was indicated in a total of 26 patients (16 in group A and 10 in group B), in whom postoperative clinical findings were analyzed with regard to the difference in preoperative urethral opening pressure. The patients who void with straining or who void following uninhibited detrusor contraction were excluded from this study. (Results) International Prostatic Symptom Score (I-PSS) revealed no significant difference in both gruops, however, patients in group A were often suffering from urge incontinence preoperatively. Significant correlation was found among the incidence of detrusor instability, detrusor trabeculation and increased opening pressure. In PFS the patients with high opening pressure tended to have higher detrusor pressure at maximum flow and greater contractile power of the detrusor in voiding. There were no difference in Qmax and residual volume between both groups. Postoperatively, symptomatic improvement was significant in both groups. There was no statistical difference in postoperative I-PSS between group A and B. Although 6 patients in group A demonstrated poor urinary control at 1 month, only two patients remained incontinent at 6 months postoperatively. As to urodynamic findings, the difference in PFS were markedly reduced between both groups. No difference was noted in postoperative Qmax as well. (Conclusion) Significant difference was found in preoperative objective findings except the flow rate between the patients with and whithout high urthral opening preessure, while no symptomatic difference was noted except urege incontinence in both groups. No prognostic value was demonstrated in urethral opening pressure, howeve, poor postoperative urianry control was often associated with initial high opening pressure in the short term. It was suggested that 1) compensatory detrusor hyperactivity improved voiding efficacy in the patients with prostatic obstruction, which was gradually normalized after the relief of obstruction, 2) symptomatic improvement was highly related to the relative improvement of the obstructive findings on PFS.
A 70-year-old female was admitted to our hospital with a complaint of gross hematuria for two months. She had a 5 years history of eczematous vulvar skin eruption. With the diagnosis of T3N0M0 bladder cancer and anogenital Paget's disease, she underwent pelvic exenteration, vulvectomy and reconstruction of the vulva. Histopathological examinations and mucin stains revealed anogenital Paget's disease and invasive bladder cancer which extended to the clitoral skin and formed Pagetoid skin lesion. CEA and cytokeratin staining demonstrated identical expression pattern in bladder cancer cells and Paget's cells, which suggested both neoplastic cells originated from one progenitor cell.
Extraosseous osteogenic sarcoma can occur anywhere in the body, but it is exceedingly rare to find this malignancy in renal tissue. A review of the literature revealed only 16 cases which appeard to be clearly identifiable as malignant extraosseous bone-forming sarcoma of the kidney and our report presents 17th case. The patient was a 67-year-old oriental woman. In March 1994, abdominal plain radiographs showed several dense calcifications in the left flank at another hospital. In May 1995, a huge tumor appeared in the left upper quadrant, so she was admitted to department of Internal Medicine of our institute for further examination. As the subsequent abdominal CT scan showed a huge renal tumor with accompanying calcifications, she was transferred to department of Urology. We diagnozed this tumor to be a huge renal cell carcinoma featuring calcifications and performed left nephrectomy. Microscopically, this tumor demonstrated predominantly osteoblast-like tumor cells coupled with osteoid and bone formation. Its histological appearance was compatible with that of osteogenic sarcoma. Bone scan and skeletal radiograph presents no evidence of malignancy, which led to our diagnosis of primary osteogenic sarcoma of the left kidney. Two months after nephrectomy, we found a large palpable recurrent mass in the left upper quadrant of the abdomen. Although two courses of cisplatin were then administered, her condition deteriorated until death on October 25, 1995, about four months after nephrectomy.