(Purpose) Adjuvant chemotherapy and neoadjuvant chemotherapy have been widely used as adjuvant treatment in patients requiring total cystectomy for locally advanced transitional cell carcinoma of the bladder. However, there has been no conclusive evidence that the adjunctive chemotherapy improves survival and no agreement exists concerning what subsets of such patients receive significant benefits from the adjunctive chemotherapy. The study retrospectively sought to clarify these points. (Patients and Methods) We retrospectively analyzed clinical and pathological records of the 229 patients with transitional cell carcinoma of the bladder who underwent total cystectomy with or without lymph node dissection in our University Hospital from January 1975 to December 1997. Forty-two patients received 1-4 cycles (mean=1.7) of adjuvant chemotherapy with VPMisCF (n=19), CisCA (n=4), MVAC (n=8), or MEC (Methotrexate, Epirubicin and Cisplatin) (n=11). Twenty-three patients received 1-4 cycles (mean=2.1) of neoadjuvant chemotherapy with CisCA (n=2), MVAC (n=5), or MEC (n=16). Using the Kaplan-Meier method, disease-specific survival rate was assessed according to various clinical and pathological factors as well as the administration of adjuvant or neoadjuvant chemotherapy. The generalized-Wilcoxon test was used to evaluate statistical significance (p<0.05) of survival curves for two or more groups. In addition, a multivariate analysis using the Cox proportional hazards model was performed with respect to mutiple clinical and pathological parameters, and treatment modalities. (Results) In patients who received neither adjuvant chemotherapy nor radiotherapy, the disease-specific survival rate was significantly lower in those with pT3a and/or more advanced tumors compared with those with pT2 or less advanced tumors. The survival rate in patients with positive lymph node metastasis was significantly lower than that in patients without lymph node metastasis. No apparent survival benefit was noted for those patients who received adjuvant chemotherapy when compared with patients who had pT3a or more advanced tumor and were followed without any adjunctive therapy. In patients with pN2 or more advanced lymph node metastasis, the survival rate of those who received adjuvant CisCA/MVAC/MEC chemothcerapy was significantly higher than that those without any adjunctive therapy. Although no apparent survival benefit was observed in patients who received neoadjuvant chemotherapy, the survival rate in patients whose tumor was considered to be down-staged to pT1 or lower was significantly higher than patients who did not receive neoadjuvant chemotherapy and had pT3a or higher pT-stage tumor. The survival rate in patients whose tumor showed clinical partial or complete response by neoadjuvant chemotherapy was also significantly higher than the same control patients. However, the multivariate analysis revealed no significant survival benefit after adjuvant chemotherapy or after neoadjuvant chemotherapy. (Conclusions) Adjuvant chemotherapy after total cystectomy is an acceptable approach in patents with pN2 or higher pN-stage bladder cancer. The significant survival benefit may be obtained who acquired pathological downstaging or partial to complete clinical response after neoadjuvant chemotherapy. To get maximum survival benefit from the present chemotherapeutic regimens and exclude administration of toxic chemotherapeutic agents to unresponsive patients, there should be more reliable markers that give clear information to differentiate tumors that will respond fairly to present chemotherapeutic regimens from tumors that will respond poorly.
(Background) Recent advance of perinatal ultrasound screening and/or physician's awareness of renal damage from recurrent pyelonephritis has brought about the increasing number of infants with primary vesicoureteral reflux (VUR) including refluxing megaureter which should be conceptually differentiated from simple high grade VUR. We evaluated the clinical outcome of infants diagnosed with refluxing megaureter. (Patients and Methods) We retrospectively reviewed the clinical records of 15 infants (17 ureters) diagnosed as refluxing megaureter (max caliber≥10mm) at our institution from 1988 to 1997. We compared the clinical outcome of refluxing megaureter with that of high grade VUR. (Results) Patients were 13 boys and 2 girls. Megaureter was unilateral in 13 patients and bilateral in 2. Fourteen infants (93.3%) presented with febrile urinary tract infection (UTI). The diameter of megaureter was 10-21mm (average: 13.6±4.0mm) at excretory urogram. Nine of 15 infants (60.0%) had breakthrough urinary infection. Its incidence was significantly higher than that of high grade VUR (21.3%) (p=0.02). In 13 cases surgical treatments were performed, however 2 cases (max caliber: 16mm, 21mm) by Politano-Leadbetter or Paquin procedure required re-ureteroneocystostomy by Psoas-hitch procedure because of persistant reflux and reccurent UTI. On the other hand no patient required re-ureteroneocystostomy in high grade VUR. (Conclusion) It is important to differentiate refluxing megaureter from high grade VUR due to high incidence of breakthrough UTI. Ureteral remodeling and/or Psoas-hitch procedure are strongly recommended for adequate length of submucosal tunnel in refluxing megaureter.
(Objectives) In order to investigate the effect of preoperative interferon (IFN)-α on Fas/Fas ligand (FasL) system, we examined Fas and FasL expression and the occurrence of apoptotic cell death in a preoperative therapy group, and in a control group using surgically resected renal cell carcinoma (RCC) tissues. (Methods) Ten cases were served as the preoperative therapy group, and sixteen cases as the control group. IFN-α was administrated at five megaunits daily intramuscularly for two weeks in the preoperative therapy group. Immunohistochemistry for Fas and FasL, and terminal-deoxynucleotidyl-transferase (TdT)-mediated digoxigenin-dUTP nick end-labeling (TUNEL) were employed. We defined the labeling index (LI) as percentage of Fas-or FasL-positive cells in carcinomatous cells, and apoptotic index (AI) as percentage of TUNEL-positive cells in carcinomatous cells. (Results) Significant correlations were found between the LIs of Fas and AIs in all 26 cases. LIs of Fas and AIs of the preoperative therapy group were significantly higher than those of the control group. FasL expression was detected in nine out of ten cases in the preoperative therapy group, and in fourteen out of sixteen cases in the control group. There were no significant differences in LIs of FasL between two groups. (Conclusion) These data suggest that apoptosis via the Fas/FasL system is functional, and that preoperative IFN-α treatment may up-regulate the Fas/FasL system in RCC. On the other hand, we need to investigate about an immune-escape mechanism through the FasL expression considering the relatively frequent expression of FasL in our results in RCC from now.
(Background) Transabdominal ultrasonography (US) has been widely accepted as a diagnostic method with which to examine multiple organs simultaneously. This study was designed to evaluate the efficacy of trans-abdominal US to screen for urogenital malignancies. (Methods) From 1993 through 1997 109, 077 men and 28, 023 women underwent abdominal US to screen for abdominal and pelvic diseases as part of a regular health check-up program at the Tokyu Medical Health Center. (Results) Twelve renal cell cancers (RCCs), 7 bladder tumors (BTs), 4 prostatic cancers (PCs), and 1 testicular tumor (TT) were detected. All cancers were diagnosed pathologically and treated surgically except for one PC. Surgical pathological examination and conventional imaging revealed that all 12 RCCa and 6 of the 7 BTs were of less advanced stage than pT1N0M0. However, all 3 PCs and the TT were pT3N0-1M0 and pT1N3M0, respectively. The stage and grade of these 12 RCCs were significantly lower than those of 29 symptomatic RCCs. All 12 patients with RCC patients and 6 of the 7 patients with BT had no urological symptom, whereas 3 of the 4 patients with PC and the patient with TT had urogenital symptoms. Microscopic examination of the urine revealed both red blood cells and tumors cells in two of the seven patients with BT. All four patients with PC had serum levels of prostatic-specific antigen greater than 4ng/ml. (Conclusion) These results indicate that screening by transabdominal US as part of regular health check-ups can detect many types of urogenital malignancy. In particular, US is useful for detecting low-grade and low-stage RCCs and superficial BTs but is less sensitive for early-stage PCs and TTs.
(Introduction and Objectives) Recently, the chemopreventive effects of various drugs on N-Butyl-N-(4-hydroxybutyl) nitrosamine (BBN) induced rat urinary bladder carcinogenesis have been reported. The aim of this study was to evaluate the effect of liarozole, an antitumor agent that inhibits the metabolism of retinoids, on the initial stage of BBN induced rat urinary bladder carcinogenesis. (Materials and Methods) Seven-week-old, male Wistar rats were used. The rats were divided into four groups. All groups except control were allowed free access to the drinking water containing 0.05%BBN. Groups Lz40 (n=5) and Lz80 (n=5) were administered the liarozole solution, twice daily by gavage (40mg/kg/day and 80mg/kg/day, respectively). Group BBN (n=5) was given no liarozole. The control group (n=4) received no carcinogen. At 9 weeks after the start of the experiment, all rats were killed by ether anesthesia and their urinary bladders were taken for evaluation. The urinary bladders were fixed in 10% buffered formalin, embedded in paraffin, sectioned, and immunohistochemical staining using anti-proliferative cell nuclear antigen (PCNA) antibody was performed by the avidin-biotin-peroxidase complex (ABC) method. We calculated the PCNA positive rate and compared among the four groups. (Results) The PCNA positive rate of group BBN was 23.5±3.7%. Compared with group BBN, the PCNA positive rate of groups Lz40 and Lz80 were statistically less (16.4±4.3% and 9.8±2.6%, respectively). Furthermore, the PCNA positive rate of group Lz80 was statistically less than that of group Lz40. (Conclusion) The results indicate that liarozole may inhibit the activity of cell proliferation in the initial stage of BBN-induced rat urinary bladder carcinogenesis and may be dose-dependent.
A case of renal actinomycosis is reported. A 63-year-old man was admitted to our hospital for further examinations of a right renal mass, complaining of dull pain in his right loin and progressive weight loss. Laboratory findings showed an anemia with a grossly raised ESR. CT, MRI and ultrasonography revealed a solid mass of the right kidney. Chest CT films revealed several infiltrates in the bilateral lobes. A diagnosis of neoplasm or inflammatory mass of the right kidney was considered, and the right nephrectomy was performed. Microscopically, characteristic colonies of actinomyces were seen, and histological diagnosis was renal actinomycosis. The patient made good progress after operation and was subsequently treated with penicillin.
The following is a case report bladder of sarcomatoid carcinoma in a Japanese 65-year old female patient treated with hemodialysis. She developed chronic renal failure due to chronic glomerulonephritis. Fifteen months after the beginning of the hemodialysis, continuous gross hematuria was noticed, and cystoscopy revealed a broad-based bladder tumor spreading from the right lateral wall to the posterior wall. The histopathologic diagnosis of the TUR-Bt specimens was sarcoma. Radical cystectomy was performed under the diagnosis clinical stage III, T3bN0M0. The post-operative histopathologic diagnosis of the tumor was sarcomatoid carcinoma, composed of nests of transitional cell carcinoma (G3) and predominant areas of spindle cell sarcomatoid transformation. Sarcomatoid carcinoma of the bladder in a hemodialysis patient is extremely rare, and to date this may be only the second case in Japanese medical literature.