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最近从老师接到一任务翻译些东东,当时满口就答应了,回来才看到有这么多,本人也就六级水平,而且过了之后,就没看过英语书了,本来想下过全文翻译软件搞定,没想到搞出来的效果这么差,没办法只有硬着头皮上了,第一次搞这东东希望大家多多拍砖!
不断更新中!!!!
如果谁有翻译好的现成的酬谢200论坛币.
EAU 2008 - - Advances in Targeted Therapy and Tissue Engineering in Urology: Targeted Therapy
EAU2008-靶向治疗和组织工程在泌尿科学的进展:靶向治疗
When a patient comes to the pharmacist in the future he may state: “Here is my sequence”. This could be a consequence of the development of targeted therapies as presented by Chris Evans. He pointed out that molecular profile of a patient will have an increasing impact on the selection patients for a diagnostic procedure or even a specific therapy. For instance it was recently shown that 5 common single-nucleotide polymorphisms (SNPs) are associated with a 46% chance to develop prostate cancer. Also, in prostate cancer: more than 80 targets (e.g. neuropeptides) have been shown to be altered following antihormonal therapy. LnCap-GRP tumors in castrated SCID mice were successfully treated with the inhibitor of src kinases AZD0530 from AstraZeneca. In bone metastases many different molecules are involved and bone metastases from prostate cancer may serve as a tool for biomarkers as well as target for therapy. Injection of AZD0530 into bone of mice resulted in disappearance of cancer cells. The drug is now in a phase-II trial for the treatment of prostate cancer.
在将来当一位病人来找药剂师他可能说:“这里是我序列”。 这可能是克里斯埃文斯所介绍的靶向治疗发展的结果。他指出病人分子的特点将对将选择病人的诊断程序甚至具体的治疗方法产生起来越多的影响. 例如最近5个普通的单一核苷酸多形性(snps)被显示与46%机会发展为前列腺癌有关. 另外,在前列腺癌:超过80靶物质(例如神经肽)已经证明改变下面的抗激素治疗 有LnCap-GRP肿瘤的去势的SCID 小鼠被src kinases AZD0530的抑制剂成功治疗.骨转移许可能跟很多不同分子有关,来自前列腺癌的骨转移灶可能成为靶向治疗的生物标记工具. 注射ZD0530进入小鼠的骨头结果导致癌细胞的消失。这种药物现在正在进行针对前列腺癌的二期实验。
In bladder cancer biomarkers such as p53, Rb, EGFR, angiogenesis markers and promoter hypermethylation are associated with a change of prognosis in terms of progression-free survival and cancer-specific survival. In kidney cancer: different enzymes are associated with histologic subtypes and an upregulation of certain molecules such as von-Hippel Lindau gene (VHL gene), hypoxia inducible factor (HIF), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF) and others justify the treatment with Sorafenib and Sunitinib.
依据无进展生存和癌症特定存活,膀胱癌生物标志物比如p53, Rb, EGFR, 血管生成标志和基因启动子过甲基化与预后的变化有关. 在肾癌症:不同的酶与组织学亚型和向上调节的确定的分子有关比如von-Hippel Lindau gene (VHL基因),缺氧诱导因子 ,血管内皮细胞生长因子(VEGF),血小板衍生生长因子(PDGF)及其他调整治疗随着Sorafenib和Sunitinib.
EAU 2008 - Research Shows Elevated Serum Amyloid Alpha (SAA-1) Levels in Renal Cell Cacinoma
EAU2008-研究显示在肾细胞癌血清淀粉状蛋白α((SAA-1))水平升高.
Serum amyloid alpha 1 (SAA-1) was measured in serum of 62 patients with renal cell carcinoma (RCC) and compared to healthy volunteers as well as patients with prostate cancer or bladder cancer (n=54).Patients with RCC demonstrated higher SAA-1 levels compared to controls, and also the clear-cell subtype was associated with two times higher levels compared to non-clear-cell subtype. Additionally, metastatic disease was associated with higher levels than non-metastatic disease and patients with response following immunotherapy showed a decrease of SAA-1 serum levels.
在肾细胞癌血清淀粉样蛋白α-1(SAA-1)被测量在62个肾细胞癌病人的血清中并且和健康志愿者以及前列腺癌和膀胱癌的病人进行比较.(n=54) 有RCC的病人显示更高的SAA-1水平和控制者比较,以及透明细胞亚型比起非透明细胞亚型高两倍. 另外,代谢性疾病比非代谢性疾病水平更高.
The authors noted that SAA-1 is a valuable biomarker for prognostic evaluation and monitoring of patients with RCC. However, SAA-1 also became elevated after surgery. This may underline its property as an acute phase protein rather than a RCC-specific biomarker.
作者认为对于肾细胞癌SAA-1是一个有价值的生物标志物做为预测,评估和监测病人.但是SAA-1在外科手术后也会升高. 这可能更强调他是一个急性期反应蛋白,而非肾癌的的特殊生物标志物
Presented by: K. Junker, MD, et al, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy
Presented by:被 K. Junker, MD 等在第23届欧洲泌尿科学年会发表2008-3-(26-29)意大
Advances in Targeted Therapy and Tissue Engineering in Urology
利米兰靶向治疗和组织工程在泌尿科学的进展
Dr. Evans (Sacramento) presented a lecture on targeted therapies. Most drugs have a mechanistic “target”, such as the enzymes 5-α reductase in the treatment of BPH or 5-phosphodiesterase in the treatment of erectile dysfunction. However, in the current presentation, “targeted therapy” is defined as molecular targeting.
医生埃文斯(萨克拉门托)介绍了有关靶向治疗的一个讲痤. 大多数药物有一个机械的目标,比如5-α还原酶在前列腺的治疗或者5-磷酸二酯在勃起功能障碍的治疗.但是,在现在介绍中,靶向治疗上档是分子.
Historically, the selection of systemic therapies for most cancer patients has been largely empiric. However, recent advances in cancer molecular biology suggest that defining biomarkers predictive of response and survival are achievable goals. The Human Genome Project, the International HapMap and progress in high-throughput assays have made genetic testing and individualized therapy a tangible reality. Using pharmacogenomic approaches to cancer therapeutics, one translational approach is to exploit the underlying molecular profile of the tumor (DNA, RNA, protein) or the host (patient genomic DNA) to improve treatment outcomes. To do this researchers must take into account both inter-individual differences (between individual patients) and population-related differences (ethnic/racial differences).
从前对癌症病人的治疗方案的选择主要靠经验.但是,最近在在肿瘤分子生物学的进展表明限定的生物标志物对预测治疗反应以及存活都是可能的. 人类基因组计划,国际HapMa和高速含量测定使基因测定和个体化治疗成为可以摸得着的事实. 利用药物基因组学的方法治疗癌症,一个相对应的方法是利用肿瘤或者宿主基因的基本分子特点改进治疗效果. 做这个研究必须考虑个体及种族之间的差异.
While patients may carry the same diagnosis and clinical features, they possibly harbor different molecular profiles. Among patients carrying the same disease diagnosis, a subset that exhibit toxicity or non-response to standard therapy may have molecular attributes that identify them for alternate therapy. The concept of prognostic biomarkers is well established, but predictive biomarkers that confirm a molecular target or reflect the impact of a therapeutic intervention are newer. For example, while HER2 status delineates poor prognosis in breast cancer, it has positive predictive value for benefit from trastuzumab. On the other hand, the epidermal growth factor receptor inhibitor gefitinib was not initially appreciated to have selectivity for lung cancer patients with mutated EGF receptor (and gene copy number by FISH) and because of this 4,000 patients in 4 major clinical trials were not optimally selected to benefit.
当病人可能有相同的诊断和临床特征时,他们可能隐藏不同的分子方面的特点. 在一些相同诊断的病人中,可能对标准治疗没有反应或者有毒性反应,这可能是由于他们的分子组成造成的,他们须要另外的治疗. 预测生物标志物的概念是被很好的建立,但是预测生物标志物确定一个分子靶点或反映介入治疗的影响是新的. 比如,当高雌激素应答者2的状态在乳腺癌表明预后差时,在曲妥珠单抗表明预后好. 在另一方面,表皮生长因子受体抑制物吉非他尼开始不被理解对肺癌有选择性随着表皮生长因子的突变并且由于在4个重要的临床试验中的4000个病人没有理想的被选择得利.
Urologists perhaps became most aware of targeted therapy with the introduction of tyrosine kinase inhibitors for renal cell carcinoma. They resulted from the discovery that most patients with conventional cell renal cancer demonstrated mutation or silencing of the VHL gene, with subsequent delineation of pathways modified by pVHL. Sorafenib and sunitinib are “multikinase” inhibitors that target several kinases to include KIT, FLT3, PDGF and VEGF receptors. But in other histologic types of kidney cancer, different molecular alterations will drive therapy; mutations in the MET proto-oncogene in hereditary papillary renal carcinoma or mutations in the fumarate hydratase gene in hereditary leiomyomatosis renal cell carcinoma for examples. As such, receptors or pathways related to these specific alterations provide different targets. In bladder and prostate cancer numerous potential targets exist, based upon oncogenes, survival genes, gene products and suppressor gene mutations. In addition to testing as monotherapy, many targeted drugs are under investigation as combination therapy, such as the targeted endothelin-1 receptor A inhibitor atrasentan and docetaxel.
随着酷氨酸激酶抑制剂对肾细胞癌治疗的介绍,泌尿外医师也许是最知道靶向治疗的. 他们从新发现中知道,大多数的有常规肾细胞癌的病人会表现出突变或VHL基因的沉默,随着后来描述的被pVHL.Sorafenib and sunitinib 修改的通路是多激酶抑制剂,他定位个别的激酶以包括KIT,FLT3,PDGF and VEGF 受体. 但是在其它的组织学类型的肾癌,不同的分子组成的变更将驱动治疗: 例如遗传性的乳突状肾癌MET原癌基因的突变或遗传性的平滑肌瘤病的肾细胞癌的延胡索酸水合酶基因的突变.同样的,受体或通道有关的这些具体的变化提供不同的靶点. 在膀胱和前列腺癌有许多潜在的靶点存在,基于致癌基因,抗凋往基因,基因产物,和抑制基因突变. 除测试象单一疗法外,许多定向的药物在联合治疗中被研究,比如定向的肉皮肽-1受体A抑制剂阿曲生坦和多西紫杉醇.
As a bench to bedside example of targeted therapy, Dr. Evans’ group has researched Src kinase, a prototypical non-receptor tyrosine kinase and the first identified oncogene. Androgen withdrawal promotes prostate cancer cells to transdifferentiate to a NE phenotype and express neuropeptides and growth factors. We identified androgen-independent activation of the androgen receptor mediated by neuropeptides, epidermal growth factor (EGF), and interleukin (IL)-8 to be mediated by Src activation. In clinical samples, Src hyperactivation correlates with aberrant androgen receptor activation of high-grade prostate cancer cells and also androgen-independent disease.
做为一个正在实验的靶向治疗的例子,医生埃文斯的团队已经在研究Src激酶,一个典型的非受体酷氨激酶和第一个被识别的致癌基因. 去雄激素促进前列腺癌细胞分化为一个NE表型并且表达神经肽和生长因子. 我们识别被神经肽,表皮生长因子和被Src活化介导的中间白细胞素-8,介导的雄激素受体的独立雄激素的活化. 在临床样本中,Src高反应性相关与高分化前列腺癌细胞和雄激素慧非依赖性的疾病的异常的雄激素受体活化.
To explore Src as a target, the investigators hypothesized that NE cells are androgen-independent and secrete neuropeptides that further support androgen sensitive cell proliferation in the absence of androgens. They developed an in vitro and in vivo model by stable overexpression of the neuropeptide gastrin-releasing peptide (GRP) in LNCaP cells (LNCaP-GRP) through transfection and selection. LNCaP-GRP cells demonstrated androgen- and anchorage-independent growth and enhanced cell motility via Src activation. LNCaP-GRP cells developed orthotopic tumors in castrated nude and SCID mice and metastasized to regional lymph nodes in the SCID mice. The tumors expressed GRP, PSA and demonstrated nuclear translocation of the androgen receptor. These xenografts were re-cultured and provided paracrine growth support and migratory stimulation to wild-type LNCaP cells under androgen-deprived conditions in vitro and in vivo. They confirmed the signaling mechanism by which neuropeptides activate the androgen receptor in the absence of androgens to be activation of a non-receptor tyrosine kinase complex of Src, FAK and Etk. Using a novel and specific Src kinase oral inhibitor AZD0530, they demonstrated inhibition of growth and metastases in vivo. These observations have resulted in a National Cancer Institute sponsored Phase II trial using AZD0530 in patients with hormone refractory prostate cancer. Biomarkers predictive of drug activity (such as activated Src in circulating mononucleocytes) or target specificity (such as tyrosine kinase activity in tumor biopsies) are central to clinical target validation.
为了探索Src做为一个靶点,研究员猜测NE细胞是雄激素非依赖性的并且分泌神经肽,神经肽长久的支持雄激素敏感细胞增殖在雄激素缺失的情况下. 他们发展了一个体外研究和体内研究模型通过稳定的神经肽,胃泌素释放肽在前列腺癌细胞系细胞中通过转染和选择. 经由Src活化前列腺癌细胞系-胃泌素释放肽细胞展示非雄激素依赖性非固定依赖性的增加并且提高细胞运动性. 前列腺癌细胞系-胃泌素释放肽细胞在去势的和严重联合免疫缺陷的老鼠发展为常规部位的肿瘤,而且在严重联合免疫缺陷鼠标转移到淋巴结. 肿瘤青表达胃泌素释放肽PSA和展示雄激素受体核转运. 这种异种移植是反复培养并且提供旁分泌生长支持并且迁徙刺激对野生型前列腺癌细胞系细胞在去雄激素下的体外体内研究. 他们证实信号肽的机制,神经肽激活雄激素受体在去雄激素以非受体酪氨酸激酶Src,FAK,Etk的复合物. 使用新的特效的口服的Src激酶抑制剂AZD0530,他们显示了在体内对增殖和转移的抑制. 这些观察导致一个国家的癌症学会赞助对激素抵抗前列腺癌使用AZD0530的二期实验. 药物活性的生物标志物的预测是主要的临床药物靶标确证批准,比如激活的Src在单核细胞的循环或特异性的靶点比如酪氨酸激酶在肿块活组织检查的活动.
Presented by: Christopher P. Evans, MD at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy
被 Christopher P. Evans MD 在第23届欧洲泌尿科学年会发表2008-3-(26-29)意大利米兰.
Optical Coherence Tomography (OCT) Helps Distinguish Normal Renal Parenchyma from Renal Cancer Tissue光学相干断层扫描帮助辨别正常的肾实质从肾癌组织中.
MILAN, ITALY (UroToday.com) - Optical coherence tomography (OCT) was shown to distinguish normal renal parenchyma from tumor tissue in 20 patients undergoing partial nephrectomy. OCT provides a 10-15 μm resolution and a depth of imaging of less than 2 mm. A group from the Cleveland Clinic compared in-vivo and ex-vivo images using the Imalux NirisTM System probe and validated their results against final pathology. Ex-vivo images were superior to in-vivo images to distinguish normal renal parenchyma from renal cancer tissue. The authors, however, were not able to identify a specific subtype of renal cell carcinoma. They also noted that a larger probe with larger scanning capacity should be developed to improve the performance of OCT.
米兰,意大利-光学相干断层扫描(光学相干断层扫描)被展示辨别正常肾实质从肿块组织在经历肾部分切除术的20个病人中. 光学相干断层扫描提供一个10-15微米分辨率和一个小于2毫米的深度成像. 一群来自克利夫兰研究所比较体内和体外影像利用ImaluxNirisTM系统探针并且证实他们的结果和最后的病理相一致. 体外影像优越于体内影像对于从肾癌症组织中辨别正常肾实质。 然而作者不能辨别一个肾细胞癌具体亚型.他们也注意到一个更大的探针带来更多的扫描容量应该被发展以发送光学相干断层扫描的性能.
Presented by: P. Koenig, MD, et al, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy
被 P. Koenig MD 等在第23届欧洲泌尿科学年会发表2008-3-(26-29)意大利米兰
The Use of Biological Markers in Clinical Practice
生物标志物在临床实践中的应用.
Dr. Bjartell (Lund) presented on the use of biological markers as they can apply to clinical practice. A useful biomarker, he said is a molecular test that provides additional information to clinical information. It can improve cancer detection, staging, predict outcome, identify subclasses of a cancer and be applied to new therapies.
Dr. Bjartell介绍可以服务于临床实践的生物标志物的利用.他说一个有用的生物标志物是一个分子测试,那可以对临床资料提供附加的信息. 它可以改进癌症的检测,分期,判定预后,识别癌症的亚型和被用于新式的治疗.
Biomarkers in prostate cancer (CaP) included nomograms and the Partin tables. These are in wide use to predict the risk of a positive prostate biopsy, adverse pathology and recurrence. The usefulness of a biomarker can be assessed by adding it to a model and assessing the receiver-operating characteristics for enhancement over the existing model. This can also be measured by the concordance index. He pointed out that many new markers do not add to existing markers.
前列腺癌的标志物包括nomograms and the Partin tables .这些广泛用于预测一个阳性前列腺活检的危险,相反的病理学和再发生. 生物标志物的有用性可以被评定通过把它放入一个模型并且评价接收器运行特性为提高现有型号. 这也可以通过一致性的指标被测量. 他指出许多新的标志物没有加入到已存在的标志物.
Biomarkers in blood are often prostate specific, but not cancer specific. Despite that, multiplexing with other forms of PSA is shown to be useful. PSAV and PSADT reflecting PSA dynamics are shown to provide improved prediction for several aspects of CaP. Other new potential markers that may be useful include TGF-beta1 and IL6-SR and PAI1. These require more validation. EPCA1, 2 are nuclear matrix proteins in clinic trial for external validation as described by Dr. Getzenberg.
生物标志物在血洗经常是前列腺特有的,但不是癌症特有的. 尽管如此,多种多样其它形式的前列腺抗原被证实是有用的. 反映前列腺特异性抗原前列腺特异性抗原动力学的PSA速率(即在一定时间内 pSA变化率)和前列腺特异性抗原倍增时间提供更好的预测对于前列腺癌的某些方面. 其它潜在可能有用的标记物包括TGF -beta 1and IL 6-6-SR and PAI 1. 这些需要更多的证据. Dr. Getzenberg曾描述EPCA 1,2在体外证实的临床实验中是核基质蛋白质.
In tissue, PSA, p63, and high molecular weight keratin can identify basal cells and AMACR can identify cancer. MSP and CRISP-3 were studied by Dr. Bjartell and reported in Clinical Cancer Research. They used tissue microarrays in over 900 patients and found that they were independent predictors of recurrence but only marginally improved the accuracy of existing nomograms. Gene fusions and PCA3 are new potential biomarkers and PCA3 can be measured in a commercially available test. A recent multiplex test using gene fusion and 2 other markers outperformed PSA in a paper published in Cancer Research last month. New biomarkers to identify indolent cancers and those likely to progress to castration-resistance are needed, he concluded. Robust assays, taken from single to multicenter trials then externally validated and applied to prospective trials will bring new tests to clinical practice.
在组织,前列腺特异性抗原,p63和高分子量角蛋白可以识别基细胞和α甲基丙烯辅酶A消旋酶可以识别癌症. MSP and CRISP -3被Dr. Dr. Bjartell 研究并且被报道在临床癌症研究。 他们对超过900个病人使用组织芯片并且发现他们能独立的预测复发,但是对改进生存列线图的准确度确很有限. 基因融合和PCA 3是新的潜在的生物标志物并且PCA 3能被市场上可买到的. 最近一个利用基因融合和2个其它标志物的多样测试的优越性超过了前列腺特异性抗原,这篇文章发表在上个月的癌症研究. 他总结新的识别隐匿性癌的生物标志物和那些可能的去势抵抗的发展是被需要的. 健康试验将来新的临床实践测试,这种健康试被从单一到多中心试验然后体外证实从应用到预测试验带来.
Presented by: A. Bjartell, MD, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy
被A. Bjartell , 在第23届欧洲泌尿科学年会发表2008-3-(26-29)意大利米兰.
Technology Makes the Single-Port Laparoscopic Nephrectomy Possible
新技术让单口腹腔镜肾切除成来可能.
MILAN, ITALY (UroToday.com) - Laparoscopic nephrectomy can be performed via one port. With the R-PortTM (Advanced Surgical Concepts, Wicklow, Ireland) a group from England and India for the first time removed a kidney with this technique and also performed some other minor procedures. They worked with three 5 mm instruments (one camera and two working instruments) and had short operating times without intraoperative complications. Besides two Single Laparoscopic Port Procedures (SLIPP), 3 “scar-less” One Port Umbilical Surgery (OPUS) operations were performed. The authors claimed superior cosmetic results when compared to the classical “one port – one instrument laparoscopy” but also stated that sometimes the grade of freedom for the instruments was impaired.
MILAN, ITALY (UroToday.com) - 经由一个孔可执行腹腔镜肾切除术. 用R-PortTM (先进的手术观念,Wicklow ,爱尔兰)一群来自英国和印度的医生第一次切除一个肾脏用这种技术并且用了更少的操作. 他们用三个5毫米的仪器(一个照相机和二工作仪器)并且在没有手术并发症的情况下使用了更少的时间. 除了二个腹腔镜孔,另一个脐部的孔是用来操作的. 比起经典的一个孔一个仪器,作者主张更好美容效果,但是有时会减弱仪器的自由度.
Presented by: A. Rane, MD, et al, at the European Association of Urology - 23rd Annual EAU
Vitespen Vaccine Demonstrates Possible Benefit for a Specific Subgroup of Renal Cancer PatientsVitespen疫苗显示对某个特殊的亚群肾癌病人有益.
An autologous heat shock peptide vaccine called Vitespen demonstrated a possible benefit for a specific subgroup of patients in a randomized open phase-III trial.
一个叫做Vitespen的自体热休克肽显示对某个特定的亚群病人有益在一个随机的三期实验中.
A total of 728 patients were included in this trial. Only patients with an intermediate risk following ECOG criteria showed an improvement of recurrence-free survival post-nephrectomy when treated with the vaccine compared to observation only. There were no grade 3 or 4 adverse events. The authors now look for the secondary end point overall survival for an additional three years.
这个实验总共有782个病人.在肾切除后给以疫苗治疗的病人仅仅中间物危险在ECOG标准后的显示有改善,相对于观察组来说. 没有3或4级相反的事情.作者现在正寻找第二次的终点全面的一个额外的三年存活.
Presented by: P. Mulders, MD, et al, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy
Molecular Detection of Lymph Node Involvement
分子检测受累的淋巴结.
MILAN, ITALY (UroToday.com) - Dr. Michael Jewett (Toronto) presented the SIU lecture on detection and mapping regional lymph nodes (LN) in genitourinary cancer. He addressed the importance of LN in staging and therapy of GU cancers. Staging is prognostic and sets the scenario for adjuvant therapy. Lymphadenectomy (LA) is therapeutic and should be performed. The first lymphangiogram was performed in Britain in 1956 and set the stage for imaging. CT scanning if less than 8mm in the round dimension or 10mm on short axis if oval are historically considered normal. However, he challenged the 8-10mm size threshold as normal, and that macrometastases can exist in this size range. Dr. Jewett felt that CT or MRI are inadequate for staging and should not replace surgical staging.
MILAN, ITALY (UroToday.com) - 医生迈克尔朱厄特介绍就探测和测绘淋巴结演讲在泌尿生殖器的癌症. 他说明了淋巴结在泌尿生殖系癌症中分期和治疗的重要性. 分期用来预测和制定治疗方案. 淋巴结切除术是治疗学的和应该执行的。 第一个淋巴管造影照片是在1956在英国被执行并且为了制定了成像的步骤. 医生朱厄特认为CT和MRI分期存在不足,不应该取代手术上的分期.
The sentinel LN can be targeted using molecular probes and has been utilized in other cancers. Quantum dots with fluorescence holds promise and has been applied to melanoma. In urology, using these techniques is less developed. Also, lymph nodes can connect to micro-vessels and these vessels can serve as a mechanism for further dissemination. Probes can be injected directly into the primary tumor and color or radiation can then be identified and surgically removed. Often, the sentinel LN can serve as an indicator for involvement of more distant nodes. A better understanding of signal noise from normal nodes needs further investigation, he said. Lymphotrophic nanoparticle enhanced MRI holds promise, but the radiologist must be dedicated to the procedure to obtain reproducible results. Dr. Jewett reviewed the work of Dr. Cabanas in using the sentinel LN in penile cancer as he reported in 1977. This has evolved into scintography that is used by some in present day. The sentinel LN concept has evolved into templates for LA in testicular cancer and the extended LA in bladder and prostate cancers.
淋巴结可以用分子探针检测并且可以用于其它的癌症. 带荧光的量子点已经做到这点,并且被用于黑色素瘤. 在泌尿科学利用这个技术发展缓慢.. 而且淋巴结可以连接显微管道并且这些管道可以做为其播散的通道. 可以将探针直接注入原发肿瘤并且标记能够被识别的颜色或放射线,最后手术切除. 常常,淋巴结可以暗示远处是否有转移. 他说来处正常结点的信号噪声的更好理解需要进一步调查. 医生Jewett 回顾医生Cabanas利用守卫淋巴结诊断阴茎癌,这被报道在1977年.这已经用到了被现代人使用的scintography. 哨兵淋巴结的概念已经成为在睾丸肿瘤的LA和在膀胱,前列腺肿瘤的扩展LA的模板.
He concluded that surgical mapping remains the standard, although newer probes may eventually have a place in clinical management.
他总结虽然新的探针可能最后在临床实践中占有一席之地,但是手术标测仍然是标准.
Presented by: Michael Jewett, MD, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy
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EAU 2008 - Sorafenib Versus Placebo as a Second Line Therapy of Metastatic Renal Cell Carcinoma (RCC)
EAU 2008 - 索拉非尼与安慰剂比较做为转移的的肾癌的二线治疗.
Written by Christian Doehn, MD
Tuesday, 08 April 2008
MILAN, ITALY (UroToday.com) - The randomized phase-III TARGETs trial compared Sorafenib versus Placebo as second line therapy of metastatic renal cell carcinoma (RCC). Beside the known efficacy outcome in terms of progression-free survival and overall survival researchers have now performed an analysis of two biomarkers (expression of pERK and serum levels of VEGF) and their potential to predict outcome. In fact both biomarkers did not allow prediction of outcome. The benefit of treatment with Sorafenib was rather seen in patients with both normal and elevated expression of expression of pERK and serum levels of VEGF.
MILAN, ITALY (UroToday.com) - 随机的三期试验比较索拉非尼和安慰剂做为转移性肾癌的二线治疗药物. 除了已知的有效结果,依据无进展生存和总生存率,研究员已经分析二种生物标志物(pERK 的表达和VEGF的血清水平)和他们预测预后的潜能. 事实上两种生物标志物没有允许预测结果.有pERK 表达和VEGF的血清水平升高或正常的病人被索拉非尼治疗能获得明显的益处.
Presented by: R. Bukowski, MD, et al, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy
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EAU 2008 - Nephron-Sparing Surgery Should be Systematically Considered Regardless of Tumor Size
EAU 2008 - 保留肾单位外科手术应该系统的考察不管肿块的大小.
Written by Christian Doehn, MD
Tuesday, 08 April 2008
MILAN, ITALY (UroToday.com) - Nephron-sparing surgery is equivalent to radical nephrectomy in terms of cancer-specific survival. This is not new for a tumor size of 4 cm or less but has now also been o shown for organ-confined tumors larger than 4 cm. In a matched comparison analysis of 546 patients with renal cell carcinoma (RCC) stage pT1b-pT2N0M0 both groups (nephron-sparing surgery and radical nephrectomy) were comparable for demographic and tumor parameters. At a mean follow-up of 54 months a total of 36/546 patients had died from cancer without statistically significant differences among both groups. In a multivariate analysis only T-stage and age at diagnosis were independent prognostic parameters.
MILAN, ITALY (UroToday.com) - 依据癌症特定存活率,保留肾单位外科手术和根治性肾切除术是等价的. 对于小于4CM或更小的肿瘤这不是什么新东西,但是现在这被显示在大于4CM的局限在器官的肿块. 对546个肾细胞癌pT1b-pT 2N0M0分期的病人进行匹配比较分析,两组(保留肾单位和根治性肾切除术)比较人和肿块的参数. 在平均54个左右36/546病人死于癌症,这没有统计学意义. 在多变量分析中只有分期和年龄是独立的预测参数.
Due to the anticipated benefit in terms if renal function, nephron-sparing surgery should be systematically considered regardless of tumor size.
由于根据肾功能可以预测的益处,保留肾单位外科手术应该被系统的考察不管肿块的大小.
Presented by: J.J. Patard, MD, et al, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy
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Perioperative Use and Surgical Complications of Sunitinib in Metastatic Renal Cell Carcinoma
EAU 2008 - 舒尼替尼在手术中的使用以及并发症在转移性肾细胞癌.
Friday, 04 April 2008
MILAN, ITALY (UroToday.com) - These investigators evaluated their postoperative complication rate in patients having metastatic renal adenocarcinoma and treated with Sunitinib during the perioperative period. From October 2005 to June 2007, 52 patients – mean age 57 – treated with Sunitinib for metastatic renal carcinoma were followed. Among these patients, all indications taken together, 9 underwent surgery. Secondary effects and complications were registered according to NCI CTC classification.
MILAN, ITALY (UroToday.com) - 这外调查评估有转移的肾腺癌的手术并发症的发生率和有手术期间用舒尼替尼治疗. 从2005年十月到2007年六月,52个病人–平均林龄57–用舒尼替尼治疗转移的肾癌。 在这些病人中,所有的指标放在一起,9个进行手术. 副效应和并发症被登记根据NCI CTC分级.
Of 52 patients admitted to follow-up, 9 (17%) had surgery during the 90 days period preceding or following treatment initiation. A total of 11 surgical events were registered. Among those patients who had surgery, 4 presented with a grade 2 cutaneous toxicity due to Sunitinib. Sunitinib administration was interrupted for a mean of 7.8 (0-54) days prior surgery and reintroduced 19.8 (0 – 55) days afterwards. Among these 11 surgical events, 2 patients presented with surgical wound necrosis. Each of those 2 patients presented before the procedure a cutaneous toxicity (grade 3) due to Sunitinib. Thus, Sunitinib administration should be suspended 10 days prior surgery as well as 10 days after.
52个病人纳入随访,9个进行了外科手术在开始治疗90左右. 总共11个手术上的事情被登记.在那些外科手术的病人中,4个表现出由于舒尼替尼的二级皮肤毒性. 舒尼替尼被打断在外科手术7.8天之前,并且再加入手术后19.8天.在这11个手术中,2个病人表现出外科手术伤口坏死. 2个病人中的每一个表现出由于舒尼替尼的三级皮肤毒性. 因此,舒尼替尼应该被终止外科手术10天前以及10天后。
Presented by: Thibault F., Billemont B., Rixe O., at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy
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Zoledronic Acid is Cost-Saving and Improves Quality Adjusted Survival in the Prevention of Skeletal Related Events in Patients with Bone Metastases Secondary to Advanced Renal Cell Carcinoma (RCC)
EAU 2008 - 唑来膦酸降低成本并且改善校准成活率的质量在预防骨骼的有关事情在肾癌继发骨转移的病人。
Friday, 04 April 2008
MILAN, ITALY (UroToday.com) - A United Kingdom (UK) Perspective
A United Kingdom (UK) Perspective
Previous analyses have shown that zoledronic acid therapy is cost effective in patients with bone metastases secondary to breast cancer, lung cancer, and other solid tumors. Zoledronic acid has recently been shown to significantly reduce the risk of new skeletal related events (SREs) in patients with bone metastases secondary to RCC. The present study assessed the cost effectiveness of zoledronic acid in this population, adopting a UK health care payer perspective. This analysis was based on a retrospective analysis of a multicenter, randomized, placebo-controlled study of zoledronic acid in 46 RCC patients with bone metastases. Patients were randomized to receive zoledronic acid (n=27) or placebo (n=19) with concomitant antineoplastic therapy every 3 weeks for up to 21 months. A patient-level model was developed to simulate the costs and quality-adjusted life-years (QALYs) of trial subjects. The costs of SREs (including fractures, radiotherapy, bone surgery, and spinal cord compression) were estimated from the published literature. Drug, drug administration, and supply costs were obtained from published sources and tariffs. Consistent with similar economic analyses, patients were assumed to experience quality of life decrements lasting 1 month for each SRE experienced. A discount rate of 3.5% per annum was applied to both costs and benefits occurring beyond the first year, which is consistent with standard practice for UK cost effectiveness analyses.
以前的分析已经证实唑来膦酸对于乳腺癌肺癌及其他肿瘤继发骨转移的病人的治疗具有更好的经济效益。 唑来膦酸最近已被证明能减少新的骨骼相关事件的危险对于住院的肾癌继发骨转移病人。 目前研究评定唑来膦酸有成本效率，已通过英国保健机构的认可。 该分析是基于一个46个有骨转移肾癌病人的多中心，随机，安慰剂对照，回顾性研究。 病从随机得到唑来膦酸和安慰剂在为期3个星期到21个月的抗肿瘤药物治疗。 一个病人水平模型被开发以模拟实验主题校准寿命的花费和质量。的花费被估计从已发表的文章，包括骨折，放射线疗法，骨科手术，和脊髓压缩。药物以及其它供应的价钱是从出版物或收费表。 符合相似的经济学分析，病人被认为生活质量递减在每一个SRES经历者的最后一个月。 每年3.5%的折扣在花费和利益方面，这与英国成本效率分析一致。
Zoledronic acid patients experienced an average of 0.66 SREs vs 1.74 for placebo patients. The discounted QALYs were 0.526 and 0.402 for zoledronic acid and placebo patients, respectively. Discounted SRE-related costs were estimated to be substantially lower for zoledronic acid patients than placebo ones (￡1305 v. ￡4454, respectively). After considering drug therapy costs, zoledronic acid resulted in net savings of ￡699 and QALY gains of 0.124 per patient. Because zoledronic acid resulted in cost savings and gains in QALY compared to placebo, it is the preferred strategy. These results were confirmed in the PSA simulation. The cost effectiveness ratio of zoledronic acid was below the ￡30000- per-QALY-gained threshold in 92% of 1000 PSA simulations. In addition, therapy with zoledronic acid was cost saving in 71% of these PSA simulations.
服用唑来膦酸的病人平均0.66SREs 对服用安慰剂的病人的1.74。 唑来膦酸和安慰剂的病酌减的生活质量调整寿命年分别是0.526和0.402。 与骨骼相关的事情的相关成本是大大降低，分别是￡1305￡4454。 每个病人提高0.124。唑来膦酸能够节省费用和提高生活质量。 这个结果在前列腺特异性抗原模仿中被证实。唑来膦酸的成本效率比在3000以下，每提高1000前列腺特异性抗原模仿的92%。 另外，用唑来膦酸治疗的费用节省PSA 模仿 的71%。
The present analysis suggests that zoledronic acid is cost saving and increases quality adjusted survival compared to placebo in RCC patients with bone metastases in the UK.
现在的分析表明唑来膦酸节省费用和增加了生存质量对于肾癌骨转移病人。
Presented by: Botteman F., Kaura S., Chen M., at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy
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EAU 2008 - Laparoscopic High-Intensity Focused Ultrasound for Energy Ablative Therapy of Small Renal Tumors
EAU 2008 - Laparoscopic 高能聚焦超声烧蚀治疗小的肾肿瘤。
Thursday, 03 April 2008
MILAN, ITALY (UroToday.com) - A group from the Medical University of Vienna, Austria presented their data on high-intensity focused ultrasound (HIFU) for the treatment of small renal tumors. They showed data that HIFU works by a targeted homogeneous ablation of renal tissue. The objective of their clinical phase I study was to evaluate the feasibility of laparoscopic HIFU ablation of small renal masses with respect to homogeneity and extent of necrosis obtained with this technique.
MILAN, ITALY (UroToday.com) - 一群来自奥地利维也纳的医科大学的成员介绍了他们用高能聚焦超声治疗小的肾肿瘤。 他们展示了高能聚焦超声通过均一的烧蚀肾组织来工作。 他们一期临床的目标是评价用腹腔镜检查的高能聚焦超声烧蚀小肾肿块的可能性。
Between November 2006 and August 2007, 16 kidneys with solitary renal lesions were treated with a newly developed 4.0MHz laparoscopic HIFU probe. They researchers targeted renal masses under ultrasonic control with a focal ablation zone of 3.5cm. In 3 patients a defined marker lesion was placed prior to laparoscopic radical nephrectomy. In 13 patients with a mean mass size of 2.5 cm the tumor was completely ablated by curative intent, followed by laparoscopic partial nephrectomy in 12. One patient only had post HIFU biopsies and was followed-up using radiographs. Specimens were analyzed by whole mount histology.
在2006年十一月和2007年八月间，16个孤立肾病变被用这种方式治疗。 他们的研究员定位肾肿块在超声控制下焦点3.5cm内的区域。 有3个病人是被定义标志损害在腹腔镜根治性肾切除术以前。 平均大小2.5CM的肿块的13个病人肿块被完全烧蚀，12个接着进行了腹腔镜肾部分切除。 只有一个病人死于高能聚焦超声活组织检查和接下来的放疗。样本被进行组织学分析。
The mean HIFU ablation time was 22 minutes, with power levels ranging between 30-38W, with a mean targeted volume of 10.2 (9-23) cm3. By histological evaluation, marker lesions showed homogeneous thermal damage that was consistent with irreversible tissue damage. Of the 15 tumors removed after HIFU 10 showed complete, homogeneous ablation of the entire tumor. Two had a 1-3 mm rim of viable tissue immediately adjacent to where the HIFU probe was approximated to the tumor. In one patient with borderline mass size, a rim of tissue 1-2mm distal to the focal ablation zone could not be ablated. One tumor showed a central area of vital tissue made up of about 20% of its volume. There were no HIFU related complications.
高能聚焦超声烧蚀时间平均是22分钟，随着功率在30-38W之间，随着平均数指标容积10.2(9-23)厘米。 通过组织学的评估，标记的损害显示均一的热损伤，这是与单一组织损伤相一致的。 被高能聚焦超声烧蚀的15个肿块，10显示完全的，均一的烧蚀整个肿块。 2个有1-3毫米有生机的边缘组织立即靠近高能聚焦超声探针所对个那个肿块。 一个有临界大小肿块的病人，烧蚀中点的远端1-2毫米的组织不能被切除。 一个肿瘤显示了一个由20%体积组成的致命组织的中央区。没有高能聚焦超声相关的并发症。
Presented by: H.C. Klingler, MD, et al at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy
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EAU 2008 - Laparoscopic Renal Cryoablation (LRC) of Small Renal Masses
EAU 2008 - 腹腔镜肾冷冻消融术治疗小的肾肿块.
Thursday, 03 April 2008
MILAN, ITALY (UroToday.com) - Lessons Learned from 104 Cases in a 7-year Experience
回顾7年来104个案例.
A group from Milan, Italy prospectively analyzed the outcome of patients with kidney masses treated with laparoscopic cryoablation over a 7-year period. Beginning in September 2000, 104 patients (mean age 61.6 years; 78 male and 26 female) underwent LRC for renal masses. The mean lesion diameter was 2.2cm. The procedure was performed transperitoneally in 60 cases and in 44 patients it was done retroperitoneoscopically, based upon the tumor position or potential difficulties due to previous abdominal surgery. Fifty-six patients (54%) had concomitant comorbidities.
一群来自意大利,米兰的成员,预测性地研究在7年时间里用腹腔镜检查的冷冻消融术治疗肾脏肿块的病人. 从2000年九月开始,104个病人(平均年龄61.6,78个男性和26个女性)使用了腹腔镜肾冷冻消融术治疗肾脏肿块. 平均损伤直径2.2厘米. 60个经腹腔,由于肿块的位置或者因为以前的腹部外科手术使经腹腔存在潜在的困难,44个病人经腹膜后腹腔镜,54%的病人有其它疾病.
The intra-operative mean diameter of the ice ball was 4.93cm. All the procedures were successfully completed laparoscopically, except 3 cases that were converted to open surgery, two of them due to bleeding from the site of the cryoprobe insertion (one of them requiring radical nephrectomy). Mean surgical time was 202.6min (range 90-320 min) and mean intra-operative blood loss was 211.6 cc (range 10-3.200 cc). Pathological evaluation of the intra-operative needle biopsies documented renal cell carcinoma in 64 cases, 23 oncocytomas, 6 angiomyolipomas, 1 case of Xantogranulomatous pyelonephritis and 10 cases “undefined” disease. Post-operative stay was 4.7 days (range 2-13).
术中冰球的平均直径是4.93cm，除了三个病例转为开腹，其中两个因为冷冻刀插入面出血（其中一个需要根治性的肾切除术），所有操作均在腹腔镜下完成。平均手术事件为202.6分钟（90－320分钟），平均术中出血为211.6cc（10－3200cc）。术中针刺活检病理结果显示64例肾癌，23例嗜酸粒细胞腺瘤，6例angiomyolipomas，1例xantogranulomatous pyelonephritis，另有10例为未定义病例。术后住院时间平均为4.7天（2－13天）。
Postoperative complications were always treated conservatively and included 7 cases of transient fever, 2 cases of small peri-renal hematomas, 1 case of pulmonary edema, 9 patients with significant blood loss and 1 case of gross hematuria.
术后并发症被谨慎的处理，包括7例一过性的发热，2例小的肾周血肿，1例肺水肿，9例明显的失血，1例肉眼血尿。
Delayed complication included 1 case of UPJ obstruction requiring open pyeloplasty 8 months after surgery and open nephrectomy one year after surgery due to suspected recurrence of the disease.
延迟后并发症包括1例UPJ梗阻，在术后8个月行肾盂切开成形术，1年后怀疑复发行肾脏切除术。
Six patients died during the follow-up, 5 due to previous illness and 1 patient due to worsening cirrhosis one month after surgery. No patients died secondary to renal cancer.
6例病人接下来死亡，其中5例归于先前的疾病，1例则是因为术后1月不断恶化的硬化。无死于肾癌的病人。
MRI scans on postoperative day one revealed a mean lesion of 4.91cm. Progressive reduction in size of the ablated lesion was visible in all patients with only a renal scar visible after 24 months of follow-up. This remained constant over time with 36 patients being followed up for 5 years and 11 patients for 7. In the question period, Dr. Jewett (Toronto) pointed out that 40% of the patients with benign lesions had unnecessary treatment and perhaps the biopsies should be performed a few weeks prior to the intended procedure.
术后MRI扫描显示平均4.91cm的创面。所有病人在术后24个月里创面逐渐减小，仅剩一肾区瘢痕。且36例病人在接下5年里无变化，另有11例7年保持不变。在答疑时间里，Jewett医生指出40％良性病变的病人无需治疗，活检应该在进行进一步治疗前若干周进行。
Presented by: A. Cestari, MD, et al, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy
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EAU 2008 - The Clinical Significance of Micro-Metastatic Lymph Node Disease in Kidney and Bladder Cancer Show Comments PDF
肾和膀胱癌淋巴结微量转移的临床意义.
Tuesday, 01 April 2008
MILAN, ITALY (UroToday.com) - Dr. Gschwend (Munich) presented a State-of-the-Art lecture on LN disease in renal and bladder cancers. He began with bladder cancer and that staging correlates with disease specific survival. The stage also correlates with the likelihood of positive LN. Dr. Gschwend stated that surgical LA is the standard for accuracy. MIcrometastasis can be detected in blood, bone marrow and lymph nodes. In bladder cancer, RT-PCR was used to detect LN’s that were “negative” by standard pathological staging. Cytokeratin 19 and Uroplakin II have been used as the markers to detect micrometastasis by RT-PCR. In rectal cancer, using this type of technique was an independent prognostic factor for disease-specific survival. This has been shown in bladder cancer, using molecular staging for CK 20 by RT-PCR in bone marrow specimens. In a preliminary German study using RT-PCR for CK 20 in bladder cancer resulted in a 4-fold increase in detection over surgical staging.
Gschwend医生报告关于肾和膀胱癌的淋巴结病变的技术进步。他从膀胱癌和与存活率密切相关的分级开始。同时分级又与淋巴结阳性结果密切相关。Gschwend医生指出淋巴结切除术是基本的治疗。微病灶转移可以在血液，骨髓及淋巴结中发现。在膀胱肿瘤中，RT－PCR被用于检测那些传统病理分级未发现异常的淋巴结。细胞角蛋白19及Up－2用作搜寻微转移灶的标记。在肾癌中，该项技术的使用是疾病特异性生存率的独立预测因子。对于膀胱肿瘤中，检测骨髓活检物中的CK20。德国一项通过RT-PCR检测膀胱癌CK20的研究使得外科分期四倍的增长。
Three systems are responsible for development of micrometastasis. They include chemokines, mostly mediated through G-protein coupled receptors. Ligand 12 and CXCR4 on leukocytes is important. But in addition to leukocytes, tumor cells utilize the same mechanism to be directed to LNs. Secondly, lymphangioneogenesis occurs through VEGF pathways. Extracellular matrix metalloproteinase inducer (EMMPRIN) increases invasive enzymes and enhances tumor cell migration and is a third mechanism. EMMPRIN keeps the tumor cells from adhering to one another and facilitates invasion and migration.
三个学会负责微灶转移的研究，他们包括主要由G蛋白受体介导的CK。白细胞中Ligand12和CXCR4在leukocytes是重要的.但是除白细胞之外,肿瘤细胞运用同样的机制诱导向淋巴结.第二点,淋巴管产生通过VEGF途径，细胞外基质金属蛋白诱导物增强穿透酶，增强肿瘤细胞的游走，这是第三条机制。EMMPRIN可以使得肿瘤细胞粘附一个又一个细胞，促进侵入及游走。
In renal cell cancer, the incidence of unsuspected LN positivity is 3.3%. Molecular staging for VHL mutation has not shown a significant yield. However, studies for molecular staging in renal cell cancer to date have been minimal and he encouraged research in this area.
在肾细胞癌中，遗漏的阳性淋巴结发生率为3.3。分子分级对于VHL基因突变并未显示出明确的一致性，但是，对于肾细胞癌的分子分级研究太少了，他估计在这个领域进行研究。
Presented by: J.E. Gschwend, MD, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy
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EAU 2008 - 根治性肾切除术没有优于保留肾单位的外科手术在pT 1b-pT 2N0M0期的肾肿瘤. Show Comments PDF Print E-mail
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Thursday, 03 April 2008
MILAN, ITALY (UroToday.com) - 来自法国Rennes 医生Patard 匹配比较分析546病例,介绍一个大的国际群体关心2406个肾部分切除术操作来自多机构的数据,289个pT 1b-pT 2N0M0期的肾肿瘤患者被选择与匹配的根治性肾切除患者相比较.和根治性肾切除术的好处对于设置器官限制肿块测量.
2406个肾部分切除术操作来自多机构的数据,289个pT 1b-pT 2N0M0期的肾肿瘤患者被选择与匹配的根治性肾切除患者相比较. 为了这个目的,1507个被执行根治性肾切除的患者和有相同的TNM分期人,257个被选中与肾部分切除术的患者进行比较,因为其肿块大小和Fuhrman 分级.
546个肾操作被纳入这个回顾性分析研究. 在平均54个月的随访中,只有36(6.6%)的病人死于癌症. 部分肾切除组和根治性切除组病人进行比较,诊断年龄(59.3vs. 61)肿块大小(5.47对比5.5厘米)分级(T1273(94.5%)vs. 241(93.8%)和Fuhrman 分级(G1-1-G2 234(81%)vs. 204(79.4%)). 比较两组病人的生存率,生存曲线完美重叠. 关于预测参数,作者发现生存率,分级,Fuhrman级数和年龄有诊断中的重要性在单变量分析中,同时分级和年龄在多变量分析中也是独立的预测参数. 对于这些选定的低危险人群手术方法对结果完全没有影响在单或多变量分析中.
Presented by: J.J. Patard, MD, et al, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy
UroToday.com Full Conference Reports
EAU 2008 - Surgical Management Safety and Short-Term Efficacy of Laparoscopic Cryoablation for Renal Tumors ≥ 3 cm: A Multicenter European Report 针对大于3cm的肾脏肿瘤腹腔镜冷冻消融术的安全性及短期疗效：欧洲一多中心报告。
Thursday, 03 April 2008
MILAN, ITALY (UroToday.com) - A multicenter European group reported on the short-term outcomes of laparoscopic cryoablation for renal lesions greater than 3cm in size. Laparoscopic cryoablation has previously been reported as safe and effective for renal tumors <3 cm. The authors studied a group of patients who were considered to be poor candidates for needle ablation therapy.
Milan，意大利，欧洲一多中心研究小组报告了大于3cm肾脏肿瘤行腹腔镜冷冻消融术的短期疗效。在以前的报告中冷冻消融术对于小于3cm的肾脏肿瘤是安全有效的。作者研究了一组被认为不适于行针刺消融治疗的病人。
Patients’ data at 7 European centers was prospectively recorded. Procedures were carried out laparoscopically using laparoscopic ultrasound guidance and 17g cryo-needles or Ice Rods. A total of 80 tumors at least 3cm in size (median 3.6) were treated over a 4 year period. Over 80% of the patients had significant comorbidity and were not considered good candidates for partial or radical nephrectomy. Twenty-five percent had a single functioning kidney.
欧洲七个中心的病人资料前瞻性的记录下来。在腹腔镜超声引导及17g冷冻针或冰杆下行腹腔镜下手术。80个最小3cm的肿瘤治疗超过4年。超过80%的病人有明显的并存症，被认为不适于行部分或根治性肾脏切除术。25％病人只有单肾功能。
A total of 20 peri-operative complications occurred in 18 of 80 patients (22.5%); 7 major and 13 minor. Major intra-operative complications included 1 nephrectomy and 2 partial nephrectomies for bleeding. Post-operatively, there was 1 hematoma requiring transfusion and 3 myocardial infarctions resulting in one death. Minor complications included chest infection (1), wound infection/hematoma (4), skin burn (1), fever (1), UTI (2) and ileus (4). Only 2 patients required transfusions. Overall, 4 major bleeding complications occurred in the 80 cases (5.0%) and the researchers stated that these could potentially be attributed to the large tumor size.
80例病例中有22.5％的病人在术前出现了总计20种并发症，包括7种主要并发症，13个次要并发症。术中主要并发症包括1个全肾切除，2个肾脏部分切除术病人发生出血，术后发生1例血肿需要输血，3例心梗病人死亡1例。次要并发症包括肺部感染（1），切口感染/血肿（4），皮肤烧伤（1），发热（1），UTI（2）及肠梗阻（4）。只有2例病人需要输血。80例病人中出现4例主要出血并发症，研究者认为并发症的发生与肿瘤大小相关。
The conclusion was that peri-operative complications for laparoscopic renal cryoablation are higher in patients with tumors larger than 3 cm; however, major bleeding complications remain relatively uncommon with 17g needles. The emphasis was that more care must be taken not to traumatize the ice ball during treatment, especially in exophytic tumors. Technical tips included freezing to a target of -40 to - 60C and no lower, which may prevent cracking and resultant bleeding complications.
肿瘤大于3cm的病人中，腹腔镜下肾脏冷冻消融术前并发症的发生率较高。而使用17g针发生主要出血并发症仍然相对较少。重点指出的是，尤其在外生性肿瘤中，需要注意勿损伤冰球。技术要点包括冷冻靶向至－40至－60度，而不致太低，可以防止破裂及出血等并发症。 |
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发表于 2008-4-27 15:30:52
