Dear Editor, Renal cell carcinoma (RCC) is among the most common human cancers in the United States, with approximately 63,990 new patients and 14,400 deaths annually [1]. However, RCC is not among the top 10 malignancies in China in terms of incidence and mortality [2]. The clini-cal and molecular features of RCC differ among distinct pathological types, mainly clear cell renal cell carcinoma (ccRCC), papillary renal cell carcinoma (PRCC), and chromophobe renal cell carcinoma (ChRCC). The most common subtype of RCC is ccRCC worldwide. Accord-ing to The Cancer Genome Atlas (TCGA), the somatic mutation landscape of RCC has been revealed by whole- exome sequencing (WES) or whole-genome sequencing (WGS). In our previous WES study, we validated most of the significantly mutated genes reported by the TCGA and identified several novel somatically altered genes [3]. The TCGA study showed that only somatic mutations in BRCA1-associated protein 1 (BAP1) were associated with patients’ poor survival outcomes among all significantly mutated genes [4]. In our previous WES study, BAP1 was somatically mutated in 2 of 15 ccRCC samples [3]. Never-theless, all of these RCC patients lacked follow-up infor-mation. Hence, further analysis is needed to determine whether there are any somatically mutated genes associ-ated with the prognosis of Chinese patients with RCC. However, WES or WGS is time-consuming and costly. Furthermore, compared with targeted sequencing, WES was more likely to generate false positives and false nega-tives due to insufficient base coverage [5].
Jie WangJianzhong XiHanshuo ZhangJuan LiYuchao XiaRuibin XiZhijun Xi
目的:比较女性膀胱癌患者腹腔镜膀胱全切术和开放膀胱全切术两种术式的围手术及肿瘤学预后差异。方法:回顾性分析2006—2017年于北京大学第一医院泌尿外科行根治性膀胱全切术的女性膀胱癌患者91例,将腹腔镜膀胱全切患者以1 ∶ 1的比例运用倾向性评分匹配(propensity score matching,PSM)方法与开放膀胱全切患者进行匹配,匹配因素包括年龄、体重指数(body mass index,BMI)、美国麻醉医师协会(American Society of Anesthesio- logists ,ASA)评分、T分期及N分期,比较匹配前后两组患者的围手术及肿瘤学特征,应用Kaplan-Meier法比较匹配前后两组间总生存时间(overall survival,OS)、肿瘤特异生存时间(cancer specific survival,CSS)、无进展生存时间(progression free survival,PFS)。采用COX多因素回归分析校正匹配因素,进行敏感性分析。结果:共纳入行开放膀胱全切术患者65例,腹腔镜膀胱全切患者26例,中位随访时间为38个月(四分位距18~69个月)。与开放膀胱全切组相比,腹腔镜膀胱全切组患者年龄更小( P <0.001),术前ASA评分更低( P =0.018),匹配后,22例开放膀胱全切患者与腹腔镜膀胱全切患者匹配成功。匹配前,腹腔镜膀胱全切组术中失血量更少( P =0.005),术中输血率更低( P <0.001),清扫淋巴结数目更多( P =0.035),围手术期并发症发生率较低( P =0.015),两组间OS( P = 0.698 )、CSS( P =0.942)、PFS( P =0.837)差异无统计学意义;匹配后,腹腔镜膀胱全切组术中失血量仍较开放膀胱全切组更少( P =0.009),术中输血率更低( P =0.001),围手术期并发症发生率较低( P =0.040),但清扫淋巴结数目两组间差异无统计学意义,两组间OS( P =0.432)、CSS( P =0.429)、PFS( P =0.284)差异亦无统计学意义。COX多因素回归分析显示,手术方式并不是女性膀胱癌患者OS( HR 1.134, 95% CI 0.335~3.835, P =0.839)、CSS( HR 1.051,95% CI 0.234~4.719, P =0.949)、PFS( HR 0.538,95% CI 0.138~2.095, P =0.
