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Karim Bensalah Morgan Roupret Evanguelos Xylinas Shahrokh Shariat 《World journal of urology》2013,31(6):1369-1376
Introduction
Lymph node dissection (LND) has been advocated by oncologic surgeons to completely eradicate cancer. However, evidence for that strategy is solely based on poor quality data. Some randomized studies done outside the field of urology failed to show any benefit to LND. Our objective was to evaluate whether LND at the time of removal of prostate, kidney and urothelial carcinomas results in a survival benefit.Methods
For that purpose, we performed a systematic literature review.Results
For kidney cancer, LND might be able to cure some patients with N+ disease. In N0 patients, although a randomized trial has been completed, the value of LND remains uncertain. LND at the time of radical prostatectomy can be useful in some patients with lymph node invasion. However, studies on the impact of LND in pN0 patients are retrospective and conflictive. Extended LND has been recommended when performing a radical cystectomy based on improved outcomes observed in retrospective studies. However, these studies are limited by selection biases and results of ongoing randomized trials will specify the template and the advantages of LND when removing a bladder cancer. Recent data of large series of radical nephro-ureterectomies for upper tract urothelial carcinomas are conflicting. Some found a benefit of LND in N0 patients while others did not.Conclusion
The studies that support LND at the time of surgery for prostate, kidney and urothelial carcinomas have low level of evidence. This should encourage urologists to design and perform well-designed randomized trials to assess the potential survival impact of a commonly done procedure. 相似文献3.
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Aurélie Mbeutcha Ilaria Lucca Vitaly Margulis Jose A. Karam Christopher G. Wood Michela de Martino Romain Mathieu Andrea Haitel Evanguelos Xylinas Luis Kluth Morgan Rouprêt Pierre I. Karakiewicz Alberto Briganti Michael Rink Malte Rieken Alon Z. Weizer Jay D. Raman Nathalie Rioux-Leclecq Christian Bolenz Karim Bensalah Yair Lotan Christian Seitz Mesut Remzi Shahrokh F. Shariat Tobias Klatte 《World journal of urology》2016,34(8):1155-1161
Background
Excision repair cross-complementing 1 (ERCC1) has been associated with outcomes of urothelial carcinoma of the bladder, but was not yet studied in upper tract urothelial carcinoma (UTUC). The aim of this study was to assess the prognostic role of ERCC1 expression in a large international cohort of UTUC patients.Methods
Immunohistochemical ERCC1 expression was evaluated in 716 UTUC patients who underwent radical nephroureterectomy with curative intent. ERCC1 was considered positive when the H-score was >1.0. Associations with overall survival and cancer-specific survival were assessed using univariable and multivariable Cox models.Results
ERCC1 was expressed in 303 tumors (42.3 %) and linked with the presence of tumor necrosis (16.2 vs. 10.4 %, p = 0.023), but not with any other clinical or pathological variable. ERCC1 status did not predict cancer-specific survival and overall survival on both univariable (p = 0.70 and 0.32, respectively) and multivariable analyses (p = 0.48 and 0.33, respectively).Conclusions
ERCC1 is expressed in a significant proportion of UTUC and is linked with tumor necrosis, but its expression appears not to be associated with prognosis following radical nephroureterectomy.7.
Luis A. Kluth Malte Rieken Evanguelos Xylinas Matthew Kent Michael Rink Morgan Rouprêt Nasim Sharifi Asha Jamzadeh Wassim Kassouf Dharam Kaushik Stephen A. Boorjian Florian Roghmann Joachim Noldus Alexandra Masson-Lecomte Dimitri Vordos Masaomi Ikeda Kazumasa Matsumoto Masayuki Hagiwara Eiji Kikuchi Yves Fradet Jonathan Izawa Ricardo Rendon Adrian Fairey Yair Lotan Alexander Bachmann Marc Zerbib Margit Fisch Douglas S. Scherr Andrew Vickers Shahrokh F. Shariat 《European urology》2014
Background
The impact of gender on the staging and prognosis of urothelial carcinoma of the bladder (UCB) is insufficiently understood.Objective
To assess gender-specific differences in pathologic factors and survival of UCB patients treated with radical cystectomy (RC).Design, setting, and participants
Data from 8102 patients treated with RC (6497 men [80%] and 1605 women [20%]) for UCB between 1971 and 2012 were analyzed.Outcome measurements and statistical analysis
Multivariable competing-risk regression analyses were performed to evaluate the relationship of gender on disease recurrence (DR) and cancer-specific mortality (CSM). We also tested the interaction of gender and tumor stage, nodal status, and lymphovascular invasion (LVI).Results and limitations
Female patients were older at the time of RC (p = 0.033) and had higher rates of pathologic stage T3/T4 disease (p < 0.001). In univariable, but not in multivariable analysis, female gender was associated with a higher risk of DR (p = 0.022 and p = 0.11, respectively). Female gender was an independent predictor for CSM (p = 0.004). We did not find a significant interaction between gender and stage, nodal metastasis, or LVI (all p values >0.05).Conclusions
We found female gender to be associated with a higher risk of CSM following RC. However, these findings do not appear to be explained by gender differences in pathologic stage, nodal status, or LVI. This gender disparity may be due to differences in care and/or the biology of UCB. 相似文献8.
Malte Rieken Evanguelos Xylinas Luis Kluth Joseph J. Crivelli James Chrystal Talia Faison Yair Lotan Pierre I. Karakiewicz Sten Holmäng Marek Babjuk Harun Fajkovic Christian Seitz Tobias Klatte Armin Pycha Alexander Bachmann Douglas S. Scherr Shahrokh F. Shariat 《European urology》2014
Background
Few studies have investigated the natural history of TaG1 urothelial carcinoma of the bladder (UCB).Objective
To assess the long-term outcomes of patients with TaG1 UCB and the impact of immediate postoperative instillation of chemotherapy (IPIC).Design, setting, and participants
A retrospective analysis of 1447 patients with TaG1 UCB treated between 1996 and 2007 at eight centers. Median follow-up was 67.2 mo (interquartile range: 67.9). Patients were stratified into three European Association of Urology (EAU) guidelines risk categories; high-risk patients (n = 11) were excluded.Intervention
Transurethral resection of the bladder with or without IPIC.Outcome measurements and statistical analysis
Univariable and multivariable Cox regression models addressed factors associated with disease recurrence, disease progression, death of disease, and any-cause death.Results and limitations
Of the 1436 patients, 601 (41.9%) and 835 (58.1%) were assigned to low- and intermediate-risk categories, respectively. The actuarial estimate of 5-yr recurrence-free survival was 56% (standard error: ±1). Advancing age (p = 0.04), tumor >3 cm (p = 0.001), multiple tumors (p < 0.001), and recurrent tumors (p < 0.001) were independently associated with increased risk of disease recurrence, whereas IPIC was associated with decreased risk (p = 0.001). The actuarial estimate of 5-yr progression-free survival was 95% ± 1. Advancing age (p < 0.001) and multiple tumors (p = 0.01) were independent risk factors for disease progression. Five-year cancer-specific survival was 98% ± 1. Advancing age (p = 0.001) and previous recurrence (p = 0.04) were associated with increased risk, whereas female gender (p = 0.02) was associated with decreased risk of cancer-specific mortality. Compared with low-risk patients, intermediate-risk patients were at significantly higher risk of disease recurrence, disease progression, and cancer-specific mortality (all p < 0.01). Limitations include the retrospective design of the study and the lack of a central pathology review.Conclusions
TaG1 UCB patients experience heterogeneous risks of disease recurrence. We validated the EAU guidelines risk stratification in TaG1 UCB patients. IPIC was associated with a reduced risk of disease recurrence in patients with low- and intermediate-risk TaG1 UCB. 相似文献9.
Pierre Bigot Tarek Fardoun Jean Christophe Bernhard Evanguelos Xylinas Julien Berger Morgan Rouprêt Jean-Baptiste Beauval Samuel Lagabrielle Souhil Lebdai Myriam Ammi Hervé Baumert Bernard Escudier Nicolas Grenier Jean-François Hétet Jean-Alexandre Long Philippe Paparel Nathalie Rioux-Leclercq Michel Soulié Abdel-Rahmène Azzouzi Karim Bensalah Jean-Jacques Patard 《World journal of urology》2014,32(1):109-114
Objective
To assess the effect of neoadjuvant targeted molecular therapies (TMTs) on size and level of inferior vena cava tumor thrombi and to evaluate their impact on surgical management.Methods
We retrospectively analyzed the data of 14 patients treated for a clear cell renal cell carcinoma with inferior vena cava thrombi by neoadjuvant TMT before nephrectomy. Clinical, pathological and perioperative data were gathered retrospectively at each institution. The primitive tumor size and the thrombus size were defined by computed tomography before TMT. The tumor thrombus level was defined according to the Novick’s classification.Results
Before TMT, thrombus level was staged I for 1 (7 %), II for 10 (72 %) and III (21 %) for 3 patients. First-line therapy was sunitinib in 11 cases and sorafenib in 3 cases. Median therapy duration was two cycles (1–5). Three patients experienced major adverse effects (grade III) during TMT. Following TMT, 6 (43 %) patients had a measurable decrease, 6 (43 %) had no change, and 2 (14 %) had an increase in the thrombus. One patient (7 %) had a downstage of thrombus level, 12 (85 %) had stable thrombi, and 1 (7 %) had an upstage. Regarding primary tumor, 7 (50 %), 5 (36 %) and 2 (14 %) patients had a decrease, stabilization and an increase in tumor size, respectively.Conclusion
Neoadjuvant TMT appears to have limited effects on renal tumor thrombi. This retrospective study failed to demonstrate a significant impact of neoadjuvant TMT on surgical management of clear cell renal cell carcinoma with inferior vena cava tumor thrombi. 相似文献10.
Malte Rieken Rosa S. Djajadiningrat Luis A. Kluth Ricardo L. Favaretto Evanguelos Xylinas Gustavo C. Guimaraes Fernando A. Soares Matthew Kent Daniel D. Sjoberg Simon Horenblas Shahrokh F. Shariat 《European urology》2014
Disease recurrence occurs frequently after surgical treatment for squamous cell carcinoma of the penis (SCCp). We sought to determine prognostic factors that influence cancer-specific mortality (CSM) after disease recurrence in patients with SCCp. We performed a retrospective analysis of 314 patients who experienced disease recurrence after surgical treatment for SCCp between 1949 and 2012. Competing risk regression analysis addressed factors associated with CSM after SCCp recurrence. Median time from surgery to disease recurrence was 10.5 mo (interquartile range [IQR]: 5.9–21.3). Of the recurrences, 165 (53%), 118 (38%), and 31 (9.9%) were local, regional, or distant, respectively. Within a median follow-up of 4.5 yr (IQR: 2.0–6.5), 108 patients died of SCCp and 41 patients died of causes other than SCCp. Shorter time to disease recurrence was found to be significantly associated with a higher risk of CSM (p = 0.0006). Lymph node metastasis at the time of initial treatment (subdistribution hazard ratio [SHR]: 1.96; 95% confidence interval [CI] 1.23– 3.11; p = 0.005) and regional recurrence (SHR: 4.14; 95% CI, 2.16–7.93; p < 0.0001) or distant recurrence (SHR: 5.75; 95% CI, 2.59–12.73; p < 0.0001) were associated with increased risk of CSM after disease recurrence. Inclusion of time to recurrence into risk stratification may help patient counseling and treatment planning. 相似文献