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1.
William P. Parker Christine M. Lohse Harras B. Zaid John C. Cheville Stephen A. Boorjian Bradley C. Leibovich R. Houston Thompson 《Urologic oncology》2017,35(1):36.e1-36.e6
Objectives
Beta-blocker use is associated with improved survival for multiple nonurologic malignancies. Our objective was to evaluate the association between beta-blocker use and survival among surgically managed hypertensive patients with clear-cell renal cell carcinoma (ccRCC).Methods
Hypertensive patients with ccRCC treated with either radical or partial nephrectomy between 2000 and 2010 were identified from our Nephrectomy Registry. Beta-blocker use within 90 days before surgery was identified. The associations between beta-blocker use and risk of disease progression, death from renal cell carcinoma (RCC), and all-cause mortality were assessed using Cox proportional hazards regression models.Results
In total, 913 hypertensive patients were identified who underwent either partial or radical nephrectomy for ccRCC. Of these, 104 (11%) had documented beta-blocker use within 90 days before surgery. At last follow-up (median 8.2 y among survivors), 258 patients showed progression (median 1.6 y following surgery), and 369 patients had died (median 4.1 y following surgery), including 138 who died of RCC. After adjusting for PROG (progression-free survival) and SSIGN (cancer-specific survival) scores, beta-blocker use was not significantly associated with the risk of disease progression (hazard ratio [HR] = 0.94; 95% CI: 0.61–1.47; P = 0.80) or the risk of death from RCC (HR = 0.74; 95% CI: 0.38–1.41; P = 0.35). Similarly, on multivariable analysis adjusting for clinicopathologic features, there was not a significant association between beta-blocker use and the risk of all-cause mortality (HR = 0.83; 95% CI: 0.59–1.16; P = 0.27).Conclusions
Beta-blocker use for hypertension within 90 days before surgery was not associated with the risk of progression, death from RCC, or death from any cause. 相似文献2.
Hakmin Lee Jong Jin Oh Seok Soo Byun Chang Wook Jeong Cheol Kwak Byong Chang Jeong Seong Soo Jeon Hyun Moo Lee Han-Yong Choi Seong Il Seo 《Urologic oncology》2017,35(6):379-385
Objective
Although partial nephrectomy (PN) is the standard treatment for localized clinical T1a renal cell carcinoma (RCC), treatment of larger renal tumors is controversial. We evaluated the oncological outcomes and perioperative complications after radical and PN for RCC ≥4 cm.Patients and methods
We retrospectively analyzed the data of 2,373 patients surgically treated for nonmetastatic RCC with clinical T1b or T2 (≥4 cm). The propensity scores for surgery type were calculated, and the partial group was matched to the radical group in a 1:3 ratio. The oncological outcomes were compared using Kaplan-Meier analysis and multivariate Cox regression models were used to identify the independent predictors of progression-free, cancer-specific, and overall survival.Results
All differences in preoperative clinical characteristics disappeared after matching. There were no significant differences in progression-free, cancer-specific, or overall survival between the partial and radical groups in the matched cohort. The patients’ age, tumor size, cellular grade, and pathologic stage were independent predictors for all 3 survival outcomes. However, early complications (<30 d postoperative) were significantly more common in the partial group (P<0.001). In a subgroup analysis of the patients with clinical T2 stage, there were no significant differences in all 3 survival outcomes.Conclusions
The partial and radical nephrectomy groups had equivalent oncological outcomes. Although the early complication rate was significantly higher after PN, it should be considered as a valuable treatment option even in patients with clinical T1b or higher RCC. 相似文献3.
Rebecca A. Campbell Emily A. Slopnick Elizabeth K. Ferry Hui Zhu Simon P. Kim Robert Abouassaly 《Urologic oncology》2017,35(8):531.e9-531.e14
Objective
To determine the locoregional management of penile cancer before the introduction of NCCN guidelines and how much shift in practice patterns is required to meet the guidelines.Methods
The National Cancer Data Base was queried to identify 6,396 patients with squamous cell carcinoma of the penis diagnosed between 2004 and 2013. The cohort was divided into management groups based on the NCCN guidelines: cTa and cTis (cTa/is), pT1 low grade (T1LG), pT1 high grade (T1HG), and pT2 or greater (T234). These groups were analyzed to determine if management of locoregional disease complies with the 2016 NCCN guidelines and logistic regression analyses were performed to determine factors associated with adherence.Results
Nationwide management of the primary tumor closely follows the NCCN guidelines, with 96.9% adherence for cTa/is, 91.4% for T1LG, and 94.2% for T234. Management of regional lymph nodes (LNs) was inadequate with only 62.9% of patients with clinical N1 or N2 disease undergoing regional LN dissection (LND). The percentage of patients with known LN metastases who received regional LND increased over time (46.2% in 2004 to 69.4% in 2013, P = 0.034). Patients treated at community cancer programs (odds ratio [OR] = 0.26, 95% CI: 0.19–0.35), comprehensive community cancer programs (OR = 0.34, 95% CI: 0.29–0.41), and integrated network cancer programs (OR = 0.36, 95% CI: 0.25–0.52) were significantly less likely to receive LND compared with patients treated at academic comprehensive cancer programs.Conclusions
Before the introduction of NCCN guidelines, national practice patterns for the management of the primary tumor were consistent with the recommendations. However, the management of regional LNs deviated from the guidelines, reflecting an area for improvement. 相似文献4.
Ning Liu Daoguang Huang Xiangming Cheng Yankun Chong Wei Wang Weidong Gan Hongqian Guo 《Urologic oncology》2017,35(8):530.e1-530.e6
Objectives
To compare the clinical outcomes of percutaneous radiofrequency ablation (PRFA) and partial nephrectomy (PN) in patients with clear cell renal cell carcinoma (ccRCC) and non–clear cell RCC (nccRCC) of the most common subtypes.Materials and methods
A retrospective study was conducted to review the records of all the patients who underwent PRFA or PN between February 2005 and April 2014 at our institution. Patients with histologic confirmation of ccRCC, papillary RCC, and chromophobe RCC were included. The Mann-Whitney U test was applied to compare PRFA to PN in the ccRCC and nccRCC groups. The Kaplan-Meier method was used to generate the survival curves that were compared to the log-rank test.Results
A total of 264 patients meeting the selection criteria were included in this study. The tumor size ranged from 0.9 to 7.0 cm. The median follow-up period was 78 months (range: 8–132 mo). Although PRFA provided comparable 10-year overall survival rates and 10-year disease-free survival (DFS) rates to PN both in ccRCC ≤4 cm and nccRCC, the 10-year DFS for patients treated with PRFA was lower than that of PN in ccRCC >4 cm. The DFS survival curve between the 2 operations and 2 subtypes was statistically significant in patients with tumor size >4 cm. Limitations include retrospective review and selection bias.Conclusions
Patients with T1b ccRCC treated with PRFA have less favorable outcomes than those with PN whereas PRFA provides comparable oncologic outcomes to PN in patients with T1b nccRCC. It is necessary to take RCC subtypes into consideration when choosing a surgical approach to treat T1b RCC between PFRA and PN. 相似文献5.
Michael Kongnyuy Abhinav Sidana Arvin K. George Akhil Muthigi Amogh Iyer Richard Ho Raju Chelluri Francesca Mertan Thomas P. Frye Daniel Su Maria J. Merino Peter L. Choyke Bradford J. Wood Peter A. Pinto Baris Turkbey 《Urologic oncology》2017,35(1):30.e1-30.e8
Background
The high-spatial resolution of multiparametric magnetic resonance imaging (mpMRI) has improved the detection of clinically significant prostate cancer. mpMRI characteristics (extraprostatic extension [EPE], number of lesions, etc.) may predict final pathological findings (positive lymph node [pLN] and pathological ECE [pECE]) and biochemical recurrence (BCR). Tumor contact length (TCL) on MRI, defined as the length of a lesion in contact with the prostatic capsule, is a novel marker with promising early results. We aimed to evaluate TCL as a predictor of +pathological EPE (+pEPE),+pathological LN (+pLN), and BCR in patients undergoing robotic-assisted laparoscopic radical prostatectomy.Materials and methods
A review was performed of a prospectively maintained single-institution database of men with prostate cancer who underwent prostate mpMRI followed by robotic-assisted laparoscopic radical prostatectomy without prior therapy from 2007 to 2015. TCL was measured using T2-weighted magnetic resonance images. Logistic and Cox regression analysis were used to assess associations of clinical, imaging, and histopathological variables with pEPE, pLN, and BCR. Receiver operating characteristic curves were used to characterize and compare TCL performance with Partin tables.Results
There were 87/379 (23.0%)+pEPE, 18/384 (4.7%)+pLN, and 33/371 (8.9%) BCR patients. Patients with adverse pathology/oncologic outcomes had longer TCL compared to those without adverse outcomes (+pEPE: 19.8 vs. 10.1 mm, P<0.0001,+pLN: 38.0 vs. 11.7 mm, P<0.0001, and BCR: 19.2 vs. 11.2 mm, P = 0.001). On multivariate analysis, TCL remained a predictor of+pEPE (odds ratio: 1.04, P = 0.001),+pLN (odds ratio: 1.07, P<0.0001), and BCR (hazard ratio: 1.03, P = 0.02). TCL thresholds for predicting+pEPE and+pLN were 12.5 and 19.7 mm, respectively. TCL alone was found to have good predictive ability for+pEPE and+PLN (pEPE:TCLAUC: 0.71 vs. PartinAUC: 0.66, P = 0.21; pLN:TCLAUC: 0.77 vs. PartinAUC: 0.88, P = 0.04).Conclusion
We demonstrate that TCL is an independent predictor of+pEPE, +pLN, and BCR. If validated, this imaging biomarker may facilitate and inform patient counseling and decision-making. 相似文献6.
Michael Daugherty Dillon Sedaghatpour Oleg Shapiro Srinivas Vourganti Alexander Kutikov Gennady Bratslavsky 《Urologic oncology》2017,35(4):153.e15-153.e20
Objective
The influence of histology in metastatic potential is often overlooked when discussing the management options of small renal masses (SRM), with size or growth rate often serving as the triggers for the intervention. We aim to re-examine the definition of a SRM by evaluating the metastatic potential of renal masses incorporating tumor size and histology to create metastatic risk tables.Materials and methods
Surveillance Epidemiology and End Results (SEER)-18 registries database was queried for all cases of clear cell, papillary, and chromophobe renal cell carcinoma (RCC) diagnosed between 2004 and 2012. There were 55,478 cases identified that included 43,783, 8,587, and 3,208 cases of clear cell, papillary, and chromophobe, respectively. Tumors were stratified using 1-cm increments to determine the metastatic potential by calculating the metastatic rate at presentation for different size intervals in histologic categories.Results
For all 3 histologies, tumors measuring 5 cm or less had a rate of metastatic RCC at presentation of less than 4%. The metastatic potential was highest for clear cell, followed by papillary and then chromophobe tumors. Setting a cutoff of no more than 3% for metastatic potential to be called a SRM, makes clear cell carcinoma and papillary carcinoma a SRM up to 4 cm, whereas the chromophobe RCC would be considered a SRM up to 7 cm.Conclusion
Although clinical staging and tumor size have been the key determinants in decision-making of patients with solid renal tumors, the histology-specific risks of metastatic potential are different for each mass. The definition of a SRM should be based on the metastatic potential and not on tumor size alone. This information could be helpful for counseling and managing patients with SRMs as well as for modifying active surveillance protocols. 相似文献7.
Oleksandr N. Kryvenko 《Urologic oncology》2017,35(6):453-454
Objective
To determine characteristics of the peritumoral pseudocapsule (PC) between renal tumor subtypes.Methods
The peritumoral PCs of 160 pT1 renal tumors were examined, including 60 clear cell renal cell carcinomas (RCCs), 50 papillary RCCs, 25 chromophobe RCCs, and 25 oncocytoma. Pathologic features (presence or absence of PC, mean thickness, continuity, and invasion by tumor) were analyzed. PC thickness was measured using an ocular micrometer to the nearest 1/10 mm.Results
A complete PC was found in 77% of clear cell tumors, 74% of papillary, 28% of chromophobe, and 4% of oncocytomas. Tumor PC was present but incomplete in 18% of clear cell, 18% of papillary, 44% of chromophobe, and 56% of oncocytoma. The PC was entirely absent in no clear cell tumors, 6% of papillary, 28% of chromophobe, and 40% of oncocytoma. Mean PC thickness and presence of invasion beyond the PC differed significantly by tumor subtype. Clear cell RCC possessed the thickest PC showing invasion through the capsule in 8% of tumors compared to 30% of papillary tumors. Complete PC invasion was not seen in chromophobe RCC or renal oncocytoma. Oncocytoma and chromophobe RCC characteristically exhibited an incomplete or absent PC.Conclusions
The characteristics of peritumoral PC vary predictably with histologic subtype of renal neoplasms. Clear cell RCC shows the most consistent PC, with a lower rate of invasion beyond it compared to papillary RCC. Chromophobe and oncocytoma characteristically have an incomplete or absent PC. 相似文献8.
Hiroki Ishihara Tsunenori Kondo Kazuhiko Yoshida Kenji Omae Toshio Takagi Junpei Iizuka Kazunari Tanabe 《Urologic oncology》2017,35(9):542.e1-542.e9
Objectives
The effect of response to first-line tyrosine kinase inhibitor (TKI) therapy on second-line survival in patients with metastatic renal cell carcinoma who receive second-line molecular-targeted therapy (mTT) after first-line failure remains unclear.Materials and methods
Sixty patients who developed disease progression after first-line TKI, without prior cytokine therapy, were enrolled. According to the median first-line time to progression (1L-TTP), patients were divided into 2 groups (i.e., short vs. long). Second-line progression-free survival (2L-PFS) and second-line overall survival (2L-OS) were defined as the time from second-line mTT initiation. Survival was calculated with the Kaplan-Meier method and compared using the log-rank test between patients with short and long 1L-PFS. Predictors for survivals were identified using Cox proportional hazards regression models.Results
The median 1L-TTP was 8.84 months. Thirty patients (50.0%) with short 1L-TTP (<8.84 mo) had significantly shorter 2L-PFS and 2L-OS compared to patients with long 1L-TTP (2L-PFS: 4.96 vs. 10.2 mo, P = 0.0002; 2L-OS: 9.6 vs. 28.0 mo, P = 0.0036). Multivariable analyses for 2L-PFS and 2L-OS showed that 1L-TTP was an independent predictor both as a categorical classification (cutoff: 8.84 mo) and as a continuous variable (both P<0.05). The median follow-up duration was 13.1 months (interquartile range: 6.56–24.7).Conclusions
Patients who achieve a long-term response after first-line TKI therapy could have a favorable prognosis with second-line mTT. 相似文献9.
Daniel E. Spratt Hebert A. Vargas Zachary S. Zumsteg Jennifer S. Golia Pernicka Joseph R. Osborne Xin Pei Michael J. Zelefsky 《European urology》2017,71(1):37-43
Background
Clinical trials evaluating the benefit of pelvic radiotherapy (PRT) in the radiotherapeutic management of patients with higher-risk prostate cancer have limited the superior field border to the S1/S2 or L5/S1 interspace. However, imaging and surgical series have demonstrated a high frequency of prostatic lymph node (LN) drainage beyond these landmarks.Objective
To determine the patterns of radiographically defined abdominopelvic LN failures and their potential implications for PRT field design.Design, setting, and participants
During 1992–2008, 2694 patients with localized prostate cancer were treated with prostate/seminal vesicle–only radiotherapy without PRT. Some 156 patients had their first failure within the abdominopelvic LNs, of whom 60 had isolated failures within the pelvic LNs.Outcome measurements and statistical analysis
A radiologist reviewed all imaging and mapped each LN failure to a template consisting of 34 abdominopelvic LN stations.Results and limitations
The median follow-up was 8.9 yr. Of patients who experienced first recurrence in the pelvic LNs (n = 60), the common iliac station was involved in 55% (n = 33) of patients, including 10% (n = 6) who had isolated common iliac failures. Use of a PRT field superior border of L5/S1 would fully cover only 42% of the first recurrences among these patients. Extending the field to cover the common iliac stations would increase coverage to 93% of recurrences. The presence of T3/T4 disease and omission of androgen-deprivation therapy both independently conferred an approximate fivefold increase in the likelihood of having a common iliac LN failure. Use of imaging as a surrogate for LN involvement is the primary study limitation.Conclusions
Pelvic LN failures frequently occur superior to the commonly used L5/S1 landmark for PRT coverage, and use of ADT may be protective of more superior LN failures. The current RTOG 0924 trial is evaluating the benefit of PRT with extended superior coverage to L4/5 when possible, which, according to our data, should significantly improve the coverage of potential sites of failure.Patient summary
We looked at lymph node recurrence patterns after external beam radiotherapy of the prostate in men who did not have their lymph nodes treated. We found that there was a high incidence of pelvic lymph node recurrences above the internal and external iliac lymph node regions. Therefore, the current field recommendation for pelvic lymph nodes that stops at the superior border of the internal and external iliac vessels provides inadequate coverage of common sites of cancer recurrence, namely the common iliac lymph nodes. 相似文献10.
Qun Lu Changwei Ji Xiaozhi Zhao Yao Fu Suhan Guo Guangxiang Liu Shiwei Zhang Xiaogong Li Weidong Gan Hongqian Guo 《Urologic oncology》2017,35(10):603.e15-603.e20
Purpose
This study was designed to assess the feasibility and histopathologic safety of tumor enucleation for renal cell carcinoma, through histopathologic analysis of the tumor bed and peritumoral pseudocapsule (PC) after in vitro tumor enucleation.Materials and methods
We studied 176 radical nephrectomy specimens for clinical T1b renal cell carcinoma in our institution, from January 2013-February 2016. Immediately after the kidney was excised, the tumor of radical specimen was enucleated in vitro. The tumor bed parenchyma of 15 mm beyond the PC was examined to investigate the possible presence of tumor invasion or satellite lesions. The PC invasion was also evaluated.Results
The average tumor size was 5.7±0.7 cm. The histopathologic evaluation revealed that 68.2% of tumors were clear cell renal cell carcinoma (RCC). The pathological staging showed that 92.6% of tumors were pT1b, 2.8% were pT2, and 4.5% were pT3a. For clinical T1b RCC, tumor infiltration on tumor bed was detected in 6 cases (3.4%), and satellite lesion was detected in 3 (1.7%). In the group of grade 1 to 2, 4 (2.3%) were found with residual tumor, and 5 (2.8%) in the group of grade 3 to 4 (P = 0.133). Papillary RCC had the highest rate of residual tumors (8.8%). A statistically significant association of peritumoral PC invasion with tumor size and pathologic grade was observed. Median follow-up was 23 months (range: 6–43) with a recurrence rate of 6.3% (11 of 176) and a cancer-specific mortality rate of 2.8% (5 of 176).Conclusions
For clinical T1b renal cell carcinoma, the risks of tumor infiltration or satellite lesions on enucleation tumor bed or both are relatively low. Peritumoral PC invasion is associated with tumor size and pathologic stage. Tumor enucleation is a histopathologically safe technique for patients undergoing partial nephrectomy. 相似文献11.
Rahul Aggarwal Alan Bryce Charles J. Ryan Andrea Harzstark Christina Derleth Won Kim Terence Friedlander Amy M. Lin Tammy Rodvelt-Bagchi Mallika Dhawan Li Zhang Mina Lee Eric Siebeneck Jeffrey Hough Eric J. Small 《Urologic oncology》2017,35(4):149.e7-149.e13
Background
Cabazitaxel plus prednisone has significant activity in patients with chemotherapy-naïve and pretreated metastatic castration-resistant prostate cancer (mCRPC). Mitoxantrone has antitumor activity in mCRPC and nonoverlapping mechanism of action and toxicity profile.Objective
To establish the maximally tolerated dose of the combination of cabazitaxel, mitoxantrone, and prednisone.Methods and materials
Patients with chemotherapy-naïve mCRPC were prospectively enrolled in a multicenter phase 1 trial. Cabazitaxel 20 and 25 mg/m2 were each evaluated in combination with escalating doses of mitoxantrone (starting dose 4 mg/m2), given with prednisone 5 mg twice daily.Results
A total of 25 patients were enrolled, with median age of 67 (range: 51–78) and prostate-specific antigen of 66.8 ng/ml (range: 3–791.2). There were 4 dose-limiting toxicities (febrile neutropenia, n = 3; sepsis, n = 1). The maximally tolerated dose was cabazitaxel 20 mg/m2 plus mitoxantrone 12 mg/m2. The most common treatment-related grade≥3 related adverse events included neutropenia (n = 8; 32%), febrile neutropenia (n = 5; 20%), and thrombocytopenia (n = 4; 16%). The median number of treatment cycles was 8 (range: 2 to 19+). Decline in prostate-specific antigen to≥50% from baseline was observed in 15 patients (60%). Objective responses were observed in 10/14 (71%) evaluable patients. The median radiographic progression-free survival was 14.5 months (95% CI: 8.0-not reached (NR)), and median overall survival was 23.3 months (95% CI: 14.3-NR).Conclusions
The approved single-agent doses of mitoxantrone and cabazitaxel were safely combined. The combination led to durable tumor responses in most patients. Further study of the combination is warranted. 相似文献12.
Donghyun Lee Sangjun Yoo Dalsan You Bumsik Hong Yong Mee Cho Jun Hyuk Hong Choung-Soo Kim Hanjonh Ahn Jae Y. Ro In Gab Jeong 《Urologic oncology》2017,35(4):151.e1-151.e7
Purpose
We compared the prognostic value of the American Joint Committee on Cancer (AJCC) TNM nodal staging system with that of lymph node (LN) density in patients with LN-positive bladder cancer who received extended or super-extended pelvic lymphadenectomy.Methods
Of the 1,018 patients, who underwent radical cystectomy and pelvic lymphadenectomy between February 2005 and August 2014, 110 patients with LN metastases with extended (n = 68) or super-extended (n = 42) pelvic lymphadenectomy were included. All patients were staged using the 2002 (sixth edition) and 2010 (seventh edition) AJCC TNM staging systems. The association of several variables with recurrence-free survival (RFS) and overall survival (OS) was evaluated.Results
The median number of total LNs removed was 29 (6–118) and the median LN density was 12.5% (1.6%–100%). RFS and OS were not significantly different between the 2002 (pN1-pM1) and 2010 (pN1-N3) AJCC TNM nodal staging systems (sixth edition: P = 0.512 and P = 0.519; seventh edition: P = 0.676 and P = 0.671, respectively). The 2-year RFS and OS rates according to the LN density quartiles were 58.5% and 76.9% in Q1, 39.1% and 70.8% in Q2, 28.8% and 50.1% in Q3, and 12.7% and 20.8% in Q4 (P = 0.001 and P = 0.001, respectively). Multivariate analysis adjusted for the 2010 AJCC TNM staging system showed that LN density was associated with a decreased OS (HR = 1.024; 95% CI: 1.010–1.039; P = 0.001). The nodal staging system (2002 or 2010) was not associated with the RFS and OS.Conclusions
LN density shows a better prognostic value than the AJCC TNM nodal staging system in patients with LN-positive bladder cancer receiving extended or super-extended pelvic lymphadenectomy. 相似文献13.
Emil Christensen Karin Birkenkamp-Demtröder Iver Nordentoft Søren Høyer Kirstin van der Keur Kim van Kessel Ellen Zwarthoff Mads Agerbæk Torben Falck Ørntoft Jørgen Bjerggaard Jensen Lars Dyrskjøt 《European urology》2017,71(6):961-969
Background
Disease surveillance in patients with bladder cancer is important for early diagnosis of progression and metastasis and for optimised treatment.Objective
To develop urine and plasma assays for disease surveillance for patients with FGFR3 and PIK3CA tumour mutations.Design, setting, and participants
Droplet digital polymerase chain reaction (ddPCR) assays were developed and tumour DNA from two patient cohorts was screened for FGFR3 and PIK3CA hotspot mutations. One cohort included 363 patients with non–muscle-invasive bladder cancer (NMIBC). The other cohort included 468 patients with bladder cancer undergoing radical cystectomy (Cx). Urine supernatants (NMIBC n = 216, Cx n = 27) and plasma samples (NMIBC n = 39, Cx n = 27) from patients harbouring mutations were subsequently screened using ddPCR assays.Outcome measurements and statistical analysis
Progression-free survival, recurrence-free survival, and overall survival were measured. Fisher's exact test, the Wilcoxon rank-sum test and Cox regression analysis were applied.Results and limitations
In total, 36% of the NMIBC patients (129/363) and 11% of the Cx patients (44/403) harboured at least one FGFR3 or PIK3CA mutation. Screening of DNA from serial urine supernatants from the NMIBC cohort revealed that high levels of tumour DNA (tDNA) were associated with later disease progression in NMIBC (p = 0.003). Furthermore, high levels of tDNA in plasma samples were associated with recurrence in the Cx cohort (p = 0.016). A positive correlation between tDNA levels in urine and plasma was observed (correlation coefficient 0.6). The retrospective study design and low volumes of plasma available for analysis were limitations of the study.Conclusions
Increased levels of FGFR3 and PIK3CA mutated DNA in urine and plasma are indicative of later progression and metastasis in bladder cancer.Patient summary
Urine and plasma from patients with bladder cancer may be monitored for diagnosis of progression and metastasis using mutation assays. 相似文献14.
Viacheslav Iremashvili Murugesan Manoharan Bruce R. Kava Dipen J. Parekh Sanoj Punnen 《Urologic oncology》2017,35(2):37.e1-37.e8
Objective
To analyze the performance of different radical prostatectomy–based prognostic tools in predicting the biopsy progression in our active surveillance cohort.Materials and methods
We analyzed 326 patients with biopsy Gleason grade≤6,≤2 positive biopsy cores,≤20% tumor present in any core, prostate-specific antigen<15 ng/dl, and clinical stages T1–T2a all of whom had at least single surveillance biopsy. Probabilities of pathologically relatively aggressive disease were estimated using Partin and Dinh risk tables and Kattan, Truong, and Kulkarni nomograms for each individual patient. Using these predictions, performance of these tools was quantified regarding discrimination, stratification at different cut-points, calibration, and the clinical net benefit.Results
Predictions of Partin and Dinh tables were not associated with the biopsy progression. The predictive value of Kattan and Truong nomograms was higher when compared with the other tools, although it was significant only on the first and second surveillance biopsies. Both nomograms were able to identify low- and high-risk subgroups within the cohort. Kattan nomogram demonstrated better correlation with the observed rate of progression over the first 3 biopsies and higher clinical net benefit.Conclusion
Kattan and Truong nomograms demonstrated the best performance in predicting biopsy progression, although their value was largely limited to the first 2 surveillance biopsies. Both tools were able to stratify patients into subgroups with different risks of progression. These nomograms have important differences, which suggest that a more effective predictive model combining the strong sides of both tools and possibly some other variables could be developed. 相似文献15.
Francesco Soria Marco Moschini Mohammad Abufaraj Gregory J. Wirth Beat Foerster Kilian M. Gust Mehmet Özsoy Alberto Briganti Paolo Gontero Romain Mathieu Morgan Rouprêt Pierre I. Karakiewicz Shahrokh F. Shariat 《Urologic oncology》2017,35(3):113.e9-113.e14
Purpose
To evaluate the effect of preoperative anemia (PA) on oncological outcomes in a multicenter cohort of patients with non–muscle-invasive bladder cancer (NMIBC) treated with transurethral resection of the bladder (TURB) and adjuvant intravesical therapies. We hypothesize that PA represents a marker of disease aggressiveness and could be used to improve the discrimination of prognostic tools for the prediction of disease recurrence and progression.Methods
This multicenter retrospective study included 1,117 patients from 4 different centers. The presence of PA was assessed according to the World Health Organization classification as a preoperative hemoglobin level of≤13 g/dl in men and≤12 g/dl in women. PA evaluation was done at each institution, generally 1 to 3 days before surgery. Multivariable Cox regression models were performed to evaluate the prognostic effect of PA on survival outcomes.Results
Overall, 381 (34%) patients with NMIBC treated with TURB, had PA. Median follow-up for patients alive at last follow-up was 62.7 months (interquartile range: 25–110.7). On multivariable Cox regression analyses that accounted for the effect of standard clinicopathologic prognosticators, PA was independently associated with recurrence-free survival (P = 0.045) and progression-free survival (P = 0.01). Adding PA to a model for the prediction of disease recurrence and progression improved the discrimination of the prognostic models marginally from 69.8% to 70.3% and from 71.6% to 73.1%, respectively.Conclusions
PA was found in more than one-third of patients with NMIBC treated with TURB. PA was associated with poor oncological outcomes and was an independent predictor of intravesical disease recurrence and progression. However, the additional prognostic information provided by PA remains limited. 相似文献16.
Pierre Bigot Jean-Christophe Bernhard Vincent Flamand Inderbir Gill Grégory Verhoest Jean Baptiste Beauval François Xavier Nouhaud Evren Suer Guillaume Ploussard Jean François Hetet Jérôme Rigaud Eduard Baco Stéphane Larré Philippe Sebe Nicolas Koutlidis Aurélien Descazeaud Masatoshi Eto Arnaud Doerfler Karim Bensalah 《Urologic oncology》2017,35(1):35.e15-35.e19
Objective
To evaluate the oncologic outcomes of nephron-sparing surgery (NSS) for localized chromophobe renal cell carcinoma (cRCC).Material and methods
We performed a multicenter international study involving the French Network for Research on Kidney Cancer (UroCCR) and 5 international teams. Data from 808 patients treated with NSS between 2004 and 2014 for non–clear cell RCCs were analyzed.Results
We included 234 patients with cRCC. There were 123 (52.6%) females. Median age was 61 (23–88) years. Median tumor size was 3 (1–11) cm. A positive surgical margin was identified in 14 specimens (6%). Pathologic stages were T1, T2, and T3a in 202 (86.3%), 9 (3.8%), and 23 (9.8%) cases, respectively. After a mean follow-up of 46.6 ± 36 months, 2 (0.8%) patients experienced a local recurrence. No patient had metastatic progression, and no patient died from cancer. Three-years estimated cancer-free survival and cancer-specific survival were 99.1% and 100%, respectively.Conclusion
Oncological results of NSS for localized cRCC are excellent. In this series, only 2 patients had a local recurrence, and no patient had metastatic progression or died from cancer. 相似文献17.
Alexander M. Helfand Rebekah Beach Miriam Hadj-Moussa Naveen Krishnan Chang He Jeffrey S. Montgomery Todd M. Morgan Alon Z. Weizer Khaled Hafez Cheryl T. Lee John T. Stoffel Ted A. Skolarus 《Urologic oncology》2017,35(1):33.e1-33.e9
Objective
To examine whether long-term renal function and overall survival outcomes vary according to management approach for ureteral anastomotic stricture (UAS) after cystectomy and urinary diversion.Methods
We conducted a retrospective cohort study of patients with benign UAS following cystectomy and urinary diversion using our institutional database. We compared time to stricture, renal function, rates of renal loss, and overall survival between patients undergoing ureteral reimplantation vs. those undergoing nonoperative management (nephrostomy tube or ureteral stent). A multivariable Cox proportional hazard model was used to determine whether reimplantation was independently associated with overall survival.Results
We identified 87 UAS in 69 patients. Reimplantation was performed in 26 patients (37.7%), and 43 patients (62.3%) were managed nonoperatively. The interval between cystectomy and stricture diagnosis was similar in the reimplanted and nonoperative groups (3.06 vs. 4.34 mo, P = 0.42). The differences between baseline and follow-up creatinine levels (+0.40 vs.+0.40 mg/dl, P = 0.72) and estimated glomerular filtration rate (?25.0 vs.?18.9 ml/min/1.73 m2, P = 0.66) were similar between groups, as were rates of renal loss (34.6% vs. 39.5%, P = 0.68); however, mortality was significantly higher in the nonoperative group. After multivariable adjustment, overall survival remained significantly higher among UAS patients who underwent reimplantation (adjusted hazard ratio [aHR] for risk of death = 0.32, 95% CI: 0.13–0.80).Conclusion
Reimplantation was associated with improved overall survival but not with improved long-term renal functional outcomes compared with nonoperative management. Nonrenal complications of nonoperative UAS management may play an important role in reducing longevity. 相似文献18.
Jürgen E. Gschwend Matthias M. Heck Jan Lehmann Herbert Rübben Peter Albers Johannes M. Wolff Detlef Frohneberg Patrick de Geeter Axel Heidenreich Tilman Kälble Michael Stöckle Thomas Schnöller Arnulf Stenzl Markus Müller Michael Truss Stephan Roth Uwe-Bernd Liehr Joachim Leißner Margitta Retz 《European urology》2019,75(4):604-611
Background
The extent of lymph node dissection (LND) in bladder cancer (BCa) patients at the time of radical cystectomy may affect oncologic outcome.Objective
To evaluate whether extended versus limited LND prolongs recurrence-free survival (RFS).Design, setting, and participants
Prospective, multicenter, phase-III trial patients with locally resectable T1G3 or muscle-invasive urothelial BCa (T2-T4aM0).Intervention
Randomization to limited (obturator, and internal and external iliac nodes) versus extended LND (in addition, deep obturator, common iliac, presacral, paracaval, interaortocaval, and para-aortal nodes up to the inferior mesenteric artery).Outcome measurements and statistical analysis
The primary endpoint was RFS. Secondary endpoints included cancer-specific survival (CSS), overall survival (OS), and complications. The trial was designed to show 15% advantage of 5-yr RFS by extended LND.Results and limitations
In total, 401 patients were randomized from February 2006 to August 2010 (203 limited, 198 extended). The median number of dissected nodes was 19 in the limited and 31 in the extended arm. Extended LND failed to show superiority over limited LND with regard to RFS (5-yr RFS 65% vs 59%; hazard ratio [HR] = 0.84 [95% confidence interval 0.58–1.22]; p = 0.36), CSS (5-yr CSS 76% vs 65%; HR = 0.70; p = 0.10), and OS (5-yr OS 59% vs 50%; HR = 0.78; p = 0.12). Clavien grade ≥3 lymphoceles were more frequently reported in the extended LND group within 90 d after surgery. Inclusion of T1G3 tumors may have contributed to the negative study result.Conclusions
Extended LND failed to show a significant advantage over limited LND in RFS, CSS, and OS. A larger trial is required to determine whether extended compared with limited LND leads to a small, but clinically relevant, survival difference (ClinicalTrials.gov NCT01215071).Patient summary
In this study, we investigated the outcome in bladder cancer patients undergoing cystectomy based on the anatomic extent of lymph node resection. We found that extended removal of lymph nodes did not reduce the rate of tumor recurrence in the expected range. 相似文献19.
Seok Cho Jeong Hyeon Lee Seung Hyun Jeon Jinsung Park Sang Hyub Lee Chul Hwan Kim Ji-Youn Sung Joo Heon Kim Jong Hyun Pyun Jeong Gu Lee Je Jong Kim Jun Cheon Sung Gu Kang Seok Ho Kang 《Urologic oncology》2017,35(6):370-378
Objectives
To assess the characteristics of pseudocapsule (PC) in localized renal cell carcinoma (RCC) by analyzing the rates of completeness of PC and pseudocapsular invasion and clinical and pathological risk factors of it.Materials and methods
Between February 2013 and September 2015, data were gathered prospectively from 180 consecutive patients who underwent partial nephrectomy or radical nephrectomy at 3 institutions, and 161 were enrolled. Evaluated factors included age and sex; histologic factors such as tumor diameter, stage, tumor subtype, necrosis, and Fuhrman grade; and clinical factors such as RENAL score; and completeness of PC.Results
Only 94 tumors (58.4%) were surrounded by a continuous PC completely, 62 (38.5%) were partially surrounded, and 5 (3.1%) had no PC. Overall, 56 PCs (34.8%) were free from invasion, 58 PCs (36.0%) had partial invasion of PC without parenchymal invasion, and 47 PCs (29.2%) had parenchymal invasion. Defining parenchymal invasion as true pseudocapsular invasion, histologic diameter, RCC subtype, and completeness of PC were significant predictors for parenchymal invasion on multivariate analysis (P = 0.006, 0.046, and 0.002, respectively).Conclusions
Rate of complete PC in RCC is relatively low in this study. The risk factors for pseudocapsular invasion were a histologic diameter greater than 4 cm, non–clear cell histology, and an incomplete PC. Surgeons must prepare for the possibility of a positive surgical margin if a tumor has at least one of these risk factors. 相似文献20.
