Is there a role of the histologic subtypes of papillary renal cell carcinoma as a prognostic factor?

OBJECTIVE

The aim of this study was to compare type 1 and type 2 papillary renal cell carcinoma (RCC) for validating this subclassification as a prognostic factor.

METHODS

A total of 70 patients with chromophobe RCC were included in the analysis. Patients with papillary RCC were categorized into type 1 (n = 33) and type 2 (n = 37).

RESULTS

The median progression-free survival was 31.0 months for the type 1 group and 12.0 months for the type 2 group (P = 0.001). The median cancer-specific survival was 41.1 months for the type 1 group and 24.0 months for the type 2 group (P = 0.097). Multivariate Cox proportional hazards model for patients with papillary RCC showed that no variables including histologic subtyping were independent predictors of progression-free and cancer-specific survival.

CONCLUSIONS

In the present study, the type of papillary RCC does not reach independent prognostic significance.

Bladder cancer after nephroureterectomy in patients with urothelial carcinoma of the upper urinary tract

OBJECTIVES

To determine the independent risk factors of bladder recurrence in patients with upper urinary tract (UUT) urothelial carcinoma (UC).

MATERIALS AND METHODS

A total of 181 patients with UUT-UC were enrolled in this study. Their median age was 63 years (range 36-90), and median follow-up after total nephroureterectomy was 37.5 months (range 1.0-174.0). The end-point of this study was defined as the initial intravesical recurrence of UC.

RESULTS

Of the 181 patients, 64 (35.4%) developed subsequent bladder tumors at a median interval of 6.3 months (range 1.7-50.1) after initial treatment. By univariate analysis, a previous bladder tumor history (P = 0.046) and tumor necrosis (P < 0.001) were found to have a significant prognostic impact on bladder tumor-free survival in patients with superficial UUT-UC, whereas surgical margin status (P = 0.045) and the use of adjuvant chemotherapy (P = 0.003) were found to be prognostic factors for bladder tumor-free survival in those with invasive UUT-UC. However, by multivariate analysis, only tumor necrosis (P = 0.012, relative risk = 6.512) was found to have a significant impact on intravesical recurrence in patients with superficial UUT-UC. However, surgical margin status (P = 0.007, relative risk = 5.846) and the use of adjuvant chemotherapy (P = 0.001, relative risk = 0.223) were retained as independent predictors of bladder tumor survival in those with invasive UUT-UC.

CONCLUSIONS

Our findings may be useful in patients with UUT-UC who may require more stringent follow-up by cystoscopy to detect bladder tumors.

External validation of an international multicenter study to predict survival in Korean patients with pT2N0M0 renal cell carcinoma

OBJECTIVES

To determine whether a tumor size cut-off can improve the prognostic accuracy of the current tumor-node-metastasis staging system in Korean patients with pT2 renal cell carcinoma (RCC).

METHODS

We identified 819 patients treated with radical nephrectomy for clinical RCC between 1995 and 2005. The study included 102 patients of pT2N0M0 RCC.

RESULTS

When 5-year survival rates were calculated using 0.5-cm increments between 7.5 and 12.5 cm, none of the cut-offs provided a significant difference in 5-year overall and cancer-specific survival. Cut-offs of 9.5 and 10.0 cm provided significant difference in 5-year progression-free survival (log-rank score 4.37, P = .037; log-rank score 6.75, P = .009, respectively). However, a 10.5-cm cut-off provided the greatest difference in 5-year progression-free survival (log-rank score 7.19; P = .007). Multivariate Cox proportional hazards model analysis using the variables of age, sex, American Society of Anesthesiologists score, tumor side, histologic type, tumor grade, and tumor diameters showed that tumor diameter was an independent predictor of progression-free survival when 10.0 cm (hazard ratio [HR], 2.72; 95% confidence interval [CI] 1.19-6.22; P = .018), and 10.5 cm (HR, 2.77; 95% CI 1.21-6.33; P = .016) were chosen as the cut-offs.

CONCLUSIONS

In our study, only size-related recurrence or metastatic potential was found, and a 10.5-cm cut-off best stratified this difference. However, size-related cancer-specific and overall survival differences were not found among patients.

Chronic pulmonary disease negatively influences the prognosis of patients with advanced prostate cancer

OBJECTIVE

We examined the prognostic value of chronic pulmonary disease (CPD), which can cause hypoxemic hypoxia possibly resulting in tumor hypoxia, in patients with advanced prostate cancer (APC).

METHODS

We evaluated 295 patients with APC who had initially received androgen deprivation therapy. The progression to hormone refractory prostate cancer (HRPC), and the overall and disease specific survival were analyzed; the relationship to clinicopathological variables, including the presence of CPD, result of pulmonary function tests (PFT), smoking history and hemoglobin level were evaluated by the Kaplan-Meier method. A multivariate analysis was then performed according to the Cox regression model.

RESULTS

The median time to HRPC was 14 and 38 months in patients with and without CPD, respectively (P = 0.001). The median overall survival from diagnosis was 51 and 81 months (P = 0.007), and the median disease specific survival was 56 and 135 months, respectively (P = 0.008). A univariate analysis showed that the result of PFT was a significant variable for progression to HRPC. In addition, the hemoglobin level (11.4 g/dl, 25th percentile) was a significant variable for overall and disease specific survival. As a result of the multivariate analysis, the presence of CPD was an independent prognostic variable for progression to HRPC, as were the Gleason score and stage. As well, CPD was an independent prognostic variable for overall and disease specific survival, as were alkaline phosphatase levels and nadir PSA.

CONCLUSION

Our findings strongly implicate CPD as a factor that contributes to a poor prognosis in patients with APC.

A comparison of prostate cancer detection rates by 12 or 6 core biopsy at different prostate-specific antigen densities in Korean men

OBJECTIVES

To evaluate the diagnostic value of 12 core biopsy versus sextant biopsy at different prostatic-specific antigen densities (PSAD).

METHODS

We retrospectively analyzed the records of 1,463 patients who underwent transrectal ultrasound-guided prostate biopsies at our institution. 995 patients underwent 12 core biopsy and 468 sextant biopsy of the prostate. The cancer detection rates achieved by these two methods were analyzed at different PSAD levels.

RESULTS

All patients were stratified into 5 groups according to PSAD level; group A: PSAD < 0.1 (n = 290), group B: 0.1 < or = PSAD < 0.2 (n = 572), group C: 0.2 < or = PSAD < 0.3 (n = 248), group D: 0.3 < or = PSAD < 0.4 (n = 122), and group E: PSAD > or = 0.4 (n = 231). In group B, 12 core biopsy had a higher detection rate than 6 core biopsy (P = 0.017).

CONCLUSIONS

These results demonstrate 12 core biopsy is better able to detect cancer than 6 core biopsy in patients with a PSAD in the range 0.1-0.2, which suggests that PSAD be considered when deciding on the number of prostate biopsy cores required.

Expression of CD24 in clear cell renal cell carcinoma and its prognostic significance

OBJECTIVES

To evaluate the expression patterns of CD24 in clear cell renal cell carcinoma (CCRCC) and to investigate its prognostic significance. CD24 is a cell adhesion molecule that has been thought to play an important role in tumor progression and metastasis of various cancers. CD24 expression has previously been reported in RCC, although little is known about its prognostic significance.

METHODS

We immunohistochemically analyzed CD24 expression using tissue microarray in 328 cases of CCRCC. The percentage of positively stained tumor cells was evaluated and classified into four categories: 0, 0%; 1+, 1% to 10%; 2+, 11% to 50%; and 3+, more than 50%. For statistical analysis, the cases were subdivided into a CD24-low-expression group (0 and 1+) and CD24-high-expression group (2+ and 3+).

RESULTS

High CD24 expression was significantly associated with a high nuclear grade (P = 0.005) and large tumor size (P = 0.04). The survival analysis revealed no significant association between CD24 expression and disease-specific survival (P = 0.141). However, the CD24-high-expression group had a significantly shortened progression-free survival (P = 0.005). Multivariate analysis also revealed that high CD24 expression was an independent covariate for poor progression-free survival (P = 0.043).

CONCLUSIONS

We investigated CD24 expression in CCRCC and found that high CD24 expression was associated with high nuclear grade, large tumor size, and shortened progression-free survival. Although the biologic function of CD24 in CCRCC remains unknown, the expression of CD24 can provide new prognostic information about disease progression.

High-dose terazosin therapy (5mg) in Korean patients with lower urinary tract symptoms with or without concomitant hypertension: a prospective, open-label study

PURPOSE

We determined the efficacy and safety of a relatively high dose of terazosin (5mg) in Korean patients with lower urinary tract symptoms (LUTS), with or without concomitant hypertension.

MATERIALS AND METHODS

From July to December 2006, 200 men who consecutively presented with LUTS were prospectively studied. Eight weeks after treatment, blood pressure (BP), uroflowmetry, and International Prostate Symptom Score (I-PSS) were assessed. For analysis purposes, patients were stratified according to concomitant hypertension. Of the 200 patients, 173 completed the scheduled eight-week treatment period.

RESULTS

At baseline, no differences were evident in the two groups in terms of I-PSS, Qmax, PVR and BP. After eight weeks of treatment-although I-PSS and uroflowmetry parameters were not significantly different in the two groups-systolic and diastolic BP in the non-hypertensive control group were higher than in the hypertensive group (p= 0.001 and p=0.0100, respectively). Changes in I-PSS, uroflowmetry parameters, and BPs measured at week eight post- treatment commencement did not significantly differ between the two groups. Moreover, the addition of 5mg of terazosin to antihypertensives did not cause a significant reduction in either systolic or diastolic BP in either group.

CONCLUSION

Adding terazosin to existing antihypertensive regimens did not seem to increase the incidence of adverse events. Our findings suggest that 5mg terazosin is effective and that it has an acceptable safety profile as an add-on therapy for patients with LUTS and concomitant hypertension.

WITHDRAWN: Prognostic factors of biochemical recurrence after radical prostatectomy in Korean men with high-risk prostate cancer

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No role of adjuvant systemic therapy after complete metastasectomy in metastatic renal cell carcinoma?

OBJECTIVE

To compare the effects of metastasectomy combined with immunotherapy and metastasectomy alone in the treatment of patients with metastatic renal cell carcinoma.

MATERIALS AND METHODS

A total of 93 patients who had undergone metastasectomy were included in the study. Patients were categorized according to immunotherapy status, including the immunotherapy group (n = 70) and the no immunotherapy group (n = 23).

RESULTS

In the immunotherapy group, median overall survival was 56.1 months (95% confidence interval [CI] 34.1-78.2), whereas the no immunotherapy group reached a median overall survival of 21.3 months (95% CI 3.4-39.2), respectively. The 1, 3, and 5-year overall survival rates were calculated at 67.1% and 56.5%, 30.0% and 34.8%, and 7.1% and 19.0%, for the immunotherapy group and the no immunotherapy group, respectively (P = 1.000). When patients were stratified according to the time of metastasis, overall survival was not significantly different among the groups in patients with synchronous metastasis or in those with metachronous metastasis. Multivariate Cox proportional hazards model analysis showed that multiplicity of metastasis (odds ratio 3.68; 95% CI 1.85-7.34; P < 0.001) and metastatic sites (odds ratio 2.12; 95% CI 1.15-3.90; P = 0.016) were independent predictors of overall survival.

CONCLUSIONS

Metastasectomy combined with adjuvant immunotherapy did not result in a significantly higher overall survival rate as compared with metastasectomy alone. Our findings raise the question of "Is there a role of adjuvant immunotherapy after complete metastasectomy in patients with metastatic renal cell carcinoma?"

Metastasectomy without Systemic Therapy in Metastatic Renal Cell Carcinoma: Comparison with Conservative Treatment

AIM

The objective of this study was to evaluate the efficacy of metastasectomy after nephrectomy in patients with metastatic renal cell carcinoma who had not received systemic therapy.

PATIENTS AND METHODS

A total of 62 patients were included in the study. The patients were categorized according to their surgical treatment: the metastasectomy group (n = 21) and the nonmetastasectomy group (n = 41).

RESULTS

In the metastasectomy group, the median overall survival was 36.5 (range 4.0-182.7) months, whereas the patients of the nonmetastasectomy group reached a median overall survival of 8.4 (range 0.9-63.7) months (p < 0.001). The 1-, 3-, and 5-year overall survival rates were calculated at 71.4 and 34.1%, 47.6 and 9.8%, and 9.8 and 2.4%, respectively (p < 0.001). When the patients were stratified according to their characteristics, the overall survival was lower in the nonmetastasectomy group than in the metastasectomy group in the younger patients (p = 0.002), in both male (p = 0.001) and female (p = 0.030) patients, in patients with a poor performance status (p = 0.027), in patients with a shorter time between diagnosis of the primary tumor and development of metastases (p < 0.001), and in patients with a solitary metastasis (p = 0.005). Multivariate analysis using the Cox proportional hazards model showed that only the metastasectomy status was an independent predictor of the overall survival (Hazard ratio 2.57, 95% confidence interval 1.21-5.44; p = 0.014).

CONCLUSION

Our findings suggest that for the management of metastatic renal cell carcinoma, complete surgical resection of the metastatic lesions may prolong survival even in patients with some poor prognostic factors who cannot or are not willing to receive systemic therapy.