51
|
Emerson RE, Kao CS, Eble JN, Grignon DJ, Wang M, Zhang S, Wang X, Fan R, Masterson TA, Roth LM, Cheng L. Evidence of a dual histogenetic pathway of sacrococcygeal teratomas. Histopathology 2016; 70:290-300. [DOI: 10.1111/his.13062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/12/2016] [Indexed: 12/19/2022]
|
52
|
Kaimakliotis HZ, Monn MF, Cho JS, Pedrosa JA, Hahn NM, Albany C, Gellhaus PT, Cary KC, Masterson TA, Foster RS, Bihrle R, Cheng L, Koch MO. Neoadjuvant chemotherapy in urothelial bladder cancer: impact of regimen and variant histology. Future Oncol 2016; 12:1795-804. [DOI: 10.2217/fon-2016-0056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We compared the efficacy of methotrexate/vinblastine/doxorubicin/cisplatin (MVAC) versus gemcitabine/cisplatin in urothelial cancer and neoadjuvant chemotherapy (NACT) efficacy in variant histology (VH). Materials & methods: Radical cystectomy patients were retrospectively compared with those who received NACT. Factors associated with survival, pathologic complete response (pCR) and downstaging (pDS) were evaluated in multivariable models. Results: 9% of radical cystectomy patients (84/919) received NACT, with improved survival, pCR and pDS on both regimens. MVAC lead to higher pDS without an increase in pCR. On multivariable analysis, there was a nonsignificant increase in pDS with MVAC. NACT conferred similar responses in squamous and glandular differentiation VH. Conclusion: NACT was associated with improved survival, pCR and pDS. Furthermore, responses to NACT were not dependent on presence of VH.
Collapse
|
53
|
Hahn NM, Bivalacqua TJ, Ross A, Netto GJ, Park JC, Masterson TA, Koch MO, Bihrle R, Foster R, Gardner TA, Cheng L, Jones DR, McElyea K, Sandusky G, Liu Z, Turner SA, Tsongalis GJ, Plimack ER, Greenberg RE, Geynisman DM. Phase 2 trial of dovitinib in Bacillus Calmette-Guerin (BCG) refractory urothelial carcinoma (UC) with tumor FGFR3 mutations or over-expression: Hoosier Cancer Research Network GU12-157. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.4526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
54
|
Jacob JM, Kaimakliotis HZ, Liu NW, Cho JS, Monn F, Cary C, Masterson TA, Gardner TA, Foster RS, Bihrle R, Koch MO. MP56-02 EMPIRIC TREATMENT OF IDENTIFIED CLOSTRIDIUM DIFFICILE CARRIERS AT TIME OF CYSTECTOMY: PRELIMINARY OUTCOMES. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
55
|
Blute ML, Masterson TA, Master VA, Margulis V, Lorentz CA, Bauman TM, Karam JA, Wood CG, Abel EJ. PD41-02 NOMOGRAM TO PREDICT RECURRENCE IN NON-METASTATIC RCC WITH THROMBUS USING A MULTI-CENTER CONTEMPORARY SERIES. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
56
|
Masterson TA, Cary C, Cheng L. Early detection of prostate cancer: can we have our cake and eat it too? Expert Rev Anticancer Ther 2016; 16:247-9. [PMID: 26760708 DOI: 10.1586/14737140.2016.1139459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
57
|
Hahn NM, Cramer HM, Badve SS, Cheng L, Gokmen-Polar Y, Miller DF, Buechlein A, Rusch DB, Fang F, Frankhouser D, Bundschu R, Javkhlan-Ochir G, Koch MO, Bihrle R, Foster R, Masterson TA, Gardner TA, Yan P, Nephew KP, Marchionni L. Identification of novel immunomodulatory tumor biology through comprehensive characterization of a metastases-specific epigenome in patients with metachronous primary and metastatic urothelial carcinoma (UC) tumor pairs. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
452 Background: The Cancer Genome Atlas project identified a distinct cluster of hypermethylated muscle-invasive UC tumors in one third of patients. It is unknown if this epigenetic biology persists or changes in UC metastases. The present study aimed to identify uniquely hypermethylated regions in UC metastases compared to their matched primary tumors. Methods: UC patients with paired formalin fixed paraffin embedded tissue samples ( > 75% tumor) from primary and metachronous metastatic tumors were identified. DNA methylation was analyzed on the Illumina HiSeq platform by double-enzyme reduced representation bisulfite sequencing (dRRBS). Results were analyzed by BS-seq within BSmooth open source software. Alignment and methylation estimation was done using Bismark open source software. CpG regions with coverage < 2 in more than 66% of samples were removed to reduce false positive results. Differentially methylated regions (DMRs) in metastases compared to primary tumors were determined by paired t-test. Gene set enrichment analysis (GSEA) of the top 5% DMRs was performed utilizing multiple gene set collections including c7IMMUNO. A false discovery rate of < 10% defined significant DMRs. Results: 15 UC primary/metachronous metastases pairs were analyzed. After filtering for low coverage, 1,781,762 loci remained for analysis. After merging loci within 2500 bp of each other, the top 5% DMRs resulted in 18,452 DMRs. GSEA including the c7IMMUNO gene set identified multiple previously undescribed hypermethylated genes modulating immune function through TGF-beta and Treg signaling including: TGFBR2, TGFBR3, SMAD1, SMAD3, SMAD4, BACH1, BACH2, and VDR all q < 0.05. Conclusions: We identified numerous genes with immunomodulatory functions significantly hypermethylated in UC metastases compared to their matched primary tumors. Our findings provide rationale to examine epigenetic approaches as a means to improve clinical outcomes of UC patients treated with immunotherapy. Our small sample size limits definitive conclusions and warrants validation in independent data sets.
Collapse
|
58
|
Liu NW, Shatagopam K, Monn MF, Kaimakliotis HZ, Cary C, Boris RS, Mellon MJ, Masterson TA, Foster RS, Gardner TA, Bihrle R, House MG, Koch MO. Risk for Clostridium difficile infection after radical cystectomy for bladder cancer: Analysis of a contemporary series. Urol Oncol 2015; 33:503.e17-22. [PMID: 26278363 DOI: 10.1016/j.urolonc.2015.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/23/2015] [Accepted: 07/10/2015] [Indexed: 12/23/2022]
Abstract
INTRODUCTION This study seeks to evaluate the incidence and associated risk factors of Clostridium difficile infection (CDI) in patients undergoing radical cystectomy (RC) for bladder cancer. METHODS We retrospectively reviewed a single institution׳s bladder cancer database including all patients who underwent RC between 2010 and 2013. CDI was diagnosed by detection of Clostridium difficile toxin B gene using polymerase chain reaction-based stool assay in patients with clinically significant diarrhea within 90 days of the index operation. A multivariable logistic regression model was used to identify demographics and perioperative factors associated with developing CDI. RESULTS Of the 552 patients who underwent RC, postoperative CDI occurred in 49 patients (8.8%) with a median time to diagnosis after RC of 7 days (interquartile range: 5-19). Of the 122 readmissions for postoperative complications, 10% (n = 12) were related to CDI; 2 patients died of sepsis directly related to severe CDI. On multivariate logistic regression, the use of chronic antacid therapy (odds ratio = 1.9, 95% CI: 1.02-3.68, P = 0.04) and antibiotic exposure greater than 7 days (odds ratio = 2.2, 95% CI: 1.11-4.44, P = 0.02) were independently associated with developing CDI. The use of preoperative antibiotics for positive findings on urine culture within 30 days before surgery was not statistically significantly associated with development of CDI (P = 0.06). CONCLUSIONS The development of CDI occurs in 8.8% of patients undergoing RC. Our study demonstrates that use of chronic antacid therapy and long duration of antimicrobial exposure are associated with development of CDI. Efforts focusing on minimizing antibiotic exposure in patients undergoing RC are needed, and perioperative antimicrobial prophylaxis guidelines should be followed.
Collapse
|
59
|
Liu NW, Cary C, Strine AC, Beck SDW, Masterson TA, Bihrle R, Foster RS. Risk of Recurrence for Clinical Stage I and II Patients With Teratoma Only at Primary Retroperitoneal Lymph Node Dissection. Urology 2015; 86:981-4. [PMID: 26232690 DOI: 10.1016/j.urology.2015.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/12/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the oncologic outcomes of patients with retroperitoneal teratoma only at primary retroperitoneal lymph node dissection (RPLND) who did not receive adjuvant chemotherapy. MATERIALS AND METHODS Between 1979 and 2010, 23 patients with clinical stage (CS) I and II disease underwent primary RPLND at our institution with teratoma only in the retroperitoneum. No patient received adjuvant chemotherapy and the minimum follow-up was 2 years. RESULTS At the initial diagnosis, 13 patients (56.5%) had CS I disease and 10 patients (43.5%) had CS II disease. Pathologic staging demonstrated IIA in 13 patients (56.5%), IIB in 8 patients (34.8%), and IIC in 2 patients (8.7%). The 5-year disease-free survival (DFS) was 100% with a median follow-up of 5.8 years (range, 2.1-25.4). DFS was not significantly different comparing pathologic stage IIA vs IIB/IIC disease (P = .73). Two patients (14%) developed late relapses. One patient had a pelvic recurrence 11 years after primary RPLND. Final pathology from the pelvic resection demonstrated embryonal carcinoma. He remains disease free after his second surgery. The second patient had a contralateral retroperitoneal recurrence with yolk-sac tumor and teratoma 11 years after primary RPLND. He was treated with chemotherapy followed by postchemotherapy RPLND. CONCLUSION The relapse rate for patients with teratoma only at primary RPLND is low irrespective of PS. Adjuvant chemotherapy is therefore not recommended in the management of these patients.
Collapse
|
60
|
Lee HJ, Yue S, Li J, Lee SY, Shao T, Song B, Cheng L, Masterson TA, Liu X, Ratliff TL, Cheng JX. Abstract A06: Cholesteryl ester accumulation induced by PTEN loss and PI3K/AKT activation underlies human prostate cancer aggressiveness. Mol Cancer Ther 2015. [DOI: 10.1158/1538-8514.pi3k14-a06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Altered lipid metabolism is increasingly recognized as a signature of cancer cells. Enabled by label-free Raman spectromicroscopy, we performed quantitative analysis of lipogenesis at single-cell level in human patient cancerous tissues. Our imaging data revealed an unexpected, aberrant accumulation of esterified cholesterol in lipid droplets of high-grade prostate cancer and metastases. Biochemical study showed that such cholesteryl ester accumulation was a consequence of loss of tumor suppressor PTEN and subsequent activation of PI3K/AKT pathway in prostate cancer cells. Furthermore, we found that such accumulation arose from significantly enhanced uptake of exogenous lipoproteins and required cholesterol esterification. Depletion of cholesteryl ester storage significantly reduced cancer proliferation, impaired cancer invasion capability, and suppressed tumor growth in mouse xenograft models with negligible toxicity. These findings open opportunities for diagnosing and treating prostate cancer by targeting the altered cholesterol metabolism.
Citation Format: Hyeon Jeong Lee, Shuhua Yue, Junjie Li, Seung-Young Lee, Tian Shao, Bing Song, Liang Cheng, Timothy A. Masterson, Xiaoqi Liu, Timothy L. Ratliff, Ji-Xin Cheng. Cholesteryl ester accumulation induced by PTEN loss and PI3K/AKT activation underlies human prostate cancer aggressiveness. [abstract]. In: Proceedings of the AACR Special Conference: Targeting the PI3K-mTOR Network in Cancer; Sep 14-17, 2014; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(7 Suppl):Abstract nr A06.
Collapse
|
61
|
Pedrosa JA, Masterson TA, Rice KR, Kaimakliotis HZ, Monn MF, Bihrle R, Koch MO, Boris RS. Oncologic outcomes and prognostic impact of urothelial recurrences in patients undergoing segmental and total ureterectomy for upper tract urothelial carcinoma. Can Urol Assoc J 2015; 9:E187-92. [PMID: 26085878 DOI: 10.5489/cuaj.2408] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION We evaluated the impact of urothelial recurrences in a cohort of patients undergoing segmental (SU) and total ureterectomy (TU) as an alternative to nephroureterectomy (NU) for upper tract urothelial carcinoma. METHODS Between 1999 and 2012, patients who underwent SU, TU and NU for treatment of upper tract urothelial carcinoma were evaluated. Demographic, surgical, pathologic and oncologic data were collected. Recurrence-free (RFS) and disease-specific survival (DSS) were analyzed using Kaplan-Meier and multivariable Cox methods. RESULTS A total 141 patients were evaluated, 35 underwent SU, 10 TU and 96 NU. Patients who underwent TU were more likely to have bilateral disease (p < 0.01), solitary kidney (p < 0.01), and multifocal disease (p = 0.01). Organ-confined (p < 0.01) and low-grade disease (p < 0.01) were more common in the TU and SU groups compared with NU. At a median follow-up of 56.9 months (range: 0.2-181.1) disease relapse occurred in 88 (55.3%) patients. Localized recurrence occurred in 31.1% of SU/TU group compared to 27.1% (p = 0.62) of the NU group. Neither total nor segmental ureterectomy demonstrated significantly worse RFS (p = 0.26 and p = 0.81), CSS (p = 0.96 and p = 0.52) or overall survival (p = 0.59 and p = 0.55) compared with complete NU. Localized urothelial recurrence did not confer increased risk of cancer-specific (p = 0.73) or overall mortality (p = 0.39). The paper's most important limitations include its retrospective nature and its relatively small number of patients. CONCLUSION No significant survival differences were demonstrated between surgical approaches for upper tract urothelial cancer. Localized urothelial recurrence after surgical treatment for upper tract urothelial cancer does not affect mortality in this population. TU with ileal-substitution may provide an alternative option for patients with extensive ureteral disease and poor renal function.
Collapse
|
62
|
Masterson TA, Cary C, Rice KR, Foster RS. The Evolution and Technique of Nerve-Sparing Retroperitoneal Lymphadenectomy. Urol Clin North Am 2015. [PMID: 26216818 DOI: 10.1016/j.ucl.2015.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The evolution of retroperitoneal lymph node dissection technique and associated template modifications for nonseminomatous germ cell tumors have resulted in significant improvement in the long-term morbidity. Through the preservation of sympathetic nerves via exclusion from or prospective identification within the boundaries of resection, maintenance and recovery of antegrade ejaculation are achieved. Nerve-sparing strategies in early-stage disease are feasible in most patients. Postchemotherapy, select patients can be considered for nerve preservation. This article describes the anatomic and physiologic basis for, indications and technical aspects of, and functional and oncologic outcomes reported after nerve-sparing retroperitoneal lymphadenectomy in testicular cancer.
Collapse
|
63
|
Bahler CD, Cary KC, Garg S, DeRoo EM, Tabib CH, Kansal JK, Monn MF, Flack CK, Masterson TA, Sandrasegaran MK, Foster RS, Sundaram CP. Differentiating reconstructive techniques in partial nephrectomy: a propensity score analysis. THE CANADIAN JOURNAL OF UROLOGY 2015; 22:7788-7796. [PMID: 26068626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION To assess whether volumetric measurements can differentiate functional changes between reconstructive techniques after partial nephrectomy. MATERIALS AND METHODS One hundred and fifty-six patients undergoing partial nephrectomy for a single renal mass were retrospectively studied between 2008 and 2012. Computed tomography scans were available for volume calculations on 56 (18 non-renorrhaphy and 38 renorrhaphy). Institutional review board approval was obtained. The primary outcome was %volume loss in the operated kidney, which was calculated from three-dimensional reconstructions using a semiautomatic segmentation algorithm. Multivariable regression and propensity score analysis was performed. RESULTS Volumetric analysis detected a difference in mean %volume loss between two-layer reconstruction (cortical renorrhaphy and base-layer) and base-layer only (15.6% versus 3.8%, p < 0.001). The mean %glomerular filtration rate (GFR) loss was also greater in the two-layer group (8.9% versus 2.4%, p = 0.03). Demographics were similar between groups except the two-layer group was older, had more males, and increased ischemia time. On multivariable regression the presence of two-layer closure (β = -15.2%, p < 0.001) and tumor diameter (β = -7.4, p = 0.004) were significant predictors of %volume loss while ischemia time (p = 0.88) was not. Two-layer closure remained a predictor on propensity-adjusted analysis (β = -14.3, p = 0.004). The base-layer only group had two (5.3%) urine leaks and two (5.3%) bleeding complications. The two-layer group had two (1.7%) urine leaks and three (2.5%) bleeding complications (p = 0.23, 0.41). CONCLUSIONS Volume loss calculated from CT scans can be used to monitor postoperative renal function. Techniques for renal reconstruction and tumor diameter are associated with volume and functional loss after partial nephrectomy and should be controlled for in future studies.
Collapse
|
64
|
Cho JS, Kaimakliotis H, Cary KC, Masterson TA, Bihrle R, Foster RS. MP10-17 MANAGEMENT OF CHYLOUS LEAK AFTER RETROPERITONEAL LYMPH NODE DISSECTION FOR ADVANCED TESTICULAR CANCER. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
65
|
Cho JS, Kaimakliotis H, Masterson TA, Cary KC, Bihrle R, Foster RS. MP10-08 MODIFIED TEMPLATE RETROPERITONEAL LYMPH NODE DISSECTION FOR POSTCHEMOTHERAPY RESIDUAL TUMOR: A LONG TERM UPDATE. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
66
|
Monn MF, Kaimakliotis HZ, Cary KC, Bihrle R, Pedrosa JA, Masterson TA, Foster RS, Gardner TA, Cheng L, Koch MO. The changing reality of urothelial bladder cancer: should non-squamous variant histology be managed as a distinct clinical entity? BJU Int 2015; 116:236-40. [DOI: 10.1111/bju.12877] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
67
|
Kerian KS, Jarmusch AK, Pirro V, Koch MO, Masterson TA, Cheng L, Cooks RG. Differentiation of prostate cancer from normal tissue in radical prostatectomy specimens by desorption electrospray ionization and touch spray ionization mass spectrometry. Analyst 2015; 140:1090-8. [PMID: 25521825 PMCID: PMC4314440 DOI: 10.1039/c4an02039a] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Radical prostatectomy is a common treatment option for prostate cancer before it has spread beyond the prostate. Examination for surgical margins is performed post-operatively with positive margins reported to occur in 6.5-32% of cases. Rapid identification of cancerous tissue during surgery could improve surgical resection. Desorption electrospray ionization (DESI) is an ambient ionization method which produces mass spectra dominated by lipid signals directly from prostate tissue. With the use of multivariate statistics, these mass spectra can be used to differentiate cancerous and normal tissue. The method was applied to 100 samples from 12 human patients to create a training set of MS data. The quality of the discrimination achieved was evaluated using principal component analysis - linear discriminant analysis (PCA-LDA) and confirmed by histopathology. Cross validation (PCA-LDA) showed >95% accuracy. An even faster and more convenient method, touch spray (TS) mass spectrometry, not previously tested to differentiate diseased tissue, was also evaluated by building a similar MS data base characteristic of tumor and normal tissue. An independent set of 70 non-targeted biopsies from six patients was then used to record lipid profile data resulting in 110 data points for an evaluation dataset for TS-MS. This method gave prediction success rates measured against histopathology of 93%. These results suggest that DESI and TS could be useful in differentiating tumor and normal prostate tissue at surgical margins and that these methods should be evaluated intra-operatively.
Collapse
|
68
|
Rice KR, Beck SDW, Pedrosa JA, Masterson TA, Einhorn LH, Foster RS. Surgical management of late relapse on surveillance in patients presenting with clinical stage I testicular cancer. Urology 2015; 84:886-90. [PMID: 25260450 DOI: 10.1016/j.urology.2014.05.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/28/2014] [Accepted: 05/12/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine survival outcomes in clinical stage I germ cell tumor (GCT) patients requiring retroperitoneal lymph node dissection (RPLND) for late relapse (LR) occurring while on surveillance. METHODS The Indiana University Testis Cancer Database was queried from 1985 to 2013 to identify all patients who presented with clinical stage I GCT, elected surveillance, relapsed ≥ 2 years after initial diagnosis, and underwent RPLND in treatment of their LR. Clinical, pathologic, and treatment characteristics were reviewed. RESULTS Twenty-eight patients met inclusion criteria. The mean age at diagnosis was 29.3 years. Testicular primary was pure seminoma in 2, intratubular germ cell neoplasia with scar in 1, nonseminomatous GCT in 24, and unknown in 1 patient. The median time from diagnosis to relapse was 48.5 months (range, 28-321 months). At relapse, serum tumor markers were elevated in 13 patients (46.4%). Nineteen patients were given cisplatin-based chemotherapy at LR. RPLND was initial management of LR in 9. At RPLND, 10, 5, and 13 patients demonstrated fibrosis, teratoma, and viable malignancy, respectively. On the last follow-up, 24 patients (85.7%) were free of disease and 4 patients (14.3%) had died of their disease. CONCLUSION When examining outcomes among patients undergoing RPLND at LR of GCT, it appears that patients experiencing LR on surveillance have more favorable histology and survival outcomes than previously reported for unselected patients experiencing LR.
Collapse
|
69
|
Pedrosa JA, Koch MO, Kaimakliotis HZ, Monn MF, Masterson TA, Rice KR, Cary KC, Foster RS, Bihrle R, Cheng L. Three-tiered nodal classification system for bladder cancer: a new proposal. Future Oncol 2015; 11:399-408. [DOI: 10.2217/fon.14.267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Aim: To evaluate a three-tiered prognostic stratification using one, two to five and >five positive lymph nodes (LNs) and this nodal staging system performs across different pelvic LN dissection (PLND) templates and adjuvant chemotherapy status. Methods: We evaluated 244 patients with positive LN urothelial cancer who underwent radical cystectomy and PLND between 2000 and 2011. Survival analyses utilizing the Kaplan-Meier method and log rank test were performed. Median follow-up was 55.3 months (range: 0.4–141). Multivariable Cox proportional hazards models were built to evaluate the prognostic stratification. Results: Extended PLND template was performed on 152 (62.3%) patients and standard on 92 (37.7%). The median number of LNs resected was 14 in the standard group vs 22 in the extended group (p < 0.01) and positive LNs was 2 vs 3 (p = 0.09), respectively. Stratification in patients with: one positive LN, two to five positive LNs or >five positive LNs lead to 5-year recurrence-free survival of: 48.6, 34.5 and 15.9% for each group, while the 5-year overall survival was: 43.0, 22.1 and 11.3%, respectively. Stratification in the three groups was also verified irrespective of PLND template and adjuvant chemotherapy. Two multivariable models confirmed the findings when controlling for demographic features and known pathologic risk factors. Conclusion: Three-tiered nodal classification system using the number of metastatic LNs (one, two to five and >five) stratifies patients with lymphatic disease into distinct prognostic groups.
Collapse
|
70
|
Cary KC, Pedrosa JA, Kaimakliotis HZ, Masterson TA, Einhorn LH, Foster RS. The Impact of Bleomycin on Retroperitoneal Histology at Post-Chemotherapy Retroperitoneal Lymph Node Dissection of Good Risk Germ Cell Tumors. J Urol 2015; 193:507-12. [DOI: 10.1016/j.juro.2014.09.090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2014] [Indexed: 10/24/2022]
|
71
|
Strine AC, Rice KR, Masterson TA. Metabolic syndrome in the development and progression of prostate cancer. World J Clin Urol 2014; 3:168-183. [DOI: 10.5410/wjcu.v3.i3.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 06/12/2014] [Accepted: 07/14/2014] [Indexed: 02/06/2023] Open
Abstract
Prostate cancer (PCa) is the most common noncutaneous malignancy and second leading cause of cancer-specific mortality for men in the United States. There is a wide spectrum of aggressiveness ranging from biologically significant to indolent disease, which has led to an interest in the identification of risk factors for its development and progression. Emerging evidence has suggested an association between metabolic syndrome (MetS) and PCa. MetS represents a cluster of metabolic derangements that confer an increased risk of cardiovascular disease and type 2 diabetes mellitus. Its individual components include obesity, dyslipidemias, high blood pressure, and high fasting glucose levels. MetS has become pervasive and is currently associated with a high socioeconomic cost in both industrialized and developing countries throughout the world. The relationship between MetS and PCa is complex and yet to be fully defined. A better understanding of this relationship will facilitate the development of novel therapeutic targets for the prevention of PCa and improvement of outcomes among diagnosed men in the future. In this review, we evaluate the current evidence on the role of MetS in the development and progression of PCa. We also discuss the clinical implications on the management of PCa and consider the future direction of this subject.
Collapse
|
72
|
Monn MF, Gellhaus PT, Patel AA, Masterson TA, Tann M, Boris RS. Can radiologists and urologists reliably determine renal mass histology using standard preoperative computed tomography imaging? J Endourol 2014; 29:391-6. [PMID: 25222030 DOI: 10.1089/end.2014.0560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To determine the extent to which radiologists and urologists can predict histology using multiphasic CT imaging. METHODS Patients with a preoperative multiphasic CT undergoing surgery for a renal mass were identified between 2003 and 2013. Tumors >10 cm, locally advanced or metastatic disease, and patients managed by reviewers were excluded. A survey and deidentified scans were provided to reviewers. Sensitivity and accuracy in predicting histology was calculated for each reviewer. Correlation was assessed by the Fleiss kappa coefficient. Multivariable logistic regression determined factors associated with predictive accuracy for final pathology. RESULTS There were 120 patients who met criteria. Mean tumor size was 3.3 cm; there were 102 (85%) that were malignant, and 73% of these were clear-cell renal-cell carcinoma (RCC). The most common benign histology was angiomyolipoma (n=10, 56%) followed by oncocytoma (n=5, 28%). Correlation among reviewers was statistically fair for predicting malignant (κ=0.25) and final pathology (κ=0.22). Sensitivity for predicting malignant masses was 90%. Reviewers accurately predicted malignant pathology in 82% of cases and predicted final pathology in 58% of cases. Adjusted for size, scan type, and reviewer, clear-cell RCC vs benign histology was associated with 21 times increased odds of accurate pathologic identification (P<0.001). CONCLUSIONS Urologists and radiologists were able to accurately identify malignant histology in 82% of cases, although sensitivity for malignant histology was 90%. Developing a preoperative nomogram for identification of clear-cell RCC may be feasible and should be further explored.
Collapse
|
73
|
Pedrosa JA, Kaimakliotis HZ, Monn MF, Cary KC, Masterson TA, Rice KR, Foster RS, Bihrle R, Koch MO, Cheng L. Critical analysis of the 2010 TNM classification in patients with lymph node–positive bladder cancer: Influence of lymph node disease burden. Urol Oncol 2014; 32:1003-9. [DOI: 10.1016/j.urolonc.2014.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
|
74
|
Kaimakliotis HZ, Monn MF, Cary KC, Pedrosa JA, Rice K, Masterson TA, Gardner TA, Hahn NM, Foster RS, Bihrle R, Cheng L, Koch MO. Plasmacytoid variant urothelial bladder cancer: is it time to update the treatment paradigm? Urol Oncol 2014; 32:833-8. [PMID: 24954925 DOI: 10.1016/j.urolonc.2014.03.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/12/2014] [Accepted: 03/08/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Plasmacytoid variant (PCV) urothelial cancer (UC) of the bladder is rare, with poor clinical outcomes. We sought to identify factors that may better inform expectations of tumor behavior and improve management options in patients with PCV UC. MATERIALS AND METHODS A retrospective analysis of the Indiana University Bladder Cancer Database between January 2008 and June 2013 was performed comparing 30 patients with PCV UC at cystectomy to 278 patients with nonvariant (NV) UC at cystectomy who underwent surgery for muscle-invasive disease. Multivariable logistic regression was used to assess precystectomy variables associated with non-organ-confined disease at cystectomy and Cox regression analysis to assess variables associated with mortality. RESULTS Patients with PCV UC who were diagnosed with a higher stage at cystectomy (73% pT3-4 vs. 40%, P = 0.001) were more likely to have lymph node involvement (70% vs. 25%, P<0.001), and positive surgical margins were found in 40% of patients with PCV UC vs. 10% of patients with NV UC (P<0.001). Median overall survival and disease-specific survival were 19 and 22 months for PCV, respectively. Median overall survival and disease-specific survival had not been reached for NV at 68 months (P<0.001). Presence of PCV UC on transurethral resection of bladder tumor was associated with non-organ-confined disease (odds ratio = 4.02; 95% CI: 1.06-15.22; P = 0.040), and PCV at cystectomy was associated with increased adjusted risk of mortality (hazard ratio = 2.1; 95% CI: 1.2-3.8; P = 0.016). CONCLUSIONS PCV is an aggressive UC variant, predicting non-organ-confined disease and poor survival. Differentiating between non-muscle- and muscle-invasive disease in patients with PCV UC seems less important than the aggressive nature of this disease. Instead, any evidence of PCV on transurethral resection of bladder tumor may warrant aggressive therapy.
Collapse
|
75
|
Monn MF, Gellhaus PT, Masterson TA, Patel AA, Tann M, Cregar DM, Boris RS. R.E.N.A.L. Nephrometry scoring: how well correlated are urologist, radiologist, and collaborator scores? J Endourol 2014; 28:1006-10. [PMID: 24708445 DOI: 10.1089/end.2014.0166] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE R.E.N.A.L. Nephrometry Score (NS) is an imaging-based (CT/MRI) scoring system commonly used by urologists to standardize the reporting of renal masses by enabling quantification of anatomical characteristics. We sought to examine the inter-rater correlation of NS between urologists, radiologists, and tumor-board collaborators. METHODS We identified adult patients undergoing partial or radical nephrectomy over 10 years (n=2450). Patients with autosomal dominant polycystic kidney disease (ADPKD), metastatic disease, masses >10 cm, and studies in which the study urologists or radiologists partook in patient care were excluded. Preoperative imaging was evaluated and patients with multiphasic CT available were included. Scans were provided to the reviewers to evaluate with a R.E.N.A.L. nephrometry questionnaire. Results were analyzed using kappa correlation coefficients. RESULTS One hundred twenty patients met inclusion criteria with mean age of 59.5 years. The majority of cases were partial nephrectomies (72%). Eighty-five percent of the tumors were malignant, with 26% having high-grade histology. The mean (standard deviation) overall NS was 6.8 (1.9) with fair correlation among reviewers (κ=0.222). Collaborators had the highest inter-rater correlation, ranging from 0.41 to 0.84 for NS component scores, compared with 0.42-0.85 for radiologists and 0.36-0.86 for urologists. "R" scores were best correlated (κ>0.8). NS correlation ranged between 0.16 and 0.31 for the groups while the NS complexity category correlation ranged between 0.50 and 0.61. CONCLUSIONS Despite being naive to NS, inter-radiologist scoring patterns were better correlated than inter-urologist. The urologist and radiologist collaborating in tumor board showed the highest agreement, suggesting that a multidisciplinary approach in the characterization of renal masses may provide benefit to patient management.
Collapse
|
76
|
Kaimakliotis HZ, Pedrosa JA, Monn MF, Gellhaus P, Bihrle R, Cary KC, Masterson TA, Foster R, Cheng L, Hahn NM, Koch MO. Consolidation cystectomy after induction chemotherapy in node-positive urothelial bladder cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
77
|
Cary KC, Pedrosa JA, Kaimakliotis HZ, Masterson TA, Einhorn LH, Foster R. Survival of good-risk germ cell tumor patients following post-chemotherapy retroperitoneal lymph node dissection: The effect of bleomycin during induction chemotherapy. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.4565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
78
|
Liu NW, Hackney JT, Gellhaus PT, Monn MF, Masterson TA, Bihrle R, Gardner TA, House MG, Koch MO. Incidence and Risk Factors of Parastomal Hernia in Patients Undergoing Radical Cystectomy and Ileal Conduit Diversion. J Urol 2014; 191:1313-8. [DOI: 10.1016/j.juro.2013.11.104] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2013] [Indexed: 12/12/2022]
|
79
|
Pedrosa JA, Kaimakliotis HZ, Monn MF, Masterson TA, Sundaram CP, Koch MO, Bihrle R, Boris RS. MP77-18 CAN LYMPHOVASCULAR INVASION BE USED AS A SURROGATE FOR LYMPH NODE INVOLVEMENT IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA? J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
80
|
Monn MF, Kaimakliotis HZ, Pedrosa JA, Cary KC, Gellhaus PT, Rice K, Masterson TA, Gardner TA, Foster RS, Bihrle R, Cheng L, Koch MO. MP55-07 SIGNIFICANCE OF LYMPH NODE INVOLVEMENT IN VARIANT HISTOLOGY UROTHELIAL BLADDER CANCER. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
81
|
Kaimakliotis HZ, Pedrosa JA, Monn MF, Cary KC, Roth J, Masterson TA, Gardner TA, Foster RS, Cheng L, Bihrle R, Koch MO. MP55-19 EFFICACY OF NEOADJUVANT CHEMOTHERAPY IN BLADDER CANCER. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
82
|
Pedrosa JA, Kaimakliotis HZ, Masterson TA, Cary KC, Monn MF, Rice KR, Foster RS, Bihrle R, Koch MO, Cheng L. MP65-17 PROPOSED NODAL STAGING CLASSIFICATION IN UROTHELIAL CARCINOMA OF THE BLADDER BASED ON BURDEN OF LYMPH LODE INVOLVEMENT. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
83
|
Yue S, Li J, Lee SY, Lee HJ, Shao T, Song B, Cheng L, Masterson TA, Liu X, Ratliff TL, Cheng JX. Cholesteryl ester accumulation induced by PTEN loss and PI3K/AKT activation underlies human prostate cancer aggressiveness. Cell Metab 2014; 19:393-406. [PMID: 24606897 PMCID: PMC3969850 DOI: 10.1016/j.cmet.2014.01.019] [Citation(s) in RCA: 590] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 11/24/2013] [Accepted: 01/23/2014] [Indexed: 01/02/2023]
Abstract
Altered lipid metabolism is increasingly recognized as a signature of cancer cells. Enabled by label-free Raman spectromicroscopy, we performed quantitative analysis of lipogenesis at single-cell level in human patient cancerous tissues. Our imaging data revealed an unexpected, aberrant accumulation of esterified cholesterol in lipid droplets of high-grade prostate cancer and metastases. Biochemical study showed that such cholesteryl ester accumulation was a consequence of loss of tumor suppressor PTEN and subsequent activation of PI3K/AKT pathway in prostate cancer cells. Furthermore, we found that such accumulation arose from significantly enhanced uptake of exogenous lipoproteins and required cholesterol esterification. Depletion of cholesteryl ester storage significantly reduced cancer proliferation, impaired cancer invasion capability, and suppressed tumor growth in mouse xenograft models with negligible toxicity. These findings open opportunities for diagnosing and treating prostate cancer by targeting the altered cholesterol metabolism.
Collapse
|
84
|
Pedrosa JA, Masterson TA, Rice KR, Bihrle R, Beck SDW, Foster RS. Reoperative retroperitoneal lymph node dissection for metastatic germ cell tumors: analysis of local recurrence and predictors of survival. J Urol 2014; 191:1777-82. [PMID: 24518787 DOI: 10.1016/j.juro.2014.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE While reoperative retroperitoneal lymph node dissection results in durable long-term survival, outcomes are comparatively worse than in patients who undergo initial adequate resection. We identified predictors of cancer specific survival and correlated technical aspects of initial resection to local recurrence in patients treated with repeat retroperitoneal lymph node dissection. MATERIALS AND METHODS We reviewed subsequent data on 203 patients treated with reoperation for recurrent retroperitoneal germ cell tumor after initial retroperitoneal lymph node dissection with local relapse. We used multivariate Cox proportion hazard models for cancer specific survival and multivariate logistic regression for local recurrence. RESULTS The only 2 factors associated with local recurrence at lymph node dissection were incomplete lumbar vessel division at initial resection (p<0.01) and teratoma histology in the reoperative pathology specimen (p=0.01). Median followup was 73 months. Initial survival analysis including preoperative variables indicated that active cancer at initial operation (p=0.04), increased serum tumor markers (p=0.02), M1b stage (p<0.01) and salvage chemotherapy (p=0.01) were independent predictors of worse cancer specific survival. After introducing the final pathological data from reoperation into the final multivariate model only active cancer at reoperation (p<0.01), M1b stage (p=0.01) and salvage chemotherapy before reoperation (p=0.02) retained the association with worse oncologic outcomes. CONCLUSIONS Tumor biology and inadequate surgical technique (incomplete lumbar ligation) are associated with local recurrence after initial retroperitoneal lymph node dissection. Decreased cancer specific survival is expected in this population, mostly driven by active cancer in the final pathology specimen.
Collapse
|
85
|
Masterson TA, Cheng L, Boris RS, Koch MO. Open vs. robotic-assisted radical prostatectomy: A single surgeon and pathologist comparison of pathologic and oncologic outcomes. Urol Oncol 2013; 31:1043-8. [DOI: 10.1016/j.urolonc.2011.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 12/02/2011] [Accepted: 12/03/2011] [Indexed: 10/14/2022]
|
86
|
Masterson TA, Rice KR, Beck SDW. Current and future biologic markers for disease progression and relapse in testicular germ cell tumors: a review. Urol Oncol 2013; 32:261-71. [PMID: 24035725 DOI: 10.1016/j.urolonc.2013.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 04/30/2013] [Accepted: 05/15/2013] [Indexed: 01/27/2023]
Abstract
Testicular germ cell tumors represent a biologically unique disease process. These tumors are exquisitely sensitive to platinum-based chemotherapy, can be cured with surgical metastasectomy, and are known for the integration of biologic markers to stage and assign risk. Exploring further biologic markers that offer insight into the molecular mechanisms that contribute to disease biology is important. In this review, we attempt to summarize the utility of the current and some future biologic markers for disease monitoring and relapse.
Collapse
|
87
|
Pedrosa JA, Rice K, Thomas DE, Johnston P, Moore ML, Reed AD, Cregar DM, Franklin C, Koch MO, Bihrle R, Foster R, Masterson TA, Gardner TA, Sundaram C, Powell CR, Beck S, Grignon DA, Cheng L, Hahn NM. Presence of variant histology (VarHst) in transurethral resection of bladder tumor (TURBT) biopsies and its prognostic significance on pathologic complete response (pCR) rates to neoadjuvant chemotherapy (neo-CTx). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.6_suppl.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
295 Background: Randomized phase III clinical trial data (S8710) supports an overall survival (OS) advantage with neo-CTx for muscle-invasive urothelial carcinoma (miUC) patients (pts) prior to cystectomy. Recent S8710 subset analyses have demonstrated an OS for pts with both pure UC and VarHst. pCR to neo-CTx has been suggested as a surrogate endpoint for OS. The relationship between VarHist in TURBT specimens and pCR rates is uncertain. Methods: A retrospective review of the Indiana University Simon Cancer Center urology and medical oncology clinical databases was performed spanning the years 1991 – 2012. Subjects with miUC, pathology reports available for both TURBT and cystectomy procedures, and confirmed receipt of neo-CTx with regimen details were included in this analysis. Pts with clinically positive lymph nodes (LN+) were included provided they underwent cystectomy with curative intent and distant metastases were not present. Associations between pCR and pt baseline age, gender, race, clinical stage (T2N0 vs. T3/T4/N+), chemotherapy regimen received (cisplatin combination therapy (CisCTx) vs. non-cisplatin based), and presence of VarHst on TURBT sample were tested by multinomial logistic regression analysis with statistical significance set at p<0.05. Results: 72 miUC pts satisfying the inclusion criteria were identified. Cohort demographics included: age (median) – 59 yrs, 76% male, 93% Caucasian, 63% T2N0, 32% LN+, 81% CisCTx neo-CTx regimen, 42% VarHst on TURBT, pCR for entire cohort 18%. The presence of VarHst on TURBT sample was not associated with decreased rates of pCR (6/30 vs. 7/42) p=0.610. A trend toward significance with age over 59 was also observed. Conclusions: The presence of VarHst in TURBT specimen is not associated with decreased rates of pCR at cystectomy in miUC pts treated with neo-CTx. Further characterization of the amount of VarHst and reproducibility of its recognition in TURBT samples is warranted to determine its ultimate clinical value.
Collapse
|
88
|
Thomas DE, Rice K, Pedrosa JA, Johnston P, Moore ML, Reed AD, Cregar DM, Franklin C, Koch MO, Bihrle R, Foster R, Masterson TA, Gardner TA, Sundaram C, Powell CR, Beck S, Grignon DA, Cheng L, Hahn NM. Presence of carcinoma in situ (CIS) in bladder cancer biopsies and its relationship to pathologic complete response (pCR) rates to neoadjuvant chemotherapy (neo-CTx). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.6_suppl.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
286 Background: Despite an improved overall survival with neo-CTx for muscle-invasive urothelial carcinoma (miUC) patients (pts) prior to cystectomy, the adoption of neo-CTx in suitable pts has been suboptimal. While associated with a more aggressive phenotype in early stage UC, the prognostic role of CIS in miUC is less clear. In particular, the effect of concurrent CIS in pts undergoing neo-CTx prior to cystectomy is unknown. Methods: A retrospective review of the Indiana University Simon Cancer Center urology and medical oncology clinical databases was performed spanning the years 1991 – 2012. Subjects with miUC, pathology reports available for both transurethral resection of bladder tumor (TURBT) and cystectomy procedures, and confirmed receipt of neo-CTx were included in this analysis. Pts with clinically positive lymph nodes (LN+) were included provided they underwent cystectomy with curative intent. Associations between pCR and pt baseline age, gender, race, clinical stage (T2N0 vs. T3/T4/N+), chemotherapy regimen received (cisplatin combination therapy (CisCTx) vs. non-cisplatin based), and presence of CIS on TURBT sample were tested by multinomial logistic regression analysis with statistical significance set at p<0.05. Results: 72 miUC pts satisfying the inclusion criteria were identified. Cohort demographics included: median age – 59 yrs, 76% male, 93% Caucasian, 63% T2N0, 32% LN+, 81% CisCTx neo-CTx regimen, 32% CIS on TURBT, pCR for entire cohort 18%. The presence of CIS on TURBT was significantly associated with decreased rates of pCR (1/23 vs. 12/49) p=0.002. TURBT CIS was not associated with decreased rates of less than pT2N0 (12/23 vs. 18/49) p=0.562. Seven pts (30%) with CIS on TURBT sample achieved pTisN0 at cystectomy. Conclusions: The presence of CIS in TURBT specimens is associated with decreased rates of pCR at cystectomy in miUC pts treated with neo-CTx. The finding of pTisN0 at cystectomy is common after neo-CTx in pts with CIS in preop TURBT specimens. Validation of the prognostic significance of TURBT CIS on pCR rates and characterization of pTisN0 clinical course in TURBT CIS pts after neo-CTx is warranted.
Collapse
|
89
|
Rice KR, Koch MO, Cheng L, Masterson TA. Dyslipidemia, statins and prostate cancer. Expert Rev Anticancer Ther 2013; 12:981-90. [PMID: 22845413 DOI: 10.1586/era.12.75] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Dyslipidemia and prostate cancer are two of the most common medical conditions affecting adult males in the USA. In recent years, a large volume of research has focused on investigating the relationship between these two disease processes as well as the effect of the cholesterol-lowering medications, such as 3-hydroxyl-3-methylglutaryl-coenzyme A reductase inhibitors (better known as 'statins'), on the development and progression of prostate cancer. While there is a paucity of prospective research, encouraging results have been reported in several retrospective clinical studies. Additionally, basic science research has identified interactions between lipids and prostate cancer cells in several key areas. This article will discuss recent clinical and basic science research examining the relationship between dyslipidemia, statins and prostate cancer.
Collapse
|
90
|
Hahn NM, Daneshmand S, Posadas EM, Koch MO, Bihrle R, Foster R, Masterson TA, Cheng L, Liu Z, Breen T, Fleming MT, Lance R, Ryan CW, Corless CL, Galsky MD, Alva AS, Mitchell C, Shen SS, Lerner SP, Sonpavde G. A phase II trial of neoadjuvant dasatinib (Neo-D) in muscle-invasive urothelial carcinoma of the bladder (miUCB): Hoosier Oncology Group GU07-122 trial. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.4586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4586 Background: Neoadjuvant chemotherapy (NC) preceding radical cystectomy (RC) is an accepted standard for miUCB patients (pts). Dasatinib (D) is an oral tyrosine kinase inhibitor of Src mediated signaling, and has demonstrated promising preclinical anti-tumor activity, providing a rationale to evaluate Neo-D in human miUCB. Methods: A phase II trial was conducted to assess the safety and biologic activity of Neo-D in miUCB. Key eligibility criteria included: miUCB (T2-T4a, N0, M0), unsuitable or willing to forego platinum-based NC, adequate TURBT tissue available, ECOG PS 0-1, creatinine < 2 x ULN. Pts received D 100 mg po once daily for 28 +/- 7 days followed by RC 8-24 hours after the last dose. The primary endpoint was feasibility defined as > 60% of pts completing therapy without treatment-related dose limiting toxicity (DLT) specified as grade 4 hematologic toxicity, grade 3 non-hematologic toxicity, or any grade 2 toxicity > 14 days. Secondary endpoints included the assessment of biologic activity as assessed by pre- and post-treatment tumor tissue immunohistochemistry analysis of Src, pSrc, EPHA2, pEPHA2, FAK, pFAK, AKT, pAKT, CD31, Ki67, TUNEL. Results: The study completed accrual with enrollment of 25pts. 22 and 24 pts were respectively evaluable for feasibility and toxicity endpoints. Patient demographics included: median age – 62, M/F – 20/5, ECOG PS 0/1 – 19/6. Baseline tumor staging included: T2 – 17, T3 – 7. The study achieved its primary endpoint with 15 pts (68%) completing therapy without treatment related DLT’s. DLT’s included: fatigue (2 pts), DVT/PE, abdominal pain, supraventricular tachycardia, enteric fistula, and hematuria (1 pt each). Frequency of highest observed toxicity on study included: Grade 1 – 13%, Grade 2 – 38%, Grade 3 – 46%, Grade 4 – 4%. Among 22 patients, pathologic stage at RC was T1/Tis in 3 pts (14%), ≥T2 in 19 pts (86%), and node positive in 6 pts (27%). Correlative analyses of pre- and post-treatment tumor Src signaling are ongoing and will be updated at the meeting. Conclusions: Neoadjuvant dasatinib preceding RC is feasible in miUCB patients. Tumor tissue correlative studies may provide directions for further development.
Collapse
|
91
|
Masterson TA, Carver BS, Shayegan B, Feldman DR, Motzer RJ, Bosl GJ, Sheinfeld J. Outcomes in patients with clinical stage III NSGCT who achieve complete clinical response to chemotherapy at extraretroperitoneal disease site. Urology 2012; 79:1079-84. [PMID: 22446341 DOI: 10.1016/j.urology.2011.11.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 11/18/2011] [Accepted: 11/24/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare the survival outcomes of patients with advanced nonseminoma and extraretroperitoneal (ERP) disease observed for a clinical complete response (CCR) with those demonstrating a pathologic complete response (PCR). METHODS From 1989 to 2003, 237 patients with clinical Stage III nonseminoma underwent induction chemotherapy followed by retroperitoneal lymph node dissection. After chemotherapy, 107 demonstrated a CCR to treatment at the ERP disease site. Of the remaining 130 patients with radiographic evidence of residual ERP disease, 86 (66%) had fibrosis only on pathologic review (ie, PCR). The probability of progression-free and disease-specific survival was estimated using the Kaplan-Meier method. Cox proportional hazards regression analysis was used to determine the prognostic significance of risk factors for progression and survival. RESULTS The median follow-up was similar for both CCR and PCR patients (44.5 and 50.7 months, respectively). Overall, the 5-year probability of freedom from progression (93% vs 72%, respectively; P = .0005) and disease-specific survival (96% vs 87%, respectively; P = .08) rates were far better for men with a PCR. The predictors of disease progression included residual retroperitoneal nodal size after chemotherapy (P = .05), and resection of the residual disease at the ERP site was protective (P = .02). CONCLUSION A CCR at the ERP disease site is associated with a greater likelihood of relapse compared with a PCR, underscoring the limitations of radiographic imaging after chemotherapy in detecting microscopic residual disease and need for rigorous monitoring of patients observed after a CCR. Furthermore, until more accurate clinical predictors of ERP histologic features are identified, we advocate for complete surgical resection of all sites of residual disease, when feasible.
Collapse
|
92
|
Masterson TA, Carver BS, Abel EJ, Pettus JA, Bosl GJ, Sheinfeld J. Impact of age on clinicopathological outcomes and recurrence-free survival after the surgical management of nonseminomatous germ cell tumour. BJU Int 2012; 110:950-5. [DOI: 10.1111/j.1464-410x.2012.10947.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
93
|
Masterson TA, Shayegan B, Carver BS, Bajorin DF, Feldman DR, Motzer RJ, Bosl GJ, Sheinfeld J. Clinical Impact of Residual Extraretroperitoneal Masses in Patients With Advanced Nonseminomatous Germ Cell Testicular Cancer. Urology 2012; 79:156-9. [DOI: 10.1016/j.urology.2011.09.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 09/27/2011] [Accepted: 09/28/2011] [Indexed: 11/30/2022]
|
94
|
Masterson TA, Dill AL, Eberlin LS, Mattarozzi M, Cheng L, Beck SDW, Bianchi F, Cooks RG. Distinctive glycerophospholipid profiles of human seminoma and adjacent normal tissues by desorption electrospray ionization imaging mass spectrometry. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2011; 22:1326-33. [PMID: 21953186 PMCID: PMC10712021 DOI: 10.1007/s13361-011-0134-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 01/14/2011] [Accepted: 01/14/2011] [Indexed: 05/31/2023]
Abstract
Desorption electrospray ionization mass spectrometry (DESI-MS) has been successfully used to discriminate between normal and cancerous human tissue from different anatomical sites. On the basis of this, DESI-MS imaging was used to characterize human seminoma and adjacent normal tissue. Seminoma and adjacent normal paired human tissue sections (40 tissues) from 15 patients undergoing radical orchiectomy were flash frozen in liquid nitrogen and sectioned to 15 μm thickness and thaw mounted to glass slides. The entire sample was two-dimensionally analyzed by the charged solvent spray to form a molecular image of the biological tissue. DESI-MS images were compared with formalin-fixed, hematoxylin and eosin (H&E) stained slides of the same material. Increased signal intensity was detected for two seminolipids [seminolipid (16:0/16:0) and seminolipid (30:0)] in the normal tubule testis tissue; these compounds were undetectable in seminoma tissue, as well as from the surrounding fat, muscle, and blood vessels. A glycerophosphoinositol [PI(18:0/20:4)] was also found at increased intensity in the normal testes tubule tissue when compared with seminoma tissue. Ascorbic acid (i.e., vitamin C) was found at increased amounts in seminoma tissue when compared with normal tissue. DESI-MS analysis was successfully used to visualize the location of several types of molecules across human seminoma and normal tissues. Discrimination between seminoma and adjacent normal testes tubules was achieved on the basis of the spatial distributions and varying intensities of particular lipid species as well as ascorbic acid. The increased presence of ascorbic acid within seminoma compared with normal seminiferous tubules was previously unknown.
Collapse
|
95
|
Masterson TA, Cheng L, Mehan RM, Koch MO. Tumor focality does not predict biochemical recurrence after radical prostatectomy in men with clinically localized prostate cancer. J Urol 2011; 186:506-10. [PMID: 21679993 DOI: 10.1016/j.juro.2011.03.106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE We characterized prostate cancer focality in regard to clinicopathological features, prognostic value and impact on biochemical outcome. MATERIALS AND METHODS We retrospectively reviewed the records of 1,366 patients in our prospective database who underwent radical prostatectomy between 1999 and 2010 for clinically localized prostate cancer with pathological evaluation using whole mount sectioning techniques and tumor mapping. Unifocal disease was defined as the identification of a solitary cancer focus in the prostate without additional tumor foci or satellite lesions, ie multifocal disease, on histopathological evaluation. Cox regression modeling was used to identify predictors of biochemical progression among groups. RESULTS A total of 184 patients (13%) fulfilled our unifocal tumor criteria. Unifocal tumors tended to be smaller in volume and in greatest diameter than multifocal tumors (p<0.0001 and <0.005, respectively). Of patients with pathologically insignificant disease the relative proportion with unifocal tumors increased to 28% from 13% in the overall cohort (p<0.0005). Also, tumor focality failed to predict biochemical recurrence in univariate and multivariate models. Accordingly we noted no significant differences in 5-year biochemical recurrence-free survival for unifocal and multifocal tumors (66% and 61%, respectively, p=0.76). Limitations of this study include its retrospective nature. CONCLUSIONS In this study tumor focality failed to predict patients likely to experience biochemical failure. Tumor characteristics were similar regardless of focality. However, unifocal tumors had smaller volume and were more commonly seen as clinically insignificant compared to multifocal tumors.
Collapse
|
96
|
Risk MC, Masterson TA. Intratubular germ cell neoplasms of the testis and bilateral testicular tumors: clinical significance and management options. Indian J Urol 2011; 26:64-71. [PMID: 20535289 PMCID: PMC2878442 DOI: 10.4103/0970-1591.60454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objectives: Intratubular germ cell neoplasia (ITGCN) is the precursor lesion for invasive testicular germ cell tumors (TGCTs) of adolescents and young adults. The rising incidence of these tumors has prompted a rigorous investigation of the etiology, diagnosis and management of ITGCN. Bilateral testicular cancer is closely linked with ITGCN, as patients with unilateral testicular cancer are at the highest risk for a future malignancy in the contralateral testicle. Methods: A literature review directed at ITGCN and bilateral testis cancer was performed using the Medline/PubMed database. Our review focused on the pathogenesis, risk factors, diagnosis and treatment regimens utilized. Results: Major advances have been made in the understanding of ITGCN over the past 30 years. There is evidence that TGCTs arise from ITGCN, ITGCN is closely related to fetal gonocytes, and that events in pre- and perinatal period may result in abnormal persistence of fetal gonocytes leading to ITGCN and subsequent TGCT. Controversy exists regarding the need to biopsy men at increased risk of TGCT, as well as the best approach to managing patients with known ITGCN. Bilateral testicular cancer has excellent outcomes in the current era of platinum-based chemotherapy. Conclusion: The optimal management of patients at risk for ITGCN and future TGCT is still a matter of debate. Individualization of management, including biopsy and treatment, should be based on risk factors for TGCT, compliance with potential surveillance, and patient preferences particularly with regard to fertility.
Collapse
|
97
|
Dill AL, Eberlin LS, Costa AB, Zheng C, Ifa DR, Cheng L, Masterson TA, Koch MO, Vitek O, Cooks RG. Multivariate statistical identification of human bladder carcinomas using ambient ionization imaging mass spectrometry. Chemistry 2011; 17:2897-902. [PMID: 21284043 PMCID: PMC3050580 DOI: 10.1002/chem.201001692] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 10/03/2010] [Indexed: 11/06/2022]
Abstract
Diagnosis of human bladder cancer in untreated tissue sections is achieved by using imaging data from desorption electrospray ionization mass spectrometry (DESI-MS) combined with multivariate statistical analysis. We use the distinctive DESI-MS glycerophospholipid (GP) mass spectral profiles to visually characterize and formally classify twenty pairs (40 tissue samples) of human cancerous and adjacent normal bladder tissue samples. The individual ion images derived from the acquired profiles correlate with standard histological hematoxylin and eosin (H&E)-stained serial sections. The profiles allow us to classify the disease status of the tissue samples with high accuracy as judged by reference histological data. To achieve this, the data from the twenty pairs were divided into a training set and a validation set. Spectra from the tumor and normal regions of each of the tissue sections in the training set were used for orthogonal projection to latent structures (O-PLS) treated partial least-square discriminate analysis (PLS-DA). This predictive model was then validated by using the validation set and showed a 5% error rate for classification and a misclassification rate of 12%. It was also used to create synthetic images of the tissue sections showing pixel-by-pixel disease classification of the tissue and these data agreed well with the independent classification that uses histological data by a certified pathologist. This represents the first application of multivariate statistical methods for classification by ambient ionization although these methods have been applied previously to other MS imaging methods. The results are encouraging in terms of the development of a method that could be utilized in a clinical setting through visualization and diagnosis of intact tissue.
Collapse
|
98
|
Dill AL, Eberlin LS, Zheng C, Costa AB, Ifa DR, Cheng L, Masterson TA, Koch MO, Vitek O, Cooks RG. Multivariate statistical differentiation of renal cell carcinomas based on lipidomic analysis by ambient ionization imaging mass spectrometry. Anal Bioanal Chem 2010; 398:2969-78. [PMID: 20953777 PMCID: PMC10712022 DOI: 10.1007/s00216-010-4259-6] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 09/23/2010] [Accepted: 09/27/2010] [Indexed: 12/12/2022]
Abstract
Desorption electrospray ionization (DESI) mass spectrometry (MS) was used in an imaging mode to interrogate the lipid profiles of thin tissue sections of 11 sample pairs of human papillary renal cell carcinoma (RCC) and adjacent normal tissue and nine sample pairs of clear cell RCC and adjacent normal tissue. DESI-MS images showing the spatial distributions of particular glycerophospholipids (GPs) and free fatty acids in the negative ion mode were compared to serial tissue sections stained with hematoxylin and eosin (H&E). Increased absolute intensities as well as changes in relative abundance were seen for particular compounds in the tumor regions of the samples. Multivariate statistical analysis using orthogonal projection to latent structures treated partial least square discriminate analysis (PLS-DA) was used for visualization and classification of the tissue pairs using the full mass spectra as predictors. PLS-DA successfully distinguished tumor from normal tissue for both papillary and clear cell RCC with misclassification rates obtained from the validation set of 14.3% and 7.8%, respectively. It was also used to distinguish papillary and clear cell RCC from each other and from the combined normal tissues with a reasonable misclassification rate of 23%, as determined from the validation set. Overall DESI-MS imaging combined with multivariate statistical analysis shows promise as a molecular pathology technique for diagnosing cancerous and normal tissue on the basis of GP profiles.
Collapse
|
99
|
Masterson TA, Cheng L, Koch MO. Pathological characterization of unifocal prostate cancers in whole-mount radical prostatectomy specimens. BJU Int 2010; 107:1587-91. [PMID: 21062398 DOI: 10.1111/j.1464-410x.2010.09849.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE • To characterize the anatomical distribution and pathological features of unifocal cancers, which have been reported to occur in 17-33% of men undergoing radical prostatectomy (RP), in whole- mount prostatectomy specimens. PATIENTS AND METHODS • Between 1999 and 2008, a retrospective review of 1274 patients undergoing RP for clinically localized prostate cancer with pathological evaluation using whole-mount sectioning techniques and tumour mapping was performed from our prospective database. • The study cohort comprised those patients who were found to have unifocal tumours. RESULTS • A total of 176 (14%) patients fulfilled our criteria for having unifocal tumours. The median age at time of surgery was 61 years. The mean preoperative PSA level was 8.6 ng/mL. • In all, 28% of patients were identified as having extracapsular extension (ECE) and 11% had seminal vesicle invasion (SVI). • Of 98 patients undergoing pelvic lymph dissection, six (6%) had positive lymph nodes; 49% of tumours had Gleason score ≥7 and 60% had Gleason pattern 4 or 5 found within the tumour. • Mean tumour volume and maximum diameter were 3.3 mL and 1.7 cm, respectively. Overall, 89 (51%) tumours qualified as localized, organ-confined and low-grade cancers, possibly amenable to focal ablative approaches. • The limitations of the present study include its descriptive and retrospective nature. CONCLUSIONS • While unifocal prostate cancers were most commonly localized to the prostate, half of these patients were associated with intermediate- or high-grade disease. • High-risk features including ECE, SVI, lymph node invasion (LNI), and large tumour volume were identified in a third of patients. • Further studies assessing predictors beyond focality will be needed to determine whether patients can be identified before surgery who might be suitable candidates for lesion-ablative therapies.
Collapse
|
100
|
Gross JL, Masterson TA, Cheng L, Johnstone PA. pT0 prostate cancer after radical prostatectomy. J Surg Oncol 2010; 102:331-3. [DOI: 10.1002/jso.21647] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|