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Lee JN, Kang JK, Jeong SY, Lee SM, Cho MH, Ha YS, Kim HT, Kim TH, Yoo ES, Kwon TG, Chung SK. Predictive value of cortical transit time on MAG3 for surgery in antenatally detected unilateral hydronephrosis caused by ureteropelvic junction stenosis. J Pediatr Urol 2018; 14:55.e1-55.e6. [PMID: 28988673 DOI: 10.1016/j.jpurol.2017.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/16/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND In children with antenatally detected hydronephrosis caused by ureteropelvic junction (UPJ) stenosis, the main challenge is preserving renal function by identifying children who require early surgical intervention from those for whom watchful waiting may be appropriate because of the potential for spontaneous resolution without a significant loss of renal function. OBJECTIVE To assess the impact of initial cortical transit time (CTT) on technetium-99m mercaptoacetyltriglycerine (MAG3) diuretic renogram on the need for surgery in children with antenatally detected unilateral hydronephrosis caused by UPJ stenosis. STUDY DESIGN We retrospectively reviewed the medical records of 33 patients with antenatally detected unilateral hydronephrosis caused by UPJ stenosis who were managed at our institution between 2006 and 2014. Delayed CTT was defined as the absence of activity in the subcortical structures within 3 min of tracer injection on a MAG3 scan. The surgical indication includes symptomatic UPJ stenosis, seriously deteriorating hydronephrosis with parenchymal thinning on serial USG, split renal function <40%, or progressive deterioration of split renal function (>5%) on a MAG3 scan. This study analyzed and compared the initial level of Society for Fetal Urology grade, anteroposterior diameter (APD), split renal function, drainage pattern on a diuretic renogram, and CTT with the need for surgery. RESULTS Of the 33 children, 16 were classified into the delayed CTT group and 17 were placed in the normal CTT group. During the follow-up period (mean 31.8 months), surgery was needed in 75.0% (12/16) of patients in the delayed CTT group and in 5.9% (1/17) of those in the normal CTT group. Multivariate analysis showed that delayed CTT on initial MAG3 scan and APD on initial ultrasonography were independent predictive factors of the need for surgery. DISCUSSION In this era of conservative management of antenatally detected hydronephrosis caused by UPJ stenosis, it is critical to identify which measurement on an image study is the most reliable for predicting the need for surgery by reflecting functional deterioration. In this study, multivariate analysis revealed that CTT on the initial MAG3 scan was an independent predictive factor of the need for surgery. In addition, CTT showed high negative predictive value for surgical need in children with antenatally detected unilateral hydronephrosis caused by UPJ stenosis. CONCLUSION CTT on an initial MAG3 scan may be a useful predictor of the need for surgery in children with antenatally detected unilateral hydronephrosis caused by UPJ stenosis.
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Ha US, Lee KW, Jung JH, Byun SS, Kwak C, Chung J, Hwang EC, Kim YJ, Kwon TG, Kang SH, Hong SH. Renal capsular invasion is a prognostic biomarker in localized clear cell renal cell carcinoma. Sci Rep 2018; 8:202. [PMID: 29317731 PMCID: PMC5760639 DOI: 10.1038/s41598-017-18466-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 12/04/2017] [Indexed: 12/24/2022] Open
Abstract
Renal capsular invasion (RCI) and lymphovascular invasion (LVI) are potential prognostic factors of significance in renal cell carcinoma (RCC). We evaluated the independent prognostic implications of RCI and LVI in localized clear cell RCC based on a large multi-institutional cohort. 6, 849 patients who had undergone radical or partial nephrectomy for RCC were included. Associations between recurrence and RCI or LVI were analyzed by constructing statistical models that combined Cox proportional hazard regression and propensity score matching. To analyze RCI, 2, 733 patients including 603 patients with RCI were enrolled. To analyze LVI, 3, 586 patients including 121 patients with LVI were enrolled. Recurrence was observed in 75 (12.4%) patients with RCI and 134 (6.3%) patients without RCI. In all statistical models, RCI was significantly associated with an increased risk of recurrence. Recurrence was observed 29 (24.0%) patients with LVI and 207 (6.0%) patients without LVI. LVI was significantly associated with an increased risk of recurrence only in non-adjusted univariate models, but not in multivariate adjusted analysis or propensity score matching models. In conclusion, these findings suggest that RCI could be a significant risk factor for localized clear cell RCC recurrence. In contrast to RCI, LVI cannot be an independent prognostic variable.
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Kim JY, Chun SY, Park JS, Chung JW, Ha YS, Lee JN, Kwon TG. Laminin and Platelet-Derived Growth Factor-BB Promote Neuronal Differentiation of Human Urine-Derived Stem Cells. Tissue Eng Regen Med 2017; 15:195-209. [PMID: 30603547 DOI: 10.1007/s13770-017-0102-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/15/2017] [Accepted: 11/20/2017] [Indexed: 11/24/2022] Open
Abstract
Urine-derived stem cells (USCs) are considered as a promising cell source capable of neuronal differentiation. In addition, specific growth factors and extracellular matrix are essential for enhancing their neuronal differentiation efficiency. In this study, we investigated the possibility of neuronal differentiation of USCs and the role of laminin and platelet-derived growth factor BB (PDGF-BB) as promoting factors. USCs were isolated from fresh urine of healthy donors. Cultured USCs were adherent to the plate and their morphology was similar to the cobblestone. In addition, they showed chromosome stability, rapid proliferation rate, colony forming capacity, and mesenchymal stem cell characteristics. For inducing the neuronal differentiation, USCs were cultured for 14 days in neuronal differentiation media supplemented with/without laminin and/or PDGF-BB. To identify the expression of neuronal markers, RT-PCR, flow cytometry analysis and immunocytochemistry were used. After neuronal induction, the cells showed neuron-like morphological change and high expression level of neuronal markers. In addition, laminin and PDGF-BB respectively promoted the neuronal differentiation of USCs and the combination of laminin and PDGF-BB showed a synergistic effect for the neuronal differentiation of USCs. In conclusion, USCs are noteworthy cell source in the field of neuronal regeneration and laminin and PDGF-BB promote their neuronal differentiation efficiency.
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Sung Y, Park S, Park SJ, Jeong J, Choi M, Lee J, Kwon W, Jang S, Lee MH, Kim DJ, Liu K, Kim SH, Lee JH, Ha YS, Kwon TG, Lee S, Dong Z, Ryoo ZY, Kim MO. Jazf1 promotes prostate cancer progression by activating JNK/Slug. Oncotarget 2017; 9:755-765. [PMID: 29416651 PMCID: PMC5787507 DOI: 10.18632/oncotarget.23146] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 11/14/2017] [Indexed: 01/23/2023] Open
Abstract
Juxtaposed with another zinc finger protein 1 (Jazf1) is a zinc finger protein and is known to affect both prostate cancer and type 2 diabetes. Jazf1 inhibits testicular nuclear receptor 4 (TR4) activation through protein-protein interaction, which results in weight loss and alleviates diabetes. However, the role of Jazf1 in prostate cancer is still poorly understood. Hence, we investigated whether the expression of Jazf1 is associated with prostate cancer progression. We confirmed the upregulation of Jazf1 expression in human prostate tissue samples. In addition, using Jazf1 overexpressing prostate cancer cell lines, DU145 and LNCaP, we found Jazf1 promoted cell proliferation and colony formation ability. We also observed that Jazf1 dramatically enhanced cell migration and invasion in transwell assays. Additionally, we checked the upregulation of vimentin and downregulation of E-cadherin expression in Jazf1-overexpressing DU145 and LNCaP cells. Moreover, we found that Slug, which is known to be regulated by JNK/c-Jun phosphorylation, was upregulated in the microarray analysis of two prostate cancer cell lines. Jazf1 promotes the phosphorylation of JNK/c-Jun, likely promoting cell proliferation and invasion through Slug. In a xenograft model, tumors overexpressing Jazf1 were larger than control tumors, and tumors with decreased Jazf1 were smaller. These data indicated that Jazf1 enhances prostate cancer progression and metastasis via regulating JNK/Slug signaling. Taken together, these results suggest that Jazf1 plays an important role in both androgen dependent and independent prostate cancer.
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Lee CH, Ku JY, Jeong CW, Ku JH, Kwak C, Kim HH, Tae BS, Choi SH, Kim HT, Kim TH, Kwon TG, Hwang EC, Jung SI, Kang TW, Kwon DD, Ha HK. Predictors for Intravesical Recurrence Following Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A National Multicenter Analysis. Clin Genitourin Cancer 2017; 15:e1055-e1061. [PMID: 28802888 DOI: 10.1016/j.clgc.2017.07.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/06/2017] [Accepted: 07/18/2017] [Indexed: 11/28/2022]
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Choi JY, Chun SY, Ha YS, Kim DH, Kim J, Song PH, Kim HT, Yoo ES, Kim BS, Kwon TG. Potency of Human Urine-Derived Stem Cells for Renal Lineage Differentiation. Tissue Eng Regen Med 2017; 14:775-785. [PMID: 30603527 PMCID: PMC6171660 DOI: 10.1007/s13770-017-0081-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/01/2017] [Accepted: 09/03/2017] [Indexed: 01/09/2023] Open
Abstract
Kidney is one of the most difficult organs for regeneration. Several attempts have been performed to regenerate renal tissue using stem cells, the results were not satisfactory. Urine is major product of kidney and contains cells from renal components. Moreover, urine-derived stem cells (USCs) can be easily obtained without any health risks throughout a patient's entire life. Here, we evaluated the utility of USCs for renal tissue regeneration. In this study, the ability of USCs to differentiate into renal lineage cells was compared with that of adipose tissue-derived stem cells (ADSCs) and amniotic fluid-derived stem cells (AFSCs), with respect to surface antigen expression, morphology, immunocytochemistry, renal lineage gene expression, secreted factors, immunomodulatory marker expression, in vivo safety, and renal differentiation potency. Undifferentiated USCs were positive for CD44 and CD73, negative for CD34 and CD45, and formed aggregates after 3 weeks of renal differentiation. Undifferentiated USCs showed high SSEA4 expression, while renal-differentiated cells expressed PAX2, WT1, and CADHERIN 6. In the stem/renal lineage-associated gene analysis, OCT4, SSEA4, and CD117 were significantly downregulated over time, while PAX2, LIM1, PDGFRA, E-CADHERIN, CD24, ACTB, AQP1, OCLN, and NPHS1 were gradually upregulated. In the in vivo safety evaluation, renal-differentiated USCs did not show abnormal histology. These findings demonstrated that USCs have a similar MSC potency, renal lineage-differentiation ability, immunomodulatory effects, and in vivo safety as ADSCs and AFSCs, and showed higher levels of growth factor secretion for paracrine effects. Therefore, urine and USCs can be one of good cell sources for kidney regeneration.
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Ahn H, Kim HJ, Jeon SS, Kwak C, Sung GT, Kwon TG, Park JY, Paick SH. Establishment of Korean prostate cancer database by the Korean Urological Oncology Society. Investig Clin Urol 2017; 58:434-439. [PMID: 29124243 PMCID: PMC5671963 DOI: 10.4111/icu.2017.58.6.434] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/23/2017] [Indexed: 12/21/2022] Open
Abstract
Purpose Despite the necessity, to date, no detailed database of prostate cancer, especially one that includes clinicopathological data, has been created in Korea. For that reason, the Korean Urological Oncology Society (KUOS) decided to create the Korean Prostate Cancer Database (KPCD). Materials and Methods The KPCD program was introduced in 2010. After considering regional distribution, a total of 20 hospitals participated in the KPCD. The Database consists of 4 domains (demographic, pretreatment, treatment, and follow-up data) and 135 variables. Results In total, 7,608 men with prostate cancer between 2000 and 2010 were registered in the KPCD. The mean age at the time of diagnosis was 67.6±7.7 years. The mean PSA at diagnosis was 74.0±366.9 ng/mL, and the proportions of patients with Gleason scores of ≤6, 7, and 8–10 were 37.0%, 26.7%, and 34.2%, respectively. At diagnosis, 62.3% of the patients had localized tumors, 14.6% had regional, 12.8% had distant, and 10.4% cases were from unknown diseases. With regards to the initial treatment modality employed, 1.3% of patients were managed with active surveillance, 62.1% underwent surgery, 4.3% underwent radiotherapy, 27.1% had androgen deprivation therapy, and 5.2% underwent unknown therapies. The 5-year cancer-specific survival rate of patients in the KPCD was 98.6% in the localized stage, 94.8% in the regional stage, 74.7% in the distant stage, and 86.9% in the unknown stage. Conclusions The KUOS created a relatively successful database of patients with prostate cancer in Korea. The KPCD will continue to improve the availability of data regarding prostate cancer.
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Kwon SY, Lee JN, Ha YS, Choi SH, Kim TH, Kwon TG. Open radical prostatectomy reproducing robot-assisted radical prostatectomy: Involving antegrade nerve sparing and continuous anastomosis. Int Braz J Urol 2017; 43:1043-1051. [PMID: 29039893 PMCID: PMC5734066 DOI: 10.1590/s1677-5538.ibju.2016.0627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 05/07/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To present modified RRP using the same method as RALP and compare its surgical outcomes with RALP. MATERIALS AND METHODS Demographics, perioperative and functional outcomes of the 322 patients that underwent RRP (N=99) or RALP (N=223) at our institution from January 2011 through June 2013 were evaluated retrospectively. Postoperative incontinence and erectile dysfunction are involved functional outcomes. During the modified procedure, the bladder neck was dissected first as for RALP. After dissection of vas deference and seminal vesicle, the prostate was dissected in an antegrade fashion with bilateral nerve saving. Finally, the urethra was cut at the prostate apex. After a Rocco suture was applied, and then urethrovesical anastomosis was performed with continuous suture as for RALP. RESULTS Perioperative characteristics and complication rates were similar in the RRP and RALP groups except for mean estimated blood loss (p<0.001) and operative time (p<0.001). Incontinence rates at 3 and 12 months after RRP decreased from 67.6% to 10.1 and after RALP decreased from 53.4% to 5.4%. Positive surgical margin rates were non-significantly different in the RRP and RALP groups (30.3% and 37.2%, respectively). Overall postoperative potency rate at 12 months was not significant different in RRP and RALP groups (34.3% and 43.0%). CONCLUSIONS RRP reproducing RALP was found to have surgical outcomes comparable to RALP. This technique might be adopted by experienced urologic surgeons as a standard procedure.
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Shim JS, Kwon TG, Rha KH, Lee YG, Lee JY, Jeong BC, Kim JY, Pyun JH, Kang SG, Kang SH. Oncologic Outcomes and Predictive Factors for Recurrence Following Robot-Assisted Radical Cystectomy for Urothelial Carcinoma: Multicenter Study from Korea. J Korean Med Sci 2017; 32:1662-1668. [PMID: 28875611 PMCID: PMC5592181 DOI: 10.3346/jkms.2017.32.10.1662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/01/2017] [Indexed: 11/24/2022] Open
Abstract
The aim of our study was to evaluate intermediate-term oncologic outcomes, predictive factors for recurrence, and recurrence patterns in a multicenter series of patients treated with robot-assisted radical cystectomy (RARC) for urothelial carcinoma (UC) of the bladder. Between 2007 and 2015, 346 patients underwent RARC at multiple tertiary referral centers in Korea. Descriptive statistics were used for demographics and perioperative variables. Survival and recurrence were estimated with Kaplan-Meier analysis. Logistic regression models were used to determine predictors of recurrence. Median follow-up was 33 months (interquartile range [IQR], 7-50). The numbers of patients with organ-confined and lymph node (LN)-positive disease were 237 (68.4%) and 68 (19.7%), respectively. LN density (1-20 vs. > 20) was 13.6% and 6.1%, with a median of 17 nodes removed (IQR, 9-23). In logistic regression analysis, type of LN dissection, and pathologic tumor stage were significant predictors of cancer recurrence and death from cancer. Local, distal recurrence and secondary UC occurred in 7 (2.0%), 53 (15.3%), and 4 (1.2%) patients, respectively. The 5-year overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were 78%, 84%, and 73%, respectively. At last follow-up, RFS for extended pelvic LN dissection vs. standard pelvic LN dissection was 70% and 47% (P = 0.038). In addition, at last follow-up, LN density (0 vs. 1-20 vs. over 20) was 67%, 41%, and 29%, respectively (P < 0.001). Patients undergoing RARC in this multi-institutional cohort demonstrated intermediate-term oncologic outcomes, predictive factors for recurrence, and recurrence patterns that were not unusual.
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Kim BS, Chun SY, Lih E, Ha YS, Yu NH, Kim DH, Kim J, Song PH, Han DK, Kwon TG. Optimal Molecular Weight of Poly(lactic-co-glycolic acid) and Mg(OH)2 Concentration to Fabricate Anti-Inflammatory Scaffold for Renal Tissue Regeneration. J BIOMATER TISS ENG 2017. [DOI: 10.1166/jbt.2017.1662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Byun SS, Hwang EC, Kang SH, Hong SH, Chung J, Kwon TG, Kim HH, Kwak C, Kim YJ, Lee WK. Sex-Specific Prognostic Significance of Obesity in Nonmetastatic Clear-Cell Renal-Cell Carcinoma in Korea: A Large Multicenter Cohort Analysis. Clin Genitourin Cancer 2017; 16:S1558-7673(17)30270-7. [PMID: 28958676 DOI: 10.1016/j.clgc.2017.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/15/2017] [Accepted: 08/28/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION We assessed the prognostic significance of obesity in relation to sex in patients with nonmetastatic clear-cell renal-cell carcinoma (nm-cRCC) in a large multicenter setting in Korea. PATIENTS AND METHODS A total of 2097 patients with nm-cRCC who underwent surgery with curative intent were enrolled from 6 institutions in Korea between April 2000 and February 2014. Obesity was determined by body mass index (BMI) before surgery. BMI was used as a continuous variable and was categorized as normal (≥ 18.5 to < 25.0 kg/m2, normal BMI) and overweight or obese (≥ 25 kg/m2, high BMI). The relationships between BMI, sex, recurrence-free survival (RFS), and cancer-specific survival (CSS) were evaluated. RESULTS Male patients had a greater high BMI ratio than female patients (P = .030). In men, the 5-year RFS and CSS rates in the high BMI group were greater than those in the normal BMI group (P = .003 and .006, respectively). Multivariate analyses revealed that in men, a high BMI was associated with greater RFS or CSS rates (hazard ratio: RFS, 0.901, P = .001; CSS, 0.822, P < .001). In women, there were no significant differences in the 5-year RFS and CSS rates according to BMI (P = .531 and .323, respectively), and high BMI was not associated with RFS or CSS (P = .250 and .180, respectively). CONCLUSION In patients with nm-cRCC, obesity was a favorable prognosticator in male but not female patients. Therefore, the association between obesity and nm-cRCC prognosis might differ by sex.
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Kang HW, Kim YH, Jeong P, Park C, Kim WT, Ryu DH, Cha EJ, Ha YS, Kim TH, Kwon TG, Moon SK, Choi YH, Yun SJ, Kim WJ. Expression levels of FGFR3 as a prognostic marker for the progression of primary pT1 bladder cancer and its association with mutation status. Oncol Lett 2017; 14:3817-3824. [PMID: 28927152 DOI: 10.3892/ol.2017.6621] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/28/2017] [Indexed: 11/05/2022] Open
Abstract
The present study examined the utility of fibroblast growth factor receptor 3 (FGFR3) mutation status and gene expression as a prognostic marker in primary pT1 bladder cancer (BC). A total of 120 patients with primary pT1 BC were enrolled. FGFR3 mutation status was determined by direct sequencing and FGFR3 mRNA expression level was determined by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) analysis. The results were compared with the clinicopathological parameters, and the prognostic value of FGFR3 was evaluated by Kaplan-Meier analysis and a multivariate Cox regression test. FGFR3 mutations were identified in 48/120 (40.0%) patients with pT1 BC. FGFR3 mRNA expression level was significantly higher in those with BC harboring FGFR3 mutations (P<0.001). Low FGFR3 expression level was associated with high-grade tumors and cancer progression (P=0.006 and P=0.001), whereas FGFR3 mutation status was not associated with cancer progression. Kaplan-Meier analysis revealed a similar result (log-rank, P<0.001). Multivariate analysis identified low FGFR3 expression level (odds ratio, 3.300; 95% confidence interval, 1.310-8.313; P=0.011) as an independent predictor of cancer progression. Stratification by exon site of FGFR3 mutations yielded significant differences in mRNA expression level. None of the patients with BC harboring FGFR3 mutations in exon 9 demonstrated disease progression. The mRNA expression level of the FGFR3 gene may be used to precisely identify subsets of patients with pT1 BC that have a relatively better prognosis. The prognostic influences of FGFR3 mutations may be modulated by the exon site of FGFR3 mutations.
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Ha US, Lee KW, Kim SW, Jeon SH, Kwon TG, Park HK, Hong SH. The influence of prior laparoscopic experience on learning laparoendoscopic single site surgery: a prospective comparative preliminary study using cystorraphy in a live porcine model. BMC Urol 2017; 17:57. [PMID: 28697805 PMCID: PMC5506604 DOI: 10.1186/s12894-017-0242-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 06/23/2017] [Indexed: 11/12/2022] Open
Abstract
Background The purpose of this study is to assess the impact of prior laparoscopic experience on the ability to learn laparoendoscopic single site surgery (LESS) skills. Methods A total of 33 urologists who completed a training program in LESS surgery were recruited for this study. After completing the educational course and training, the study participants demonstrated LESS suturing and knot-tying via a 2-cm cystotomy in a live porcine model for 15 min. An objective structured assessment of technical skills (OSATS) was used to evaluate videos of each participant’s procedure. The participants were divided according to laparoscopic experience; advanced experienced group (AS), intermediate experienced group (IS), novice group (NS). Results Three participants in the NS group completed the porcine cystorrhaphy in 15 min (30.0%), 3 (25.0%) completed the task in the IS group, and 3 (27.2%) completed it in the AS group. There were no statistically significant differences in the mean total OSATS quality score (NS; 16.7, IS; 18.5, AS; 16.8) among the 3 groups. Concerning all each assessment, there were also no statistically significant difference. Additionaly, the mean total OSATS quantity score (NS; 4.1, IS; 3.5, AS; 4.3) did not differ significantly among groups. The NS group succeeded a mean of 1.4 knots, the IS group succeeded 0.9, and the AS group 1.3 (p = 0.727). Conclusions There was no significant difference among the groups in LESS proficiency after training. Surgeons who were novices in conventional laparoscopic surgery reached comparable scores to those of experienced laparoscopic surgeons after training.
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Lee H, Kim YJ, Hwang EC, Kang SH, Hong SH, Chung J, Kwon TG, Kwak C, Kim HH, Oh JJ, Lee SC, Hong SK, Lee SE, Byun SS. Preoperative cholesterol level as a new independent predictive factor of survival in patients with metastatic renal cell carcinoma treated with cyto-reductive nephrectomy. BMC Cancer 2017; 17:364. [PMID: 28545466 PMCID: PMC5445323 DOI: 10.1186/s12885-017-3322-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/03/2017] [Indexed: 12/20/2022] Open
Abstract
Background The obesity and lipid metabolism were previously proposed to be related with the clinical outcomes of metastatic renal cell carcinoma (mRCC). We tried to investigate the relationship between preoperative cholesterol level (PCL) and survival outcomes in patients with mRCC. Methods We analysed the data of 244 patients initially treated with cyto-reductive nephrectomy after being diagnosed with mRCC. Patients were stratified into two groups according to the PCL cut-off level of 170 mg/dL. The postoperative survival rates were compared using Kaplan-Meier analysis and the possible predictors of patients’ cancer-specific survival (CSS) and overall survival (OS) were tested using multivariate Cox-proportional hazard models. Results The low cholesterol group showed significantly worse postoperative CSS (p = 0.013) and OS (p = 0.009) than the high cholesterol group. On multivariate analysis, low PCL was revealed as an independent predictor of worse CSS (hazard ratio [HR], 2.162; 95% CI, 1.221–3.829; p = 0.008) and OS (HR, 2.013; 95% CI, 1.206–3.361; p = 0.007). Subsequent subgroup analysis showed that these results were maintained in the clear cell subgroup but not in the non-clear cell subgroup. Conclusion Decreased PCL was significantly correlated with worse survival outcomes in patients with mRCC treated with cytoreductive nephrectomy. The underlined mechanism is still uncharted and requires further investigation.
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Cho YH, Hwang JE, Chung HS, Kim MS, Hwang EC, Jung SI, Kang TW, Kwon DD, Choi SH, Kim HT, Kim TH, Kwon TG, Noh JH, Kim MK, Kim CS, Kang SG, Kang SH, Cheon J, Lee CH, Ku JY, Ha HK, Tae BS, Jeong CW, Ku JH, Kwak C, Kim HH. The De Ritis (aspartate transaminase/alanine transaminase) ratio as a predictor of oncological outcomes in patients after surgery for upper urinary tract urothelial carcinoma. Int Urol Nephrol 2017; 49:1383-1390. [PMID: 28484945 DOI: 10.1007/s11255-017-1613-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/02/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE Recently, several studies have shown that the De Ritis ratio (aspartate transaminase/alanine transaminase) can be a useful prognostic biomarker for certain types of malignant tumors. However, the prognostic value of the De Ritis ratio in patients with upper tract urothelial carcinoma remains largely unknown. The aim of the present study was to evaluate the prognostic significance of the De Ritis ratio in patients who had undergone radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma. METHODS In total, 1049 patients who underwent RNU at eight institutions from 2004 to 2015 were reviewed retrospectively. The De Ritis ratio and conventional clinicopathological parameters were analyzed. Survival analysis was performed using the Kaplan-Meier method and log-rank test. Multivariate analysis was carried out using the Cox proportional hazards regression model. De Ritis ratio cutoff values were derived from receiver operating characteristic (ROC) curves. RESULTS ROC analysis showed the cutoff De Ritis ratio for overall death to be 1.6 (p = 0.002). The cancer-specific survival (CSS) and overall survival (OS) were significantly shorter for patients with a high De Ritis ratio (>1.6). Multivariate analysis revealed an independent relationship between an increased De Ritis ratio (>1.6) and shorter CSS (hazard ratio, HR 2.49, 95% confidence interval, CI 1.70-3.64; p = 0.001) and OS (HR 1.84, 95% CI 1.34-2.52; p = 0.001). CONCLUSION The De Ritis ratio can be a significant predictor of oncological outcomes in patients with upper urinary tract urothelial carcinoma after surgery.
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Jeong CW, Hong SK, Byun SS, Jeon SS, Seo SI, Lee HM, Ahn H, Kwon DD, Ha HK, Kwon TG, Chung JS, Kwak C, Kim HJ. Selection Criteria for Active Surveillance of Patients with Prostate Cancer in Korea: A Multicenter Analysis of Pathology after Radical Prostatectomy. Cancer Res Treat 2017; 50:265-274. [PMID: 28421726 PMCID: PMC5784641 DOI: 10.4143/crt.2016.477] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 04/06/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose Korean patients with prostate cancer (PC) typically present with a more aggressive disease than patients in Western populations. Consequently, it is unclear if the current criteria for active surveillance (AS) can safely be applied to Korean patients. Therefore, this study was conducted to define appropriate selection criteria for AS for patients with PC in Korea. Materials and Methods We conducted a multicenter retrospective study of 2,126 patients with low risk PC who actually underwent radical prostatectomy. The primary outcome was an unfavorable disease, which was defined by non-organ confined disease or an upgrading of the Gleason score to ≥ 7 (4+3). Predictive variables of an unfavorable outcome were identified by multivariate analysis using randomly selected training samples (n=1,623, 76.3%). We compared our selected criteria to various Western criteria for the primary outcome and validated our criteria using the remaining validation sample (n=503, 23.7%). Results A non-organ confined disease rate of 14.9% was identified, with an increase in Gleason score ≥ 7 (4+3) of 8.7% and a final unfavorable disease status of 20.8%. The following criteria were selected: Gleason score ≤ 6, clinical stage T1-T2a, prostate-specific antigen (PSA) ≤ 10 ng/mL, PSA density < 0.15 ng/mL/mL, number of positive cores ≤ 2, and maximum cancer involvement in any one core ≤ 20%. These criteria provided the lowest unfavorable disease rate (11.7%) when compared to Western criteria (13.3%-20.7%), and their validity was confirmed using the validation sample (5.9%). Conclusion We developed AS criteria which are appropriate for Korean patients with PC. Prospective studies using these criteria are now warranted.
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Hwang EC, Cho YH, Chung HS, Jung SI, Kang TW, Kwon DD, Kim MK, Kang SG, Kang SH, Cheon J, Ku JY, Ha HK, Jeong CW, Ku JH, Kwak C, Kwon TG, Kim TH, Choi SH, Seo IY. MP67-08 PREOPERATIVE SYSTEMIC INFLAMMATORY MARKERS IN UPPER TRACT UROTHELIAL CELL CARCINOMA: WHICH IS BETTER AS A PROGNOSTIC FACTOR? J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ha YS, Chung JW, Choi SH, Lee JN, Kim HT, Kim TH, Chung SK, Byun SS, Hwang EC, Kang SH, Hong SH, Chung J, Kwak C, Kim YJ, Kwon TG. Clinical Significance of Subclassification of Papillary Renal Cell Carcinoma: Comparison of Clinicopathologic Parameters and Oncologic Outcomes Between Papillary Histologic Subtypes 1 and 2 Using the Korean Renal Cell Carcinoma Database. Clin Genitourin Cancer 2017; 15:e181-e186. [DOI: 10.1016/j.clgc.2016.07.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/16/2016] [Accepted: 07/30/2016] [Indexed: 01/18/2023]
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Kim BS, Chung JW, Song PH, Chun SY, Kim YY, Lee HJ, Lee JN, Ha YS, Yoo ES, Kwon TG, Choi SH, Kim HT, Kim TH, Chung SK. MP29-04 COMPARISON OF FIVE DIFFERENT ANIMAL MODELS TO ESTABLISH THE BEST INTERSTITIAL CYSTITIS RAT MODEL SIMILAR TO HUMAN DISEASE. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kim BS, Chung JW, Song PH, Lee JN, Ha YS, Kwon TG, Choi SH, Kim HT, Kim TH, Chung SK, Kim KH, Kim BH, Ha JY, Cho DH, Kim GN, Lee YH, Kim JS, Jung HJ, Shin HS, Yoon JH, Kim JH, Yoo ES. MP09-11 MEASURING AND PREDICTING THE PATIENT-REPORTED GOAL ACHIEVEMENT AFTER TREATING MALE BENIGN PROSTATIC HYPERPLASIA WITH TAMSULOSIN MONOTHERAPY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.319] [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]
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Ha YS, Chung JW, Chun SY, Choi SH, Lee JN, Kim BS, Kim HT, Kim TH, Byun SS, Hwang EC, Kang SH, Hong SH, Chung J, Kwak C, Kim YJ, Kwon TG. Impact of preoperative thrombocytosis on prognosis after surgical treatment in pathological T1 and T2 renal cell carcinoma: results of a multi-institutional comprehensive study. Oncotarget 2017; 8:64449-64458. [PMID: 28969084 PMCID: PMC5610016 DOI: 10.18632/oncotarget.16136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/03/2017] [Indexed: 11/25/2022] Open
Abstract
Background The prognostic significance of preoperative thrombocytosis (TC) in renal cell carcinoma (RCC) is not without some debate. The aim of the present multi-institutional study was to determine the association of preoperative TC with the clinicopathological features and prognosis of localized RCC patients who underwent surgery in a large cohort. Methods A study involving 8 institutions, and 4,376 patients with pT1 and pT2 RCC from the Korean renal cell carcinoma (KORCC) database, was conducted. TC was defined as a platelet count ≥400,000/μL. Patients were divided into 2 groups based on the presence of preoperative TC. Clinicopathological variables and survival rates were compared between the 2 groups. Results Out of the 4,376 patients in the study, 106 (2.4%) had preoperative TC. Compared to patients without TC, these patients had a lower body mass index. Additionally, these patients had more advanced stage tumors with a higher Fuhrman grade, and higher incidence of symptoms at the time of diagnosis. Kaplan-Meier curves revealed that patients with TC had a significantly lower rate of recurrence-free survival (RFS). Furthermore, a lower rate of overall survival (OS) was exhibited amongst patients with TC. Multivariate analysis revealed that TC was an independent prognostic factor in terms of the RFS and OS. Conclusions TC appeared to be an important prognostic determinant in localized RCC. Furthermore, preoperative platelet count may be clinically useful for risk stratification of patients with surgically treated localized RCC.
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Yoo ES, Ha YS, Lee JN, Kim BS, Kim BW, Byun SS, Choi YD, Kang HW, Yun SJ, Kim WJ, Kim JH, Kwon TG. Can lymphovascular invasion replace the prognostic value of lymph node involvement in patients with upper tract urothelial carcinoma after radical nephroureterectomy? Can Urol Assoc J 2017; 10:E229-E236. [PMID: 28255413 DOI: 10.5489/cuaj.3557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aimed to evaluate whether lymphovascular invasion (LVI) can replace lymph node (LN) involvement as a prognostic marker in patients who do not undergo lymph node dissection (LND) during surgery in patients with upper tract urothelial carcinoma (UTUC). METHODS A total of 505 patients who underwent radical nephroureterectomy (RNU) were recruited from four academic centres and divided into four groups: node negative (N0, Group 1); node positive (N+, Group 2); no LND without LVI (NxLVI-, Group 3); and no LND with LVI (NxLVI+, Group 4). RESULTS Patients in Group 2 had larger tumours, a higher incidence of left-sided involvement, more aggressive T stage and grade, and a higher positive surgical margin rate than patients in other groups. Pathological features (T stage and grade) were poorer in Group 4 than in Groups 1 and 3. Compared to other groups, Group 2 had the worst prognostic outcomes regarding locoregional/distant metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). LVI and LN status in Group 4 was not associated with MFS in multivariate analysis. Among Nx diseases, LVI was not an independent predictor of MFS or CCS. The small number of cases in Groups 2 and 4 is a major limitation of this study. CONCLUSIONS Clinical outcomes according to LVI did not correlate with those outcomes predicted by LN involvement in patients with UTUC. Therefore, LVI may not be used as a substitute for nodal status in patients who do not undergo LND at the time of surgery.
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Kang HW, Seo SP, Kim WT, Kim YJ, Yun SJ, Lee SC, Choi YD, Ha YS, Kim TH, Kwon TG, Byun SS, Jeh SU, Kim WJ. Impact of the ASA Physical Status Score on Adjuvant Chemotherapy Eligibility and Survival of Upper Tract Urothelial Carcinoma Patients: a Multicenter Study. J Korean Med Sci 2017; 32:335-342. [PMID: 28049247 PMCID: PMC5220002 DOI: 10.3346/jkms.2017.32.2.335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/16/2016] [Indexed: 11/24/2022] Open
Abstract
The aim of the present multi-institutional study was to assess the influence of the American Society of Anesthesiologists Physical Status (ASA-PS) classification on adjuvant chemotherapy eligibility and survival in a multi-institutional cohort of patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). We retrospectively reviewed data from 416 patients who underwent RNU for UTUC at four Korean institutions between 2001 and 2013. The ASA-PS classification was obtained from the anesthesia chart. Locally advanced UTUC was defined as ≥ pT3 and/or pN1 disease. The influence of ASA-PS score on survival was evaluated by Kaplan-Meier analyses and a multivariate Cox regression model. Patients with a higher ASA-PS class were less likely to be eligible for adjuvant chemotherapy in locally advanced UTUC (P = 0.016). Kaplan-Meier estimates showed that the high-risk ASA-PS group has a poorer overallsurvival (OS) and cancer-specific survival (CSS) compared to low risk ASA-PS groups in both the total and locally advanced UTUC cohorts. Based on multivariate Cox regression analysis, the high-risk ASA-PS category was an independent predictor for overall mortality (OM) (hazard ratio [HR], 1.919; 95% confidence interval [CI], 1.017-3.619; P = 0.044) and cancer-specific mortality (CSM) (HR, 2.120; 95% CI, 1.023-4.394; P = 0.043). In conclusion, high-risk ASA-PS score was independently associated with a lower survival rate in patients with UTUC after RNU. However, the influence of ASA-PS classification on survival was limited to locally advanced UTUC. The lower eligibility of patients in the high-risk ASA category for adjuvant chemotherapy may contribute to the lower survival rate in this group.
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Kang HW, Seo SP, Kim WT, Yun SJ, Lee SC, Kim WJ, Hwang EC, Kang SH, Hong SH, Chung J, Kwon TG, Kim HH, Kwak C, Byun SS, Kim YJ. Impact of Young Age at Diagnosis on Survival in Patients with Surgically Treated Renal Cell Carcinoma: a Multicenter Study. J Korean Med Sci 2016; 31:1976-1982. [PMID: 27822938 PMCID: PMC5102863 DOI: 10.3346/jkms.2016.31.12.1976] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 08/22/2016] [Indexed: 11/20/2022] Open
Abstract
The prognostic significance of age in renal cell carcinoma (RCC) is a subject of debate. The aim of the present multi-institutional study was to evaluate the impact of age on clinicopathological features and survival in a large cohort of patients with RCC. A total of 5,178 patients who underwent surgery for RCC at eight institutions in Korea between 1999 and 2011 were categorized into three groups according to age at diagnosis as follows: young age (< 40 years, n = 541), middle-age (≥ 40 and < 60 years, n = 2,551), and old age (≥ 60 years, n = 2,096) groups. Clinicopathological variables and survival rates were compared between the three groups. Young patients had lower stage tumors with a low Fuhrman grade, a lower rate of lymphovascular invasion than patients in the other age groups. Regarding histologic type, the young age group had a lower percentage of clear cell histology and a greater incidence of Xp11.2 translocation RCC. Kaplan-Meier estimates showed that cancer-specific survival was significantly better in the young age group than in the other groups (log rank test, P = 0.008). However, age at diagnosis was not an independent predictor of survival in multivariate analysis. In conclusion, young age at diagnosis was associated with favorable pathologic features, although it was not an independent prognostic factor for survival in patients with surgically-treated RCC. Age itself should not be regarded as a crucial determinant for the treatment of RCC.
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Kim SH, Seo SI, Lee HM, Choi HY, Jeon SH, Lee HL, Kwon TG, Kim YJ, Kim WJ, Chung J. A Prospective Multicenter Trial of the Efficacy and Tolerability of Neoadjuvant Sunitinib for Inoperable Metastatic Renal Cell Carcinoma. J Korean Med Sci 2016; 31:1983-1988. [PMID: 27822939 PMCID: PMC5102864 DOI: 10.3346/jkms.2016.31.12.1983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/22/2016] [Indexed: 11/23/2022] Open
Abstract
This study aimed to evaluate the efficacy, safety, and tolerability of 2-cycled neoadjuvant sunitinib therapy (NST) in patients with inoperable metastatic renal cell carcinoma (mRCC). Between 2009 and 2012, 14 patients with inoperable mRCC from 5 Korean academic centers were prospectively enrolled after collecting their clinicopathological data and completing health-related questionnaires. The best overall response (BOR), safety profile, and changes in quality of life during NST were assessed using the RECIST criteria (version 1.0), CTCAE criteria (version 4.0), and the Cancer Quality of Life Questionnaire (QLQ-C30). Among the 14 patients, 9 patients (64.3%) experienced partial response or stable disease state, and 5 patients (35.7%) did not complete treatment, with 1 case of disease progression (7.1%), 3 grade 3 adverse events (21.4%), and 1 voluntary withdrawal (7.1%). Four patients (28.6%) were successfully converted to an operable state and underwent surgery after NST. The BOR for the primary renal lesions was 22.2%, with a median 1.3-cm diameter reduction (range: 0-2.8 cm) from a baseline diameter of 10.3 cm (range: 6.6-15.8 cm). The other 18 measurable metastatic lesions exhibited a BOR of 55.6%. The QLQ-C30 questionnaire results revealed significant improvements in the quality of life domain, although we observed significant increases in the scores for fatigue, nausea and vomiting, and the financial effects of NST (P < 0.05). Two-cycle NST provided limited efficacy for resectability of inoperable mRCC, despite mild improvements in the BOR of the primary lesion and quality of life (Clinical Trial Registry 1041140-1).
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