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Wu X, Zhou M, Lyu J, Chen L. Competing risk nomogram predicting cause-specific mortality in older patients with testicular germ cell tumors. Front Med (Lausanne) 2024; 11:1327485. [PMID: 38695022 PMCID: PMC11061386 DOI: 10.3389/fmed.2024.1327485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/20/2024] [Indexed: 05/04/2024] Open
Abstract
Background Testicular germ cell tumor (TGCT) is the most common type of malignancy in young men, but rarely in older adults. We aimed to construct a competing risk model to predict the prognosis for older patients with TGCT. Methods We collected TGCT patients aged 50 years or older diagnosed between 2004 and 2015 from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. We estimated the cumulative incidences of cause-specific death (CSD) and other causes of death and established a nomogram predicting cause-specific mortality in older patients with TGCT by Fine-Gray competing risk regression. The concordance index (C-index), calibration curves, area under the receiver operating characteristic curve (AUC), and decision analysis curves (DCA) were used to evaluate the differentiation, accuracy, and clinical significance of the nomogram. Results A total of 2,751 older TGCT patients were included in the study. The 3-, 5-, and 10-year cumulative incidences were 4.4, 5.0 and 6.1%, respectively, for cause-specific death, and 3.8, 6.2, 13.1%, respectively, for other causes of death. Predictors of cause-specific mortality in older TGCT included age, marital status, annual household income, histology, tumor size, stage and surgery. In the training and validation sets, the C-indexes were greater than 0.8, indicating that the nomogram had good discrimination. The AUC revealed the same result. The calibration curves showed good agreement between the predicted and observed results of the nomogram. DCA curves indicated that the nomogram had more clinical significance than the conventional American Joint Committee on Cancer (AJCC) staging. Based on the total nomogram score of each case, all patients were categorized into low-risk and high-risk groups, and risk categorization allowed the identification of cases with a high risk of death. Conclusion We established a competing risk nomogram with good performance that may help clinicians accurately predict the prognosis of older TGCT patients.
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Affiliation(s)
- Xiaoying Wu
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Mingfei Zhou
- Drug Clinical Trial Institution, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lin Chen
- Drug Clinical Trial Institution, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Mitchell MI, Ben-Dov IZ, Liu C, Wang T, Hazan RB, Bauer TL, Zakrzewski J, Donnelly K, Chow K, Ma J, Loudig O. Non-invasive detection of orthotopic human lung tumors by microRNA expression profiling of mouse exhaled breath condensates and exhaled extracellular vesicles. EXTRACELLULAR VESICLES AND CIRCULATING NUCLEIC ACIDS 2024; 5:138-164. [PMID: 38863869 PMCID: PMC11165456 DOI: 10.20517/evcna.2023.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Aim The lung is the second most frequent site of metastatic dissemination. Early detection is key to improving survival. Given that the lung interfaces with the external environment, the collection of exhaled breath condensate (EBC) provides the opportunity to obtain biological material including exhaled miRNAs that originate from the lung. Methods In this proof-of-principal study, we used the highly metastatic MDA-MB-231 subline 3475 breast cancer cell line (LM-3475) to establish an orthotopic lung tumor-bearing mouse model and investigate non-invasive detection of lung tumors by analysis of exhaled miRNAs. We initially conducted miRNA NGS and qPCR validation analyses on condensates collected from unrestrained animals and identified significant miRNA expression differences between the condensates of lung tumor-bearing and control mice. To focus our purification of EBC and evaluate the origin of these differentially expressed miRNAs, we developed a system to collect EBC directly from the nose and mouth of our mice. Results Using nanoparticle distribution analyses, TEM, and ONi super-resolution nanoimaging, we determined that human tumor EVs could be increasingly detected in mouse EBC during the progression of secondary lung tumors. Using our customizable EV-CATCHER assay, we purified human tumor EVs from mouse EBC and demonstrated that the bulk of differentially expressed exhaled miRNAs originate from lung tumors, which could be detected by qPCR within 1 to 2 weeks after tail vein injection of the metastatic cells. Conclusion This study is the first of its kind and demonstrates that lung tumor EVs are exhaled in mice and provide non-invasive biomarkers for detection of lung tumors.
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Affiliation(s)
- Megan I. Mitchell
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
- Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ 07601, USA
| | - Iddo Z. Ben-Dov
- Laboratory of Medical Transcriptomics, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Christina Liu
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - Tao Wang
- Department of Epidemiology and Population Health, The Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA
| | - Rachel B. Hazan
- Department of Pathology, The Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA
| | - Thomas L. Bauer
- Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune City, NJ 07753, USA
| | - Johannes Zakrzewski
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
- Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ 07601, USA
| | - Kathryn Donnelly
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - Kar Chow
- Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ 07601, USA
| | - Junfeng Ma
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Olivier Loudig
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
- Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, NJ 07601, USA
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Al-Khayal A, Noureldin Y, Alghafees M, Shafqat A, Sabbah BN, Elhossiny AH, Bakir M, Omar MA, Arabi TZ, Abdul Rab S, Alsaikhan B, Aldhalaan R, Alquirnas M, Alrabeeah K. A decade in focus: mixed germ cell tumors with choriocarcinoma components. Ann Med Surg (Lond) 2023; 85:5355-5358. [PMID: 37915675 PMCID: PMC10617832 DOI: 10.1097/ms9.0000000000001314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/06/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction This 10-year registry review aimed to investigate the clinical behaviour and outcomes of mixed germ cell tumours with choriocarcinoma components, a rare and aggressive subtype of testicular cancer, in Saudi Arabia. The study explores the demographic characteristics of affected patients, tumour profiles, and the mortality rate associated with this malignancy. Methods Utilizing data from the Saudi Cancer Registry, the authors identified 33 cases of mixed germ cell tumours with choriocarcinoma components among 1001 testicular cancer cases recorded between 2008 and 2017. Demographic information, including age, marital status, region of residency, year of diagnosis, and 10-year survival status, were collected. Tumour factors, such as the basis of diagnosis, origin site, behaviour, grade, extension, and laterality, were also analyzed. Results The majority of cases (78.8%) occurred in the young age group (18-45 years), and most tumours (97%) originated in normally descended testes. Grade IV (undifferentiated anaplastic) tumours and distant metastasis were present in 45.5% of patients. All cases exhibited malignant tumour behaviour. The overall mortality rate was 15%, with a mean time from diagnosis to death of 7.72 months (range: 0.5-21.5 months). Conclusion Mixed germ cell tumours with choriocarcinoma components are rare and tend to affect younger populations. These tumours demonstrate aggressive clinical behaviour, with a significant proportion presenting with high-grade lesions and metastasis at diagnosis. The observed mortality rate underscores the poor prognosis associated with this malignancy. Our study provides essential insights into the clinical characteristics of this rare tumour subtype in the Saudi Arabian population, emphasizing the need for further research to identify prognostic factors and optimize management strategies for affected patients.
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Affiliation(s)
- Abdullah Al-Khayal
- Department of Urology, King Abdulaziz Medical City
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences
- King Abdullah International Medical Research Center
| | | | - Mohammad Alghafees
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences
| | - Areez Shafqat
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | - Mohamad Bakir
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | | | - Bader Alsaikhan
- Department of Urology, King Abdulaziz Medical City
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences
- King Abdullah International Medical Research Center
| | - Reema Aldhalaan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Muhannad Alquirnas
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences
| | - Khalid Alrabeeah
- Department of Urology, King Abdulaziz Medical City
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences
- King Abdullah International Medical Research Center
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Li S, Xiong S, Yang L, zheng F, Liu J, Jiang M, Liu X, Liu W, Deng J, Fu B, Deng W. Development and validation of a nomogram to predict lung metastasis in patients with testicular germ cell tumors. Heliyon 2023; 9:e20177. [PMID: 37809781 PMCID: PMC10559949 DOI: 10.1016/j.heliyon.2023.e20177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023] Open
Abstract
Background Lung metastatic tumor (LM) is one of testicular germ cell tumors' most common metastatic sites. Our study aimed to develop a nomogram for predicting the risk of LM among patients with testicular germ cell tumors (TGCTs). Methods Clinicopathological information of 4078 patients with TGCT between 2010 and 2015 was obtained from SEER. Univariate and multivariate logistic regression analyses were performed to identify risk factors for LM, and a nomogram was developed based on these factors. Calibration curves, area under the receiver operating curve (AUC), and decision curve analysis (DCA) were used to evaluate the accuracy and discrimination of the model. Results Study participants included 4078 people with TGCTs, including 305 people with LM. They were randomly divided into two groups (training cohort = 2854 and validation cohort = 1224) at a ratio of 7:3. The following variables were incorporated in the nomogram: marital status, tumor histological type, T stage, brain metastasis, liver metastasis, lactate dehydrogenase (LDH), and chemotherapy. Besides, the AUC of it was 0.922 in the training cohort, while was 0.930 in the validation cohort. Training and validation cohort calibrations showed that the nomogram had excellent predictive abilities. DCA suggested it was more clinically relevant than the traditional TN staging. Conclusion We have established a nomogram to predict the risk of LM in patients with TGCTs. Doctors and patients can use this nomogram to monitor and identify lung metastasis of tumors through active monitoring and follow-up.
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Affiliation(s)
- Sheng Li
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Situ Xiong
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Lin Yang
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Fuchun zheng
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Jiahao Liu
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Ming Jiang
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Xiaoqiang Liu
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Weipeng Liu
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Jun Deng
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Bin Fu
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Wen Deng
- Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
- Jiangxi Institute of Urology, Nanchang, China
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Meagher MF, Mir MC, Minervini A, Kriegmair M, Heck M, Porpiglia F, Van Bruwaene S, Linares E, Hevia V, D’Anna M, Veccia A, Roussel E, Claps F, Palumbo C, Marchioni M, Afari J, Saitta C, Liu F, Rubio J, Campi R, Mari A, Amiel T, Checcucci E, Musquera M, Guruli G, Pavan N, Albersen M, Antonelli A, Klatte T, Autorino R, McKay RR, Derweesh IH. Proposal for a Two-Tier Re-classification of Stage IV/M1 domain of Renal Cell Carcinoma into M1 (“Oligometastatic”) and M2 (“Polymetastatic”) subdomains: Analysis of the Registry for Metastatic Renal Cell Carcinoma (REMARCC). Front Oncol 2023; 13:1113246. [PMID: 37064092 PMCID: PMC10092360 DOI: 10.3389/fonc.2023.1113246] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/12/2023] [Indexed: 03/31/2023] Open
Abstract
PurposeWe hypothesized that two-tier re-classification of the “M” (metastasis) domain of the Tumor-Node-Metastasis (TNM) staging of Renal Cell Carcinoma (RCC) may improve staging accuracy than the current monolithic classification, as advancements in the understanding of tumor biology have led to increased recognition of the heterogeneous potential of metastatic RCC (mRCC).MethodsMulticenter retrospective analysis of patients from the REMARCC (REgistry of MetAstatic RCC) database. Patients were stratified by number of metastases into two groups, M1 (≤3, “Oligometastatic”) and M2 (>3, “Polymetastatic”). Primary outcome was overall survival (OS). Secondary outcomes were cancer-specific survival (CSS). Cox-regression and Kaplan-Meier (KMA) analysis were utilized for outcomes, and receiver operating characteristic analysis (ROC) was utilized to assess diagnostic accuracy compared to current “M” staging.Results429 patients were stratified into proposed M1 and M2 groups (M1 = 286/M2 = 143; median follow-up 19.2 months). Cox-regression revealed M2 classification as an independent risk factor for worsened all-cause mortality (HR=1.67, p=0.001) and cancer-specific mortality (HR=1.74, p<0.001). Comparing M1-oligometastatic vs. M2-polymetastatic groups, KMA revealed significantly higher 5-year OS (36% vs. 21%, p<0.001) and 5-year CSS (39% vs. 17%, p<0.001). ROC analyses comparing OS and CSS, for M1/M2 reclassification versus unitary M designation currently in use demonstrated improved c-index for OS (M1/M2 0.635 vs. unitary M 0.500) and CSS (M1/M2 0.627 vs. unitary M 0.500).ConclusionSubclassification of Stage “M” domain of mRCC into two clinical substage categories based on metastatic burden corresponds to distinctive tumor groups whose oncological potential varies significantly and result in improved predictive capability compared to current staging.
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Affiliation(s)
- Margaret F. Meagher
- Department of Urology, University of California (UC) San Diego School of Medicine, La Jolla, CA, United States
| | - Maria C. Mir
- Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain
| | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | | | - Matthias Heck
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Francesco Porpiglia
- Department of Urology, University of Turin-San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | | | - Vital Hevia
- Department of Urology, Hospital Ramon y Cajal, Madrid, Spain
| | - Maurizio D’Anna
- Department of Urology, Hospital Clinic, Carrer de Villarroel, Barcelona, Spain
| | - Alessandro Veccia
- Department of Urology, Virginia Commonwealth University (VCU) Medical Center, Richmond, VA, United States
| | | | - Francesco Claps
- Department of Urology, University of Trieste, Trieste, Italy
| | - Carlotta Palumbo
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Michele Marchioni
- Department of Urology, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy
| | - Jonathan Afari
- Department of Urology, University of California (UC) San Diego School of Medicine, La Jolla, CA, United States
| | - Cesare Saitta
- Department of Urology, University of California (UC) San Diego School of Medicine, La Jolla, CA, United States
| | - Franklin Liu
- Department of Urology, University of California (UC) San Diego School of Medicine, La Jolla, CA, United States
| | - Jose Rubio
- Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain
| | - Riccardo Campi
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Thomas Amiel
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Enrico Checcucci
- Department of Urology, University of Turin-San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Mireia Musquera
- Department of Urology, Hospital Clinic, Carrer de Villarroel, Barcelona, Spain
| | - Georgi Guruli
- Department of Urology, University of Trieste, Trieste, Italy
| | - Nicola Pavan
- Department of Urology, University of Trieste, Trieste, Italy
| | | | - Alessandro Antonelli
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Riccardo Autorino
- Department of Urology, Virginia Commonwealth University (VCU) Medical Center, Richmond, VA, United States
| | - Rana R. McKay
- Department of Urology, University of California (UC) San Diego School of Medicine, La Jolla, CA, United States
| | - Ithaar H. Derweesh
- Department of Urology, University of California (UC) San Diego School of Medicine, La Jolla, CA, United States
- *Correspondence: Ithaar H. Derweesh,
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Ke H, Jiang S, He Z, Song Q, Yang D, Song C, Dong C, Liu J, Su X, Zhou J, Xiong Y. Clinical features and prognostic factors in patients diagnosed with lymphovascular invasion of testicular germ-cell tumors: Analysis based on the SEER database. Front Oncol 2023; 13:1142441. [PMID: 36937437 PMCID: PMC10020199 DOI: 10.3389/fonc.2023.1142441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Background Lymphovascular invasion (LVI) is a high-risk factor for testicular germ-cell tumors (TGCT), but a prognostic model for TGCT-LVI patients is lacking. This study aimed to develop a nomogram for predicting the overall survival (OS) of TGCT-LVI patients. Methods A complete cohort of 3288 eligible TGCG-LVI patients (training cohort, 2300 cases; validation cohort, 988 cases) were obtained from the Surveillance, Epidemiology, and End Results database. Variables screened by multivariate Cox regression analysis were used to construct a nomogram, which was subsequently evaluated using the consistency index (C-index), time-dependent receiver operating characteristic curve (ROC), and calibration plots. The advantages and disadvantages of the American Joint Committee on Cancer (AJCC) staging system and the nomogram were assessed by integrated discrimination improvement (IDI) and net reclassification improvement (NRI). Decision-analysis curve (DCA) was used to measure the net clinical benefit of the nomogram versus the AJCC staging system. Finally, Kaplan-Meier curves were used to evaluate the ability to identify different risk groups between the traditional AJCC staging system and the new risk-stratification system built on the nomogram. Results Nine variables were screened by multivariate Cox regression analysis to construct the nomogram. The C-index (training cohort, 0.821; validation cohort, 0.819) and time-dependent ROC of 3-, 5-, and 9-year OS between the two cohorts suggested that the nomogram had good discriminatory ability. Calibration curves showed good consistency of the nomogram. The NRI values of 3-, 5-, and 9-year OS were 0.308, 0.274, and 0.295, respectively, and the corresponding values for the validation cohort were 0.093, 0.093, and 0.099, respectively (P<0.01). Additionally, the nomogram had more net clinical benefit as shown by the DCA curves, and the new risk-stratification system provided better differentiation than the AJCC staging system. Conclusions A prognostic nomogram and new risk-stratification system were developed and validated to assist clinicians in assessing TGCT-LVI patients.
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Affiliation(s)
- Hu Ke
- Urology Department, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Shengming Jiang
- Urology Department, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Ziqi He
- Urology Department, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Qianlin Song
- Urology Department, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Dashuai Yang
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chao Song
- Urology Department, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Caitao Dong
- Urology Department, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Junwei Liu
- Urology Department, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiaozhe Su
- Urology Department, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jiawei Zhou
- Urology Department, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yunhe Xiong
- Urology Department, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- *Correspondence: Yunhe Xiong,
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Chebli N, Dahiri M, Ahmut H, El Aamraoui M, Lannaz S, El Ghissassi I, Boutayeb S, Mrabti H, Errihani H. Symptomatic spinal cord compression in spinal epidural metastasis of a testicular germ cell tumor: a case report with review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1286. [PMID: 36618797 PMCID: PMC9816831 DOI: 10.21037/atm-2022-51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/23/2022] [Indexed: 11/24/2022]
Abstract
Background Metastatic germ cell tumors particularly in the bone are rare entities. They occur in young men and classified in the group of poor prognosis. Bone metastases are responsible for a significant functional handicap and a deep alteration in the quality of life of young patients. Metastatic germ cell tumors are rare entities with a high cure rate due to their extreme chemosensitivity. To our knowledge, epidural metastasis of this tumor has not yet been reported in the English medical literature. Tumors of the breast, lung and prostate are the most notorious for metastasizing in the epidural-spinal space. Case Description We report a clinical case of spinal cord compression secondary to metastasis in the spinal epidural space of a testicular germ cell tumor in a 23-year-old. Patient whose evolution was marked by a decrease in tumor markers and a clear clinical improvement with disappearance of lower back pain and horsetail syndrome after starting the treatment with decompressive radiotherapy and chemotherapy based on bleomycin cisplatin and etoposide. Conclusions Through this, we want to emphasize that an epidural metastasis of this tumor is possible, and that it must be part of the diagnoses to be evoked in the face of metastatic spinal cord compression, which potentially allows to avoid a significant functional handicap and a profound alteration in the quality life of young patients.
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Affiliation(s)
- Najwa Chebli
- Medical Oncology Service, National Institute of Oncology, Rabat, Morocco
| | - Mustapha Dahiri
- Department of Digestive Oncological Surgery, National Institute of Oncology, Rabat, Morocco
| | - Halima Ahmut
- Radiotherapy Department, National Institute of Oncology, Rabat, Morocco
| | - Meryem El Aamraoui
- Medical Oncology Service, National Institute of Oncology, Rabat, Morocco
| | - Saad Lannaz
- Medical Oncology Service, National Institute of Oncology, Rabat, Morocco
| | | | - Saber Boutayeb
- Medical Oncology Service, National Institute of Oncology, Rabat, Morocco
| | - Hind Mrabti
- Medical Oncology Service, National Institute of Oncology, Rabat, Morocco
| | - Hassan Errihani
- Medical Oncology Service, National Institute of Oncology, Rabat, Morocco
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Guo A, Gu J, Yang J. Characteristics of lung metastasis in testicular cancer: A large-scale population analysis based on propensity score matching. Front Surg 2022; 9:959573. [DOI: 10.3389/fsurg.2022.959573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundThis study aims to systematically evaluate predictive factors for lung metastasis (LM) in patients with testicular cancer (TC) and to investigate cancer-specific survival (CSS) and overall survival (OS) of LM in TC patients based on a large population-cohort.MethodsA total of 10,414 patients diagnosed with TC during 2010–2015 were adopted from the Surveillance, Epidemiology, and End Results (SEER). After propensity score matching (PSM), 493 patients with LM were included for subsequent analysis. Univariate and multivariate logistic regression analyses were employed to identify risk factors, a nomogram was developed, and the receiver operating characteristic (ROC) curve was utilized to confirm the validation of the nomogram. Prognostic factors for OS and CSS among TC patients with LM were estimated via Cox proportional hazards models.ResultsPostmatching indicated that 11 parameters were successfully balanced between both groups (P > 0.05). After PSM, TC patients with LM presented an undesirable prognosis in both CSS and OS than those without LM (P < 0.001). The logistic regression model showed that tumor size; T stage; N stage; liver, brain, and bone metastases; and histology were positively associated with LM (P < 0.05). A nomogram was developed to predict diagnostic possibilities based on the independent risk variables, and the ROC curve verified the predictive capacity of the logistic regression model [area under the curve (AUC) = 0.910].ConclusionThe selected variates in the nomogram can be predictive criteria for TC patients with LM. Brain metastasis, liver metastasis, and larger tumor size were prognostic factors for CCS and OS among TC patients with LM.
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Eminaga O, Shkolyar E, Breil B, Semjonow A, Boegemann M, Xing L, Tinay I, Liao JC. Artificial Intelligence-Based Prognostic Model for Urologic Cancers: A SEER-Based Study. Cancers (Basel) 2022; 14:cancers14133135. [PMID: 35804904 PMCID: PMC9264864 DOI: 10.3390/cancers14133135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 12/11/2022] Open
Abstract
Simple Summary We describe a risk profile reconstruction model for cancer-specific survival estimation for continuous time points after urologic cancer diagnosis. We used artificial intelligence (AI)-based algorithms, a national cancer registry data, and accessible clinical parameters for the risk-profile reconstruction. We derived a risk stratification model and estimated the minimum follow-up duration and the likelihood for risk stability in prostate, kidney, and testicular cancers. The estimated follow-up duration was in alignment with recognized clinical guidelines for these cancers. Moreover, the estimated follow-up duration was differed by the cancer origin and the disease dissemination status. Overall, the reconstruction of the population’s risk profile for the cancer-specific prognostic score estimation is feasible using AI and has potential application in clinical settings to improve risk stratification and surveillance management. Abstract Background: Prognostication is essential to determine the risk profile of patients with urologic cancers. Methods: We utilized the SEER national cancer registry database with approximately 2 million patients diagnosed with urologic cancers (penile, testicular, prostate, bladder, ureter, and kidney). The cohort was randomly divided into the development set (90%) and the out-held test set (10%). Modeling algorithms and clinically relevant parameters were utilized for cancer-specific mortality prognosis. The model fitness for the survival estimation was assessed using the differences between the predicted and observed Kaplan–Meier estimates on the out-held test set. The overall concordance index (c-index) score estimated the discriminative accuracy of the survival model on the test set. A simulation study assessed the estimated minimum follow-up duration and time points with the risk stability. Results: We achieved a well-calibrated prognostic model with an overall c-index score of 0.800 (95% CI: 0.795–0.805) on the representative out-held test set. The simulation study revealed that the suggestions for the follow-up duration covered the minimum duration and differed by the tumor dissemination stages and affected organs. Time points with a high likelihood for risk stability were identifiable. Conclusions: A personalized temporal survival estimation is feasible using artificial intelligence and has potential application in clinical settings, including surveillance management.
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Affiliation(s)
- Okyaz Eminaga
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA; (E.S.); (J.C.L.)
- Correspondence:
| | - Eugene Shkolyar
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA; (E.S.); (J.C.L.)
| | - Bernhard Breil
- Faculty of Health Care, Hochschule Niederrhein, University of Applied Sciences, 47805 Krefeld, Germany;
| | - Axel Semjonow
- Prostate Center, Department of Urology, University Hospital Muenster, 48149 Muenster, Germany; (A.S.); (M.B.)
| | - Martin Boegemann
- Prostate Center, Department of Urology, University Hospital Muenster, 48149 Muenster, Germany; (A.S.); (M.B.)
| | - Lei Xing
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Ilker Tinay
- Department of Urology, Marmara University School of Medicine, Istanbul 34854, Turkey;
| | - Joseph C. Liao
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA; (E.S.); (J.C.L.)
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Rodriguez Pena MDC, Canete-Portillo S, Amin A, Aron M, Colombo P, Cox R, Baydar DE, Gallegos I, Khani F, Michalova K, Lucianò R, Miyamoto H, Osunkoya AO, Raspollini MR, Sánchez DF, Scarfo F, So JS, Zynger DL, Wei S, Netto GJ, Magi-Galluzzi C. Testicular Germ-Cell Tumors with Spermatic Cord Involvement: A Retrospective International Multi-Institutional Experience. Mod Pathol 2022; 35:249-255. [PMID: 34504308 DOI: 10.1038/s41379-021-00912-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 12/14/2022]
Abstract
The 8th Edition of the American Joint Committee on Cancer (AJCC) Staging Manual designates discontinuous involvement of spermatic cord soft tissue by testicular germ cell tumors as a metastatic deposit. We conducted a retrospective international multi-institutional study to validate the current recommendations. Thirty-three (72%) nonseminomatous and 13 (28%) seminomatous testicular germ cell tumors were collected from 15 institutions in America, Europe, and Asia. Testicular tumor size ranged from 1.3 to 18.0 cm (mean: 6.1). Cases were classified as discontinuous involvement of spermatic cord soft tissue (n = 26), continuous cord involvement (n = 17), or cord lymphovascular invasion (n = 3). The mean follow-up was 39 months. Clinical stage for discontinuous involvement of spermatic cord soft-tissue patients was I (local disease) in 2/24 (8%), II (regional disease) in 6/24 (25%), and III (distant disease) in 16/24 (67%) cases; 16 (67%) patients presented with distant metastasis. Clinical stage for continuous cord involvement patients was I in 9/17 (53%), II in 4/17 (23%), and III in 4/17 (23%); 4 (23%) patients presented with distant metastasis. Disease progression was seen in 4 patients with discontinuous involvement of spermatic cord soft tissue and 5 with continuous cord-involvement (p = 0.699). When comparing discontinuous and continuous cord involvement, a significant difference was found in cord margin status (p = 0.044), spermatic cord tumor size (p = 0.016), lymph-node involvement (p = 0.037), distant metastasis (p = 0.010), individual clinical stage (p = 0.003), and nonadvanced vs. advanced disease (p = 0.003) at presentation. In multivariate analysis, after adjusting for age, histology, testicular tumor size, percent of embryonal carcinoma, lymphovascular invasion, and cord margin status, discontinuous involvement of spermatic cord soft tissue was significantly associated (p = 0.011) with advanced clinical stage at presentation. Our findings support the designation of metastatic disease for discontinuous involvement of spermatic cord soft tissue, as introduced by the 8th edition of the AJCC staging.
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Affiliation(s)
| | | | - Ali Amin
- Department of Pathology, Brown University, Providence, RI, USA
| | - Manju Aron
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Piergiuseppe Colombo
- Department of Pathology, IRCCS Humanitas Clinical and Research Center, Milan, Italy
| | - Roni Cox
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Dilek Ertoy Baydar
- Department of Pathology, Koc University School of Medicine, Istanbul, Turkey
| | - Ivan Gallegos
- Department of Pathology, Hospital Clinico, Universidad de Chile, Santiago, Chile
| | - Francesca Khani
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Květoslava Michalova
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic
| | | | - Hiroshi Miyamoto
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Diego F Sánchez
- Department of Pathology, Instituto de Patología e Investigación, Asunción, Paraguay
| | | | - Jeffrey S So
- Department of Pathology, St. Luke's Medical Center, Quezon City and Global City, Quezon City, Philippines
| | - Debra L Zynger
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Shi Wei
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - George J Netto
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
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11
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Peritoneal carcinosis in male germ cell tumor patients: a registry study compiled by the German Testicular Cancer Study Group (GTCSG). World J Urol 2022; 40:355-361. [PMID: 34993564 PMCID: PMC8921103 DOI: 10.1007/s00345-021-03905-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/11/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To report on the clinical characteristics, outcome, and frequency of peritoneal carcinosis (PC) in patients with advanced germ cell tumors (GCT), a multicenter registry analysis was carried out. METHODS A multicenter registry analysis was conducted by the German Testicular Cancer Study Group (GTCSG) with international collaborators. Data was collected and analyzed retrospectively. Patients were eligible for inclusion if PC was diagnosed either by radiologic or histopathologic finding during the course of disease. Descriptive and explorative statistical analysis was carried out with cancer-specific survival (CSS) as primary study endpoint. RESULTS Collaborators from ten GCT expert centers identified 28 GCT (0.77%) patients with PC after screening approximately 3767 GCT patient files and one case was contributed from a cancer registry request. Patients were diagnosed from 1997 to 2019 at a median age of 37 years (interquartile range, 13). Two patients (7%) presented with stage I and 27 patients (93%) with synchronous metastatic disease at first diagnosis. The primary histology was seminoma in seven (27%) and non-seminoma in 21 patients (72%). PC was detected after a median of 15.3 months from primary diagnosis (range 0-177) and two consecutive treatment lines (range 0-5), respectively. The median CSS from the time of detection of PC was 10.5 months (95%Confidence Interval 0.47-1.30) associated with an overall 2-year CSS rate of 30%. CONCLUSION PC represents a rare tumor manifestation in GCT patients and was primarily associated with the occurrence of advanced cisplatin-refractory disease conferring to a dismal prognosis.
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12
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Han L, Lu J, Fang L, Qi S, Song Y. Simultaneous intracranial and testicular germ cell tumors: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2067. [PMID: 36034508 PMCID: PMC9394165 DOI: 10.3171/case2067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/02/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Simultaneous intracranial and testicular germ cell tumors (GCTs) are
extremely rare, leading to a lack of adequate experience in their treatment.
Therefore, the authors report a case of this kind of GCT. OBSERVATIONS A 5-year-old boy was admitted to the hospital with headache and vomiting.
Computed tomography and magnetic resonance imaging suggested the possibility
of a GCT in the pineal region. The value of the serum tumor marker
alpha-fetoprotein (AFP) was 5,396.1 μg/L, and β-human chorionic
gonadotropin levels were within the normal range. Subsequently, the tumor
was removed, and the final pathological result was a mixed GCT. Therefore,
chemotherapy and radiation were added. However, the authors found a
testicular tumor on ultrasound at the same time, and pathology after surgery
suggested a mature cystic teratoma. Following treatment, the patient
recovered well, and AFP levels dropped to normal values. LESSONS To the authors’ knowledge, this report is the fourth case of
simultaneous intracranial and testicular GCTs and the first case of a
simultaneous mixed GCT in the pineal region and mature teratoma of the
testis. A combination of surgery, chemotherapy, and radiation therapy for
mixed GCTs in the pineal region and surgical excision for testicular
reproductive cell tumors are effective in these patients, but long-term
monitoring is required.
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Affiliation(s)
- Lei Han
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Jie Lu
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Luxiong Fang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Ye Song
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
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13
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Bhambhvani HP, Greenberg DR, Kasman AM, DeRouen MC, Cheng I, Eisenberg ML, Shah SA. Racial and socioeconomic disparities in retroperitoneal lymph node dissection and survival in nonseminomatous germ cell tumor: A population-based study. Urol Oncol 2021; 39:197.e1-197.e8. [PMID: 33423934 DOI: 10.1016/j.urolonc.2020.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/09/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Though testicular cancer is the most common cancer in young men, there is a paucity of epidemiologic studies examining sociodemographic disparities in adjuvant therapy and outcomes. We examined the associations of sociodemographic factors with retroperitoneal lymph node dissection (RPLND) and survival among patients with nonseminomatous germ cell tumors (NSGCTs). METHODS Within the Surveillance Epidemiology and End Results database (2005-2015), we identified 8,573 patients with nonseminomatous germ cell tumors. Multivariable logistic regression and Fine-Gray competing-risks regression models were constructed to examine the association of sociodemographic factors (neighborhood SES (nSES), race, and insurance) with, respectively, adjuvant RPLND within 1 year of diagnosis and cancer-specific mortality. RESULTS Patients in the lowest nSES quintile (OR 0.59, 95% CI = 0.40-0.88, P = 0.01) and Black patients (OR 0.41, 95% CI = 0.15-1.00, P= 0.058) with stage II disease were less likely to receive RPLND compared to those in the highest quintile and White patients, respectively. Stage III patients with Medicaid (OR 0.64, 95% CI = 0.46-0.89, P= 0.009) or without insurance (OR 0.46, 95% CI = 0.27-0.76, P= 0.003) were less likely to receive RPLND compared to patients with private insurance. Lowest quintile nSES patients of all disease stages and Black patients with stage I disease (HR = 2.64, 95% CI = 1.12-6.20, P = 0.026) or stage II disease (HR=4.93, 95% CI = 1.48-16.44, P = 0.009) had higher risks of cancer-specific mortality compared to highest quintile nSES and White patients, respectively. CONCLUSIONS This national study found multilevel, stage-specific sociodemographic disparities in receipt of RPLND and survival.
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Affiliation(s)
| | | | - Alex M Kasman
- Department of Urology, Stanford University Medical Center, Stanford, CA
| | - Mindy C DeRouen
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; UCSF Department of Epidemiology and Biostatistics, San Francisco, CA
| | - Iona Cheng
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; UCSF Department of Epidemiology and Biostatistics, San Francisco, CA
| | | | - Sumit A Shah
- Division of Oncology, Stanford University Medical Center, Stanford, CA
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14
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Chertack N, Ghandour RA, Singla N, Freifeld Y, Hutchinson RC, Courtney K, Bowman IA, Arafat W, Meng X, Moore JA, Aydin AM, Sagalowsky AI, Margulis V, Lotan Y, Woldu SL, Bagrodia A. Overcoming sociodemographic factors in the care of patients with testicular cancer at a safety net hospital. Cancer 2020; 126:4362-4370. [DOI: 10.1002/cncr.33076] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/02/2020] [Accepted: 05/30/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Nathan Chertack
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Rashed A. Ghandour
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Nirmish Singla
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Yuval Freifeld
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Ryan C. Hutchinson
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Kevin Courtney
- Division of Hematology and Oncology Department of Medicine University of Texas Southwestern Medical Center Dallas Texas
| | - I. Alex Bowman
- Division of Hematology and Oncology Department of Medicine University of Texas Southwestern Medical Center Dallas Texas
| | - Waddah Arafat
- Division of Hematology and Oncology Department of Medicine University of Texas Southwestern Medical Center Dallas Texas
| | - Xiaosong Meng
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Joseph A. Moore
- Division of Hematology and Oncology Department of Medicine University of Texas Southwestern Medical Center Dallas Texas
| | - Ahmet M. Aydin
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Arthur I. Sagalowsky
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Vitaly Margulis
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Yair Lotan
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Solomon L. Woldu
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Aditya Bagrodia
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
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