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Barker R, Biernacka K, Kingshott G, Sewell A, Gwiti P, Martin RM, Lane JA, McGeagh L, Koupparis A, Rowe E, Oxley J, Perks CM, Holly JMP. Associations of CTCF and FOXA1 with androgen and IGF pathways in men with localized prostate cancer. Growth Horm IGF Res 2023; 69-70:101533. [PMID: 37086646 DOI: 10.1016/j.ghir.2023.101533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/30/2023] [Accepted: 04/07/2023] [Indexed: 04/24/2023]
Abstract
AIMS To examine associations between the transcription factors CCCTC-binding factor (CTCF) and forkhead box protein A1 (FOXA1) and the androgen receptor (AR) and their association with components of the insulin-like growth factor (IGF)-pathway in a cohort of men with localized prostate cancer. METHODS Using prostate tissue samples collected during the Prostate cancer: Evidence of Exercise and Nutrition Trial (PrEvENT) trial (N = 70 to 92, depending on section availability), we assessed the abundance of CTCF, FOXA1, AR, IGFIR, p-mTOR, PTEN and IGFBP-2 proteins using a modified version of the Allred scoring system. Validation studies were performed using large, publicly available datasets (TCGA) (N = 489). RESULTS We identified a strong correlation between CTCF and AR staining with benign prostate tissue. CTCF also strongly associated with the IGFIR, with PTEN and with phospho-mTOR. FOXA1 was also correlated with staining for the IGF-IR, with IGFBP-2 and with staining for activated phosphor-mTOR. The staining for the IGF-IR was strongly correlated with the AR. CONCLUSION Our findings emphasise the close and complex links between the endocrine controls, well known to play an important role in prostate cancer, and the transcription factors implicated by the recent genetic evidence.
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Affiliation(s)
- Rachel Barker
- IGF & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - Kalina Biernacka
- IGF & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - Georgina Kingshott
- IGF & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - Alex Sewell
- Department of Cellular Pathology, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK
| | - Paida Gwiti
- Department of Cellular Pathology, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK; Department of Pathology, North West Anglia NHS Foundation Trust, Peterborough PE3 9GZ, UK
| | - Richard M Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK; National Institute for Health Research, Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Biomedical Research Unit Offices, University Hospitals Bristol Education Centre, Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK
| | - J Athene Lane
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Lucy McGeagh
- Supportive Cancer Care Research Group, Faculty of Health and Life Sciences, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Jack Straws Lane, Marston, Oxford OX3 0FL, UK
| | - Anthony Koupparis
- Department of Urology, Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB, UK
| | - Edward Rowe
- Department of Urology, Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB, UK
| | - Jon Oxley
- Department of Cellular Pathology, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK
| | - Claire M Perks
- IGF & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK.
| | - Jeff M P Holly
- IGF & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK
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Challapalli A, White P, Masson S, Foulstone E, Renninson E, Bravo A, Pearson S, Dailami N, Persad R, Koupparis A, Rowe E, Oxley J, Kabala J, Ash-Miles J, Bahl A. The Bristol Bladder Trial: Five year outcomes in patients treated with neoadjuvant cabazitaxel and cisplatin chemotherapy for muscle invasive transitional cell carcinoma of the urinary bladder. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
493 Background: Neoadjuvant cisplatin-based combination chemotherapy (NAC) improves survival in muscle invasive bladder cancer (MIBC). However, response rates and survival remain suboptimal. We sought to evaluate the efficacy of cabazitaxel with cisplatin in this patient group. These patients have now been followed for survival status for 5 years post NAC and radical cystectomy. Methods: This was a single arm (Simon 2 stage), phase 2 study. Patients with MIBC were included if fit to receive NAC and to undergo radical cystectomy. 26 evaluable patients were required to detect an objective response rate (ORR) of >35% with 80% power. ORR was defined as pathological complete response (pCR) plus partial response (pathological downstaging, ≥T2 at diagnosis to ≤T1 at cystectomy). Treatment was with cisplatin 70mg/m2 and cabazitaxel 15mg/m2 on day 1 of a 21-day cycle, for 4 cycles prior to surgery. Toxicity was recorded using CTCAE v.4.03. QoL data was assessed during and after chemotherapy using EQ-5D-5L and EORTC-QLQ-C30, BLM30 questionnaires. Patients were followed for 5 years post cystectomy for progression free survival (PFS) and overall survival (OS). Results: ORR was seen in 15 out of 26 evaluable patients, 57.7%, with 24.6% achieving pCR. 1 out of 15 patients who achieved ORR died due to disease progression in the 5 year follow up period. The median PFS and OS were not reached by the 5 year follow up time point with a 5 year survival rate of 65.4% being seen in this patient cohort. Median OS in non-responders (11 patients) was 20.5 months and 5 year survival rate for the non-responders was 36.4% compared to 93.3% for responders. Conclusions: Neoadjuvant cabazitaxel with cisplatin chemotherapy is an effective regimen with 65.4% patients alive and progression-free at 5 years. It also indicates that ORR (and not just pCR), is a good predictor of patient survival at 5 years post radical cystectomy with only 1 out of 15 patients who achieved ORR progressing and dying in this period. However, in current clinical practice, there are no validated predictive biomarkers regarding potential response to NAC. Taken together with our previously published data, cabazitaxel with cisplatin as neoadjuvant chemotherapy is a safe, well-tolerated and effective regimen and should be compared to the regimens e.g. cisplatin/gemcitabine considered as standard in this setting. Clinical trial information: NCT01616875 .
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Affiliation(s)
- Amarnath Challapalli
- Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Paul White
- University of the West of England, Bristol, United Kingdom
| | - Susan Masson
- Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Emily Foulstone
- Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Emily Renninson
- Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Alicia Bravo
- Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Sylvia Pearson
- Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Narges Dailami
- University of the West of England, Bristol, United Kingdom
| | - Raj Persad
- North Bristol NHS Trust, Bristol, United Kingdom
| | | | - Edward Rowe
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Jon Oxley
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Julian Kabala
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | | | - Amit Bahl
- Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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Khetrapal P, Catto J, Ambler G, Williams N, Al-Hammouri T, Khan M, Thurairaja R, Nair R, Nathan S, Sridhar A, Ahmed I, Charlesworth P, Blick C, Cumberbatch M, Hussain S, Kotwal S, Bains P, Rowe E, Koupparis A, Noon A, Vasdev N, Hanchanale V, Mcgrath J, Kelly J. Comparing objective recovery of activity levels using wearable devices in open vs. intracorporeal robotic cystectomy: An analysis of the secondary outcomes of the iROC randomized trial. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00208-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Mansor R, Holly J, Barker R, Biernacka K, Zielinska H, Koupparis A, Rowe E, Oxley J, Sewell A, Martin RM, Lane A, Hackshaw-McGeagh L, Perks C. Correction: IGF-1 and hyperglycaemia-induced FOXA1 and IGFBP-2 affect epithelial to mesenchymal transition in prostate epithelial cells. Oncotarget 2023; 14:44-46. [PMID: 36702334 PMCID: PMC9882991 DOI: 10.18632/oncotarget.28344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Rehanna Mansor
- 1IGFs and Metabolic Endocrinology Group, Bristol Medical School, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK,2Faculty of Medicine, Royal College of Medicine Perak, Universiti Kuala Lumpur, Ipoh, MY
| | - Jeff Holly
- 1IGFs and Metabolic Endocrinology Group, Bristol Medical School, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - Rachel Barker
- 1IGFs and Metabolic Endocrinology Group, Bristol Medical School, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - Kalina Biernacka
- 1IGFs and Metabolic Endocrinology Group, Bristol Medical School, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - Hanna Zielinska
- 1IGFs and Metabolic Endocrinology Group, Bristol Medical School, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - Anthony Koupparis
- 3Department of Urology, Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Edward Rowe
- 3Department of Urology, Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Jon Oxley
- 4Department of Cellular Pathology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Alex Sewell
- 4Department of Cellular Pathology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Richard M. Martin
- 5NIHR Biomedical Research Centre, Level 3, University Hospitals Bristol Education Centre, Bristol, UK,6Population Health Sciences, University of Bristol, Bristol, UK
| | - Athene Lane
- 5NIHR Biomedical Research Centre, Level 3, University Hospitals Bristol Education Centre, Bristol, UK,6Population Health Sciences, University of Bristol, Bristol, UK
| | - Lucy Hackshaw-McGeagh
- 5NIHR Biomedical Research Centre, Level 3, University Hospitals Bristol Education Centre, Bristol, UK
| | - Claire Perks
- 1IGFs and Metabolic Endocrinology Group, Bristol Medical School, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK,Correspondence to:Claire Perks, email:
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Gilliland N, Koupparis A. Urological trauma: An interesting case of posterior urethral transection and bilateral testicular avulsion following massive pelvic trauma. Journal of Clinical Urology 2022. [DOI: 10.1177/2051415819835619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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McGeagh L, Robles LA, Persad R, Rowe E, Bahl A, Aning J, Koupparis A, Abrams P, Perks C, Holly J, Johnson L, Shiridzinomwa C, Challapalli A, Shingler E, Taylor H, Oxley J, Sandu M, Martin RM, Lane JA. Prostate cancer-Exercise and Metformin Trial (Pre-EMpT): study protocol for a feasibility factorial randomized controlled trial in men with localised or locally advanced prostate cancer. Pilot Feasibility Stud 2022; 8:179. [PMID: 35962445 PMCID: PMC9372971 DOI: 10.1186/s40814-022-01136-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Evidence from observational studies have shown that moderate intensity physical activity can reduce risk of progression and cancer-specific mortality in participants with prostate cancer. Epidemiological studies have also shown participants taking metformin to have a reduced risk of prostate cancer. However, data from randomised controlled trials supporting the use of these interventions are limited. The Prostate cancer–Exercise and Metformin Trial examines that feasibility of randomising participants diagnosed with localised or locally advanced prostate cancer to interventions that modify physical activity and blood glucose levels. The primary outcomes are randomisation rates and adherence to the interventions over 6 months. The secondary outcomes include intervention tolerability and retention rates, measures of insulin-like growth factor I, prostate-specific antigen, physical activity, symptom-reporting, and quality of life. Methods Participants are randomised in a 2 × 2 factorial design to both a physical activity (brisk walking or control) and a pharmacological (metformin or control) intervention. Participants perform the interventions for 6 months with final measures collected at 12 months follow-up. Discussion Our trial will determine whether participants diagnosed with localised or locally advanced prostate cancer, who are scheduled for radical treatments or being monitored for signs of cancer progression, can be randomised to a 6 months physical activity and metformin intervention. The findings from our trial will inform a larger trial powered to examine the clinical benefits of these interventions. Trial registration Prostate Cancer Exercise and Metformin Trial (Pre-EMpT) is registered on the ISRCTN registry, reference number ISRCTN13543667. Date of registration 2nd August 2018–retrospectively registered. First participant was recruited on 11th September 2018.
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Affiliation(s)
- Lucy McGeagh
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK.,Supportive Cancer Care Research Group, Faculty of Health and Life Sciences, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Luke A Robles
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Raj Persad
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Edward Rowe
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Amit Bahl
- Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jonathan Aning
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | | | - Paul Abrams
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Claire Perks
- Insulin-like Growth Factors and Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jeffrey Holly
- Insulin-like Growth Factors and Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lyndsey Johnson
- Clinical Research Centre, North Bristol NHS Trust, Bristol, UK
| | | | - Amarnath Challapalli
- Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Ellie Shingler
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Hilary Taylor
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK.,Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Jon Oxley
- Department of Cellular Pathology, North Bristol NHS Trust, Bristol, UK
| | - Meda Sandu
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Richard M Martin
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK.,Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - J Athene Lane
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK. .,Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK.
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Robles LA, Shingler E, McGeagh L, Rowe E, Koupparis A, Bahl A, Shiridzinomwa C, Persad R, Martin RM, Lane JA. Attitudes and adherence to changes in nutrition and physical activity following surgery for prostate cancer: a qualitative study. BMJ Open 2022; 12:e055566. [PMID: 35768108 PMCID: PMC9244678 DOI: 10.1136/bmjopen-2021-055566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Interventions designed to improve men's diet and physical activity (PA) have been recommended as methods of cancer prevention. However, little is known about specific factors that support men's adherence to these health behaviour changes, which could inform theory-led diet and PA interventions. We aimed to explore these factors in men following prostatectomy for prostate cancer (PCa). DESIGN, SETTING AND PARTICIPANTS A qualitative study using semistructured interviews with men, who made changes to their diet and/or PA as part of a factorial randomised controlled trial conducted at a single hospital in South West England. Participants were 17 men aged 66 years, diagnosed with localised PCa and underwent prostatectomy. Interview transcripts underwent thematic analysis. RESULTS Men were ambivalent about the relationship of nutrition and PA with PCa risk. They believed their diet and level of PA were reasonable before being randomised to their interventions. Men identified several barriers and facilitators to performing these new behaviours. Barriers included tolerance to dietary changes, PA limitations and external obstacles. Facilitators included partner involvement in diet, habit formation and brisk walking as an individual activity. Men discussed positive effects associated with brisk walking, such as feeling healthier, but not with nutrition interventions. CONCLUSIONS The facilitators to behaviour change suggest that adherence to trial interventions can be supported using well-established behaviour change models. Future studies may benefit from theory-based interventions to support adherence to diet and PA behaviour changes in men diagnosed with PCa.
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Affiliation(s)
- Luke A Robles
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Ellie Shingler
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Lucy McGeagh
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
- Supportive Cancer Care Research Group, Faculty of Health and Life Sciences, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Edward Rowe
- Bristol Urology Institute, Department of Urology, North Bristol NHS Trust, Bristol, UK
| | - Anthony Koupparis
- Bristol Urology Institute, Department of Urology, North Bristol NHS Trust, Bristol, UK
| | - Amit Bahl
- Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Raj Persad
- Bristol Urology Institute, Department of Urology, North Bristol NHS Trust, Bristol, UK
| | - Richard M Martin
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - J Athene Lane
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
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Catto JWF, Khetrapal P, Ricciardi F, Ambler G, Williams NR, Al-Hammouri T, Khan MS, Thurairaja R, Nair R, Feber A, Dixon S, Nathan S, Briggs T, Sridhar A, Ahmad I, Bhatt J, Charlesworth P, Blick C, Cumberbatch MG, Hussain SA, Kotwal S, Koupparis A, McGrath J, Noon AP, Rowe E, Vasdev N, Hanchanale V, Hagan D, Brew-Graves C, Kelly JD. Effect of Robot-Assisted Radical Cystectomy With Intracorporeal Urinary Diversion vs Open Radical Cystectomy on 90-Day Morbidity and Mortality Among Patients With Bladder Cancer: A Randomized Clinical Trial. JAMA 2022; 327:2092-2103. [PMID: 35569079 PMCID: PMC9109000 DOI: 10.1001/jama.2022.7393] [Citation(s) in RCA: 101] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Robot-assisted radical cystectomy is being performed with increasing frequency, but it is unclear whether total intracorporeal surgery improves recovery compared with open radical cystectomy for bladder cancer. OBJECTIVES To compare recovery and morbidity after robot-assisted radical cystectomy with intracorporeal reconstruction vs open radical cystectomy. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of patients with nonmetastatic bladder cancer recruited at 9 sites in the UK, from March 2017-March 2020. Follow-up was conducted at 90 days, 6 months, and 12 months, with final follow-up on September 23, 2021. INTERVENTIONS Participants were randomized to receive robot-assisted radical cystectomy with intracorporeal reconstruction (n = 169) or open radical cystectomy (n = 169). MAIN OUTCOMES AND MEASURES The primary outcome was the number of days alive and out of the hospital within 90 days of surgery. There were 20 secondary outcomes, including complications, quality of life, disability, stamina, activity levels, and survival. Analyses were adjusted for the type of diversion and center. RESULTS Among 338 randomized participants, 317 underwent radical cystectomy (mean age, 69 years; 67 women [21%]; 107 [34%] received neoadjuvant chemotherapy; 282 [89%] underwent ileal conduit reconstruction); the primary outcome was analyzed in 305 (96%). The median number of days alive and out of the hospital within 90 days of surgery was 82 (IQR, 76-84) for patients undergoing robotic surgery vs 80 (IQR, 72-83) for open surgery (adjusted difference, 2.2 days [95% CI, 0.50-3.85]; P = .01). Thromboembolic complications (1.9% vs 8.3%; difference, -6.5% [95% CI, -11.4% to -1.4%]) and wound complications (5.6% vs 16.0%; difference, -11.7% [95% CI, -18.6% to -4.6%]) were less common with robotic surgery than open surgery. Participants undergoing open surgery reported worse quality of life vs robotic surgery at 5 weeks (difference in mean European Quality of Life 5-Dimension, 5-Level instrument scores, -0.07 [95% CI, -0.11 to -0.03]; P = .003) and greater disability at 5 weeks (difference in World Health Organization Disability Assessment Schedule 2.0 scores, 0.48 [95% CI, 0.15-0.73]; P = .003) and at 12 weeks (difference in WHODAS 2.0 scores, 0.38 [95% CI, 0.09-0.68]; P = .01); the differences were not significant after 12 weeks. There were no statistically significant differences in cancer recurrence (29/161 [18%] vs 25/156 [16%] after robotic and open surgery, respectively) and overall mortality (23/161 [14.3%] vs 23/156 [14.7%]), respectively) at median follow-up of 18.4 months (IQR, 12.8-21.1). CONCLUSIONS AND RELEVANCE Among patients with nonmetastatic bladder cancer undergoing radical cystectomy, treatment with robot-assisted radical cystectomy with intracorporeal urinary diversion vs open radical cystectomy resulted in a statistically significant increase in days alive and out of the hospital over 90 days. However, the clinical importance of these findings remains uncertain. TRIAL REGISTRATION ISRCTN Identifier: ISRCTN13680280; ClinicalTrials.gov Identifier: NCT03049410.
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Affiliation(s)
- James W. F. Catto
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, England
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
- Division of Surgery and Interventional Science, University College London, London, England
| | - Pramit Khetrapal
- Division of Surgery and Interventional Science, University College London, London, England
| | | | - Gareth Ambler
- Department of Statistical Science, University College London, London, England
| | - Norman R. Williams
- Surgical and Interventional Trials Unit (SITU), Division of Surgery and Interventional Science, University College London, London, England
| | - Tarek Al-Hammouri
- Division of Surgery and Interventional Science, University College London, London, England
| | - Muhammad Shamim Khan
- Department of Urology, Guys and St Thomas’ NHS Foundation Trust, London, England
| | - Ramesh Thurairaja
- Department of Urology, Guys and St Thomas’ NHS Foundation Trust, London, England
| | - Rajesh Nair
- Department of Urology, Guys and St Thomas’ NHS Foundation Trust, London, England
| | - Andrew Feber
- Division of Surgery and Interventional Science, University College London, London, England
| | - Simon Dixon
- Health Economics and Decision Science, NIHR Research Design Service Yorkshire and the Humber, University of Sheffield, Sheffield, England
| | - Senthil Nathan
- Division of Surgery and Interventional Science, University College London, London, England
| | - Tim Briggs
- Division of Surgery and Interventional Science, University College London, London, England
| | - Ashwin Sridhar
- Division of Surgery and Interventional Science, University College London, London, England
| | - Imran Ahmad
- Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Jaimin Bhatt
- Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Philip Charlesworth
- The Harold Hopkins Department of Urology, Royal Berkshire NHS Foundation Trust, Reading, England
| | - Christopher Blick
- The Harold Hopkins Department of Urology, Royal Berkshire NHS Foundation Trust, Reading, England
| | - Marcus G. Cumberbatch
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, England
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Syed A. Hussain
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, England
- Department of Medical Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Sanjeev Kotwal
- Pyrah Department of Urology, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | | | - John McGrath
- Department of Urology, Royal Devon University Hospitals Foundation Trust and University of Exeter, Exeter, England
| | - Aidan P. Noon
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Edward Rowe
- Department of Urology, North Bristol NHS Trust, Bristol, England
| | - Nikhil Vasdev
- Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, University of Hertfordshire, Hatfield, England
| | | | - Daryl Hagan
- Department of Statistical Science, University College London, London, England
| | - Chris Brew-Graves
- Department of Statistical Science, University College London, London, England
| | - John D. Kelly
- Division of Surgery and Interventional Science, University College London, London, England
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McPhee A, Ridgway A, Bird T, Rowe E, Koupparis A, Aning J. A comparison of Charlson comorbidity index and cardiopulmonary exercise testing in predicting outcomes after Robotic Assisted Radical Cystectomy (RARC) and intracorporeal reconstruction for bladder cancer. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01181-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Koupparis A. “response to” “Letter to the Editor re: Cycling and men’s health: A worldwide survey in association the Global Cycling Network J Clin Urol May 2019 by Koupparis et al. Journal of Clinical Urology 2021. [DOI: 10.1177/2051415820956435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Challapalli A, Masson S, White P, Dailami N, Pearson S, Rowe E, Koupparis A, Oxley J, Abdelaziz A, Ash-Miles J, Bravo A, Foulstone E, Perks C, Holly J, Persad R, Bahl A. A Single-arm Phase II Trial of Neoadjuvant Cabazitaxel and Cisplatin Chemotherapy for Muscle-Invasive Transitional Cell Carcinoma of the Urinary Bladder. Clin Genitourin Cancer 2021; 19:325-332. [PMID: 33727028 DOI: 10.1016/j.clgc.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/02/2021] [Accepted: 02/12/2021] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Neoadjuvant cisplatin-based combination chemotherapy improves survival in muscle-invasive bladder cancer. However, response rates and survival remain suboptimal. We evaluated the efficacy, safety, and tolerability of cisplatin plus cabazitaxel. METHODS A phase II single-arm trial was designed to recruit at least 26 evaluable patients. This would give 80% power to detect the primary endpoint, an objective response rate defined as a pathologic complete response plus partial response (pathologic downstaging), measured by pathologic staging at cystectomy (p0 = 0.35 and p1 = 0.60, α = 0.05). RESULTS Objective response was seen in 15 of 26 evaluable patients (57.7%) and more than one- third of patients achieved a pathologic complete response (9/26; 34.6%). Seventy-eight percent of the patients (21/27) completed all cycles of treatment, with only 6.7% of the reported adverse events being graded 3 or 4. There were 6 treatment-related serious adverse event reported, but no suspected unexpected serious adverse reactions. In the patients who achieved an objective response, the median progression-free survival and overall survival were not reached (median follow-up of 41.5 months). In contrast, the median progression-free survival (7.2 months) and overall survival (16.9 months) were significantly worse (P = .001, log-rank) in patients who did not achieve an objective response. CONCLUSION Cabazitaxel plus cisplatin for neoadjuvant treatment of muscle-invasive bladder cancer can be considered a well-tolerated and effective regimen before definitive therapy with higher rates (57.7%) of objective response, comparing favorably to that with of cisplatin/gemcitabine (23%-26%). These results warrant further evaluation in a phase III study.
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Affiliation(s)
| | - Susan Masson
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK
| | - Paul White
- Department of Statistics, University of the West of England, Bristol, UK
| | - Narges Dailami
- Department of Statistics, University of the West of England, Bristol, UK
| | - Sylvia Pearson
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK
| | - Edward Rowe
- Department of Urology, Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Anthony Koupparis
- Department of Urology, Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Jon Oxley
- Department of Pathology, North Bristol NHS Trust, Bristol, UK
| | - Ahmed Abdelaziz
- Department of Oncology, Ain Shams University Hospitals, Egypt
| | | | - Alicia Bravo
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK
| | - Emily Foulstone
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK
| | - Claire Perks
- IGFs & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jeff Holly
- IGFs & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Raj Persad
- Department of Urology, Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Amit Bahl
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK.
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12
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Kingshott G, Biernacka K, Sewell A, Gwiti P, Barker R, Zielinska H, Gilkes A, McCarthy K, Martin RM, Lane JA, McGeagh L, Koupparis A, Rowe E, Oxley J, Holly JMP, Perks CM. Alteration of Metabolic Conditions Impacts the Regulation of IGF-II/H19 Imprinting Status in Prostate Cancer. Cancers (Basel) 2021; 13:825. [PMID: 33669311 PMCID: PMC7920081 DOI: 10.3390/cancers13040825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 12/13/2022] Open
Abstract
Prostate cancer is the second major cause of male cancer deaths. Obesity, type 2 diabetes, and cancer risk are linked. Insulin-like growth factor II (IGF-II) is involved in numerous cellular events, including proliferation and survival. The IGF-II gene shares its locus with the lncRNA, H19. IGF-II/H19 was the first gene to be identified as being "imprinted"-where the paternal copy is not transcribed-a silencing phenomenon lost in many cancer types. We disrupted imprinting behaviour in vitro by altering metabolic conditions and quantified it using RFLP, qPCR and pyrosequencing; changes to peptide were measured using RIA. Prostate tissue samples were analysed using ddPCR, pyrosequencing and IHC. We compared with in silico data, provided by TGCA on the cBIO Portal. We observed disruption of imprinting behaviour, in vitro, with a significant increase in IGF-II and a reciprocal decrease in H19 mRNA; the increased mRNA was not translated into peptides. In vivo, most specimens retained imprinting status apart from a small subset which showed reduced imprinting. A positive correlation was seen between IGF-II and H19 mRNA expression, which concurred with findings of larger Cancer Genome Atlas (TGCA) cohorts. This positive correlation did not affect IGF-II peptide. Our findings show that type 2 diabetes and/or obesity, can directly affect regulation growth factors involved in carcinogenesis, indirectly suggesting a modification of lifestyle habits may reduce cancer risk.
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Affiliation(s)
- Georgina Kingshott
- IGF & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK; (K.B.); (R.B.); (H.Z.); (J.M.P.H.); (C.M.P.)
| | - Kalina Biernacka
- IGF & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK; (K.B.); (R.B.); (H.Z.); (J.M.P.H.); (C.M.P.)
| | - Alex Sewell
- Department of Cellular Pathology, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK; (A.S.); (P.G.); (J.O.)
| | - Paida Gwiti
- Department of Cellular Pathology, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK; (A.S.); (P.G.); (J.O.)
- Department of Pathology, North West Anglia NHS Foundation Trust, Peterborough PE3 9GZ, UK
| | - Rachel Barker
- IGF & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK; (K.B.); (R.B.); (H.Z.); (J.M.P.H.); (C.M.P.)
| | - Hanna Zielinska
- IGF & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK; (K.B.); (R.B.); (H.Z.); (J.M.P.H.); (C.M.P.)
| | - Amanda Gilkes
- Department of Haematology, Cardiff University, Heath Park, Cardiff CF14 4XN, UK;
| | - Kathryn McCarthy
- Department of Surgery, Department of Medicine, Southmead Hospital, Bristol BS10 5NB, UK;
| | - Richard M. Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK;
- National Institute for Health Research, Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Biomedical Research Unit Offices, University Hospitals Bristol Education Centre, Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK
| | - J. Athene Lane
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK;
| | - Lucy McGeagh
- Supportive Cancer Care Research Group, Faculty of Health and Life Sciences, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Jack Straws Lane, Marston, Oxford OX3 0FL, UK;
| | - Anthony Koupparis
- Department of Urology, Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB, UK; (A.K.); (E.R.)
| | - Edward Rowe
- Department of Urology, Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB, UK; (A.K.); (E.R.)
| | - Jon Oxley
- Department of Cellular Pathology, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK; (A.S.); (P.G.); (J.O.)
| | - Jeff M. P. Holly
- IGF & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK; (K.B.); (R.B.); (H.Z.); (J.M.P.H.); (C.M.P.)
| | - Claire M. Perks
- IGF & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK; (K.B.); (R.B.); (H.Z.); (J.M.P.H.); (C.M.P.)
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13
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Gilliland N, Vennam S, Geraghty R, Peacock J, Crockett M, Kearley S, Oxley J, Porter T, Waine E, Aning J, Rowe E, Koupparis A. Surgery for pathological T3a, T3b and lymph node positive, prostate cancer: surgical, functional and oncological outcomes. Journal of Clinical Urology 2020. [DOI: 10.1177/2051415820958207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate and document the surgical, functional and oncological outcomes following surgery for high-risk prostate cancer patients. Patients and methods: Patients with pathological T3a, T3b and N1 disease were extracted from our prospectively updated institutional database. Data include demographics, preoperative cancer parameters, short and long-term complications and functional results. Details of biochemical recurrence, type and oncological outcome of salvage treatments, cancer-specific and overall survival were also obtained. Results: A total of 669 patients were included; 58.9% had T3a disease, 35.9% had pT3b and 11.4% N1 disease. With a median follow-up of 66 months (8–129), overall survival was 94.3%, cancer-specific survival was 98.7% and biochemical recurrence was 45.6%. Average inpatient stay was 1 day and the overall complication rate was 9.1%; 54.2% experienced a biochemical recurrence and 90.3% went on to have one or more salvage treatments, which were varied. Significant predictors of biochemical recurrence included pathological stage, any positive margin and patient age ( P<0.005). A total of 44.9% had an immediate biochemical recurrence, with 90% receiving subsequent treatment and 20.5% having a durable response. None of the patients receiving prostate bed radiotherapy alone had a durable response. 54% had a delayed biochemical recurrence, with 63.5% receiving subsequent treatment and 44% having a durable response. Conclusions: Surgery is associated with encouraging surgical and functional outcomes, cancer-specific survival and overall survival rates in these patients. Pathological stage is a significant predictor of biochemical recurrence. The present analysis shows that long-term observation for certain patients with biochemical recurrence is appropriate and questions the effectiveness of further local salvage treatments in patients with an immediate biochemical recurrence postoperatively. Level of evidence: II
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Affiliation(s)
- Niall Gilliland
- The Bristol Urological Institute, North Bristol NHS Trust, UK
| | | | - Robert Geraghty
- The Bristol Urological Institute, North Bristol NHS Trust, UK
| | | | - Matthew Crockett
- Department of Urology, Gloucestershire Hospitals NHS Foundation Trust, UK
| | | | - Jon Oxley
- The Bristol Urological Institute, North Bristol NHS Trust, UK
| | - Tim Porter
- Department of Urology, Yeovil District Hospital, UK
| | | | - Jonathan Aning
- The Bristol Urological Institute, North Bristol NHS Trust, UK
| | - Edward Rowe
- The Bristol Urological Institute, North Bristol NHS Trust, UK
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14
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Koupparis A, Mehmi A, Rava M, Kearley S, Aning J, Rowe E, Richardson S. Cycling and men’s health: A worldwide survey in association the Global Cycling Network. Journal of Clinical Urology 2020. [DOI: 10.1177/2051415820915389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: This study aimed to examine the association between cycling and men’s health issues, including prostate cancer (CaP), erectile dysfunction (ED), chronic pelvic pain syndrome (CPPS) and lower urinary tract symptoms (LUTs). Methods: Information regarding CaP, ED, CPPS and LUTs were collected from 8074 male cyclists via a unique online men’s health and cycling video produced in conjunction with the Global Cycling Network (GCN) using validated questionnaires. Logistic regression analyses were used to evaluate any relationship between cycling and men’s health issues, including the effect of risk factors. Results: The GCN video received 619,105 views, and completed data were collected on 8074 male cyclists. Of these, 0.57% had a diagnosis of CaP, 14.5% described ED, 8.82 reported symptoms of CPPS and 12.5% reported LUTs. All reported symptoms were mild, and no correlation was found between cycling and CaP or ED on statistical analyses. Conclusions: This is the largest worldwide cross-section observational study on the association between cycling and men’s health. It demonstrates no negative association between cycling and CaP, ED, CPPS or LUTs. Level of evidence: Not applicable for this multicentre audit.
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15
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Mansor R, Holly J, Barker R, Biernacka K, Zielinska H, Koupparis A, Rowe E, Oxley J, Sewell A, Martin RM, Lane A, Hackshaw-McGeagh L, Perks C. IGF-1 and hyperglycaemia-induced FOXA1 and IGFBP-2 affect epithelial to mesenchymal transition in prostate epithelial cells. Oncotarget 2020; 11:2543-2559. [PMID: 32655839 PMCID: PMC7335671 DOI: 10.18632/oncotarget.27650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/01/2020] [Indexed: 12/22/2022] Open
Abstract
Localized prostate cancer (PCa) is a manageable disease but for most men with metastatic disease, it is often fatal. A western diet has been linked with PCa progression and hyperglycaemia has been associated with the risk of lethal and fatal prostate cancer. Using PCa cell lines, we examined the impact of IGF-I and glucose on markers of epithelial-to-mesenchymal transition (EMT), migration and invasion. We examined the underlying mechanisms using cell lines and tumour tissue samples. IGF-I had differential effects on the process of EMT: inhibiting in normal and promoting in cancer cells, whereas hyperglycamia alone had a stimulatory effect in both. These effects were independent of IGF and in both cases, hyperglycaemia induced an increase IGFBP-2(tumour promoter) and FOXA1. A positive correlation existed between levels of IGFBP-2 and FOXA1 in benign and cancerous prostate tissue samples and in vitro and in vivo data indicated that FOXA1 strongly interacted with the IGFBP-2 gene in normal prostate epithelial cells that was associated with a negative regulation of IGFBP-2, whereas in cancer cells the level of FOXA1 associating with the IGFBP-2 gene was minimal, suggesting loss of this negative regulation. IGF-I and hyperglycaemia-induced FOXA1/IGFBP-2 play important roles in EMT.
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Affiliation(s)
- Rehanna Mansor
- IGFs and Metabolic Endocrinology Group, Bristol Medical School, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
- Faculty of Medicine, Royal College of Medicine Perak, Universiti Kuala Lumpur, Ipoh, MY
| | - Jeff Holly
- IGFs and Metabolic Endocrinology Group, Bristol Medical School, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - Rachel Barker
- IGFs and Metabolic Endocrinology Group, Bristol Medical School, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - Kalina Biernacka
- IGFs and Metabolic Endocrinology Group, Bristol Medical School, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - Hanna Zielinska
- IGFs and Metabolic Endocrinology Group, Bristol Medical School, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - Anthony Koupparis
- Department of Urology, Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Edward Rowe
- Department of Urology, Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Jon Oxley
- Department of Cellular Pathology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Alex Sewell
- Department of Cellular Pathology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Richard M. Martin
- NIHR Biomedical Research Centre, Level 3, University Hospitals Bristol Education Centre, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Athene Lane
- NIHR Biomedical Research Centre, Level 3, University Hospitals Bristol Education Centre, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Lucy Hackshaw-McGeagh
- NIHR Biomedical Research Centre, Level 3, University Hospitals Bristol Education Centre, Bristol, UK
| | - Claire Perks
- IGFs and Metabolic Endocrinology Group, Bristol Medical School, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
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16
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Challapalli A, Masson S, White P, Dailami N, Pearson S, Rowe E, Koupparis A, Oxley J, Ash-Miles J, Bravo A, Foulstone E, Persad R, Bahl A. Pathological response rates and quality of life outcomes of neoadjuvant cabazitaxel and cisplatin chemotherapy for muscle-invasive transitional cell carcinoma of the urinary bladder. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.5030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5030 Background: Neoadjuvant cisplatin-based combination chemotherapy (NAC) improves survival in muscle invasive bladder cancer (MIBC). However, response rates and survival remain suboptimal. We sought to evaluate the efficacy, safety and tolerability of cisplatin cabazitaxel combination in this patient group. Methods: A phase 2 single arm trial (Simon 2 stage), to recruit at least 26 evaluable patients was designed with 80% power to detect the primary endpoint, objective response rate (ORR) of > 35%. ORR was defined as pathological complete response (pCR) plus partial response (pathological downstaging), measured by pathologic staging (T2 or greater at diagnosis, to T1 or less at radical cystectomy). Treatment was with Cisplatin 70mg/m2 and Cabazitaxel 15mg/m2 on day 1 of a 21 day cycle, for 4 cycles prior to surgery. Toxicity was recorded using CTCAE v.4.03. Quality of Life (QoL) data were collected at baseline, prior to each cycle of chemotherapy and at 3-5 weeks after 4th cycle of chemotherapy using EQ-5D and EORTC QLQ-C30, BLM30 questionnaires. Results: Objective response was seen in 15 out of 26 evaluable patients, 57.7% and over a third of patients achieved pCR (9/26; 34.6%). 78% (21/27) of patients completed all cycles of treatment, with only 6.7% of the reported adverse events (AEs) being graded 3 or 4. There were 6 treatment related SAEs reported but no SUSARs. In patients who achieved objective response the median progression free (PFS) and overall survival (OS) were not reached (median follow up: 41.5m). In contrast, median PFS (7.2m) and OS (16.9m) were significantly worse (p = 0.001) in patients who did not respond. Response rates for EORTC QLQ-C30, BLM 30 and EQ5D questionnaires was 70.4, 70.4 & 63% respectively, at end of treatment. There was no significant difference in EORTC QLQ C30 summary, global health scores and EQ5D score with treatment. There was a significant decline in mean QLQ C30 domain scores after 1st cycle compared to baseline, but no further deterioration with subsequent cycles of chemotherapy. Conclusions: Cabazitaxel with cisplatin as NAC of MIBC can be considered a safe, well-tolerated and effective regimen with higher pCR rate of 34.6%. This compares favorably to that with Cisplatin/Gemcitabine (23-26%). Minimal changes in Global Health & EQ5D observed during NAC further demonstrates the excellent tolerability of this regimen and to our knowledge are the first data regarding QoL in NAC in MIBC. These results warrant further evaluation in a larger phase 3 study. Clinical trial information: 2011 004090 82 .
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Affiliation(s)
| | - Susan Masson
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Paul White
- University of the West of England, Bristol, United Kingdom
| | | | - Sylvia Pearson
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Edward Rowe
- North Bristol NHS Trust, Bristol, United Kingdom
| | | | - Jon Oxley
- North Bristol NHS Trust, Bristol, United Kingdom
| | | | - Alicia Bravo
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Emily Foulstone
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Raj Persad
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Amit Bahl
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
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17
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Tang Z, Gillatt D, Rowe E, Koupparis A, Holly JM, Perks CM. IGFBP-2 acts as a tumour suppressor and plays a role in determining chemosensitivity in bladder cancer cells. Oncotarget 2019; 10:7043-7057. [PMID: 31903164 PMCID: PMC6925026 DOI: 10.18632/oncotarget.27355] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/21/2019] [Indexed: 12/13/2022] Open
Abstract
There are mixed reports on the role that IGFBP-2 plays in cancer progression, with some indicating a tumour suppressive role and others showing that IGFBP-2 may act as an oncogene. These apparent contradictions may be context and tissue specific. In this study we determined the role that IGFBP-2 played on the phenotype and chemosensitivity of a selection of bladder cancer cell lines and investigated how the abundance of IGFBP-2 was regulated. We found that IGFBP-2 was more abundant in the epithelial bladder cancer cells, RT4 and UMUC3 and absent in the more mesenchymal T24 and TCCSUP cells. Silencing IGFBP-2 using siRNA in epithelial RT4 cells promoted cell proliferation, invasion, colony formation, resulted in a reduction in epithelial (E-cadherin) and an increase in mesenchymal (N-cadherin) markers and increased sensitivity to cisplatin-induced cell death. Conversely, we observed the opposite effects when adding exogenous IGFBP-2 to the mesenchymal T24 cells. We determined that IGFBP-2 was epigenetically silenced via DNA methylation as the cells adopted a mesenchymal phenotype. Collectively these data suggest that IGFBP-2 acts as a tumour suppressor and marker of chemosensitivity in epithelial bladder cancer cells and that IGFBP-2 is epigenetically silenced by methylation to promote bladder cancer progression.
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Affiliation(s)
- Zhen Tang
- IGFs & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol BS10 5N, England
| | - David Gillatt
- Department of Surgery, Macquarie University Hospital, Macquarie University, Sydney, NSW 2109, Australia
| | - Edward Rowe
- Department of Urology, Southmead Hospital and Bristol Urological Institute, Bristol BS10 5NB, England
| | - Anthony Koupparis
- Department of Urology, Southmead Hospital and Bristol Urological Institute, Bristol BS10 5NB, England
| | - Jeff M.P. Holly
- IGFs & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol BS10 5N, England
- Co-senior authors
| | - Claire M. Perks
- IGFs & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol BS10 5N, England
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18
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Hackshaw-McGeagh LE, Penfold C, Shingler E, Robles LA, Perks CM, Holly JMP, Rowe E, Koupparis A, Bahl A, Persad R, Shiridzinomwa C, Johnson L, Biernacka KM, Frankow A, Woodside JV, Gilchrist S, Oxley J, Abrams P, Lane JA, Martin RM. Phase II randomised control feasibility trial of a nutrition and physical activity intervention after radical prostatectomy for prostate cancer. BMJ Open 2019; 9:e029480. [PMID: 31699723 PMCID: PMC6858112 DOI: 10.1136/bmjopen-2019-029480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/17/2019] [Accepted: 08/14/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Dietary factors and physical activity may alter prostate cancer progression. We explored the feasibility of lifestyle interventions following radical prostatectomy for localised prostate cancer. DESIGN Patients were recruited into a presurgical observational cohort; following radical prostatectomy, they were offered randomisation into a 2×3 factorial randomised controlled trial (RCT). SETTING A single National Health Service trust in the South West of England, UK. PARTICIPANTS Those with localised prostate cancer and listed for radical prostatectomy were invited to participate. RANDOMISATION Random allocation was performed by the Bristol Randomised Trial Collaboration via an online system. INTERVENTIONS Men were randomised into both a modified nutrition group (either increased vegetable and fruit, and reduced dairy milk; or lycopene supplementation; or control) and a physical activity group (brisk walking or control) for 6 months. BLINDING Only the trial statistician was blind to allocations. PRIMARY OUTCOME MEASURES Primary outcomes were measures of feasibility: randomisation rates and intervention adherence at 6 months. Collected at trial baseline, three and six months, with daily adherence reported throughout. Our intended adherence rate was 75% or above, the threshold for acceptable adherence was 90%. RESULTS 108 men entered the presurgical cohort, and 81 were randomised into the postsurgical RCT (randomisation rate: 93.1%) and 75 completed the trial. Of 25 men in the nutrition intervention, 10 (40.0%; 95% CI 23.4% to 59.3%) adhered to the fruit and vegetable recommendations and 18 (72.0%; 95% CI 52.4% to 85.7%) to reduced dairy intake. Adherence to lycopene (n=28), was 78.6% (95% CI 60.5% to 89.8%), while 21/39 adhered to the walking intervention (53.8%; 95% CI 38.6% to 68.4%). Most men were followed up at 6 months (75/81; 92.6%). Three 'possibly related' adverse events were indigestion, abdominal bloating and knee pain. CONCLUSIONS Interventions were deemed feasible, with high randomisation rates and generally good adherence. A definitive RCT is proposed. TRIAL REGISTRATION NUMBER ISRCTN 99048944.
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Affiliation(s)
- Lucy E Hackshaw-McGeagh
- National Institute for Health Research (NIHR) Biomedical Research Centre (Nutrition Theme), University of Bristol, Bristol, UK
| | - Chris Penfold
- National Institute for Health Research (NIHR) Biomedical Research Centre (Surgical Innovation Theme), Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Ellie Shingler
- National Institute for Health Research (NIHR) Biomedical Research Centre (Nutrition Theme), University of Bristol, Bristol, UK
| | - Luke A Robles
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Claire M Perks
- Bristol Medical School: Translational Health Sciences, University of Bristol, Bristol, UK
| | - Jeff M P Holly
- Bristol Medical School: Translational Health Sciences, University of Bristol, Bristol, UK
| | - Edward Rowe
- Bristol Urology Institute, Department of Urology, North Bristol NHS Trust, Bristol, UK
| | - Anthony Koupparis
- Bristol Urology Institute, Department of Urology, North Bristol NHS Trust, Bristol, UK
| | - Amit Bahl
- Bristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - Raj Persad
- Bristol Urology Institute, Department of Urology, North Bristol NHS Trust, Bristol, UK
| | | | - Lyndsey Johnson
- Clinical Research Centre, North Bristol NHS Trust, Bristol, UK
| | - Kalina M Biernacka
- Bristol Medical School: Translational Health Sciences, University of Bristol, Bristol, UK
| | - Aleksandra Frankow
- Bristol Medical School: Translational Health Sciences, University of Bristol, Bristol, UK
| | - Jayne V Woodside
- Institute for Global Food Security, Queens University Belfast, Belfast, UK
| | - Sarah Gilchrist
- Institute for Global Food Security, Queens University Belfast, Belfast, UK
| | - Jon Oxley
- Department of Cellular Pathology, North Bristol NHS Trust, Bristol, UK
| | - Paul Abrams
- Bristol Urology Institute, Department of Urology, North Bristol NHS Trust, Bristol, UK
| | - J Athene Lane
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Richard M Martin
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
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19
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Zamboni S, Soria F, Mathieu R, Xylinas E, Abufaraj M, D Andrea D, Tan WS, Kelly JD, Simone G, Gallucci M, Meraney A, Krishna S, Konety BR, Antonelli A, Simeone C, Baumeister P, Mattei A, Briganti A, Gallina A, Montorsi F, Rink M, Aziz A, Karakiewicz PI, Rouprêt M, Koupparis A, Scherr DS, Ploussard G, Sooriakumaran P, Shariat SF, Moschini M. Differences in trends in the use of robot-assisted and open radical cystectomy and changes over time in peri-operative outcomes among selected centres in North America and Europe: an international multicentre collaboration. BJU Int 2019; 124:656-664. [PMID: 31055865 DOI: 10.1111/bju.14791] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To compare trends in the use of robot-assisted radical cystectomy (RARC) and changes over time in peri-operative outcomes in selected North American and European centres. MATERIALS AND METHODS We conducted a retrospective evaluation of 2401 patients treated with open radical cystectomy (ORC) or RARC for bladder cancer at 12 centres in North America and Europe between 2006 and 2018. We used the Kruskal-Wallis and chi-squared test to evaluate differences between continuous and categorical variables. RESULTS Overall, 49.5% of patients underwent RARC and 51.5% ORC. RARC became the most commonly performed procedure in contemporary patients, with an increase from 29% in 2006-2008 to 54% in 2015-2018 (P < 0.001). In the North American centres the use of RARC was higher than that of ORC from 2006, and remained stable over time, whereas in the European centres its use increased exponentially from 2% to 50%. In both groups patients who underwent RARC had less advanced T stages (P < 0.001), lower American Society of Anesthesiologists scores (P < 0.05), lower blood loss (P = 0.001) and shorter length of hospital stay (P < 0.05). No differences were found in early complications. Early readmission and re-operation rates were worse for patients treated with RARC in the European centres; however, when contemporary patients only were considered, the statistical significance was lost. CONCLUSION The present study shows that the use of RARC has constantly increased since its introduction, overtaking ORC in the most contemporary series. While RARC was more frequently performed than ORC since its introduction in the North American centres and its use remained substantially stable over time, its use increased exponentially in the European centres. The different trends in use of RARC/ORC and changes over time in peri-operative outcomes between the North American and European centres can be attributed to the earlier introduction and spread of RARC in the former compared with the latter.
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Affiliation(s)
- Stefania Zamboni
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.,Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili, University of Brescia, Vienna, Austria
| | - Francesco Soria
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy
| | - Romain Mathieu
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Department of Urology, Rennes University Hospital, Rennes, France
| | - Evanguelos Xylinas
- Department of Urology Bichat Hospital, Paris Descartes University, Paris, France
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - David D Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Wei Shen Tan
- Division of Surgery and Intervention Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK.,Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, UK
| | - John D Kelly
- Division of Surgery and Intervention Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK.,Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, UK
| | - Giuseppe Simone
- Department of Urology, "ReginaElena" National Cancer Institute, Rome, Italy
| | - Michele Gallucci
- Department of Urology, "ReginaElena" National Cancer Institute, Rome, Italy
| | - Anoop Meraney
- Urology Division, Hartford Healthcare Medical Group, Hartford, CT, USA
| | - Suprita Krishna
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | | | - Alessandro Antonelli
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili, University of Brescia, Vienna, Austria
| | - Claudio Simeone
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili, University of Brescia, Vienna, Austria
| | | | - Agostino Mattei
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Gallina
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Atiqullah Aziz
- Department of Urology, University Medical Center Rostock, Rostock, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada
| | - Morgan Rouprêt
- GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Anthony Koupparis
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | | | - Prasanna Sooriakumaran
- Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, UK.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.,Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
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- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
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20
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Moschini M, Zamboni S, Soria F, Mathieu R, Xylinas E, Tan WS, Kelly JD, Simone G, Meraney A, Krishna S, Konety B, Mattei A, Baumeister P, Mordasini L, Montorsi F, Briganti A, Gallina A, Stabile A, Sanchez-Salas R, Cathelineau X, Rink M, Necchi A, Karakiewicz PI, Rouprêt M, Koupparis A, Kassouf W, Scherr DS, Ploussard G, Boorjian SA, Lotan Y, Sooriakumaran P, Shariat SF. Open Versus Robotic Cystectomy: A Propensity Score Matched Analysis Comparing Survival Outcomes. J Clin Med 2019; 8:jcm8081192. [PMID: 31395826 PMCID: PMC6722857 DOI: 10.3390/jcm8081192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/15/2019] [Accepted: 08/06/2019] [Indexed: 01/17/2023] Open
Abstract
Background: To assess the differential effect of robotic assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) on survival outcomes in matched analyses performed on a large multicentric cohort. Methods: The study included 9757 patients with urothelial bladder cancer (BCa) treated in a consecutive manner at each of 25 institutions. All patients underwent radical cystectomy with bilateral pelvic lymphadenectomy. To adjust for potential selection bias, propensity score matching 2:1 was performed with two ORC patients matched to one RARC patient. The propensity-matched cohort included 1374 patients. Multivariable competing risk analyses accounting for death of other causes, tested association of surgical technique with recurrence and cancer specific mortality (CSM), before and after propensity score matching. Results: Overall, 767 (7.8%) patients underwent RARC and 8990 (92.2%) ORC. The median follow-up before and after propensity matching was 81 and 102 months, respectively. In the overall population, the 3-year recurrence rates and CSM were 37% vs. 26% and 34% vs. 24% for ORC vs. RARC (all p values > 0.1), respectively. On multivariable Cox regression analyses, RARC and ORC had similar recurrence and CSM rates before and after matching (all p values > 0.1). Conclusions: Patients treated with RARC and ORC have similar survival outcomes. This data is helpful in consulting patients until long term survival outcomes of level one evidence is available.
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Affiliation(s)
- Marco Moschini
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Stefania Zamboni
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Francesco Soria
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria
- Division of Urology, Department of Surgical Sciences, University of Studies of Torino, 10124 Turin, Italy
| | - Romain Mathieu
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria
- Department of Urology, Rennes University Hospital, 35000 Rennes, France
| | - Evanguelos Xylinas
- Department of Urology Bichat Hospital, Paris Descartes University, 75877 Paris, France
| | - Wei Shen Tan
- Division of Surgery and Intervention Science, University College London, London WC1E 6BT, UK
- Department of Uro-Oncology, University College London Hospital NHS Foundation Trust, London W1T 4EU, UK
| | - John D Kelly
- Division of Surgery and Intervention Science, University College London, London WC1E 6BT, UK
- Department of Uro-Oncology, University College London Hospital NHS Foundation Trust, London W1T 4EU, UK
| | - Giuseppe Simone
- Department of Urology, "Regina Elena" National Cancer Institute, 00128 Rome, Italy
| | - Anoop Meraney
- Urology Division, Hartford Healthcare Medical Group, Hartford, CT 06106, USA
| | - Suprita Krishna
- Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Badrinath Konety
- Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Philipp Baumeister
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Livio Mordasini
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Andrea Gallina
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Armando Stabile
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Rafael Sanchez-Salas
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, 75014 Paris, France
| | - Xavier Cathelineau
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, 75014 Paris, France
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC H4A 3J1, Canada
| | - Morgan Rouprêt
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
| | - Anthony Koupparis
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK
| | - Wassim Kassouf
- Department of Urology, McGill University Health Center, Montreal, QC H4A3J1, Canada
| | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10038, USA
| | | | - Stephen A Boorjian
- Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Prasanna Sooriakumaran
- Department of Uro-Oncology, University College London Hospital NHS Foundation Trust, London W1T 4EU, UK
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria.
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10021, USA.
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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21
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Nakawala H, De Momi E, Tzemanaki A, Dogramadzi S, Russo A, Catellani M, Bianchi R, De Cobelli O, Sideridis A, Papacostas E, Koupparis A, Rowe E, Persad R, Ascione R, Ferrigno G. Requirements elicitation for robotic and computer-assisted minimally invasive surgery. INT J ADV ROBOT SYST 2019. [DOI: 10.1177/1729881419865805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The robotic surgical systems and computer-assisted technologies market has seen impressive growth over the last decades, but uptake by end-users is still scarce. The purpose of this article is to provide a comprehensive and informed list of the end-user requirements for the development of new generation robot- and computer-assisted surgical systems and the methodology for eliciting them. The requirements were elicited, in the frame of the EU project SMARTsurg, by conducting interviews on use cases of chosen urology, cardiovascular and orthopaedics procedures, tailored to provide clinical foundations for scientific and technical developments. The structured interviews resulted in detailed requirement specifications which are ranked according to their priorities. Paradigmatic surgical scenarios support the use cases.
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Affiliation(s)
| | - Elena De Momi
- Department of Computer Science, University of Verona, Verona, Italy
| | - Antonia Tzemanaki
- Bristol Robotics Laboratory, University of the West of England, Bristol, UK
| | - Sanja Dogramadzi
- Bristol Robotics Laboratory, University of the West of England, Bristol, UK
| | - Andrea Russo
- Division of Urology, European Institute of Oncology, Milano, Italy
| | | | - Roberto Bianchi
- Division of Urology, European Institute of Oncology, Milano, Italy
| | - Ottavio De Cobelli
- Division of Urology, European Institute of Oncology, Milano, Italy
- Department of Oncology and Hematology-Oncology University of Milan, Milan, Italy
| | | | | | | | - Edward Rowe
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Raj Persad
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Raimondo Ascione
- Translational Biomedical Research Centre and Bristol Heart Institute, University of Bristol, Bristol, UK
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22
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Moschini M, Soria F, Mathieu R, Xylinas E, D'Andrea D, Tan WS, Kelly JD, Simone G, Tuderti G, Meraney A, Krishna S, Konety B, Zamboni S, Baumeister P, Mattei A, Briganti A, Montorsi F, Galucci M, Rink M, Karakiewicz PI, Rouprêt M, Aziz A, Perry M, Rowe E, Koupparis A, Kassouf W, Scherr DS, Ploussard G, Boorjian SA, Sooriakumaran P, Shariat SF. Propensity-score-matched comparison of soft tissue surgical margins status between open and robotic-assisted radical cystectomy. Urol Oncol 2019; 37:179.e1-179.e7. [DOI: 10.1016/j.urolonc.2018.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 10/05/2018] [Accepted: 10/06/2018] [Indexed: 10/27/2022]
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23
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Catto JWF, Khetrapal P, Ambler G, Sarpong R, Khan MS, Tan M, Feber A, Dixon S, Goodwin L, Williams NR, McGrath J, Rowe E, Koupparis A, Brew-Graves C, Kelly JD. Robot-assisted radical cystectomy with intracorporeal urinary diversion versus open radical cystectomy (iROC): protocol for a randomised controlled trial with internal feasibility study. BMJ Open 2018; 8:e020500. [PMID: 30093510 PMCID: PMC6089318 DOI: 10.1136/bmjopen-2017-020500] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Bladder cancer (BC) is a common malignancy and one of the most expensive to manage. Radical cystectomy (RC) with pelvic lymphadenectomy is a gold standard treatment for high-risk BC. Reductions in morbidity and mortality from RC may be achieved through robot-assisted RC (RARC). Prospective comparisons between open RC (ORC) and RARC have been limited by sample size, use of extracorporeal reconstruction and use of outcomes important for ORC. Conversely, while RARC is gaining in popularity, there is little evidence to suggest it is superior to ORC. We are undertaking a prospective randomised controlled trial (RCT) to compare RARC with intracorporeal reconstruction (iRARC) and ORC using multimodal outcomes to explore qualitative and quantitative recovery after surgery. METHODS AND ANALYSIS: iROC is a multicentre prospective RCT in English National Health Service (NHS) cancer centres. We will randomise 320 patients undergoing RC to either iRARC or ORC. Treatment allocation will occur after trial entry and consent. The primary outcome is days alive and out of hospital within the first 90 days from surgery. Secondary outcomes will measure functional recovery (activity trackers, chair-to-stand tests and health related quality of life (HRQOL) questionnaires), morbidity (complications and readmissions), cost-effectiveness (using EuroQol-5 Domain-5 levels (EQ-5D-5L) and unit costs) and surgeon fatigue. Patients will be analysed according to intention to treat. The primary outcome will be transformed and analysed using regression. All statistical assumptions will be investigated. Secondary outcomes will be analysed using appropriate regression methods. An internal feasibility study of the first 30 patients will evaluate recruitment rates, acceptance of randomised treatment choice, compliance outcome collection and to revise our sample size. ETHICS AND DISSEMINATION The study has ethical approval (REC reference 16/NE/0418). Findings will be made available to patients, clinicians, funders and the NHS through peer-reviewed publications, social media and patient support groups. TRIAL REGISTRATION NUMBERS ISRCTN13680280 and NCT03049410.
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Affiliation(s)
- James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Pramit Khetrapal
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Rachael Sarpong
- Surgical and Interventional Trials Unit (SITU), Division of Surgery and Interventional Science, University College London, London, UK
| | | | - Melanie Tan
- Surgical and Interventional Trials Unit (SITU), Division of Surgery and Interventional Science, University College London, London, UK
| | - Andrew Feber
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Simon Dixon
- Health Economics and Decision Science, NIHR Research Design Service Yorkshire and the Humber, University of Sheffield, Sheffield, UK
| | - Louise Goodwin
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Norman R Williams
- Surgical and Interventional Trials Unit (SITU), Division of Surgery and Interventional Science, University College London, London, UK
| | - John McGrath
- Department of Urology, Royal Devon and Exeter NHS Trust, Exeter, UK
| | - Edward Rowe
- Department of Urology, North Bristol NHS Trust, Bristol, UK
| | | | - Chris Brew-Graves
- Surgical and Interventional Trials Unit (SITU), Division of Surgery and Interventional Science, University College London, London, UK
| | - John D Kelly
- Division of Surgery and Interventional Science, University College London, London, UK
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24
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Khetrapal P, Williams N, Tan M, Feber A, Ambler G, Sarpong R, Khan S, Dixon S, Goodwin L, McGrath J, Rowe E, Koupparis A, Brew-Graves C, Catto J, Kelly J. MP71-18 THE USE OF FITNESS TRACKER IN MONITORING FUNCTIONAL ACTIVITY OF PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER: A FEASIBILITY REPORT AND ANALYSIS AS PART OF THE MULTI-CENTRE RANDOMISED IROC TRIAL. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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25
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Wright EG, Challapalli A, White P, Persad R, Masson S, Kirk H, Hilman S, Koupparis A, Rowe E, Bahl A. Predictors of improved biochemical progression free survival for salvage prostate bed radiotherapy after radical prostatectomy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
38 Predictors of improved biochemical progression free survival for salvage prostate bed radiotherapy after radical prostatectomy Background: About a third of patients undergoing radical prostatectomy (RP) develop biochemical recurrence, the rate of which increases to ~50% in high risk patients, with adverse features such as positive margins & seminal vesicle invasion. Postop salvage radiotherapy (SRT) to the prostate bed improves biochemical progression free survival (bPFS). We sought to evaluate the benefit of SRT and predictors of bPFS. Methods: Patients who received SRT from Jan11 to Dec15 were retrospectively analysed. All patients had prostate bed radiotherapy (66Gy/33#/6.5wks). Hormone therapy (HT), when used was for a short duration of 3-6 months. PSA relapse after SRT was defined as serum PSA rising above the posttreatment nadir to a level of ≥0.2 ng/mL or by the initiation of HT after completion of SRT. The bPFS was calculated as the time from start of SRT till date of undetectable PSA, analysed by Kaplan-Meier estimates and log-rank test. Results: Overall, 111 patients were analysed. Median follow-up was 46 (range; 6-80) months. 46% (51/111) patients received HT. The median pre-SRT PSA was 0.4 ng/mL (range, 0.07 to 4.9). The bPFS rate was 60.4% overall, 65%for those with a pre-SRT PSA (ng/mL) level of ≤0.5 (n = 74), 53.6% for those with a PSA of > 0.5 to ≤1.5 (n = 28), 44.4% for those with a PSA of > 1.5 (n = 9); (p = 0.33). There was no significant difference in bPFS rates for pre-SRT PSA of ≤0.2 compared to PSA ≤0.5. Significantly improved bPFS rates were seen with an interval of > 6m from detectable PSA to start of SRT (69% vs. 46.5%: p = 0.026), and a trend towards better bPFS rates when the time interval was > 24m from RP to first detectable PSA (73% vs. 53%: p = 0.08). However, bPFS was similar in the proportion of patients (46%) who had HT compared to those (54%) who did not have HT. Conclusions: We have shown that there was no significant difference in bPFS rates between early (detectable PSA at 0.2) and deferred SRT and our data supports the practice of deferred SRT prior to PSA going above 0.5. Short course of HT was not shown to improve bPFS. The ongoing RADICALS and RAVE trials will further clarify these aspects.
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Affiliation(s)
| | | | - Paul White
- University of the West of England, Bristol, United Kingdom
| | | | - Susan Masson
- University Hospital Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Hannah Kirk
- University Hospital Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Serena Hilman
- University Hospital Bristol NHS Foundation Trust, Bristol, United Kingdom
| | | | - Edward Rowe
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Amit Bahl
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
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26
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Bahl A, Masson S, Challapalli A, Bravo A, Pearson S, Hilman S, Persad R, Koupparis A, Rowe E, Foulstone E, Evans H, Oxley J, Greenwood R, Kirk H, Huckett R, Kabala J, Ash-Miles J, Dailami N, Perks C, Holly J. The Bristol Bladder trial: A single-arm phase II trial of cisplatin and cabazitaxel for muscle invasive transitional cell carcinoma of the urinary bladder prior to radical cystectomy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
468 Background: Neoadjuvant cisplatin-based combination chemotherapy improves survival in muscle invasive transitional cell carcinoma (MI-TCC). However response rates and survival remain suboptimal. We sought to evaluate the efficacy of cabazitaxel (CBZ) with cisplatin (CIS) in this setting. Methods: A single arm phase 2 study was designed with 80% power to detect an objective response rate (ORR) of >35%. Patients with MI-TCC were included if fit to receive neoadjuvant chemotherapy and to undergo radical cystectomy. Treatment was with CIS 70mg/m2 and CBZ 15mg/m2 on day 1 of a 21 day cycle, for 4 cycles prior to surgery. Primary prophylaxis was with pegylated GCSF. Toxicity was recorded using CTCAE v.4.03. Objective response was defined as a reduction in Tumour (T) stage from T2 or greater at diagnosis, to T1 or less at radical cystectomy. QoL data was assessed during and after chemotherapy using EQ-5D and EORTC-BLM30 questionnaires. Results: 28 patients were enrolled with median age 68.6 years (range 47-79). Response outcome (first 23 cases) and toxicity data (first 24 cases) are in this abstract; the remaining cases, currently scheduled for surgery, will be added to the final presentation. Pathological complete response (pCR) was observed in 7/23 patients (30.4%) and ORR was 56.5% (13/23). 18/24 (75%) completed 4 cycles; reasons for stopping were disease progression (2/24, 8.3%), adverse events (2/24, 8.3%) and patient choice (2/24, 8.3%). 7/24 patients (29%) experienced treatment related grade 3 and 4 adverse events. Conclusions: These results demonstrate that CIS and CBZ chemotherapy has an acceptable safety profile and is well tolerated in this setting. This combination shows promising efficacy (pCR 30.4%, ORR 56.5%) prior to definitive treatment for MI-TCC. Response outcomes for all patients and QoL data will be reported in the final presentation. Grade 3/4 adverse events. Clinical trial information: NCT01616875. [Table: see text]
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Affiliation(s)
- Amit Bahl
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Susan Masson
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | | | - Alicia Bravo
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Sylvia Pearson
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Serena Hilman
- University Hospital Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Raj Persad
- Urology, Bristol Royal Infirmary, Bristol, United Kingdom
| | | | - Edward Rowe
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Emily Foulstone
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Heidi Evans
- University Hospital Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Jon Oxley
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Rosemary Greenwood
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Hannah Kirk
- University Hospital Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Rebecca Huckett
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Julian Kabala
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Janice Ash-Miles
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | | | | | - Jeff Holly
- University of Bristol, Bristol, United Kingdom
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27
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Bansal SS, Dogra T, Smith PW, Amran M, Auluck I, Bhambra M, Sura MS, Rowe E, Koupparis A. Cost analysis of open radical cystectomy versus robot-assisted radical cystectomy. BJU Int 2017; 121:437-444. [DOI: 10.1111/bju.14044] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
| | - Tara Dogra
- Imperial College London; London UK
- Bristol Urological Institute; Bristol UK
| | | | | | | | | | - Manraj S. Sura
- Imperial College London; London UK
- University of Birmingham; Birmingham UK
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28
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Hackshaw-McGeagh LE, Sutton E, Persad R, Aning J, Bahl A, Koupparis A, Millett C, Martin RM, Lane JA. Acceptability of dietary and physical activity lifestyle modification for men following radiotherapy or radical prostatectomy for localised prostate cancer: a qualitative investigation. BMC Urol 2017; 17:94. [PMID: 29017509 PMCID: PMC5633894 DOI: 10.1186/s12894-017-0284-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 10/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The experience and acceptability of lifestyle interventions for men with localised prostate cancer are not well understood, yet lifestyle interventions are increasingly promoted for cancer survivors. We explored the opinions, experiences and perceived acceptability of taking part in nutritional and physical activity interventions amongst men with prostate cancer and their partners; with the ultimate plan to use such information to inform the development of nutritional and physical activity interventions for men with prostate cancer. METHODS Semi-structured interviews with 16 men, and seven partners, undergoing curative surgery or radiotherapy for prostate cancer. Interviews explored experiences of lifestyle interventions, acceptable changes participants would make and perceived barriers and facilitators to change. Interviews were thematically analysed using the framework approach. RESULTS Men were frequently open to lifestyle modification and family support was considered vital to facilitate change. Health beneficial, clinician endorsed, understandable, enjoyable interventions were perceived as attractive. Barriers included 'modern' digital technology, poor weather, competing commitments or physical limitations, most notably incontinence following radical prostatectomy. Men were keen to participate in research, with few negative aspects identified. CONCLUSIONS Men are willing to change behaviour but this needs to be supported by clinicians and health professionals facilitating lifestyle change. An 'intention-behaviour gap', when an intended behaviour does not materialise, may exist. Digital technology for data collection and lifestyle measurement may not be suitable for all, and post-surgery urinary incontinence is a barrier to physical activity. These novel findings should be incorporated into lifestyle intervention development, and implemented clinically.
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Affiliation(s)
- Lucy E Hackshaw-McGeagh
- University of Bristol, NIHR Biomedical Research Centre - Nutrition, Diet and Lifestyle Theme, Level 3, University Hospitals Bristol Education Centre, Upper Maudlin Street, Bristol, BS2 8AE, England, UK. .,University of Bristol, Bristol Medical School: Population Health Sciences, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, England, UK.
| | - Eileen Sutton
- University of Bristol, Bristol Medical School: Population Health Sciences, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, England, UK
| | - Raj Persad
- Bristol Urological Institute, Southmead Hospital Bristol, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB, England, UK
| | - Jonathan Aning
- Freeman Hospital, Freeman Road, Newcastle upon Tyne, Tyne and Wear, NE7 7DN, England, UK
| | - Amit Bahl
- Bristol Haematology & Oncology Centre, Horfield Road, Bristol, BS2 8ED, England, UK
| | - Anthony Koupparis
- Bristol Urological Institute, Southmead Hospital Bristol, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB, England, UK
| | - Chris Millett
- Member of the NIHR Biomedical Research Centre - Nutrition, Diet and Lifestyle Theme Prostate Cancer Patient and Public Involvement Group, Bristol, England, UK
| | - Richard M Martin
- University of Bristol, NIHR Biomedical Research Centre - Nutrition, Diet and Lifestyle Theme, Level 3, University Hospitals Bristol Education Centre, Upper Maudlin Street, Bristol, BS2 8AE, England, UK.,University of Bristol, Bristol Medical School: Population Health Sciences, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, England, UK
| | - J Athene Lane
- University of Bristol, NIHR Biomedical Research Centre - Nutrition, Diet and Lifestyle Theme, Level 3, University Hospitals Bristol Education Centre, Upper Maudlin Street, Bristol, BS2 8AE, England, UK.,University of Bristol, Bristol Medical School: Population Health Sciences, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, England, UK
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29
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Bansal S, Dogra T, Weston Smith P, Amran M, Auluck I, Bhambra M, Sura M, Rowe E, Koupparis A. Cost-analysis of open radical cystectomy versus robot-assisted radical cystectomy. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/s1569-9056(17)31481-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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30
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Collins J, Hosseini A, Adding C, Koupparis A, Rowe E, Perry M, Issa R, Nyberg T, Schumacher M, Wijburg C, Canda AE, Balbay M, Decaestecker K, Schwentner C, Stenzl A, Edeling S, Pokupik S, D'Hondt F, Mottrie A, Wiklund P. MP34-15 A EUROPEAN MULTI-CENTRE REPORT ON CURRENT NEOADJUVANT CHEMOTHERAPY ADMINISTRATION RATES IN ROBOT-ASSISTED RADICAL CYSTECTOMY PATIENTS AND THE IMPACT ON PATHOLOGICAL STAGING. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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31
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Shingler E, Hackshaw-McGeagh L, Robles L, Persad R, Koupparis A, Rowe E, Shiridzinomwa C, Bahl A, Martin RM, Lane JA. The feasibility of the Prostate cancer: Evidence of Exercise and Nutrition Trial (PrEvENT) dietary and physical activity modifications: a qualitative study. Trials 2017; 18:106. [PMID: 28264695 PMCID: PMC5340012 DOI: 10.1186/s13063-017-1828-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 02/07/2017] [Indexed: 01/20/2023] Open
Abstract
Background There is increasing evidence that low levels of physical activity and diets low in fruit and vegetables and high in meat and dairy products are risk factors for prostate cancer disease progression. The Prostate cancer: Evidence of Exercise and Nutrition Trial (PrEvENT) aimed to assess a diet and physical activity intervention in men undergoing radical prostatectomy for localized prostate cancer. The trial included a qualitative component to explore the experiences of men participating in the trial in order to understand the acceptability of the intervention and data collection methods. We report the qualitative findings of the trial and consider how these can be used to inform future research. Methods PrEvENT involved randomizing men to either a dietary and/or physical activity intervention. Semi-structured interviews were conducted with a purposive sample of 17 men on completion of the 6 month trial. Interviews took place in clinic or as telephone interviews, if requested by the participant, and were audio recorded, transcribed, and analyzed using the thematic-based framework approach. Analysis was conducted throughout the data collection process to allow emergent themes to be further explored in subsequent interviews. Results Three overarching themes were identified: acceptability of the intervention, acceptability of the data collection methods and trial logistics. Participants were predominantly positive about both the dietary and physical activity interventions and most men found the methods of data collection appropriate. Recommendations for future trials include consideration of alternative physical activity options, such as cycling or gym sessions, increased information on portion sizes, the potential importance of including wives or partners in the dietary change process and the possibility of using the pedometer or other wearable technology as part of the physical activity intervention. Conclusions We provide insight into the opinions and experiences of the acceptability of the PrEvENT diet and physical activity intervention from the participants themselves. The interventions delivered were acceptable to this sample of participants, as were the data collection methods utilized. We also highlight some considerations for further behavioural change interventions in prostate cancer and other similar populations. Trial registration ISRCTN, ISRCTN99048944. Registered on 17 November 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1828-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Raj Persad
- Bristol Urological Institute, Bristol, UK
| | | | | | | | - Amit Bahl
- Bristol Haematology & Oncology Centre, Bristol, UK
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32
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Sutton E, Hackshaw-McGeagh LE, Aning J, Bahl A, Koupparis A, Persad R, Martin RM, Lane JA. The provision of dietary and physical activity advice for men diagnosed with prostate cancer: a qualitative study of the experiences and views of health care professionals, patients and partners. Cancer Causes Control 2017; 28:319-329. [PMID: 28220328 PMCID: PMC5357268 DOI: 10.1007/s10552-017-0861-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 01/29/2017] [Indexed: 12/22/2022]
Abstract
Purpose To explore the views and experiences of health care professionals (HCPs), men diagnosed with localised prostate cancer and their partners about the provision of advice on diet and physical activity after diagnosis and treatment for localised prostate cancer. Methods Semi-structured in-depth interviews with ten HCPs (Consultant Urological Surgeons, Uro-Oncology Clinical Nurse Specialists and Allied Health Professionals: see Table 1) and sixteen men diagnosed with localised prostate cancer and seven of their partners. Data from interviews were thematically analysed using the Framework Approach. Results The men and their partners provided differing accounts to the HCPs and sometimes to each other concerning the provision of advice on diet and physical activity. Some men were unable to recall receiving such advice from HCPs. Factors impacting upon advice-giving included the perceived lack of an evidence base to support dietary and physical activity advice and the credibility of advice providers. The timing of advice provision was a contentious issue as some HCPs believed that patients might not be willing to receive dietary and physical activity advice at the time of diagnosis, whilst others viewed this an opportune time to provide behaviour change information. Patients concurred with the latter opinion. Conclusions Men and their partners would value nutritional and physical activity advice from their HCP, after a localised prostate cancer diagnosis. Men would prefer to receive this advice at an early stage in their cancer journey and may implement behaviour change if the received advice is clear and evidence-based. HCPs should receive suitable training regarding what information to provide to men and how best to deliver this information.
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Affiliation(s)
- Eileen Sutton
- The NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Upper Maudlin Street, Bristol, BS2 8AE, UK.
| | - Lucy E Hackshaw-McGeagh
- The NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Upper Maudlin Street, Bristol, BS2 8AE, UK.,School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Jonathan Aning
- Newcastle upon Tyne NHS Hospitals Foundation Trust, Freeman Hospital, Freeman Road, Newcastle upon Tyne, Tyne and Wear, NE7 7DN, UK
| | - Amit Bahl
- Bristol Haematology and Oncology Centre, Horfield Road, Bristol, BS2 8ED, UK
| | - Anthony Koupparis
- Southmead Hospital Bristol, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - Raj Persad
- Southmead Hospital Bristol, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - Richard M Martin
- The NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Upper Maudlin Street, Bristol, BS2 8AE, UK.,School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - J Athene Lane
- The NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Upper Maudlin Street, Bristol, BS2 8AE, UK.,School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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33
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Collins JW, Hosseini A, Adding C, Nyberg T, Koupparis A, Rowe E, Perry M, Issa R, Schumacher MC, Wijburg C, Canda AE, Balbay M, Decaestecker K, Schwentner C, Stenzl A, Edeling S, Pokupić S, D'Hondt F, Mottrie A, Wiklund PN. Early Recurrence Patterns Following Totally Intracorporeal Robot-assisted Radical Cystectomy: Results from the EAU Robotic Urology Section (ERUS) Scientific Working Group. Eur Urol 2016; 71:723-726. [PMID: 27816299 DOI: 10.1016/j.eururo.2016.10.030] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
Abstract
Recurrence following radical cystectomy often occurs early, with >80% of recurrences occurring within the first 2 yr. Debate remains as to whether robot-assisted radical cystectomy (RARC) negatively impacts early recurrence patterns because of inadequate resection or pneumoperitoneum. We report early recurrence patterns among 717 patients who underwent RARC with intracorporeal urinary diversion at nine different institutions with a minimum follow-up of 12 mo. Clinical, pathologic, radiologic, and survival data at the latest follow-up were collected. Recurrence-free survival (RFS) estimates were generated using the Kaplan-Meier method, and Cox regression models were built to assess variables associated with recurrence. RFS at 3, 12, and 24 mo was 95.9%, 80.2%, and 74.6% respectively. Distant recurrences most frequently occurred in the bones, lungs, and liver, and pelvic lymph nodes were the commonest site of local recurrence. We identified five patients (0.7%) with peritoneal carcinomatosis and two patients (0.3%) with metastasis at the port site (wound site). We conclude that unusual recurrence patterns were not identified in this multi-institutional series and that recurrence patterns appear similar to those in open radical cystectomy series. PATIENT SUMMARY In this multi-institutional study, bladder cancer recurrences following robotic surgery are described. Early recurrence rates and locations appear to be similar to those for open radical cystectomy series.
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Affiliation(s)
| | | | | | | | | | | | | | - Rami Issa
- St. Georges Hospital London, London, UK
| | | | - Carl Wijburg
- Carl Wijburg, Rijnstate, Arnhem, The Netherlands
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34
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Gnanapragasam VJ, Hori S, Johnston T, Smith D, Muir K, Alonzi R, Winkler M, Warren A, Staffurth J, Khoo V, Tree A, Macneill A, McMenemin R, Mason M, Cathcart P, de Souza N, Sooriakumaran P, Weston R, Wylie J, Hall E, Lane A, Cross W, Syndikus I, Koupparis A. Clinical management and research priorities for high-risk prostate cancer in the UK: Meeting report of a multidisciplinary panel in conjunction with the NCRI Prostate Cancer Clinical Studies Localised Subgroup. Journal of Clinical Urology 2016. [DOI: 10.1177/2051415816651362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The management of high-risk prostate cancer has become increasingly sophisticated, with refinements in radical therapy and the inclusion of adjuvant local and systemic therapies. Despite this, high-risk prostate cancer continues to have significant treatment failure rates, with progression to metastasis, castrate resistance and ultimately disease-specific death. In an effort to discuss the challenges in this field, the UK National Clinical Research Institute’s Prostate Cancer Clinical Studies localised subgroup convened a multidisciplinary national meeting in the autumn of 2014. The remit of the meeting was to debate and reach a consensus on the key clinical and research challenges in high-risk prostate cancer and to identify themes that the UK would be best placed to pursue to help improve outcomes. This report presents the outcome of those discussions and the key recommendations for future research in this highly heterogeneous disease entity.
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Affiliation(s)
| | - S Hori
- Academic Urology Group, University of Cambridge, UK
| | - T Johnston
- Academic Urology Group, University of Cambridge, UK
| | - D Smith
- Prostate Cancer Support Association, UK
| | - K Muir
- Institute of Public Health, University of Manchester, UK
| | - R Alonzi
- Department of Clinical Oncology, Mount Vernon Cancer Centre, UK
| | - M Winkler
- Department of Urology, Charing Cross Hospital, UK
| | - A Warren
- Department of Pathology, Addenbrookes Hospital, UK
| | - J Staffurth
- Institute of Cancer and Genetics, Cardiff University, UK
| | - V Khoo
- Department of Clinical Oncology, Royal Marsden Hospital, UK
| | - A Tree
- Department of Clinical Oncology, Royal Marsden Hospital, UK
| | - A Macneill
- Department of Urology, Western General Hospital, NHS Lothian, UK
| | | | - M Mason
- Institute of Cancer and Genetics, Cardiff University, UK
| | - P Cathcart
- Department of Urology, UCL Hospitals, UK
| | | | | | - R Weston
- Department of Urology, Royal Liverpool University Hospital, UK
| | - J Wylie
- Department of Oncology, Christie Hospital, UK
| | - E Hall
- Clinical Trials and Statistics Unit; Institute of Cancer Research, UK
| | - A Lane
- Department of Social Medicine, University of Bristol, UK
| | - W Cross
- Department of Urology, St. James’s University Hospital, UK
| | - I Syndikus
- Radiotherapy Department, Clatterbridge Cancer Centre, UK
| | - A Koupparis
- Department of Urology, Bristol Urological Institute, UK
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35
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Robles L, Shingler E, Hackshaw-McGeagh L, Persad R, Gillatt D, Holly J, Koupparis A, Rowe E, Johnson L, Cloete J, Shiridzinomwa C, Abrams P, Penfold C, Bahl A, Oxley J, Perks C, Martin R, Lane A. Latest feasibility outcomes from the Prostate cancer Evaluation of Exercise and Nutrition Trial (PrEvENT). Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.07.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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36
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Turner EL, Metcalfe C, Donovan JL, Noble S, Sterne JAC, Lane JA, I Walsh E, Hill EM, Down L, Ben-Shlomo Y, Oliver SE, Evans S, Brindle P, Williams NJ, Hughes LJ, Davies CF, Ng SY, Neal DE, Hamdy FC, Albertsen P, Reid CM, Oxley J, McFarlane J, Robinson MC, Adolfsson J, Zietman A, Baum M, Koupparis A, Martin RM. Contemporary accuracy of death certificates for coding prostate cancer as a cause of death: Is reliance on death certification good enough? A comparison with blinded review by an independent cause of death evaluation committee. Br J Cancer 2016; 115:90-4. [PMID: 27253172 PMCID: PMC4931376 DOI: 10.1038/bjc.2016.162] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/18/2016] [Accepted: 04/30/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Accurate cause of death assignment is crucial for prostate cancer epidemiology and trials reporting prostate cancer-specific mortality outcomes. METHODS We compared death certificate information with independent cause of death evaluation by an expert committee within a prostate cancer trial (2002-2015). RESULTS Of 1236 deaths assessed, expert committee evaluation attributed 523 (42%) to prostate cancer, agreeing with death certificate cause of death in 1134 cases (92%, 95% CI: 90%, 93%). The sensitivity of death certificates in identifying prostate cancer deaths as classified by the committee was 91% (95% CI: 89%, 94%); specificity was 92% (95% CI: 90%, 94%). Sensitivity and specificity were lower where death occurred within 1 year of diagnosis, and where there was another primary cancer diagnosis. CONCLUSIONS UK death certificates accurately identify cause of death in men with prostate cancer, supporting their use in routine statistics. Possible differential misattribution by trial arm supports independent evaluation in randomised trials.
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Affiliation(s)
- Emma L Turner
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Sian Noble
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Jonathan A C Sterne
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - J Athene Lane
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Eleanor I Walsh
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Elizabeth M Hill
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Liz Down
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Steven E Oliver
- Department of Health Sciences, University of York and the Hull York Medical School, YO10 5DD, UK
| | - Simon Evans
- Urology Department, Royal United Hospital, Combe Park, Bath BA1 3NG, UK
| | - Peter Brindle
- Avon Primary Care Research Collaborative, South Plaza, Marlborough Street, Bristol BS1 3NX, UK
| | - Naomi J Williams
- School of Social and Community Medicine, University of Bristol, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Laura J Hughes
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Box 279 (S4), Cambridge CB2 0QQ, UK
| | - Charlotte F Davies
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Siaw Yein Ng
- School of Social and Community Medicine, University of Bristol, Freeman Hospital, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - David E Neal
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Peter Albertsen
- University of Connecticut Health Center, Farmington, St Francis Hospital and Medical Center, Hartford, CT, USA
| | - Colette M Reid
- Department of Palliative Medicine, Bristol Haematology and Oncology Centre, Bristol BS2 8ED, UK
| | - Jon Oxley
- Department of Cellular Pathology, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK
| | - John McFarlane
- Urology Department, Royal United Hospital, Combe Park, Bath BA1 3NG, UK
| | - Mary C Robinson
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - Jan Adolfsson
- Department of Clinical Science, Karolinska Institutet, Stokholm, Sweden
| | - Anthony Zietman
- Harvard Radiation Oncology Program, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Baum
- Department of Surgery, University College London, Gower Street, London WC1E 6BT, UK
| | - Anthony Koupparis
- Department of Urology, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK
| | - Richard M Martin
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
- School of Social and Community Medicine, MRC/University of Bristol Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
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37
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Collins JW, Patel H, Adding C, Annerstedt M, Dasgupta P, Khan SM, Artibani W, Gaston R, Piechaud T, Catto JW, Koupparis A, Rowe E, Perry M, Issa R, McGrath J, Kelly J, Schumacher M, Wijburg C, Canda AE, Balbay MD, Decaestecker K, Schwentner C, Stenzl A, Edeling S, Pokupić S, Stockle M, Siemer S, Sanchez-Salas R, Cathelineau X, Weston R, Johnson M, D'Hondt F, Mottrie A, Hosseini A, Wiklund PN. Enhanced Recovery After Robot-assisted Radical Cystectomy: EAU Robotic Urology Section Scientific Working Group Consensus View. Eur Urol 2016; 70:649-660. [PMID: 27234997 DOI: 10.1016/j.eururo.2016.05.020] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/12/2016] [Indexed: 12/17/2022]
Abstract
CONTEXT Radical cystectomy (RC) is associated with frequent morbidity and prolonged length of stay (LOS) irrespective of surgical approach. Increasing evidence from colorectal surgery indicates that minimally invasive surgery and enhanced recovery programmes (ERPs) can reduce surgical morbidity and LOS. ERPs are now recognised as an important component of surgical management for RC. However, there is comparatively little evidence for ERPs after robot-assisted radical cystectomy (RARC). Due to the multimodal nature of ERPs, they are not easily validated through randomised controlled trials. OBJECTIVE To provide a European Association of Urology (EAU) Robotic Urology Section (ERUS) policy on ERPs to guide standardised perioperative management of RARC patients. EVIDENCE ACQUISITION The guidance was formulated in four phases: (1) systematic literature review of evidence for ERPs in robotic, laparoscopic, and open RC; (2) an online questionnaire survey formulated and sent to ERUS Scientific Working Group members; (3) achievement of consensus from an expert panel using the Delphi process; and (4) a standardised reporting template to audit compliance and outcome designed and approved by the committee. EVIDENCE SYNTHESIS Consensus was reached in multiple areas of an ERP for RARC. The key principles include patient education, optimisation of nutrition, RARC approach, standardised anaesthetic, analgesic, and antiemetic regimens, and early mobilisation. CONCLUSIONS This consensus represents the views of an expert panel established to advise ERUS on ERPs for RARC. The ERUS Scientific Working Group recognises the role of ERPs and endorses them as standardised perioperative care for patients undergoing RARC. ERPs in robotic surgery will continue to evolve with technological and pharmaceutical advances and increasing understanding of the role of surgery-specific ERPs. PATIENT SUMMARY There is currently a lack of high-level evidence exploring the benefits of enhanced recovery programmes (ERPs) in patients undergoing robot-assisted radical cystectomy (RARC). We reported a consensus view on a standardised ERP specific to patients undergoing RARC. It was formulated by experts from high-volume RARC hospitals in Europe, combining current evidence for ERPs with experts' knowledge of perioperative care for robotic surgery.
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Affiliation(s)
- Justin W Collins
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Hiten Patel
- Department of Urology, University Hospital of Northern Norway, Tromsø, Norway
| | - Christofer Adding
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Walter Artibani
- Department of Urology, Verona University Hospital, Verona, Italy
| | | | | | - James W Catto
- Department of Urology, Sheffield University Hospital, Sheffield, UK
| | | | - Edward Rowe
- Department of Urology, Bristol Urological Institute, Bristol, UK
| | | | - Rami Issa
- Department of Urology, St Georges, London, UK
| | - John McGrath
- Department of Urology, Royal Devon and Exeter Hospital, Exeter, UK
| | | | | | - Carl Wijburg
- Department of Urology, Rijnstate, Arnhem, Netherlands
| | | | - Meviana D Balbay
- Department of Urology, Memorial Sisli Hospital, Istanbul, Turkey
| | | | | | - Arnulf Stenzl
- Department of Urology, University of Tuebingen, Tubingen, Germany
| | | | - Sasa Pokupić
- Department of Urology, Da Vinci Zentrum, Hanover, Germany
| | - Michael Stockle
- Department of Urology, Universittatsklinikum des Saarlandes, Homburg, Germany
| | - Stefan Siemer
- Department of Urology, Universittatsklinikum des Saarlandes, Homburg, Germany
| | | | | | - Robin Weston
- Department of Urology, Royal Liverpool Hospital, Liverpool, UK
| | - Mark Johnson
- Department of Urology, Newcastle upon Tyne Hospitals, Newcastle, UK
| | | | | | - Abolfazl Hosseini
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Peter N Wiklund
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden.
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Hosseini A, Collins J, Adding C, Nyberg T, Koupparis A, Rowe E, Perry M, Issa R, Schumacher M, Wijburg C, Canda E, Balbay M, Decaestecker K, Schwentner C, Stenzl A, Edeling S, Pokupic S, Guru K, Mottrie A, Wiklund P. PD39-03 COMPLICATIONS AFTER TOTALLY INTRACORPOREAL ROBOT-ASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE EUROPEAN ASSOCIATION OF UROLOGY ROBOTIC UROLOGY SECTION (ERUS) SCIENTIFIC WORKING GROUP. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hackshaw-McGeagh L, Lane JA, Persad R, Gillatt D, Holly JMP, Koupparis A, Rowe E, Johnston L, Cloete J, Shiridzinomwa C, Abrams P, Penfold CM, Bahl A, Oxley J, Perks CM, Martin R. Prostate cancer - evidence of exercise and nutrition trial (PrEvENT): study protocol for a randomised controlled feasibility trial. Trials 2016; 17:123. [PMID: 26948468 PMCID: PMC4780152 DOI: 10.1186/s13063-016-1248-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 02/23/2016] [Indexed: 12/26/2022] Open
Abstract
Background A growing body of observational evidence suggests that nutritional and physical activity interventions are associated with beneficial outcomes for men with prostate cancer, including brisk walking, lycopene intake, increased fruit and vegetable intake and reduced dairy consumption. However, randomised controlled trial data are limited. The ‘Prostate Cancer: Evidence of Exercise and Nutrition Trial’ investigates the feasibility of recruiting and randomising men diagnosed with localised prostate cancer and eligible for radical prostatectomy to interventions that modify nutrition and physical activity. The primary outcomes are randomisation rates and adherence to the interventions at 6 months following randomisation. The secondary outcomes are intervention tolerability, trial retention, change in prostate specific antigen level, change in diet, change in general physical activity levels, insulin-like growth factor levels, and a range of related outcomes, including quality of life measures. Methods/design The trial is factorial, randomising men to both a physical activity (brisk walking or control) and nutritional (lycopene supplementation or increased fruit and vegetables with reduced dairy consumption or control) intervention. The trial has two phases: men are enrolled into a cohort study prior to radical prostatectomy, and then consented after radical prostatectomy into a randomised controlled trial. Data are collected at four time points (cohort baseline, true trial baseline and 3 and 6 months post-randomisation). Discussion The Prostate Cancer: Evidence of Exercise and Nutrition Trial aims to determine whether men with localised prostate cancer who are scheduled for radical prostatectomy can be recruited into a cohort and subsequently randomised to a 6-month nutrition and physical activity intervention trial. If successful, this feasibility trial will inform a larger trial to investigate whether this population will gain clinical benefit from long-term nutritional and physical activity interventions post-surgery. Prostate Cancer: Evidence of Exercise and Nutrition Trial (PrEvENT) is registered on the ISRCTN registry, ref number ISRCTN99048944. Date of registration 17 November 2014.
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Affiliation(s)
- Lucy Hackshaw-McGeagh
- NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle, Level 3, University Hospitals Bristol Education Centre, Upper Maudlin Street, Bristol, BS2 8AE, UK. .,School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - J Athene Lane
- NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle, Level 3, University Hospitals Bristol Education Centre, Upper Maudlin Street, Bristol, BS2 8AE, UK. .,School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Raj Persad
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Southmead Way, Westbury-on-trym, Bristol, Avon, BS10 5NB, UK.
| | - David Gillatt
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Southmead Way, Westbury-on-trym, Bristol, Avon, BS10 5NB, UK.
| | - Jeff M P Holly
- School of Clinical Sciences, University of Bristol, Southmead Hospital, Southmead Way, Westbury-on-trym, Bristol, BS10 5NB, UK.
| | - Anthony Koupparis
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Southmead Way, Westbury-on-trym, Bristol, Avon, BS10 5NB, UK.
| | - Edward Rowe
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Southmead Way, Westbury-on-trym, Bristol, Avon, BS10 5NB, UK.
| | - Lyndsey Johnston
- North Bristol NHS Trust, Southmead Hospital, Southmead Way, Westbury-on-trym, Bristol, Avon, BS10 5NB, UK.
| | - Jenny Cloete
- North Bristol NHS Trust, Southmead Hospital, Southmead Way, Westbury-on-trym, Bristol, Avon, BS10 5NB, UK.
| | - Constance Shiridzinomwa
- North Bristol NHS Trust, Southmead Hospital, Southmead Way, Westbury-on-trym, Bristol, Avon, BS10 5NB, UK.
| | - Paul Abrams
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Southmead Way, Westbury-on-trym, Bristol, Avon, BS10 5NB, UK.
| | - Chris M Penfold
- NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle, Level 3, University Hospitals Bristol Education Centre, Upper Maudlin Street, Bristol, BS2 8AE, UK.
| | - Amit Bahl
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Southmead Way, Westbury-on-trym, Bristol, Avon, BS10 5NB, UK. .,University Hospital Bristol NHS Trust, Bristol Haematology and Oncology Centre, Horfield Road, Bristol, BS2 8ED, UK.
| | - Jon Oxley
- Cellular Pathology, North Bristol NHS Trust, Southmead Hospital, Southmead Way, Westbury-on-trym, Bristol, Avon, BS10 5NB, UK.
| | - Claire M Perks
- School of Clinical Sciences, University of Bristol, Southmead Hospital, Southmead Way, Westbury-on-trym, Bristol, BS10 5NB, UK.
| | - Richard Martin
- NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle, Level 3, University Hospitals Bristol Education Centre, Upper Maudlin Street, Bristol, BS2 8AE, UK. .,School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
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Bullock N, Potts J, Simpkin AJ, Koupparis A, Harper SJ, Oxley J, Oltean S. Serine-arginine protein kinase 1 (SRPK1), a determinant of angiogenesis, is upregulated in prostate cancer and correlates with disease stage and invasion. J Clin Pathol 2015; 69:171-5. [PMID: 26500332 PMCID: PMC4752636 DOI: 10.1136/jclinpath-2015-203125] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/16/2015] [Indexed: 01/21/2023]
Abstract
Vascular endothelial growth factor (VEGF) undergoes alternative splicing to produce both proangiogenic and antiangiogenic isoforms. Preferential splicing of proangiogenic VEGF is determined by serine-arginine protein kinase 1 (SRPK1), which is upregulated in a number of cancers. In the present study, we aimed to investigate SRPK1 expression in prostate cancer (PCa) and its association with cancer progression. SRPK1 expression was assessed using immunohistochemistry of PCa tissue extracted from radical prostatectomy specimens of 110 patients. SRPK1 expression was significantly higher in tumour compared with benign tissue (p<0.00001) and correlated with higher pT stage (p=0.004), extracapsular extension (p=0.003) and extracapsular perineural invasion (p=0.008). Interestingly, the expression did not correlate with Gleason grade (p=0.21), suggesting that SRPK1 facilitates the development of a tumour microenvironment that favours growth and invasion (possibly through stimulating angiogenesis) while having little bearing on the morphology or function of the tumour cells themselves.
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Affiliation(s)
- Nicholas Bullock
- School of Physiology and Pharmacology, University of Bristol, Bristol, UK
| | | | - Andrew J Simpkin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Steve J Harper
- School of Physiology and Pharmacology, University of Bristol, Bristol, UK
| | - Jon Oxley
- Department of Cellular Pathology, Southmead Hospital, Bristol, UK
| | - Sebastian Oltean
- School of Physiology and Pharmacology, University of Bristol, Bristol, UK
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Koupparis A, Villeda-Sandoval C, Weale N, El-Mahdy M, Gillatt D, Rowe E. Robot-assisted radical cystectomy with intracorporeal urinary diversion: impact on an established enhanced recovery protocol. BJU Int 2015; 116:924-31. [PMID: 25943158 DOI: 10.1111/bju.13171] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the impact of the introduction of robot-assisted radical cystectomy (RARC) on an established enhanced recovery programme (ERP) and to examine the effect on mortality and morbidity rates, transfusion rates, and length of stay (LOS). PATIENTS AND METHODS Data on 102 consecutive patients undergoing RARC with full intracorporeal reconstruction were obtained from our prospectively updated institutional database. These data were compared to previously published retrospective results from three separate groups of patients undergoing open radical cystectomy (ORC) at our centre. Our primary focus was perioperative outcomes including transfusion rate, complication rates, 30- and 90-day mortality rates, and LOS. RESULTS The demographics of the comparative groups showed no significant difference in age, gender distribution, and American Society of Anesthesiologists grade. A significant reduction in transfusion rate was seen in RARC vs ORC (P < 0.001). The median LOS for the RARC group was 8 vs 13 days for the ORC group (P < 0.001). There was trend to a lower total complication rate (48% vs 31%). The 30- and 90-day mortality rates were equivalent between the groups (2%). CONCLUSIONS Introduction of RARC and intracorporeal reconstruction represents the single biggest impact on our ERP, with significant reduction in transfusion rates and LOS, and a trend towards a lower complication rate.
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Affiliation(s)
- Anthony Koupparis
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | | | - Nicola Weale
- Department of Anaesthetics, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Motaz El-Mahdy
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - David Gillatt
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Edward Rowe
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
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Moradi M, Mahdavi SS, Nir G, Mohareri O, Koupparis A, Gagnon LO, Fazli L, Casey RG, Ischia J, Jones EC, Goldenberg SL, Salcudean SE. Multiparametric 3D in vivo ultrasound vibroelastography imaging of prostate cancer: Preliminary results. Med Phys 2015; 41:073505. [PMID: 24989419 DOI: 10.1118/1.4884226] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Ultrasound-based solutions for diagnosis and prognosis of prostate cancer are highly desirable. The authors have devised a method for detecting prostate cancer using a vibroelastography (VE) system developed in our group and a tissue classification approach based on texture analysis of VE images. METHODS The VE method applies wide-band mechanical vibrations to the tissue. Here, the authors report on the use of this system for cancer detection and show that the texture of VE images characterized by the first and the second order statistics of the pixel intensities form a promising set of features for tissue typing to detect prostate cancer. The system was used to image patients prior to radical surgery. The removed specimens were sectioned and studied by an experienced histopathologist. The authors registered the whole-mount histology sections to the ultrasound images using an automatic registration algorithm. This enabled the quantitative evaluation of the performance of the authors' imaging method in cancer detection in an unbiased manner. The authors used support vector machine (SVM) classification to measure the cancer detection performance of the VE method. Regions of tissue of size 5 × 5 mm, labeled as cancer and noncancer based on automatic registration to histology slides, were classified using SVM. RESULTS The authors report an area under ROC of 0.81 ± 0.10 in cancer detection on 1066 tissue regions from 203 images. All cancer tumors in all zones were included in this analysis and were classified versus the noncancer tissue in the peripheral zone. This outcome was obtained in leave-one-patient-out validation. CONCLUSIONS The developed 3D prostate vibroelastography system and the proposed multiparametric approach based on statistical texture parameters from the VE images result in a promising cancer detection method.
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Affiliation(s)
- Mehdi Moradi
- University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - S Sara Mahdavi
- British Columbia Cancer Agency, Vancouver, British Columbia V5Z 4E6, Canada
| | - Guy Nir
- University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Omid Mohareri
- University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Anthony Koupparis
- Bristol Urological Institute, Brunel Building, Southmead Hospital, Bristol BS10 5NB, UK
| | | | - Ladan Fazli
- Vancouver Prostate Center, Vancouver, British Columbia V6H 3Z6, Canada
| | - Rowan G Casey
- Consultant Urologist, Essex Cancer Centre, Colchester University NHS Foundation Trust, Essex, CO62QL, UK
| | - Joseph Ischia
- University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Edward C Jones
- Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada
| | - S Larry Goldenberg
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
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Abstract
Objective: The objective of this article is to investigate the safety and efficacy of both monopolar and bipolar transurethral resection of the prostate (TURP) performed on a day-case basis. Materials and methods: Data were collected prospectively for two cohorts of consecutive patients undergoing a day-case monopolar TURP (mTURP) by surgeon 1 in centre 1 (Group M) and a day case bipolar TURP (bTURP) by surgeon 2 in centre 2 (Group B). All were scheduled to be discharged on the day of surgery, with an indwelling catheter to be removed on an outpatient basis. Results: Fifty men underwent a day-case mTURP (Group M) and 27 men underwent a day-case bTURP (Group B) in centre 1 and 2, respectively. Patient age ( p = 0.71) and resection weight ( p = 0.35) were comparable between the two groups. No statistically significant difference in the number of admissions ( p = 1.00) or re-admissions ( p = 0.55) between the two groups was observed, with an identical day case discharge rate of 92%. Conclusions: Day-case TURP can be provided safely and effectively to patients regardless of the diathermy method employed, with successful discharge rates and low risk of admission or re-admission.
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Affiliation(s)
- Elizabeth Bright
- Department of Urology, Royal Devon and Exeter NHS Foundation Trust, UK
| | - Mary Stocker
- Department of Anaesthetics, Torbay District General Hospital, UK
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Abstract
We present the case of a 17-year-old girl with pure malignant rhabdoid tumour of the bladder treated with a multimodal approach. She is recurrence-free at her 1-year follow-up.
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Affiliation(s)
| | - Jon Oxley
- Department of Pathology, Southmead Hospital, Westbury on Trym, Bristol, United Kingdom
| | - Anthony Koupparis
- Department of Urology, Southmead Hospital, Westbury on Trym, Bristol, United Kingdom
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Bach C, Pisipati S, Daneshwar D, Wright M, Rowe E, Gillatt D, Persad R, Koupparis A. The status of surgery in the management of high-risk prostate cancer. Nat Rev Urol 2014; 11:342-51. [DOI: 10.1038/nrurol.2014.100] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Koupparis A. The Consultant urological surgeon: Surviving the first few years. Arab J Urol 2014; 12:30-1. [PMID: 26019918 PMCID: PMC4434503 DOI: 10.1016/j.aju.2013.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- A Koupparis
- Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB, UK
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Koupparis A, Gleave M. Ensuring quality for radical prostatectomies in Canada. Can Urol Assoc J 2013; 4:26-7. [DOI: 10.5489/cuaj.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Aning J, Diamond J, Koupparis A. Risk of post-operative visual loss and robotic surgery. J Robot Surg 2012; 6:275-6. [DOI: 10.1007/s11701-012-0363-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 06/11/2012] [Indexed: 10/28/2022]
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Thurairaja R, Koupparis A. The role of surgery in high-risk localised prostate cancer. BJU Int 2012; 110:E1-2. [PMID: 22691024 DOI: 10.1111/j.1464-410x.2012.11303_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Widespread use of testing for prostate-specific antigen (PSA) has led to a migration in the stage and grade of prostate cancer (PCa), with most men presenting with localized disease. However, 20%-35% of patients still present with high-risk disease (PSA > 20 ng/mL, biopsy Gleason score 8-10, or clinical stage T3). Despite advances in various treatment modalities, patients with high-risk disease have a significant chance of recurrence and death after surgery, often because of the presence of early occult metastasis at time of diagnosis. The optimal management of high-risk pca remains controversial. The present article aims to discuss the traditional approaches and the more recent evolution toward multimodal therapies.
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Affiliation(s)
- A Koupparis
- The Vancouver Prostate Centre and Department of Urological Sciences, University of British Columbia, Vancouver, BC.
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