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Tan WS, Krimphove MJ, Cole AP, Marchese M, Berg S, Lipsitz SR, Löppenberg B, Nabi J, Abdollah F, Choueiri TK, Kibel AS, Sooriakumaran P, Trinh QD. Variation in Positive Surgical Margin Status After Radical Prostatectomy for pT2 Prostate Cancer. Clin Genitourin Cancer 2019; 17:e1060-e1068. [PMID: 31303561 DOI: 10.1016/j.clgc.2019.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/13/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We evaluated patient, hospital, and cancer-specific factors associated with positive surgical margin (PSM) variability after radical prostatectomy in pT2 prostate cancer in the United States. PATIENTS AND METHODS A total of 45,426 men from 1152 hospitals with pT2 prostate cancer and known margin status after radical prostatectomy were identified using the National Cancer Database (2010-2015). Data on patient, cancer, hospital factors, and surgical approach were extracted. A mixed effects logistic regression model was computed to examine factors associated with PSM and partial R2 values to assess the relative contributions of patient, cancer, and hospital variables to PSM status. RESULTS Median PSM rate of 8.5% (interquartile range, 5.2%-13.0%). Robotic (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.83-0.99) and laparoscopic (OR, 0.74; 95% CI, 0.64-0.90) surgical approach, academic institution (OR, 0.87; 95% CI, 0.76-1.00) and high hospital surgical volume (>297 cases [OR], 0.83; 95% CI, 0.70-0.99) were independently associated with a lower PSM. Black men (OR, 1.13; 95% CI, 1.01-1.26) and adverse cancer-specific features (prostate-specific antigen [PSA], 10-20; PSA >20; cT3 stage; Gleason 7, 8, 9-10; all P > .01) were independently associated with a higher PSM. Patient-specific, hospital-specific, and cancer-specific factors had a contribution of 2.3%, 3.9%, and 15.2%, respectively, to the variation in PSM. Facility had a contribution of 23.7% to the variation in PSM. CONCLUSION Cancer-specific factors account for 15.2% of PSM variation with the remaining 84.8% of PSM variation due to patient, hospital, and other factors not accounted within the model. Noncancer-specific factors represent addressable factors that are important for policy-makers in efforts to improve patient outcome.
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Affiliation(s)
- Wei Shen Tan
- Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals, London, United Kingdom
| | - Marieke J Krimphove
- Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alexander P Cole
- Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Maya Marchese
- Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sebastian Berg
- Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Björn Löppenberg
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Junaid Nabi
- Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA
| | - Adam S Kibel
- Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Prasanna Sooriakumaran
- Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals, London, United Kingdom
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Lank Center for Genitourinary Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA.
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Tully K, Palisaar RJ, Brock M, Bach P, von Landenberg N, Löppenberg B, von Bodman C, Noldus J, Roghmann F. Transurethral resection of bladder tumours: established and new methods of tumour visualisation. Transl Androl Urol 2019; 8:25-33. [PMID: 30976565 PMCID: PMC6414343 DOI: 10.21037/tau.2018.12.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Indexed: 01/14/2023] Open
Abstract
Transurethral resection (TUR) of bladder tumours does not only serve diagnostic purposes by securing histological proof of the disease but might also resemble the final therapy. During recent years, technical innovations improved the intraoperative detection and visibility of tumourous lesions during TUR. The most important techniques, which have individually found their way into international guidelines, are photodynamic imaging (PDI) and narrowband imaging (NBI). Furthermore, there are more or less experimental approaches such as optical coherence tomography (OCT), confocal laser endomicroscopy (CLE), red/green/blue analysis (RGB) of WLC. Moreover, the combination of two or more techniques in a multiparametric setting is another development in improving intraoperative imaging. The aim of this review is to describe today’s knowledge of the more established methods and to depict the most recent developments in intraoperative imaging.
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Affiliation(s)
- Karl Tully
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Rein-Jüri Palisaar
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Marko Brock
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Peter Bach
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | | | - Björn Löppenberg
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | | | - Joachim Noldus
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Florian Roghmann
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
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Zavaski ME, Hanske J, Löppenberg B, Cole AP, Hanna N, Gupta S, Eswara JR, Preston MA, Kibel AS, Lipsitz SR, Sun M, Trinh QD, Meyer CP. Contemporary perceptions of human papillomavirus and penile cancer: Perspectives from a national survey. Can Urol Assoc J 2018; 13:32-37. [PMID: 30138094 DOI: 10.5489/cuaj.5366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to assess the contemporary knowledge of human papillomavirus (HPV) and its association with penile cancer in a nationwide cohort from the U.S. METHODS We used the Health Information National Trends Survey (HINTS), a cross-sectional telephone survey performed in the U.S. initiated by the National Cancer Institute. The most recent iteration, HINTS 4 Cycle 4, was conducted in mail format between August 19 and November 17, 2014. Primary endpoints included knowledge of HPV and its causal relationship to penile cancer. Baseline characteristics included sex, age, education, race and ethnicity, income, residency, personal or family history of cancer, health insurance status, and internet use. Multivariable logistic regression assessed predictors of HPV and penile cancer knowledge. RESULTS An unweighted sample of 3376 respondents was extracted from the HINTS 4, Cycle 4. Whereas 64.4% of respondents had heard of HPV, only 29.5% of these were aware that it could cause penile cancer. Men were significantly less likely to have heard of HPV than women (odds ratio [OR] 0.32; 95% confidence interval [CI] 0.24-0.43). Older age; African-American, Asian, and "other race"; being married; from a lower education bracket; having a personal cancer history; and those without internet access were significantly less likely to have heard of HPV. None of our examined variables were independent predictors for the knowledge of the association of penile cancer and HPV. CONCLUSIONS Our analysis of a large, nationally representative survey demonstrates that the majority of the American public is familiar with HPV, but lack a meaningful understanding between this virus and penile cancer. Primary care providers and specialists should be encouraged to intensify counselling about this significant association as a primary preventive measure of this potentially fatal disease.
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Affiliation(s)
- Michael E Zavaski
- Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Julian Hanske
- Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Björn Löppenberg
- Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Alexander P Cole
- Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Nawar Hanna
- Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Soham Gupta
- CURE Program, Dana-Faber Cancer Institute, Boston, MA, United States
| | - Jairam R Eswara
- Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Mark A Preston
- Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Adam S Kibel
- Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Stuart R Lipsitz
- Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Maxine Sun
- Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Christian P Meyer
- Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Vetterlein MW, Dalela D, Sammon JD, Karabon P, Sood A, Jindal T, Meyer CP, Löppenberg B, Sun M, Trinh QD, Menon M, Abdollah F. State-by-state Variation in Prostate-specific Antigen Screening Trends Following the 2011 United States Preventive Services Task Force Panel Update. Urology 2018; 112:56-65. [DOI: 10.1016/j.urology.2017.08.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/29/2017] [Accepted: 08/09/2017] [Indexed: 10/18/2022]
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Löppenberg B, Friedlander DF, Krasnova A, Tam A, Leow JJ, Nguyen PL, Barry H, Lipsitz SR, Menon M, Abdollah F, Sammon JD, Sun M, Choueiri TK, Kibel AS, Trinh QD. Variation in the use of active surveillance for low-risk prostate cancer. Cancer 2017; 124:55-64. [DOI: 10.1002/cncr.30983] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/28/2017] [Accepted: 08/04/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Björn Löppenberg
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Department of Urology; Marien Hospital Herne, Ruhr-University Bochum; Herne Germany
| | - David F. Friedlander
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Anna Krasnova
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Andrew Tam
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | | | - Paul L. Nguyen
- Department of Radiation Oncology; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Hawa Barry
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Stuart R. Lipsitz
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Mani Menon
- VUI Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
| | - Jesse D. Sammon
- Division of Urology and Center for Outcomes Research and Evaluation, Maine Medical Center; Portland Maine
| | - Maxine Sun
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Toni K. Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute; Boston Massachusetts
| | - Adam S. Kibel
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Quoc-Dien Trinh
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
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Vetterlein MW, Wankowicz SAM, Seisen T, Lander R, Löppenberg B, Chun FKH, Menon M, Sun M, Barletta JA, Choueiri TK, Bellmunt J, Trinh QD, Preston MA. Neoadjuvant chemotherapy prior to radical cystectomy for muscle-invasive bladder cancer with variant histology. Cancer 2017; 123:4346-4355. [DOI: 10.1002/cncr.30907] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/30/2017] [Accepted: 07/05/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Malte W. Vetterlein
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Stephanie A. M. Wankowicz
- Lank Center for Genitourinary Oncology; Dana-Farber Cancer Institute, Harvard Medical School; Boston Massachusetts
| | - Thomas Seisen
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Department of Urology; Pitié-Salpêtriére Hospital, Pierre and Marie Curie University; Paris France
| | - Richard Lander
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Björn Löppenberg
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Department of Urology; Marien Hospital Herne, Ruhr-University Bochum; Herne Germany
| | - Felix K.-H. Chun
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Mani Menon
- Center for Outcomes Research; Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
| | - Maxine Sun
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Justine A. Barletta
- Department of Pathology; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Toni K. Choueiri
- Lank Center for Genitourinary Oncology; Dana-Farber Cancer Institute, Harvard Medical School; Boston Massachusetts
| | - Joaquim Bellmunt
- Lank Center for Genitourinary Oncology; Dana-Farber Cancer Institute, Harvard Medical School; Boston Massachusetts
| | - Quoc-Dien Trinh
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Mark A. Preston
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
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Vetterlein MW, Löppenberg B, Karabon P, Dalela D, Jindal T, Sood A, Chun FKH, Trinh QD, Menon M, Abdollah F. Impact of travel distance to the treatment facility on overall mortality in US patients with prostate cancer. Cancer 2017; 123:3241-3252. [DOI: 10.1002/cncr.30744] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/09/2017] [Accepted: 03/29/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Malte W. Vetterlein
- Center for Outcomes Research; Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
- Division of Urological Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Björn Löppenberg
- Center for Outcomes Research; Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
- Division of Urological Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Department of Urology; Marien Hospital Herne, Ruhr-University Bochum; Herne Germany
| | - Patrick Karabon
- Center for Outcomes Research; Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
- Department of Public Health Sciences; Henry Ford Health System; Detroit Michigan
| | - Deepansh Dalela
- Center for Outcomes Research; Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
| | - Tarun Jindal
- Center for Outcomes Research; Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
| | - Akshay Sood
- Center for Outcomes Research; Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
| | - Felix K.-H. Chun
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Mani Menon
- Center for Outcomes Research; Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
| | - Firas Abdollah
- Center for Outcomes Research; Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
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Löppenberg B, Sood A, Dalela D, Karabon P, Sammon J, Vetterlein M, Noldus J, Peabody J, Trinh QD, Menon M, Abdollah F. PD47-08 VARIATION AND TRENDS IN PROSTATE CANCER CARE AT COMMISSION ON CANCER DESIGNATED FACILITIES. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2368] [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: 10/19/2022]
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Vetterlein MW, Mullane S, Seisen T, Lander R, Löppenberg B, Choueiri TK, Bellmunt J, Menon M, Kibel AS, Trinh QD, Preston MA. MP34-11 NEOADJUVANT CHEMOTHERAPY PRIOR TO RADICAL CYSTECTOMY FOR MUSCLE-INVASIVE BLADDER CANCER WITH VARIANT HISTOLOGY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dalela D, Karabon P, Sammon J, Sood A, Löppenberg B, Trinh QD, Menon M, Abdollah F. Generalizability of the Prostate Cancer Intervention Versus Observation Trial (PIVOT) Results to Contemporary North American Men with Prostate Cancer. Eur Urol 2017; 71:511-514. [DOI: 10.1016/j.eururo.2016.08.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
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Roghmann F, von Landenberg N, Schmidt J, Hanske J, Löppenberg B, von Bodman C, Bach P, Brock M, Palisaar J, Noldus J. MP54-01 EVALUATION OF POSTOPERATIVE COMPLICATIONS AFTER RADICAL CYSTECTOMY USING THE COMPREHENSIVE COMPLICATION INDEX. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Vetterlein MW, Löppenberg B, Karabon P, Dalela D, Jindal T, Sood A, Trinh QD, Menon M, Abdollah F. PD18-07 THE IMPACT OF TRAVEL DISTANCE TO THE TREATMENT FACILITY ON OVERALL MORTALITY IN PROSTATE CANCER PATIENTS: EVIDENCE FROM THE NATIONAL CANCER DATA BASE. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.867] [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: 12/01/2022]
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Löppenberg B, Müller G, Bach P, von Bodman C, Brock M, Roghmann F, Noldus J, Palisaar J. MP82-10 CHARACTERIZATION OF THE “ONE-PAD PATIENT” AT LONG-TERM FOLLOW-UP AFTER RADICAL PROSTATECTOMY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2557] [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: 11/30/2022]
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Löppenberg B, Trinh QD. Editorial Commentary. Urol Pract 2017; 4:20. [PMID: 37592626 DOI: 10.1016/j.urpr.2016.03.017] [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: 11/28/2022]
Affiliation(s)
- Björn Löppenberg
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Orberger M, Palisaar J, Roghmann F, Mittelstädt L, Bischoff P, Noldus J, Löppenberg B. Association between the Surgical Apgar Score and Perioperative Complications after Radical Prostatectomy. Urol Int 2016; 98:61-70. [PMID: 27907923 DOI: 10.1159/000450795] [Citation(s) in RCA: 11] [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] [Received: 07/05/2016] [Accepted: 09/12/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate whether the Surgical Apgar Score (SAS) can identify patients who are at risk for perioperative adverse events (PAE) following radical prostatectomy for prostate cancer. PATIENTS AND METHODS At a single academic institution, 994 patients undergoing radical prostatectomy between 2010 and 2013 were analyzed retrospectively. The SAS was calculated from anesthesia records, evaluated to predict PAE within a 30-day time period postoperatively; these events were classified according to standardized classification systems. RESULTS We observed adverse events in 45.4% (451/994) of patients with a total of 694 events. Overall, 41% (408/994) had low- and 9.9% (98/994) had high-grade events. A lower SAS was identified as an independent predictor of any (p < 0.001) and low-grade adverse events (p = 0.001) for those patients who had undergone open retropubic radical prostatectomy (ORRP). Each 1-point increment resulted in a 24% decrease in the odds of any (95% CI 0.66-0.88) and a 21% decrease in the odds of a low-grade (95% CI 0.69-0.91) event. Adverse events of robot-assisted prostatectomy were not associated with the SAS. CONCLUSIONS Lower SAS values indicate patients at risk for adverse events after ORRP. The SAS might serve as one variable for outcome assessment, reflecting the challenge of mutual surgical and anesthesiology procedure management.
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Affiliation(s)
- Matthias Orberger
- Department of Urology, Ruhr-University Bochum, Marien Hospital Herne, Herne, Germany
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Vetterlein MW, Seisen T, Löppenberg B, Hanna N, Cheng PJ, Fisch M, Chun FKH, Kibel AS, Preston MA, Meyer CP. Resident Involvement in Radical Inguinal Orchiectomy for Testicular Cancer Does Not Adversely Impact Perioperative Outcomes - A Retrospective Study. Urol Int 2016; 98:472-477. [DOI: 10.1159/000448596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/20/2016] [Indexed: 11/19/2022]
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17
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Sood A, Li H, Suson KD, Majumder K, Sedki M, Abdollah F, Sammon JD, Friedman A, Löppenberg B, Lakshmanan Y, Trinh QD, Elder JS. Treatment patterns, testicular loss and disparities in inpatient surgical management of testicular torsion in boys: a population-based study 1998-2010. BJU Int 2016; 118:969-979. [PMID: 27322784 DOI: 10.1111/bju.13557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/28/2022]
Abstract
OBJECTIVES To examine temporal trends in inpatient testicular torsion (TT) treatment and testicular loss (TL), and to identify risk factors for TL using a large nationally representative paediatric cohort, stratified to established high prevalence TT cohorts (neonatal TT [NTT]; age <1 years) and adolescent TT (ATT; age 12-17 years). METHODS Boys (age ≤17 years, n = 17 478) undergoing surgical exploration for TT were identified within the Nationwide Inpatient Sample (1998-2010). Temporal trends in inpatient TT management (salvage surgery vs orchiectomy) and TL were examined using estimated annual percent change methodology. Multivariable logistic regression models were used to identify risk factors for TL. RESULTS Teaching hospitals treated 90% of boys with NTT, compared with 55% with ATT (P < 0.001). Of boys with NTT, 85% lost their testis, compared with 35% with ATT (P < 0.001). Inpatient management of NTT declined during the study period, from 7.5/100 000 children in 1998 to 3/100 000 in 2010 (estimated annual percent change -4.95%; P < 0.001). The decrease was similar but less dramatic in ATT. TL patterns did not improve. In adjusted analyses, for NTT, orchiectomy was more likely at teaching hospitals. For ATT, orchiectomy was more likely in children with comorbidities (odds ratio 5.42; P = 0.045), Medicaid coverage or self-pay (P < 0.05) and weekday presentation (P = 0.001). Regional or racial disposition was not associated with TL. CONCLUSIONS There has been a gradual decrease in inpatient surgical treatment for both NTT and ATT, presumably as a result of increased outpatient and/or non-operative management of these children. Concerningly, TL patterns have not improved; targeted interventions such as parental and adolescent male health education may lead to timely recognition/intervention in children at-risk for ATT. We noted no regional/racial disparities in contrast to earlier studies.
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Affiliation(s)
- Akshay Sood
- VCORE, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.,Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Hanhan Li
- VCORE, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Kristina D Suson
- Department of Urology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Kaustav Majumder
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Mai Sedki
- VCORE, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Firas Abdollah
- VCORE, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Jesse D Sammon
- VCORE, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.,Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Ariella Friedman
- VCORE, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Björn Löppenberg
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Jack S Elder
- VCORE, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.,Department of Urology, Children's Hospital of Michigan, Detroit, MI, USA.,Pediatric Urology, Massachusetts General Hospital for Children, Boston, MA, USA
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Löppenberg B, Dalela D, Karabon P, Sood A, Sammon JD, Meyer CP, Sun M, Noldus J, Peabody JO, Trinh QD, Menon M, Abdollah F. The Impact of Local Treatment on Overall Survival in Patients with Metastatic Prostate Cancer on Diagnosis: A National Cancer Data Base Analysis. Eur Urol 2016; 72:14-19. [PMID: 27174537 DOI: 10.1016/j.eururo.2016.04.031] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/22/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The role of local treatment (LT) in patients with metastatic prostate cancer (mPCa) at diagnosis is controversial. OBJECTIVE We set to evaluate the potential impact of LT on overall mortality (OM) in men with mPCa, and how this impact is influenced by tumor and patient characteristics. DESIGN, SETTINGS, AND PARTICIPANTS A total of 15 501 patients with mPCa were identified in the National Cancer Data Base (2004-2012) and categorized in LT (radical prostatectomy or radiation therapy targeted to prostate) versus nonlocal treatment (NLT; all other patients). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The two arms (LT vs NLT) were matched using propensity scores to minimize selection bias. To evaluate LT impact on OM in relation to baseline characteristics, first multivariable Cox regression analysis was used to predict OM in patients treated with NLT, then interaction between predicted OM risk and LT status was tested. RESULTS AND LIMITATIONS Overall, 9.5% (n=1470) of patients received LT. In the postpropensity matched cohorts, 3-yr OM-free survival was higher in the LT group versus the NLT group (69% vs 54%; p<0.001). In multivariable Cox regression, the NLT group, age, and Charlson comorbidity index were predictors of OM (all p≤0.03). This model was used to predict the 3-yr OM risk. The interaction between predicted OM and LT status was significant (p<0.001). The benefit of LT on OM decreased progressively as predicted OM risk increased. Specifically, the 3-yr absolute improvement in OM-free survival was 15.7%, for patients with predicted OM risk ≤20% versus 0% for those with predicted OM risk ≥72%. CONCLUSIONS Men with mPCa at diagnosis benefit from LT in terms of OM. This is largely affected by baseline characteristics. Specifically, patients with a relatively low tumor risk and good general health status appear to benefit the most. PATIENT SUMMARY We used a large hospital-based database to evaluate which patients might benefit from local therapy when metastasized prostate cancer was present at diagnosis. Local therapy is associated with a survival benefit in men with less aggressive tumors and good general health.
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Affiliation(s)
- Björn Löppenberg
- VUI Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA; Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Deepansh Dalela
- VUI Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Patrick Karabon
- VUI Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA; Henry Ford Health System, Public Health Sciences, Detroit, MI, USA
| | - Akshay Sood
- VUI Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Jesse D Sammon
- VUI Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Christian P Meyer
- Division of Urology, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maxine Sun
- Division of Urology, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joachim Noldus
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - James O Peabody
- VUI Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Quoc-Dien Trinh
- Division of Urology, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mani Menon
- VUI Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
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Abdollah F, Dalela D, Karabon P, Sammon J, Sood A, Löppenberg B, Trinh QD, Sun M, Meyer C, Peabody J, Menon M. PD37-03 IS THE PROSTATE CANCER INTERVENTION VERSUS OBSERVATION TRIAL REFLECTIVE OF THE CONTEMPORARY US POPULATION DIAGNOSED WITH PROSTATE CANCER? RESULTS FROM THE NATIONAL CANCER DATABASE 2004-2011. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1142] [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: 12/01/2022]
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Meyer C, Sood A, Abdollah F, Sammon J, Vetterlein M, Löppenberg B, Hanske J, Leow J, Cole A, Kibel A, Sun M, Menon M, Trinh QD. MP69-11 MINIMALLY INVASIVE VS. OPEN RADICAL PROSTATECTOMY: AN ANALYSIS OF 30-DAY POSTOPERATIVE COMPLICATIONS, UNPLANNED READMISSIONS, AND MORTALITY. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1389] [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: 11/29/2022]
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Cole A, Meyer C, Vetterlein M, Löppenberg B, Kibel A, Abdollah F, Leow J, Seisen T, Zavaski M, Sun M, Sammon J, Trinh QD. MP21-07 THE AFFORDABLE CARE ACT AND PSA SCREENING PRACTICES: ANALYSIS OF RACIAL SUBGROUPS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.641] [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: 11/15/2022]
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Meyer C, Trinh QD, Vetterlein M, Löppenberg B, Adollah F, Seisen T, Hanske J, Leow J, Sammon J, Menon M, Kibel A, Chang S, Choueiri T, Sun M. PD04-05 TRENDS OF METASTASECTOMY FOR METASTATIC RENAL CELL CARCINOMA AND THEIR IMPACT ON OVERALL SURVIVAL. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Löppenberg B, Dalela D, Karabon P, Sood A, Sammon J, Trinh QD, Meyer C, Sun M, Peabody J, Menon M, Abdollah F. MP50-12 THE IMPACT OF LOCAL TREATMENT ON OVERALL MORTALITY IN PATIENTS DIAGNOSED WITH PRIMARY METASTATIC PROSTATE CANCER. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.446] [Citation(s) in RCA: 2] [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: 11/28/2022]
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Meyer CP, Hollis M, Cole AP, Hanske J, O‘Leary J, Gupta S, Löppenberg B, Zavaski ME, Sun M, Sammon JD, Kibel AS, Fisch M, Chun FK, Trinh QD. Complications Following Common Inpatient Urological Procedures: Temporal Trend Analysis from 2000 to 2010. Eur Urol Focus 2016; 2:3-9. [DOI: 10.1016/j.euf.2015.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 10/09/2015] [Accepted: 10/19/2015] [Indexed: 11/16/2022]
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Meyer C, Sammon J, Löppenberg B, Leow J, Hanna N, Hanske J, Cole A, Abdollah F, Menon M, Sun M, Trinh QD. MP21-10 THE IMPACT OF MEDICARE ELIGIBILITY ON PROSTATE CANCER SCREENING BEHAVIORS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.644] [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: 10/22/2022]
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Dalela D, Löppenberg B, Sood A, Sammon J, Abdollah F. Contemporary Role of the Decipher® Test in Prostate Cancer Management: Current Practice and Future Perspectives. Rev Urol 2016; 18:1-9. [PMID: 27162506 PMCID: PMC4859922] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We performed a systematic literature search to identify original articles and editorials about the Decipher(®) Prostate Cancer Test (GenomeDx Biosciences, San Diego, CA) to provide an overview of the current literature and its present role in urologic clinical practice. The Decipher test, which uses the expression of 22 selected RNA markers (from a total of over 1.4 million), showed a very high discrimination in predicting clinical metastasis (0.75-0.83) and cancer-specific mortality (0.78) in external validation studies, outperforming all routinely available clinicopathologic characteristics. Further, the timing of postoperative radiotherapy (adjuvant vs salvage) may be guided based on Decipher scores. The Decipher test was also the only independent predictor of clinical metastasis in patients with biochemical recurrence after surgery. The Decipher Genomic Resource Information Database (GRID) is a novel research tool that captures 1.4 million marker expressions per patient and may facilitate precision-guided, individualized care to patients with prostate cancer. In this era of precision medicine, Decipher, along with the Decipher GRID platform, is a promising genomic tool that may aid in managing prostate cancer patients throughout the continuum of care and delivering appropriate treatment at an individualized level.
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Affiliation(s)
- Deepansh Dalela
- VUI Center for Outcomes, Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Björn Löppenberg
- VUI Center for Outcomes, Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Akshay Sood
- VUI Center for Outcomes, Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Jesse Sammon
- VUI Center for Outcomes, Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Firas Abdollah
- VUI Center for Outcomes, Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
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Brock M, Roghmann F, Sonntag C, Sommerer F, Tian Z, Löppenberg B, Palisaar RJ, Noldus J, Hanske J, von Bodman C. Fusion of Magnetic Resonance Imaging and Real-Time Elastography to Visualize Prostate Cancer: A Prospective Analysis using Whole Mount Sections after Radical Prostatectomy. Ultraschall Med 2015; 36:355-361. [PMID: 24854132 DOI: 10.1055/s-0034-1366563] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To determine whether the fusion of multiparametric magnetic resonance imaging (MRI) with transrectal real-time elastography (RTE) improves the visualization of PCa lesions compared to MRI alone. MATERIALS AND METHODS In a prospective setting, 45 patients with biopsy-proven PCa received prostate MRI prior to radical prostatectomy (RP). T2 and diffusion-weighted imaging (T2WI/DW-MRI) and, if applicable, dynamic contrast-enhanced sequences (T2WI/DW/DCE-MRI) were used to perform MRI/RTE fusion. The probability of PCa on MRI was graded according to the PI-RADS score for 12 different prostate sectors per patient. MRI images were fused with RTE to stratify suspicious from non-suspicious sectors. Imaging results were compared to whole mount sections using nonparametrical receiver operating characteristic curves and the area under these curves (AUC). RESULTS 41 of 45 patients were eligible for final analyses. Histopathology confirmed PCa in 261 (53%) of 492 prostate sectors. MRI alone provided an AUC of 0.62 (T2WI/DW-MRI) and 0.65 (T2WI/DW/DCE-MRI) to predict PCa and was meaningfully enhanced to 0.75 (T2WI/DW-MRI) and 0.74 (T2WI/DW/DCE-MRI) using MRI/RTE fusion. Sole MRI showed a sensitivity and specificity of 57.9% and 61% with the best results for ventral prostate sectors whereas RTE was superior in dorsal and apical sectors. MRI/RTE fusion improved sensitivity and specificity to 65.9% and 75.3%, respectively. Additional use of DCE sequences showed a sensitivity and specificity of 65% and 55.7% for MRI and 72.1% and 66% for MRI/RTE fusion. CONCLUSION MRI/RTE fusion provides improved PCa visualization by combining the strength of both imaging techniques in regard to prostate zonal anatomy and thereby might improve future biopsy-guided PCa detection.
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Affiliation(s)
- M Brock
- Urology, Ruhr-University Bochum, Marienhospital Herne, Germany
| | - F Roghmann
- Urology, Ruhr-University Bochum, Marienhospital Herne, Germany
| | - C Sonntag
- Radiology, Ruhr-University Bochum, Marienhospital Herne, Germany
| | - F Sommerer
- Pathology, Ruhr-University Bochum, Berufsgenossenschaftliche Universitätsklinik Bergmannsheil GmbH, Bochum, Germany
| | - Z Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
| | - B Löppenberg
- Urology, Ruhr-University Bochum, Marienhospital Herne, Germany
| | - R J Palisaar
- Urology, Ruhr-University Bochum, Marienhospital Herne, Germany
| | - J Noldus
- Urology, Ruhr-University Bochum, Marienhospital Herne, Germany
| | - J Hanske
- Urology, Ruhr-University Bochum, Marienhospital Herne, Germany
| | - C von Bodman
- Urology, Ruhr-University Bochum, Marienhospital Herne, Germany
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Löppenberg B, Roghmann F, Brock M, von Bodmann C, Michels CJ, Noldus J, Palisaar J. [Clinical and histopathological parameters of prostate cancer: influence of anthropometric indices]. Urologe A 2014; 54:22-7. [PMID: 25503718 DOI: 10.1007/s00120-014-3700-4] [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: 11/28/2022]
Abstract
BACKGROUND Adipose tissue is increasingly considered as an endocrinal active organ and may have an influence on the development and progression of prostate cancer. Adverse body fat distribution, considered a risk factor for cardiovascular disease, is not reflected by the body mass index (BMI). OBJECTIVE The purpose of this work was to assess anthropometric indices which provide a better estimate of body fat distribution and to evaluate their association with clinical and histopathological parameters of prostate cancer. PATIENTS AND METHODS In patients scheduled for radical prostatectomy between March 2011 and March 2013, height, weight, waist circumference (WC) and hip circumference were measured, then the BMI, waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were calculated. The relationships between anthropometric measures and indices and clinical and histopathological features of PCA were evaluated with uni- and multivariate analyses. RESULTS In 668 patients available for evaluation, obesity rates were 22.8 %, 50.6% and 30.2 % as defined by BMI ≥ 30, WHR ≥ 1 and WHtR ≥ 0.6, respectively. On univariate analysis, WC and WHtR ≥ 0.6 correlated with tumor volume (TV) > 2.1 cm(2) (p < 0.05), respectively. WC and WHtR were independent predictors of a TV ≥ 2.1 cm(2) (p < 0.05) and a WHtR ≥ 0.6 was an independent predictor of a TV ≥ 2.1 cm(2) (p < 0.018, risk ratio 1.506, 95 % confidence interval 1.072-2.115). CONCLUSION In general a higher degree of adiposity seems to correlate with a higher tumor volume. Whether anthropometric indices have prognostic impact needs to be clarified during follow-up.
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Affiliation(s)
- B Löppenberg
- Klinik für Urologie, Marien-Hospital Herne, Klinikum der Ruhr-Universität Bochum, Widumerstraße 8, 44627, Herne, Deutschland,
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Brock M, Löppenberg B, Roghmann F, Pelzer A, Dickmann M, Becker W, Martin-Seidel P, Sommerer F, Schenk L, Palisaar RJ, Noldus J, von Bodman C. Impact of real-time elastography on magnetic resonance imaging/ultrasound fusion guided biopsy in patients with prior negative prostate biopsies. J Urol 2014; 193:1191-7. [PMID: 25451832 DOI: 10.1016/j.juro.2014.10.106] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The fusion of multiparametric resonance imaging and ultrasound has been proven capable of detecting prostate cancer in different biopsy settings. The addition of real-time elastography promises to increase the precision of the outcome of targeted biopsies. We investigated whether real-time elastography improves magnetic resonance imaging/transrectal ultrasound fusion targeted biopsy in patients after previous negative biopsies. MATERIALS AND METHODS Prospectively 121 men underwent 3T magnetic resonance imaging. Using magnetic resonance imaging/real-time elastography fusion every suspicious lesion was characterized according to its tissue density and sampled by 2 fusion guided targeted biopsies. Additionally, all patients underwent 12-core systematic biopsy. The detection rate of clinically significant and insignificant cancers was compared between targeted und systematic biopsies. The accuracy to predict high grade prostate cancer was evaluated for with the PI-RADS scoring system and compared to the magnetic resonance imaging/real-time elastography fusion score. RESULTS Overall prostate cancer was detected in 52 patients (43%). Targeted fusion guided biopsy revealed prostate cancer in 32 men (26.4%) and systematic biopsy in 46 (38%). The proportion of clinically significant cancers was higher for targeted biopsy (90.6%) compared to systematic biopsy (73.9%). The detection rate per core was higher for targeted biopsies (14.7%) compared to systematic biopsies (6.5%, p <0.001). The prediction of biopsy result according to magnetic resonance imaging/real-time elastography fusion was better (AUC 0.86) than magnetic resonance imaging alone (AUC 0.79). Sensitivity and specificity for magnetic resonance imaging/real-time elastography fusion was 77.8% and 77.3% vs 74.1% and 62.9% for magnetic resonance imaging. CONCLUSIONS Magnetic resonance imaging/transrectal ultrasound fusion enhances the likelihood of detecting clinically significant cancers in a repeat biopsy setting. Adding real-time elastography to magnetic resonance imaging supports the characterization of cancer suspicious lesions.
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Affiliation(s)
- Marko Brock
- Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany
| | - Björn Löppenberg
- Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany
| | - Florian Roghmann
- Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany
| | | | - Martin Dickmann
- Department of Urology, Klinikum Ingolstadt, Ingolstadt, Germany
| | | | | | - Florian Sommerer
- Department of Pathology, Berufsgenossenschaftliche Universitätsklinik Bergmannsheil GmbH, Ruhr University Bochum, Bochum, Germany
| | - Lena Schenk
- Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany
| | - Rein Jüri Palisaar
- Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany
| | - Joachim Noldus
- Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany
| | - Christian von Bodman
- Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany
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Löppenberg B, von Bodman C, Brock M, Roghmann F, Noldus J, Palisaar RJ. Effect of perioperative complications and functional outcomes on health-related quality of life after radical prostatectomy. Qual Life Res 2014; 23:2743-56. [PMID: 24902939 DOI: 10.1007/s11136-014-0729-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE Radical prostatectomy is a commonly performed procedure with perioperative complication rates of 30 % using standardized reporting methodology. We aim to determine whether perioperative complications and functional outcomes impact quality of life 1 year after surgical treatment. PATIENTS AND METHODS Quality of life, functional and oncological outcomes were assessed in patients who underwent open retropubic radical prostatectomy at a single academic institution between 2003 and 2009, preoperatively and 1 year after surgery using the EORTC QLQ-C30, the IIEF-5 and an institutional questionnaire. Perioperative complications were recorded using the Clavien-Dindo classification. Patients without complications were compared to patients with any, low- or high-grade complications. The global health score domain of the EORTC QLQ-C30 is reported for various oncological and functional outcomes and contrasted to stratified categories of complications and functional outcomes. RESULTS A full dataset was available for 29.5 % (n = 856) of all patients. The overall complication rate was 27.5 % (235/856). A total of 307 complications were recorded of whom 88.9 % (273/307) were low grade. In this study, population global health perception did not decline after surgery (70.5 ± 21.2 vs. 74.4 ± 19.7; p < 0.0001). Complications showed only statistical but no clinical meaningful influence on global health perception as well as on functional and symptom scales. Patients who met combined outcome criteria experienced the best postoperative global health score (86.0 ± 13.1 and 86.0 ± 14.2). CONCLUSIONS Perioperative complications and functional outcomes have a measurable impact on quality of life 1 year following surgery. While perioperative complications have a statistical effect, functional outcomes showed a clinically more profound effect on postoperative global health perception.
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Affiliation(s)
- Björn Löppenberg
- Department of Urology and Neuro-Urology, Marien Hospital Herne, Ruhr-University Bochum, Widumerstrasse 8, 44627, Herne, Germany,
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von Bodman C, Brock M, Roghmann F, Byers A, Löppenberg B, Braun K, Pastor J, Sommerer F, Noldus J, Palisaar RJ. Intraoperative Frozen Section of the Prostate Decreases Positive Margin Rate While Ensuring Nerve Sparing Procedure During Radical Prostatectomy. J Urol 2013; 190:515-20. [DOI: 10.1016/j.juro.2013.02.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Christian von Bodman
- Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany
| | - Marko Brock
- Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany
| | - Florian Roghmann
- Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany
| | - Anne Byers
- Department of Epidemiology and Biostatistics, George Washington University, Washington, D.C
| | - Björn Löppenberg
- Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany
| | - Katharina Braun
- Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany
| | - Jobst Pastor
- Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany
| | - Florian Sommerer
- Department of Pathology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany
| | - Joachim Noldus
- Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany
| | - Rein Jüri Palisaar
- Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany
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von Bodman C, Brock M, Löppenberg B, Roghmann F, Byers A, Braun K, Pastor J, Sommerer F, Noldus J, Palisaar J. 355 INTRAOPERATIVE SURFACE FROZEN SECTION OF THE PROSTATE TO MINIMIZE POSITIVE MARGIN RATE AND ENSURE PRESERVATION OF NEUROVASCULAR BUNDLES. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1742] [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: 10/27/2022]
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Brock M, Eggert T, Löppenberg B, Braun K, Roghmann F, Palisaar R, Noldus J, von Bodman C. [Value of real-time elastography to guide the systematic prostate biopsy in men with normal digital rectal exam]. Aktuelle Urol 2013; 44:40-4. [PMID: 23325671 DOI: 10.1055/s-0032-1333257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The aim of this study was to evaluate whether real-time elastography-guided biopsy in comparison to grey-scale ultrasound improves prostate cancer detection in patients with an unremarkable digital rectal exam.A total of 231 patients suspicious for prostate cancer were prospectively randomised to transrectal real-time elastography- (126) or grey-scale ultrasound (105)-guided biopsy. The peripheral zone was divided into 6 sectors from base, mid-gland to apex. Lesions with reduced elasticity during real-time elastography and hypoechoic areas during grey-scale ultrasound were defined as suspicious for prostate cancer. Prostate biopsy was guided by real-time elastography (RTE) or grey-scale ultrasound (GSU) using a systematic 10-core approach. Suspicious lesions on RTE or GSU in the corresponding randomised group were targeted within each sector. Accuracy of cancer prediction and histopathological cancer detection rates were evaluated and compared between the 2 imaging modalitiesBaseline characteristics of patients undergoing real-time elastography and grey-scale ultrasound, including age, prostate-specific antigen and prostate volume were not significantly different statistically (p>0.05). Overall, prostate cancer was detected in 76 of 231 cases (32.9%). The cancer detection rate was significantly higher (p=0.007) in patients who underwent a biopsy using real-time elastography (40.5%) compared to the grey-scale-guided group of men (23.8%). Sensitivity and specificity to detect prostate cancer in 1 386 prostate sectors was 53.5% and 70.5% for real-time elastography vs. 11.7% and 93.7% for grey-scale ultrasound, respectively.Compared to conventional grey-scale ultrasound, accuracy to detect prostate cancer using a systematic 10-core biopsy approach was significantly improved under the guidance of real-time elastography.
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Affiliation(s)
- M. Brock
- Urologische Klinik, Marienhospital Herne, Ruhr-Universität Bochum
| | - T. Eggert
- Urologische Klinik, Marienhospital Herne, Ruhr-Universität Bochum
| | - B. Löppenberg
- Urologische Klinik, Marienhospital Herne, Ruhr-Universität Bochum
| | - K. Braun
- Urologische Klinik, Marienhospital Herne, Ruhr-Universität Bochum
| | - F. Roghmann
- Urologische Klinik, Marienhospital Herne, Ruhr-Universität Bochum
| | - R. Palisaar
- Urologische Klinik, Marienhospital Herne, Ruhr-Universität Bochum
| | - J. Noldus
- Urologische Klinik, Marienhospital Herne, Ruhr-Universität Bochum
| | - C. von Bodman
- Urologische Klinik, Marienhospital Herne, Ruhr-Universität Bochum
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Brock M, Eggert T, Palisaar RJ, Roghmann F, Braun K, Löppenberg B, Sommerer F, Noldus J, von Bodman C. Multiparametric ultrasound of the prostate: adding contrast enhanced ultrasound to real-time elastography to detect histopathologically confirmed cancer. J Urol 2012; 189:93-8. [PMID: 23164379 DOI: 10.1016/j.juro.2012.08.183] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 07/06/2012] [Indexed: 11/13/2022]
Abstract
PURPOSE We prospectively assessed whether a combined approach of real-time elastography and contrast enhanced ultrasound would improve prostate cancer visualization. MATERIAL AND METHODS Between June 2011 and January 2012, 100 patients with biopsy proven prostate cancer underwent preoperative transrectal multiparametric ultrasound combining real-time elastography and contrast enhanced ultrasound. After initial elastographic screening for suspicious lesions, defined as blue areas with decreased tissue strain, each lesion was allocated to the corresponding prostate sector. The target lesion was defined as the largest cancer suspicious area. Perfusion was monitored after intravenous injection of contrast agent. Target lesions were examined for hypoperfusion, normoperfusion or hyperperfusion. Imaging results were correlated with final pathological evaluation on whole mount slides after radical prostatectomy. RESULTS Of 100 patients 86 were eligible for final analysis. Real-time elastography detected prostate cancer with 49% sensitivity and 73.6% specificity. Histopathology confirmed malignancy in 56 of the 86 target lesions (65.1%). Of these 56 lesions 52 (92.9%) showed suspicious perfusion, including hypoperfusion in 48.2% and hyperperfusion in 48.2%, while only 4 (7.1%) showed normal perfusion patterns (p = 0.001). The multiparametric approach decreased the false-positive value of real-time elastography alone from 34.9% to 10.3% and improved the positive predictive value of cancer detection from 65.1% to 89.7%. CONCLUSIONS Perfusion patterns of prostate cancer suspicious elastographic lesions are heterogeneous. However, the combined approach of real-time elastography and contrast enhanced ultrasound in this pilot study significantly decreased false-positive results and improved the positive predictive value of correctly identifying histopathological cancer.
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Affiliation(s)
- Marko Brock
- Department of Urology, Ruhr University Bochum, Marienhospital Herne, Herne, Germany.
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Brock M, von Bodman C, Palisaar RJ, Löppenberg B, Sommerer F, Deix T, Noldus J, Eggert T. The impact of real-time elastography guiding a systematic prostate biopsy to improve cancer detection rate: a prospective study of 353 patients. J Urol 2012; 187:2039-43. [PMID: 22498211 DOI: 10.1016/j.juro.2012.01.063] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE We evaluated whether real-time elastography guided biopsy improves prostate cancer detection compared to conventional systematic gray scale ultrasound guidance. MATERIALS AND METHODS A total of 353 consecutive patients suspicious for prostate cancer were prospectively randomized for real-time elastography (178) or gray scale ultrasound (175). Each patient enrolled in the study underwent a 10-core prostate biopsy. Six lateral prostate sectors (base, mid, apex) were scanned for cancer suspicious areas, defined as stiffer blue lesions using real-time elastography and hypoechoic lesions using gray scale ultrasound. Suspicious areas were sampled by a single targeted biopsy and considered representative of a defined prostate sector. If real-time elastography or gray scale ultrasound did not visualize a suspicious area in a sector, the biopsy core was taken systematically. Imaging findings were correlated with histopathological reports. Real-time elastography and gray scale ultrasound cases were compared in terms of cancer detection rate and imaging guidance accuracy. RESULTS Characteristics of patients undergoing real-time elastography and gray scale ultrasound, including age, prostate specific antigen, prostate volume and digital rectal examination, were not significantly different (p>0.05). Prostate cancer was detected in 160 of 353 patients (45.3%). The prostate cancer detection rate was significantly higher in patients who underwent biopsy with the real-time elastography guided approach compared to the gray scale ultrasound guided biopsy at 51.1% (91 of 178) vs 39.4% (69 of 175) (p=0.027). Overall sensitivity and specificity to detect prostate cancer was 60.8% and 68.4% for real-time elastography vs 15% and 92.3% for gray scale ultrasound, respectively. CONCLUSIONS Sensitivity to visualize and detect prostate cancer improved using real-time elastography in addition to gray scale ultrasound during prostate biopsy. Overall sensitivity did not reach levels to omit a systematic biopsy approach.
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Affiliation(s)
- Marko Brock
- Department of Urology, Ruhr University Bochum, Marienhospital Herne, Herne, Germany.
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Roghmann F, von Bodman C, Löppenberg B, Hinkel A, Palisaar J, Noldus J. Is there a need for the Fournier's gangrene severity index? Comparison of scoring systems for outcome prediction in patients with Fournier's gangrene. BJU Int 2012; 110:1359-65. [PMID: 22494217 DOI: 10.1111/j.1464-410x.2012.11082.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
UNLABELLED Study Type - Prognosis (prospective cohort) Level of Evidence 2a. What's known on the subject? and What does the study add? Fournier's gangrene (FG) is a rare but life-threatening disease challenging the treating medical staff. Despite the fact that antibiotic therapy combined with surgery and intensive care surveillance are performed as standard treatment, mortality rates remain high. There have been efforts to develop a reliable tool to predict severity of the disease, not only to identify patients at highest risk of major complications or death but also to provide a target for medical teams and researchers aiming to improve outcome and to gather information for counselling patients. Laor et al. published the FG severity index (FGSI) in 1995 presenting a complex prediction score solely for patients with FG. Fifteen years later, Yilmazlar et al. suggested a new and supposedly more powerful scoring system, the Uludag FGSI (UFGSI), adding an age score and an extent of disease score to the FGSI. In the present study population we applied two scoring systems for outcome prediction that are solitarily applicable in patients with FG (FGSI, UFGSI), as well as two general scoring systems such as the established age-adjusted Charlson Comorbidity Index (ACCI) and the recently introduced surgical Apgar Score (sAPGAR) to compare them and to test whether one system might be superior to the other. In addition, we identified potential prognostic factors in the study population. By contrast to many earlier studies, we performed a combined prospective and retrospective analysis and provided a 30-day follow up. In the cohort of the present study, older patients with comorbidities as well as a need for mechanical ventilation and blood transfusion are at higher risk of lethal outcome. All scores are useful to predict mortality. Despite including more variables, the UFGSI does not seem to be more powerful than the FGSI. In daily routine we suggest applying ACCI and sAPGAR, as they are more easily calculated, generally applicable and well validated. OBJECTIVE • To compare four published scoring systems for outcome prediction (Fournier's gangrene severity index [FGSI], Uludag FGSI [UFGSI], age-adjusted Charlson Comorbidity Index [ACCI] and surgical Apgar Score [sAPGAR]) and evaluate risk factors in patients with Fournier's gangrene (FG). PATIENTS AND METHODS • In all, 44 patients were analysed. The scores were applied. • A Mann-Whitney U-test, Fisher's exact test, receiver operator characteristic (ROC) analysis and Pearson correlation analysis were performed. RESULTS • The results of the present study show a significant association among FGSI (P= 0.002), UFGSI (P= 0.002), ACCI (P= 0.004), sAPGAR (P= 0.018) and death. • The differences between the area under the receiver operating characteristic curve of the scores were not significant. • Non-survivors were older (P= 0.046), had a greater incidence of acute renal failure (P < 0.001) and coagulopathy (P= 0.041), were treated more often with mechanical ventilation (P= 0.001) and received more packed red blood cells (RBCs; P= 0.001). CONCLUSION • Older patients with comorbidities and need for mechanical ventilation and RBCs are at higher risk for death. • In the present cohort, scores calculated easily at the bedside, such as ACCI and sAPGAR, seemed to be as good at predicting outcome in patients with FG as FGSI and UFGSI.
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Affiliation(s)
- Florian Roghmann
- Department of Urology, Ruhr-University Bochum, Marienhospital, Widumer Strasse 8, D-44627 Herne, Germany. fl
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Palisaar JR, Noldus J, Löppenberg B, von Bodman C, Sommerer F, Eggert T. Comprehensive report on prostate cancer misclassification by 16 currently used low-risk and active surveillance criteria. BJU Int 2012; 110:E172-81. [PMID: 22314081 DOI: 10.1111/j.1464-410x.2012.10935.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
UNLABELLED What's known on the subject? and What does the study add? Prostate cancer characterisation, based on laboratory findings, clinical examination and histopathological cancer features that are used to define selection criteria for AS, is not ideal. Consequently, a panel of strict or more lenient criteria to select patients for AS have been published. Studies investigating the relationship between pretreatment variables and final pathology have been done in the past showing the risk of cancer misclassification for some criteria. No study has presented an overview of cancer selection using a panel of 16 currently used AS criteria that is presented in the present study. In an exactly defined cohort after radical prostatectomy, each set of criteria was used as a diagnostic test to separate between patients with more favourable (pT2, no Gleason upgrade between biopsy grading and final pathology) and unfavourable cancer features (pT3, pN+, Gleason upgrade). To the best of our knowledge a comparison of test quality criteria for AS criteria given by sensitivity, specificity, positive and negative predictive value and likelihood ratio has not yet been reported. Moreover, we showed that tumour characterisation, by a formally sufficient 12-core biopsy, in the present dataset harboured a risk of ≈20% that unfavourable cancer features were missed regardless of whether strict or more lenient selection criteria for AS were chosen. OBJECTIVE To evaluate final histopathological features among men diagnosed with prostate cancer eligible for low-risk (LR) or active surveillance (AS) criteria. PATIENTS AND METHODS Retrospective application of 16 definitions for AS or LR prostate cancer to a contemporary (January 2008 to March 2011) open retropubic radical prostatectomy (RRP) series of 1745 patients. EXCLUSION CRITERIA neoadjuvant hormones, radiotherapy, inadequate histopathological reports, <10 biopsy cores. Report on the number of men with insignificant tumours (defined as: ≤pT2, Gleason score ≤6, tumour volume <0.5 mL) and men who had unfavourable tumour characteristics on final pathology (defined as: extracapsular extension or seminal vesicle invasion or lymph node metastasis or Gleason upgrading). Sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were calculated. RESULTS Eligibility of patients in the final study cohort (n = 1070) varied from 5.1% to 92.7% depending on the AS or LR criteria used. Final pathology revealed 77 insignificant cancers and 578 patients who had unfavourable histopathological criteria. The detection rate for insignificant cancers on final pathology was variable ranging from 7.8% to 28.3% depending on the AS- or LR-prediction tool used; unfavourable tumour characteristics were found in up to 33.5% on final pathology. The sensitivity, specificity, PPV and NPV were 8.5-97.9%, 24.7-97.8%, 67.7-89.1% and 45.3-78.2%, respectively. The likelihood ratio to correctly identify a patient with LR disease on final pathology ranged from 1.3 to 8. CONCLUSIONS AS or LR criteria have a significant risk of cancer misclassification. Better prediction tools are needed to improve these criteria. Re-biopsy might improve safety and should be considered more frequently in patients who opt for AS.
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Affiliation(s)
- Jüri R Palisaar
- Department of Urology, Ruhr-University Bochum, Marienhospital Herne, Germany.
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Brock M, von Bodman C, Sommerer F, Löppenberg B, Klein T, Deix T, Palisaar JR, Noldus J, Eggert T. Comparison of real-time elastography with grey-scale ultrasonography for detection of organ-confined prostate cancer and extra capsular extension: a prospective analysis using whole mount sections after radical prostatectomy. BJU Int 2011; 108:E217-22. [PMID: 21819532 DOI: 10.1111/j.1464-410x.2011.10209.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE •To evaluate whether transrectal real-time elastography (RTE) improves the detection of intraprostatic prostate cancer (PCa) lesions and extracapsular extension (ECE) compared with conventional grey-scale ultrasonography (GSU). PATIENTS AND METHODS •In total, 229 patients with biopsy-proven PCa were prospectively screened for cancer-suspicious areas and ECE using GSU and RTE. •The largest tumour focus detected by RTE was defined as the index lesion. •The prostate gland was stratified into six sectors on GSU and RTE, which were compared with histopathological whole mount sections after radical prostatectomy. RESULTS •Histopathologically, PCa was confirmed in 894 out of 1374 (61.8%) evaluated sectors and ECE was identified in 47 (21%) patients. •Of these 894 sectors, RTE correctly detected 594 (66.4%) and GSU 215 (24.0%) cancer suspicious lesions. •Sensitivity was 51% and specificity 72% using RTE compared to 18% and 90% for GSU. •RTE identified the largest side specific tumour focus in 68% of patients. •ECE was identified with a sensitivity of 38% and specificity of 96% using RTE compared to 15% and 97% using GSU. CONCLUSIONS •Compared with GSU, RTE provides a statistically significant improvement in detection of PCa lesions and ECE. •RTE enhances GSU, although improvement is still needed to achieve a clinically meaningful sensitivity.
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Affiliation(s)
- Marko Brock
- Department of Urology, Ruhr-Universität Bochum, Marienhospital Herne, Widumer Strsee 8, 44627 Herne, Germany.
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Abstract
BACKGROUND In 2002 the ten Martin criteria were proposed which should be met when reporting complications following surgery. Only a few studies have evaluated complication rates after open retropubic radical prostatectomy using these criteria. In this study we report on complications of open retropubic radical prostatectomy using the standardized Clavien-Dindo reporting methodology. PATIENTS AND METHODS The overall complication rate was 28.6% (907 of 3,172). We registered 1,069 medical or surgical complications in 907 patients. Of these, 714 complications were grade I (66.8%), 195 grade II (18.2%), 139 grade III (13%), and 17 grade IV (1.6%), respectively. The mortality rate (grade V) was 0.1% (4 of 3,172). Older age (hazard ratio 1.049, p=0.023) and a performed lymphadenectomy (hazard ratio 1.804, p=0.024) were independent predictors for high-grade complications (grade III or greater) on multivariate analysis. RESULTS Between 08/2003 and 06/2010 complications of 3172 consecutive men who underwent open retropubic radical prostatectomy at a single center were recorded prospectively. Complications which occurred within a period of 30 days postoperatively were graded retrospectively according to the Clavien-Dindo classification. Clinical and histopathological risk factors were statistically evaluated for an association with complication grades. All 10 Martin criteria were fulfilled. CONCLUSIONS Using the Clavien-Dindo classification as a standardized reporting methodology, we observed an acceptable overall complication rate of 28.6%. In the majority (85% of all complications) lower grade complications occurred. In this series older age and a lymphadenectomy were risk factors for high-grade complications (III-V). A patient's age remains an important factor when considering the indication for radical prostatectomy.
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Affiliation(s)
- B Löppenberg
- Klinik für Urologie, Marienhospital Herne, Klinikum der Ruhr-Universität Bochum, Widumerstraße 8, Herne, Germany.
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Löppenberg B, von Bodman C, Roghmann F, Holz A, Palisaar J, Noldus J. 1470 INFLUENCE OF COMPLICATIONS ON HEALTH-RELATED QUALITY OF LIFE AFTER OPEN RETROPUBIC RADICAL PROSTATECTOMY. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.1405] [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: 10/18/2022]
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Löppenberg B, Noldus J, Holz A, Palisaar RJ. Reporting Complications After Open Radical Retropubic Prostatectomy Using the Martin Criteria. J Urol 2010; 184:944-8. [DOI: 10.1016/j.juro.2010.05.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Indexed: 11/28/2022]
Affiliation(s)
- Björn Löppenberg
- Department of Urology and Neuro-Urology, Ruhr-University Bochum, Marienhospital Herne, Herne, Germany
| | - Joachim Noldus
- Department of Urology and Neuro-Urology, Ruhr-University Bochum, Marienhospital Herne, Herne, Germany
| | - Alexander Holz
- Department of Urology and Neuro-Urology, Ruhr-University Bochum, Marienhospital Herne, Herne, Germany
| | - Rein Jüri Palisaar
- Department of Urology and Neuro-Urology, Ruhr-University Bochum, Marienhospital Herne, Herne, Germany
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