Prognostic role of plasma vitamin D and its association with disease characteristics in germ cell tumours

Background

Testicular cancer is the most common malignancy among young men. Vitamin D has pluripotent effects on cancer pathogenesis and plays a role in the metastatic cascade. The aim of this study is to analyze plasma vitamin D in association with clinico-pathological findings and prognosis in patients with germ-cell tumors (GCTs).

Methods

This study included 120 newly diagnosed and/or relapsed GCT patients treated from April 2013 to July 2020, for whom plasma was available in the biobank. Blood samples were drawn the 1st chemotherapy cycle as well as before the 2nd cycle. Plasma vitamin D was measured using ELISA and correlated with disease characteristics and the outcome. For survival analysis, the cohort was dichotomized into "low" and "high" based on median vitamin D.

Results

There was no significant difference in vitamin D plasma levels between healthy donors and GCT patients (p = 0.71). Vitamin D level was not associated with disease characteristics except for brain metastases, where patients with brain metastases had a vitamin D level that was 32% lower compared to patients without brain metastases, p = 0.03. Vitamin D was also associated with response to chemotherapy, with an approximately 32% lower value in patients with an unfavorable response compared to a favorable response, p = 0.02. Moreover, low plasma levels of vitamin D were significantly associated with disease recurrence and inferior progression-free survival (PFS), but not with overall survival (OS) (HR = 3.02, 95% CI 1.36-6.71, p = 0.01 for PFS and HR = 2.06, 95% CI 0.84-5.06, p = 0.14 for OS, respectively).

Conclusion

Our study suggests the prognostic value of pretreatment vitamin D concentrations in GCT patients. Low plasma vitamin D was associated with an unfavorable response to therapy and disease recurrence. However, it remains to be determined whether the biology of the disease confirms a causative role for low vitamin D and whether its supplementation affects the outcome.

Survival Prediction by Baseline Systemic Immune-inflammation Index (SII) and its Changes During First-line Platinum-based Treatment in a Caucasian Population of Patients With Metastatic Urothelial Carcinoma (MUC)

BACKGROUND/AIM

Systemic immune-inflammation index (SII) predicts survival of patients with various malignancies. This study explored the prognostic value of SII in metastatic urothelial carcinoma (MUC) subjects.

PATIENTS AND METHODS

We evaluated 181 consecutive MUC patients treated with first-line platinum-based therapy. Karnofsky performance status <80% and visceral metastasis were present in 18.2% and 46.4% of patients, respectively. SII was based on platelet × neutrophil/lymphocyte counts. Study population was dichotomized by median into high and low SII groups before the initiation of chemotherapy and at week 6. Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan-Meier method and compared with the log-rank test.

RESULTS

At median follow-up of 9.6 months, 174 patients experienced disease progression and 173 died. Patients with low SII at baseline and at week 6 had significantly better PFS (HR=0.58; p=0.0002 and HR=0.55; p<0.0001) and OS (HR=0.54; p<0.0001 and HR=0.54; p<0.0001) compared to patients with high SII. Independent prognostic value of SII was confirmed in a multivariate analysis.

CONCLUSION

High SII before chemotherapy that persists at week 6 negatively affects survival. SII at baseline can be used in the stratification of patients within clinical trials and in clinical practice.

Strength training as a supplemental therapy for androgen deficiency of the aging male (ADAM): study protocol for a three-arm clinical trial

INTRODUCTION

Androgen deficiency of the ageing male is a clinical syndrome resulting from the low production of androgens (testosterone levels <6.9 nmol/L) with symptoms including decline in lean mass, muscle strength, increases in body mass and overall fat mass. The aim of the study is to examine the effect of a 12 week strength training intervention on body composition, physical function, muscle cellular and molecular and selected biochemical markers of metabolic health in hypogonadal patients.

METHODS AND ANALYSIS

The study is three-group controlled 12-week experiment to assess the effect of strength training on hypogonadal patients with testosterone replacement therapy and newly diagnosed males without testosterone replacement therapy. Age matched healthy eugonadal males are also engaged in strength training. Lean mass is used to determine sample size indicating, that 22 subjects per group will be sufficient to detect intervention related changes at the power of 0.90. All outcomes are collected before the intervention (pre-intervention assessments) and after the intervention (post-intervention assessments). Clinical outcomes are body composition (lean mass, fat mass and total body mass) measured by dual-energy X-ray absorptiometry, physical functioning assessed by physical tests and psychosocial functioning. The most important haematological and biochemical parameters included are glucose, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, testosterone, luteinizing hormone, follicle-stimulating hormone, sexhormone-binding globulin, insulin and prostate-specific antigen. Muscle cellular and molecular outcomes are muscle fibre size and regulators of muscle fibre size. Muscle cellular outcomes are measured from muscle biopsies obtained from musculus vastus lateralis.

ETHICS AND DISSEMINATION

This trial is approved by Ethics Committee of the University Hospital in Bratislava, Slovakia, (ref. trial number: 127/2017) and all subjects will be fully informed on the rationale, risks and benefits of the study and sign the written informed consent prior to entering the study. Results will be published in peer-reviewed journals and presented in scientific conferences.

TRIAL REGISTRATION NUMBER

NCT03282682.

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Urinary fluorescence analysis in diagnosis of bladder cancer

Early diagnosis of bladder cancer is crucial for improvement of cancer specific survival and recurrence rate. We analyzed the possible role of fluorescence urine analysis in bladder cancer diagnosis. The cohort consisted of 20 healthy controls, 40 patients with hematuria and 75 patients with hematuria and histologically proven bladder tumor. Synchronous fluores- cence spectra with a 70 nm wavelength difference were recorded for (1:1-1:128) urine dilutions. Concentration matrices of synchronous spectra (CMSS) were used to classify samples into tested groups. CMSS analysis allowed us to distinguish patients with tumor from patients with hematuria with a sensitivity 55% and specificity 74.7%. This is comparable to the sensitivity and specificity of other non-invasive tests like BTA stat and nmP-22 (Bladder check®). Lower fluorescence inten- sity of Imax 280 nm and ratio of 280 nm to 450 nm was found to be associated with the presence of tumor. We have found an association of decreased fluorescence with the stage of the disease. Our data suggest that CMSS urine analysis has a potential role in the non-invasive diagnostic tests for bladder cancer, but it cannot replace the current diagnostic algorithm yet.

A practical guide and decision-making protocol for the management of complex renal cystic masses

Objectives

To analyse the management, pathology and outcomes of complex renal cystic masses (CRCM) and to develop a decision-making tool for daily clinical care using the Bosniak classification system for CRCM.

Patients and methods

A comprehensive dataset of 185 patients with 188 CRCM and a minimum follow-up of 3 years were analysed for management, pathology and outcomes.

Results

We analysed 35 Bosniak II, 34 Bosniak IIF, 58 Bosniak III, and 61 Bosniak IV lesions. The overall incidence of renal cell carcinoma was 8.6%, 29.4%, 62.1%, and 78.7% for each category. Based on our surveillance strategy of Bosniak IIF masses, we recommend computed tomography (CT)/magnetic resonance imaging (MRI) every 2 years after the initial examination. We also recommend performing one MRI (as an adjunct to CT) during the early follow-up period (<4 years). The use of MRI correlation for differential diagnostic purposes has proven useful for marginal Bosniak II, IIF and III cases.

Conclusions

From our data, we have created a decision-making protocol to guide urologists in planning a safe and effective diagnostic and treatment strategy for CRCM. The Bosniak classification is a useful tool for clinical decision-making. Uncertainties still remain for Bosniak IIF and III lesions. Our protocol shows that individualised decision-making is necessary in a significant proportion of CRCM.

Interpersonal variability and present diagnostic dilemmas in Bosniak classification system

OBJECTIVE

The purpose of the study was to evaluate the management and interpersonal variability of Bosniak classification and demonstrate the present diagnostic dilemmas.

MATERIAL AND METHODS

One-hundred and four patients with 113 complex renal cystic masses (26 Bosniak II,15 IIF,28 III and 44 IV) were included and analysed between April 1996 and May 2009.In total, 71 cystic masses were characterized by two radiologists in consensus initially as the first diagnosis (group 1), and then by a radiologist (group 2) and a urologist (group 3) independently in a blinded fashion.

RESULTS

Only 11 patients (10.6%) were symptomatic (one Bosniak IIF, six III and four IV). Only one had renal cell carcinoma (RCC) on final histology, whereas the others (n = 10) had benign lesions. An overall pathological result was obtained in 71 masses (62.8%) (two Bosniak II, three IIF, 27 III and 39 IV). The overall incidence of RCC in surgically treated patients was 0%, 20%, 55.6% and 76.9% for each category, respectively. The interpersonal variability was significant among the three groups (especially in Bosniak II, IIF), and the overall category was changed in 54%, 20% and 41%, respectively (p < 0.001). After correlation with final histology and presumed benign character of Bosniak II/IIF lesions (all patients having reached 5-year follow-up) the differences were not significant.

CONCLUSION

It is challenging to minimize unnecessary surgical procedures in Bosniak category III. According to these results, it may make practical sense to group Bosniak II and IIF masses in one category.

Growth rates are similar in potentially benign and malignant small renal masses detected incidentally

OBJECTIVE

Generally small renal masses grow at slow rate; some of them do not exhibit any growth. Does it mean that they are less aggressive? The aim of our study was to compare the growth of enhancing, non-enhancing solid renal masses, angiomyolipomas and complex renal cystic masses < or =4 cm in diameter.

MATERIALS AND METHODS

12 patients with solid enhancing, 20 with solid non-enhancing, 8 with angiomyolipomas and 25 with Bosniak II/IIF/III and IV masses were enrolled and prospectively studied during the surveillance period. The mean diameter of the lesion at presentation was 3.5; 3.1; 3.2 and 3.9 cm, the mean period of observation was 47; 48; 35 and 48 for each group respectively. All masses were detected incidentally. Progression rates (the largest diameter was calculated) were compared among the groups.

RESULTS

The range and mean growth rates among all groups after one year of observation were (0.0-0.3; 0.2 cm); (0.0-0.3; 0.2 cm); (0.0-0.4; 0.3 cm); (0.0-0.3; 0.1 cm); (0.0-0.2; 0.1 cm); (0.0-0.0; 0.0 cm) and (-0.6-0.0; -0.2 cm) for 7 groups respectively. Overall 55.4% of masses did not exhibit any growth. We did not monitor any pathological lymph node enlargement, distant metastases in any group of patients. Overall, 85% of masses that exhibited growth during the first year did so at the end of follow up.

CONCLUSIONS

The vast majority of small solid and complex cystic renal masses exhibit similar slow growth rates. According to these results, urologists can not predict the biological potential of the mass based on radiographic criteria and growth rates only (Tab. 2, Ref. 12).

Critical appraisal of prognostic factors for transobturator tape implantation

OBJECTIVES

The aim of the study was (1) to compare early results of transobturator tape (TOT) implantation in women with lower and higher Valsalva leak point pressure (VLPP) and (2) to find out significant and independent prognostic factors of TOT implantation.

MATERIAL AND METHODS

97 female patients (pts) underwent TOT implantation between March 2004 and September 2007. We observed preoperative parameters including VLPP, urine leakage (PWT1), quality of life (IQOL1), age, BMI, parity, previous anti-incontinence surgery, hysterectomy status (HYE) and symptoms of OAB. According to VLPP value, pts were divided into two groups, namely those with lower VLPP values (< or =60 cmH2O) and those with higher VLPP values (> 60 cmH2O). Two different tapes were used for TOT implantation (resorbable and non-resorbable). Six months after surgery, urine leakage (PWT2) was reassessed and pts were classed into two main categories as 'cured' (PWT2 < or =2 g), or 'not cured' (PWT2 >2 g).

RESULTS

Pts with lower VLPP values had significantly lower cure rates than those with higher VLPP values (43.8% vs. 81.5%, p < 0.001, respectively). Univariate logistic regresion analysis identified VLPP, PWT1, IQOL1, age, HYE, and TOT type parameters as significant factors for cure. Of these significant parameters, the multivariate logistic regresion analysis identified PWT1 and TOT type as the only independent ones.

CONCLUSIONS

Pts with lower VLPP values are at a five-fold greater risk of not being cured than those with higher VLPP values. Preoperative urine leakage and TOT type are the only independent prognostic factors for cure after TOT implantation (Tab. 5, Fig. 3, Ref. 32).

Spontaneous regression of complex cystic renal mass of bosniak class IV--a rare phenomenon

Spontaneous remission of simple renal cyst or complex renal cyst Bosniak III or IV class is a rare phenomenon. Our report describes a spontaneous partial regression of complex renal cyst Bosniak IV during the observation of complex cystic renal masses. A 66 year old male high risk patient (ASA score 3-4) refused all surgical intervention and was suggested for active surveillance strategy. We observed spontaneous partial regression of the complex cyst in this patient. To our knowledge this is the first report of spontaneous partial regression of complex renal cyst Bosniak IV class (Fig. 3, Ref. 5). Full Text (Free, PDF) www.bmj.sk.