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Deligiannis D, Anastasiou I, Mitropoulos D, Mitsos P, Theocharis S. Clinical Importance of Cannabinoid Type 1 Receptor (CB1R) and Cannabinoid Type 2 Receptor (CB2R) Expression in Renal Cell Carcinoma. Cureus 2024; 16:e55121. [PMID: 38420293 PMCID: PMC10901042 DOI: 10.7759/cureus.55121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 03/02/2024] Open
Abstract
Background and objective The purpose of our study was to assess the expression of cannabinoid type 1 receptor (CB1R) and cannabinoid type 2 receptor (CB2R), including positivity, intensity, percentage, site of distribution, and immunohistochemical score, in renal cell carcinomas (RCCs) and explore their correlation with various clinicopathological aspects. Methodology We retrospectively obtained data and specimens from 87 patients diagnosed with RCC after partial or radical nephrectomy, and the CB1R and CB2R expression was assessed immunohistochemically on paraffin-embedded tissues. The results were statistically analyzed uni- and multi-factorial along with clinicopathological parameters. Results CB1R was not expressed at all, and CB2R was highly expressed in 78 (89.7%) patients with RCC. In unifactorial analysis, no statistical significance was found in any of the analyzed parameters. However, in the multifactorial analysis, we found that patients with a papillary histologic type (P < 0.0005) were associated with a lower likelihood of expression of the CB2R in the membranous compared with those with clear-cell and were also associated with a higher likelihood of moderate or strong expression of CB2R immunohistochemical score compared with those with clear-cell (P = 0.03). Patients with stage T2 (P = 0.010) had more enhanced expression (grade 3 CB2R intensity) compared with those with stage T1. Males (beta coefficient ± standard error [SE] 13.70 ± 7.04; P = 0.056) and patients with chromophobe histologic type (beta coefficient ± SE 23.45 ± 9.86; P = 0.020) were associated with a higher percentage of CB2R expression. Conclusions Our data suggest that although the CB1R was not expressed in RCCs, CB2R was expressed in almost every patient and enhanced expression was noted in correlation with specific clinicopathological aspects of the patients. Thus, following well-designed studies, especially CB2R could be used as a prognostic marker or even as a potential therapeutic target in RCC.
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Affiliation(s)
| | - Ioannis Anastasiou
- First Department of Urology, Medical School, Laiko Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Dionysios Mitropoulos
- First Department of Urology, Medical School, Laiko Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | | | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, GRC
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Cacciamani GE, Sholklapper T, Dell'Oglio P, Rocco B, Annino F, Antonelli A, Amenta M, Borghesi M, Bove P, Bozzini G, Cafarelli A, Celia A, Leonardo C, Ceruti C, Cindolo L, Crivellaro S, Dalpiaz O, Falabella R, Falsaperla M, Galfano A, Gallo F, Greco F, Minervini A, Parma P, Chiara Sighinolfi M, Pastore AL, Pini G, Porreca A, Pucci L, Sciorio C, Schiavina R, Umari P, Varca V, Veneziano D, Verze P, Volpe A, Zaramella S, Lebastchi A, Abreu A, Mitropoulos D, Shekhar Biyani C, Sotelo R, Desai M, Artibani W, Gill I. The Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration Project: Development of Criteria for Reporting Adverse Events During Surgical Procedures and Evaluating Their Impact on the Postoperative Course. Eur Urol Focus 2022; 8:1847-1858. [PMID: 35177353 DOI: 10.1016/j.euf.2022.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/22/2021] [Accepted: 01/28/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Intraoperative adverse events (iAEs) are surgical and anesthesiologic complications. Despite the availability of grading criteria, iAEs are infrequently reported in the surgical literature and in cases for which iAEs are reported, these events are described with significant heterogeneity. OBJECTIVE To develop Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration criteria to standardize the assessment, reporting, and grading of iAEs. The ultimate aim is to improve our understanding of the nature and frequency of iAEs and our ability to counsel patients regarding surgical procedures. DESIGN, SETTING, AND PARTICIPANTS The present study involved the following steps: (1) collecting criteria for assessing, reporting, and grading of iAEs via a comprehensive umbrella review; (2) collecting additional criteria via a survey of a panel of experienced surgeons (first round of a modified Delphi survey); (3) creating a comprehensive list of reporting criteria; (4) combining criteria acquired in the first two steps; and (5) establishing a consensus on clinical and quality assessment utility as determined in the second round of the Delphi survey. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Panel inter-rater agreement and consistency were assessed as the overall percentage agreement and Cronbach's α. RESULTS AND LIMITATIONS The umbrella review led to nine common criteria for assessing, grading, and reporting iAEs, and review of iAE grading systems led to two additional criteria. In the first Delphi round, 35 surgeons responded and two criteria were added. In the second Delphi round, 13 common criteria met the threshold for final guideline inclusion. All 13 criteria achieved the consensus minimum of 70%, with agreement on the usefulness of the criteria for clinical and quality improvement ranging from 74% to 100%. The mean inter-rater agreement was 89.0% for clinical improvement and 88.6% for quality improvement. CONCLUSIONS The ICARUS Global Collaboration criteria might aid in identifying important criteria when reporting iAEs, which will support all those involved in patient care and scientific publishing. PATIENT SUMMARY We consulted a panel of experienced surgeons to develop a set of guidelines for academic surgeons to follow when publishing surgical studies. The surgeon panel proposed a list of 13 criteria that may improve global understanding of complications during specific procedures and thus improve the ability to counsel patients on surgical risk.
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Affiliation(s)
- Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA.
| | - Tamir Sholklapper
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Bernardo Rocco
- Urological Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | | | | | - Michele Amenta
- Department of Urology, Azienda ULSS n.4 Veneto Orientale, Portogruaro, Italy
| | | | | | | | | | - Antonio Celia
- Urology Unit, Ospedale San Bassiano, Bassano del Grappa, Italy
| | | | - Carlo Ceruti
- Urology Unit, AOU Citta della Salute e della Scienza, Turin, Italy
| | | | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | | | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | | | - Andrea Minervini
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Parma
- Urology Unit, Ospedale San Carlo Poma, Mantova, Italy
| | | | | | | | - Angelo Porreca
- Department of Oncological Urology, Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Luigi Pucci
- Urology Unit, Azienda Ospedaliera A. Cardarelli, Naples, Italy
| | | | | | - Paolo Umari
- Urology Unit, Ospedale Maggiore della Carita, Novara, Italy
| | - Virginia Varca
- Urology Unit, ASAT Rhodense Ospedale Guido Salvini di Garbagnate, Garbagnate, Italy
| | | | - Paolo Verze
- Urology Unit, AOU San Giovanni di Rio e Ruggi d'Aragona, Salerno, Italy
| | | | | | - Amir Lebastchi
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Andre Abreu
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Dionysios Mitropoulos
- Department of Urology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Chandra Shekhar Biyani
- Department of Urology, St. James' Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rene Sotelo
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Mihir Desai
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | | | - Inderbir Gill
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
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Bamias A, Tzannis K, Zakopoulou R, Sakellakis M, Dimitriadis J, Papatheodoridi A, Rallidis L, Halvatsiotis P, Tsiara A, Kaparelou M, Kostouros E, Barbarousi D, Koutsoukos K, Fragiadis E, Dellis AE, Anastasiou I, Stravodimos K, Pinitas A, Papatsoris A, Adamakis I, Varkarakis I, Fragoulis C, Pagoni S, Matsouka C, Skolarikos A, Mitropoulos D, Doumas K, Deliveliotis C, Constantinides C, Dimopoulos MA. Risk for Arterial Thromboembolic Events (ATEs) in Patients with Advanced Urinary Tract Cancer (aUTC) Treated with First-Line Chemotherapy: Single-Center, Observational Study. Curr Oncol 2022; 29:6077-6090. [PMID: 36135047 PMCID: PMC9498031 DOI: 10.3390/curroncol29090478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Arterial thromboembolism has been associated with cancer or its treatment. Unlike venous thromboembolism, the incidence and risk factors have not been extensively studied. Here, we investigated the incidence of arterial thromboembolic events (ATEs) in an institutional series of advanced urinary tract cancer (aUTC) treated with cytotoxic chemotherapy. The ATE definition included peripheral arterial embolism/thrombosis, ischemic stroke and coronary events. A total of 354 aUTC patients were analyzed. Most patients (95.2%) received platinum-based chemotherapy. A total of 12 patients (3.4%) suffered an ATE within a median time of 3.6 months from the start of chemotherapy. The most frequent ATE was ischemic stroke (n = 7). Two ATEs were fatal. The 6-month and 24-month incidence were 2.1% (95% confidence interval [CI]: 0.9–4.1) and 3.6% (95% CI: 1.9–6.2), respectively. Perioperative chemotherapy increased the risk for ATE by 5.55-fold. Tumors other than UTC and pure non-transitional cell carcinoma histology were also independent risk factors. No association with the type of chemotherapy was found. Overall, ATEs occur in 4.6% of aUTC patients treated with chemotherapy and represent a clinically relevant manifestation. Perioperative chemotherapy significantly increases the risk for ATE. The role of prophylaxis in high-risk groups should be prospectively studied.
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Affiliation(s)
- Aristotelis Bamias
- 2nd Propaedeutic Dept of Internal Medicine, National & Kapodistrian University of Athens, ATTIKON University Hospital, Rimini st 1, 12642 Chaidari, Attiki, Greece
- Hellenic GU Cancer Group, Evrou st 89, 11527 Athens, Attiki, Greece
- Correspondence: ; Tel.: +30-21-0583-1255; Fax: +30-21-0532-6454
| | - Kimon Tzannis
- 2nd Propaedeutic Dept of Internal Medicine, National & Kapodistrian University of Athens, ATTIKON University Hospital, Rimini st 1, 12642 Chaidari, Attiki, Greece
- Hellenic GU Cancer Group, Evrou st 89, 11527 Athens, Attiki, Greece
| | - Roubini Zakopoulou
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Minas Sakellakis
- Hellenic GU Cancer Group, Evrou st 89, 11527 Athens, Attiki, Greece
| | - John Dimitriadis
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Alkistis Papatheodoridi
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Loukianos Rallidis
- 2nd Department of Cardiology, National & Kapodistrian University of Athens, ATTIKON University Hospital, Rimini st 1, 12642 Chaidari, Attiki, Greece
| | - Panagiotis Halvatsiotis
- 2nd Propaedeutic Dept of Internal Medicine, National & Kapodistrian University of Athens, ATTIKON University Hospital, Rimini st 1, 12642 Chaidari, Attiki, Greece
| | - Anna Tsiara
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Maria Kaparelou
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Efthymios Kostouros
- Oncology Department, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Despina Barbarousi
- Haematology Division, Alexandra Hospital, Vasilissis Sofias 80, 11528 Athens, Attiki, Greece
| | - Konstantinos Koutsoukos
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Evangelos Fragiadis
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Athanasios E. Dellis
- 2nd Dept of Surgery, Aretaieion Academic Hospital, National & Kapodistrian University of Athens, Vas. Sofias Ave 76, 11528 Athens, Attiki, Greece
| | - Ioannis Anastasiou
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Konstantinos Stravodimos
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Alexandros Pinitas
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Athanasios Papatsoris
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Ioannis Adamakis
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Ioannis Varkarakis
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Charalampos Fragoulis
- Department of Urology, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Stamatina Pagoni
- Oncology Department, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Charis Matsouka
- Oncology Department, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Andreas Skolarikos
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Dionysios Mitropoulos
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Konstantinos Doumas
- Department of Urology, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Charalampos Deliveliotis
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Constantinos Constantinides
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Meletios-Athanasios Dimopoulos
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
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Fragkiadis E, Alamanis C, Constantinides CA, Mitropoulos D. Prediction of post radical nephrectomy complications based on patient comorbidity preoperatively. Arch Ital Urol Androl 2021; 93:251-254. [PMID: 34839625 DOI: 10.4081/aiua.2021.3.251] [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] [Received: 07/29/2021] [Accepted: 08/22/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Comorbidity along with tumor and patient characteristics is taken into account when deciding for the surgical treatment of renal cell carcinoma (RCC). Comorbidity has also been used as an independent predictive factor for postoperative complications of several major urological procedures including radical nephrectomy for RCC. The aim of the present study was to objectively evaluate the association between comorbidity and postoperative complications after radical nephrectomy for RCC, using standardized systems to grade both comorbidity and severity of postoperative complications. MATERIALS AND METHODS Clinicopathological data of 171 patients undergoing open radical nephrectomy for lesions suspected of RCC were prospectively recorded for a period of 3 years. Comorbidity was scored using the Charlson Comorbidity Index (CCI) while postoperative complications were graded according to the Clavien-Dindo system. RESULTS Patients were predominantly males (59.1%); their age ranged from 35 to 88 years (mean ± SD: 63.6 ± 11.9 yrs) with 50.8% of them being ≤ 65 yrs. CCI ranged from 0 to 8 with the majority (85.3%) scoring ≤ 2. The procedure was uncomplicated in 57.3% cases; 10 patients suffered major (grade III/IV) complications and 4 patients died within the 40 days postoperative period. CCI correlated with the manifestation of any postoperative complication, Clavien ≥ 1, OR (95% CI): 1.47 (1.09-1.96), p = 0.011 and the occurrence of severe complications, Clavien > 2. OR (95% CI): 1.29 (1.01-1.63), p = 0.038. CONCLUSIONS The present prospective study showed that considerable complications occur in patients with major comorbidities. CCI is easily calculated and should be incorporated in preoperative consultation especially in cases of elder patients with severe comorbidity and favorable tumor characteristics where less invasive interventions or even active surveillance could be applied.
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Dell’Oglio P, Andras I, Ortega D, Galfano A, Artibani W, Autorino R, Mazzone E, Crisan N, Bocciardi A, Sanchez-Salas R, Gill I, Wiklund P, Desai M, Mitropoulos D, Mottrie A, Cacciamani G. Impact of the implementation of the EAU Guidelines recommendation on reporting and grading of complications in patients undergoing robot assisted radical cystectomy: A systematic review. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00708-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mitropoulos D, Chlosta P, Häggman M, Ström T, Markussis V. Androgen deprivation monotherapy usage in non-metastatic prostate cancer: results from eight European countries. Cent European J Urol 2021; 74:161-168. [PMID: 34336233 PMCID: PMC8318023 DOI: 10.5173/ceju.2021.0343.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/27/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to investigate the attitudes towards use of androgen deprivation therapy (ADT) as monotherapy for localized or locally advanced prostate cancer (PC). Material and methods A survey using a 28-item, structured, quantitative questionnaire about the management of patients with PC was conducted in eight European countries between February and May 2018. Survey recipients were selected from a private database of healthcare providers. Results Overall, 375 physicians completed the survey (response rate, 58%). Participants were urologists (71.2%) or medical oncologists (28.8%), with a mean practice duration of 19.9 years and with university hospital or cancer center (41.6%), non-teaching hospital (38.4%) or private-sector clinic (20.0%) affiliations. Median proportions of physicians considering ADT as monotherapy to treat patients with PC in different risk groups varied between countries, but overall were: high/very high-risk, 60%; intermediate-risk, 30%; low-risk, 7.5%. The use of ADT monotherapy in the different risk groups also varied by medical specialty and type of affiliation. Proportions of participants applying different target thresholds for testosterone (T) levels also varied by country, but overall were: <50 ng/dL, 29.9%; <32 ng/dL, 4.8%; <20 ng/dL, 54.3%; castration but no specific target, 11%. More than half of participants (58.7%) determined target T levels only when prostate-specific antigen level was increased. Conclusions Our multinational survey provides evidence that PC management varies across European countries and with clinical context, and frequently diverges from European Association of Urology (EAU) - European Society for Radiotherapy and Oncology (ESTRO) - European Society of Urogenital Radiology (ESUR) - International Society of Geriatric Oncology (SIOG) guidelines. Strategies for effective implementation of evidence-based recommendations in clinical practice may be needed to optimize patient outcomes.
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Affiliation(s)
- Dionysios Mitropoulos
- National and Kapodistrian University of Athens Medical School, 1 Department of Urology, Athens, Greece
| | - Piotr Chlosta
- Jagiellonian University, Department of Urology, Cracow, Poland
| | - Michael Häggman
- Uppsala University Hospital, Department of Urology, Uppsala, Sweden
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Stergiou IE, Christoforou P, Sypsa G, Skoufias S, Mitropoulos D, Tzioufas AG, Voulgarelis M. Extraordinary extrahaematological manifestations of chronic myelomonocytic leukaemia. Lancet 2020; 396:853. [PMID: 32950091 DOI: 10.1016/s0140-6736(20)31905-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/09/2020] [Accepted: 08/06/2020] [Indexed: 11/20/2022]
MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Aged
- Antineoplastic Agents, Alkylating/therapeutic use
- Biopsy, Needle/methods
- Bone Marrow/pathology
- Cyclophosphamide/therapeutic use
- Facial Paralysis/diagnosis
- Facial Paralysis/etiology
- Female
- Hematoma/etiology
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Kidney/blood supply
- Kidney/diagnostic imaging
- Kidney/pathology
- Knee Joint/pathology
- Leukemia, Myelomonocytic, Chronic/complications
- Leukemia, Myelomonocytic, Chronic/pathology
- Leukemia, Myelomonocytic, Chronic/therapy
- Male
- Nephrectomy/methods
- Polyarteritis Nodosa/drug therapy
- Polyarteritis Nodosa/pathology
- Stomatitis, Aphthous/etiology
- Synovitis/etiology
- Tongue Diseases/pathology
- Wrist Joint/pathology
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Affiliation(s)
- Ioanna E Stergiou
- Pathophysiology Department, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece.
| | - Panagiotis Christoforou
- Pathophysiology Department, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Georgia Sypsa
- Radiology Department, Laikon Hospital, Athens, Greece
| | - Spyridon Skoufias
- 1st Department of Urology, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Dionysios Mitropoulos
- 1st Department of Urology, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Athanasios G Tzioufas
- Pathophysiology Department, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Michael Voulgarelis
- Pathophysiology Department, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
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Papatsoris A, Fragkoulis C, Fragkiadis E, Pinitas A, Tzannis K, Gavalas N, Stravodimos K, Ntoumas K, Mitropoulos D, Constantinides K, Giannopoulou E, Bamias A, Deliveliotis C. A run-in phase clinical study for intravesical administration of durvalumab in patients with high-risk, non-muscle-invasive bladder cancer (NMIBC). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33374-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Leotsakos I, Katafigiotis I, Gofrit ON, Duvdevani M, Mitropoulos D. Postoperative Delirium after Urological Surgery: A Literature Review. Curr Urol 2020; 13:133-140. [PMID: 31933591 DOI: 10.1159/000499280] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 12/17/2018] [Indexed: 12/19/2022] Open
Abstract
Purpose We aimed to thoroughly search and identify studies referring to risk factors associated with postoperative delirium (POD) in patients undergoing open as well as en-doscopic urological surgery. Methods The review after a systematic literature search included 5 studies. Results The incidence of POD was reported to be between 7.8 and 30% depending on the type of the urologic surgery, while in the majority of the studies the onset happened on the first postoperative day and the symptoms lasted 3 ± 0.8 days. Seventeen different risk factors for POD were identified and presented in detail. Conclusion The Mini-Mental State Examination score and older age were significantly associated with the development of POD. However, the Confusion Assessment Method is very well validated against the diagnosis of delirium from the specialists.
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Affiliation(s)
- Ioannis Leotsakos
- 1st Department of Urology, University of Athens Medical School, Athens, Greece.,Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ioannis Katafigiotis
- 1st Department of Urology, University of Athens Medical School, Athens, Greece.,Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Biyani CS, Pecanka J, Rouprêt M, Jensen JB, Mitropoulos D. Intraoperative Adverse Incident Classification (EAUiaiC) by the European Association of Urology ad hoc Complications Guidelines Panel. Eur Urol 2019; 77:601-610. [PMID: 31787430 DOI: 10.1016/j.eururo.2019.11.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 11/19/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND A surgical adverse incident (AI) is defined as any deviation from the normal operative course. Current complication-grading systems mostly focus on postoperative events. OBJECTIVE To propose an intraoperative AI classification (EAUiaiC) to facilitate reporting. DESIGN, SETTING, AND PARTICIPANTS The classification was developed using a modified Delphi process in which experts answered two rounds of survey questionnaires organised by the European Association of Urology ad hoc Complications Guidelines Panel. Experts evaluated AI terminology using a 5-point Likert scale for clarity, exhaustiveness, hierarchical order, mutual exclusivity, clinical utility, and quality improvement. OUTCOME MEASURES AND STATISTICAL ANALYSIS We considered ≥70% agreement for inclusion or exclusion. The resultant EAUiaiC was evaluated using ten sample clinical scenarios. Numerical and graphical statistical techniques were used to report the results. RESULTS AND LIMITATIONS In total, 343 respondents participated. The proposed EAUiaiC system comprises eight AI grades ranging from grade 0 (no deviation and no consequence to the patient) to grade 5B (wrong surgery site or intraoperative death). In the validation stage, EAUiaiC was rated highly favourably in terms of relevance and reliability (consistency) by 126 experts. Ratings for self-reported ease of use were at acceptable levels. CONCLUSIONS We propose a novel intraoperative AI classification (EAUiaiC) for use for urological procedures. Both the initial assessment of feasibility and the subsequent assessment of reliability suggest that it is a simple and effective tool for classifying intraoperative complications. PATIENT SUMMARY Complications in surgery are common. It is helpful to classify complications in a uniform and objective manner so that surgeons can easily compare outcomes and learn from complications. Here we propose a new classification system for complications that occur during urological surgical procedures. An abstract of this work was presented at the 2018 congress of the European Association of Urology.
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Affiliation(s)
| | - Jakub Pecanka
- Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - Morgan Rouprêt
- Sorbonne Université, GRC n°, ONCOTYPE-URO, Urology, AP-HP, Hôpital Pitié-Salpêtrière, F-75013, Paris, France
| | | | - Dionysios Mitropoulos
- 1(st) Department of Urology, Medical School, National and Kapodistrian University of Anthens, Athens, Greece
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Dellis A, Zagouri F, Liontos M, Mitropoulos D, Bamias A, Papatsoris AG. Management of advanced prostate cancer: A systematic review of existing guidelines and recommendations. Cancer Treat Rev 2019; 73:54-61. [DOI: 10.1016/j.ctrv.2018.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
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Alivizatos G, Pavlaki K, Giannopoulos A, Mitropoulos D, Tsega A, Deliveliotis C, Dimopoulos C. Nucleolar Organizer Regions in Prostatic Adenocarcinomas. Eur Urol 2017. [DOI: 10.1159/000474821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bamias A, Escudier B, Sternberg CN, Zagouri F, Dellis A, Djavan B, Tzannis K, Kontovinis L, Stravodimos K, Papatsoris A, Mitropoulos D, Deliveliotis C, Dimopoulos MA, Constantinides CA. Current Clinical Practice Guidelines for the Treatment of Renal Cell Carcinoma: A Systematic Review and Critical Evaluation. Oncologist 2017; 22:667-679. [PMID: 28592625 DOI: 10.1634/theoncologist.2016-0435] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [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: 11/02/2016] [Accepted: 01/05/2017] [Indexed: 02/07/2023] Open
Abstract
The landscape of local and systemic therapy of renal cell carcinoma (RCC) is rapidly changing. The increase in the incidental finding of small renal tumors has increased the application of nephron-sparing procedures, while ten novel agents targeting the vascular endothelial growth factor (VEGF) or the mammalian target of rapamycin pathways, or inhibiting the interaction of the programmed death 1 receptor with its ligand, have been approved since 2006 and have dramatically improved the prognosis of metastatic RCC (mRCC). These rapid developments have resulted in continuous changes in the respective Clinical Practice Guidelines/Expert Recommendations. We conducted a systematic review of the existing guidelines in MEDLINE according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, aiming to identify areas of agreement and discrepancy among them and to evaluate the underlying reasons for such discrepancies. Data synthesis identified selection criteria for nonsurgical approaches in renal masses; the role of modern laparoscopic techniques in the context of partial nephrectomy; selection criteria for cytoreductive nephrectomy and metastasectomy in mRCC; systemic therapy of metastatic non-clear-cell renal cancers; and optimal sequence of available agents in mRCC relapsed after anti-VEGF therapy as the major areas of uncertainty. Agreement or uncertainty was not always correlated with the availability of data from phase III randomized controlled trials. Our review suggests that the combination of systematic review and critical evaluation can define practices of wide applicability and areas for future research by identifying areas of agreement and uncertainty among existing guidelines. IMPLICATIONS FOR PRACTICE Currently, there is uncertainity on the role of surgery in MRCC and on the choice of available guidelines in relapsed RCC. The best practice is individualization of targeted therapies. Systematic review of guidelines can help to identify unmet medical needs and areas of future research.
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Affiliation(s)
- Aristotle Bamias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece
- Hellenic GU Cancer Group, Athens, Greece
| | | | - Cora N Sternberg
- Department of Medical Oncology San Camillo and Forlanini Hospitals, Rome, Italy
| | - Flora Zagouri
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece
| | - Athanasios Dellis
- Hellenic GU Cancer Group, Athens, Greece
- 2nd Department of Surgery, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Bob Djavan
- Department of Onology, Medical School, New York University, New York, New York, USA
- Department of Onology, Medical School, University of Vienna, Vienna, Austria
| | | | | | - Konstantinos Stravodimos
- Hellenic GU Cancer Group, Athens, Greece
- 1st Department of Urology National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece
| | - Athanasios Papatsoris
- Hellenic GU Cancer Group, Athens, Greece
- 2nd Department of Urology, National and Kapodistrian University of Athens Medical School, Sismanoglion Hospital, Athens, Greece
| | - Dionysios Mitropoulos
- Hellenic GU Cancer Group, Athens, Greece
- 1st Department of Urology National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece
| | - Charalampos Deliveliotis
- Hellenic GU Cancer Group, Athens, Greece
- 2nd Department of Urology, National and Kapodistrian University of Athens Medical School, Sismanoglion Hospital, Athens, Greece
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece
- Hellenic GU Cancer Group, Athens, Greece
| | - Constantine A Constantinides
- Hellenic GU Cancer Group, Athens, Greece
- 1st Department of Urology National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece
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Mitropoulos D, Artibani W, Biyani CS, Bjerggaard Jensen J, Rouprêt M, Truss M. Validation of the Clavien-Dindo Grading System in Urology by the European Association of Urology Guidelines Ad Hoc Panel. Eur Urol Focus 2017; 4:608-613. [PMID: 28753862 DOI: 10.1016/j.euf.2017.02.014] [Citation(s) in RCA: 170] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/21/2017] [Indexed: 01/13/2023]
Abstract
CONTEXT Since 2012 uniformed reporting of complications after urological procedures has been advocated by the European Association of Urology (EAU) guidelines. The Clavien-Dindo grading system was recommended to report the outcomes of urologic procedures. OBJECTIVE To validate the Clavien-Dindo grading system in urology. DESIGN, SETTING, AND PARTICIPANTS Members of the EAU working group compiled a list of case scenarios including those with minor and major complications. A survey was administered online via Survey Monkey to the members of EAU committees for the appropriate grading according to the Clavien-Dindo classification of surgical complications. Scenarios with intraoperative complications were intentionally included to assess respondents' awareness of the Clavien-Dindo applicability. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Survey data collected were used to calculate agreement rates and to estimate the overall inter-rater agreement on all cases using Fleiss' kappa (κ). Differences in agreement rates for each scenario among groups with different criteria about the system were estimated using the chi-square test. RESULTS AND LIMITATIONS Evaluable responses were received from 81 out of 174 invited raters (46.5%). Of them 56.9% believed that the Clavien-Dindo system was adequate for grading postoperative complications. The agreement rate was over a score of ≥80% in nine cases, 60-79% in 10 cases, 40-59% in 14 cases, and <40% in two cases. Interestingly, the agreement rate on the nonapplicability of the Clavien-Dindo system was quite low, ranging from 27.5% to 67.2% (κ=0.147). Being a resident rather than a specialist affected only the distribution of agreement rates in case 1 (ie, score IIIb: 83.3% vs 94.1%). Being an academic or having affiliation did not have any impact on the distribution of agreement rates in all cases but one. CONCLUSIONS The Clavien-Dindo classification is a standardised approach to grade and report postoperative complications in urology and should be used systematically. However, it does not apply for intraoperative complications, and there is a need for an additional tool. PATIENT SUMMARY A rigorous methodology is mandatory when surgeons report about complications after surgery. In this study, the European Association of Urology Guidelines Panel has validated the use of the Clavien-Dindo grading system in urology.
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Affiliation(s)
- Dionysios Mitropoulos
- 1st Department of Urology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Walter Artibani
- Department of Surgery, Urology Clinic, University of Verona, Verona, Italy
| | | | | | - Morgan Rouprêt
- Academic Department of Urology, Pitié-Salpétrière Hospital, AP-HP, Paris, France; UPMC University Paris 06, Institut Universitaire de Cancérologie, Paris, France
| | - Michael Truss
- Department of Urology, Klinikum Dortmund GmbH, Dortmund, Germany
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Liontos M, Trigka EA, Korkolopoulou P, Tzannis K, Lainakis G, Koutsoukos K, Kostouros E, Lykka M, Papandreou CN, Karavasilis V, Christodoulou C, Papatsoris A, Skolarikos A, Varkarakis I, Adamakis I, Alamanis C, Stravodimos K, Mitropoulos D, Deliveliotis C, Constantinidis CA, Saetta A, Patsouris E, Dimopoulos MΑ, Bamias A. Expression and prognostic significance of VEGF and mTOR pathway proteins in metastatic renal cell carcinoma patients: a prognostic immunohistochemical profile for kidney cancer patients. World J Urol 2016; 35:411-419. [PMID: 27395374 DOI: 10.1007/s00345-016-1890-7] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/29/2016] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To identify prognostic molecular profiles in patients with mRCC treated with sunitinib, we performed immunohistochemical analysis for VEGF and PI3K/Akt/mTOR pathway components. METHODS The immunohistochemical expression of VEGF, p85α, p110γ, PTEN, p-Akt, p-mTOR, p-4E-BP1 and p-p70S6K was studied in 79 patients with mRCC who received first-line treatment with sunitinib. Expression was correlated with clinicopathological features and survival. RESULTS VEGF was highly expressed (median H-Score 150), while positivity for the markers of the PI3K/Akt/mTOR pathway was: p85α 43/66 (65 %), p110γ41/60 (68 %), PTEN 32/64 (50 %), p-Akt57/63 (90 %), p-mTOR48/64 (75 %), p-4E-BP1 58/64 (90 %) and p-p70S6K 60/65 (92 %). No single immunohistochemical marker was found to have prognostic significance. Instead, the combination of increased p-mTOR and low VEGF expression was adversely correlated with overall survival (OS) (3.2 vs. 16.9 months, P = 0.001). CONCLUSION Immunohistochemistry for VEGF and p-mTOR proteins may discriminate patients refractory to first-line sunitinib with poor prognosis. Prospective validation of our findings is needed.
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Affiliation(s)
- Michalis Liontos
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 80 V.Sofias Ave, 11528, Athens, Greece.
| | - Eleni-Andriana Trigka
- 1st Department of Pathology, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Penelope Korkolopoulou
- 1st Department of Pathology, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kimon Tzannis
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 80 V.Sofias Ave, 11528, Athens, Greece.,Hellenic GenitoUrinary Cancer Group, Athens, Greece
| | - Giorgos Lainakis
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 80 V.Sofias Ave, 11528, Athens, Greece
| | - Konstantinos Koutsoukos
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 80 V.Sofias Ave, 11528, Athens, Greece
| | - Efthymios Kostouros
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 80 V.Sofias Ave, 11528, Athens, Greece
| | - Maria Lykka
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 80 V.Sofias Ave, 11528, Athens, Greece
| | - Christos N Papandreou
- Department of Medical Oncology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Vassilis Karavasilis
- Department of Medical Oncology, "Papageorgiou" Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Athanasios Papatsoris
- 2nd Department of Urology, Sismanoglio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic GenitoUrinary Cancer Group, Athens, Greece
| | - Andreas Skolarikos
- 2nd Department of Urology, Sismanoglio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic GenitoUrinary Cancer Group, Athens, Greece
| | - Ioannis Varkarakis
- 2nd Department of Urology, Sismanoglio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic GenitoUrinary Cancer Group, Athens, Greece
| | - Ioannis Adamakis
- 1st Department of Urology, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Alamanis
- 1st Department of Urology, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Stravodimos
- Hellenic GenitoUrinary Cancer Group, Athens, Greece.,1st Department of Urology, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dionysios Mitropoulos
- Hellenic GenitoUrinary Cancer Group, Athens, Greece.,1st Department of Urology, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Deliveliotis
- 2nd Department of Urology, Sismanoglio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic GenitoUrinary Cancer Group, Athens, Greece
| | - Constantinos A Constantinidis
- Hellenic GenitoUrinary Cancer Group, Athens, Greece.,1st Department of Urology, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelica Saetta
- 1st Department of Pathology, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstratios Patsouris
- 1st Department of Pathology, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios Α Dimopoulos
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 80 V.Sofias Ave, 11528, Athens, Greece.,Hellenic GenitoUrinary Cancer Group, Athens, Greece
| | - Aristotelis Bamias
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 80 V.Sofias Ave, 11528, Athens, Greece.,Hellenic GenitoUrinary Cancer Group, Athens, Greece
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16
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Bamias A, Tsantoulis P, Zilli T, Papatsoris A, Caparrotti F, Kyratsas C, Tzannis K, Stravodimos K, Chrisofos M, Wirth GJ, Skolarikos A, Mitropoulos D, Constantinides CA, Deliveliotis C, Iselin CE, Miralbell R, Dietrich PY, Dimopoulos MA. Outcome of patients with nonmetastatic muscle-invasive bladder cancer not undergoing cystectomy after treatment with noncisplatin-based chemotherapy and/or radiotherapy: a retrospective analysis. Cancer Med 2016; 5:1098-107. [PMID: 27004619 PMCID: PMC4924368 DOI: 10.1002/cam4.685] [Citation(s) in RCA: 6] [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] [Received: 10/22/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 11/13/2022] Open
Abstract
Transurethral resection of bladder tumor (TURBT), radiotherapy, chemotherapy, or combinations can be used in patients with muscle‐invasive bladder cancer (MIBC) not undergoing cystectomy. Nevertheless, unfitness for cystectomy is frequently associated with unfitness for other therapeutic modalities. We report the outcome of patients with MIBC who did not undergo cystectomy and did not receive cisplatin‐based chemotherapy. Selection criteria for the study were nonmetastatic MIBC, no cystectomy, no cisplatin‐based chemotherapy. Chemotherapy and/or radiotherapy should have been used aside from TURBT. Forty‐nine patients (median age 79), managed between April 2001 and January 2012, were included in this analysis. Median Charlson Comorbidity Index was 5, while 76% were unfit for cisplatin. Treatment included radiotherapy (n = 7), carboplatin‐based chemotherapy (n = 25), carboplatin‐based chemotherapy followed by radiotherapy (n = 10), and radiochemotherapy (n = 7). Five‐year event‐free rate was 26% (standard error [SE] = 7) for overall survival, 23% (SE = 7) for progression‐free survival, and 30 (SE = 8) for cancer‐specific survival (CSS). Patients who were treated with combination of radiotherapy and chemotherapy had significantly longer CSS compared to those treated with radiotherapy or chemotherapy only (5‐year CSS rate: 16% [SE 8] vs. 63% [SE 15], P = 0.053). Unfit‐for‐cystectomy patients frequently receive suboptimal nonsurgical treatment. Their outcome was poor. Combining chemotherapy with radiotherapy produced better outcomes and should be prospectively evaluated.
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Affiliation(s)
- Aristotle Bamias
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,Department of Clinical Therapeutics, Medical School, Athens University, Athens, Greece
| | - Petros Tsantoulis
- Department of Oncology and Centre de Recherche Clinique Dubois Ferrari, Geneva University Hospital, Geneva, Switzerland
| | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Athanasios Papatsoris
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,2nd Department of Urology, University of Athens, Athens, Greece
| | - Francesca Caparrotti
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Christos Kyratsas
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,2nd Department of Urology, University of Athens, Athens, Greece
| | - Kimon Tzannis
- Department of Clinical Therapeutics, Medical School, Athens University, Athens, Greece
| | - Kostas Stravodimos
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,1st Department of Urology, University of Athens, Athens, Greece
| | - Michael Chrisofos
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,2nd Department of Urology, University of Athens, Athens, Greece
| | - Gregory J Wirth
- Department of Urology Department, Geneva University Hospital, Geneva, Switzerland
| | - Andreas Skolarikos
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,2nd Department of Urology, University of Athens, Athens, Greece
| | - Dionysios Mitropoulos
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,1st Department of Urology, University of Athens, Athens, Greece
| | - Constantinos A Constantinides
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,1st Department of Urology, University of Athens, Athens, Greece
| | - Charalambos Deliveliotis
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,2nd Department of Urology, University of Athens, Athens, Greece
| | - Christophe E Iselin
- Department of Urology Department, Geneva University Hospital, Geneva, Switzerland
| | - Raymond Miralbell
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Pierre-Yves Dietrich
- Department of Oncology and Centre de Recherche Clinique Dubois Ferrari, Geneva University Hospital, Geneva, Switzerland
| | - Meletios A Dimopoulos
- Hellenic Genito-Urinary Cancer Group, Athens, Greece.,Department of Clinical Therapeutics, Medical School, Athens University, Athens, Greece
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Adamakis I, Katafigiotis I, Tyritzis SI, Mygdalis V, Sfoungaristos S, Katafigioti A, Mitropoulos D, Constantinides CA. Treating anterior vaginal wall prolapse with polypropylene mesh via the transoburator route minimizing the complications with the use of preventing measures. A prospective study with 2-year follow-up. Minerva Ginecol 2015; 67:231-238. [PMID: 25668420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Our objectives were to evaluate the efficacy of the Perigee™ transoburator (TOT) mesh kit (American Medical Systems [AMS]-Minnetonka, MN, USA) in the treatment of ≥ stage 2 symptomatic AVP following a 2-year follow-up and to discuss the role of the pre-, peri- and postoperative measures taken to prevent complications METHODS A total of 50 patients were eligible and were subjected to AVP surgical treatment with the use of the Perigee™ system. All patients were followed-up at 4 weeks, 2, 6, 12 and 24 months. Our primary objective was treatment success and efficacy after anatomical examination of the patient at the 24-month follow-up. Efficacy was defined as ≤ stage I AVP. All patients completed the 24-month follow-up. Our secondary objective was to examine the complication rates in relation to the use of preventative measures. RESULTS The proportion of patients with II to III stage significantly decreased postoperatively (P<0.001). A significantly improvement was found in all POP-Q measures (P<0.05) while mean vaginal length was similar to the preoperative values. At 24-month follow-up, 45 women were defined as ≤ stage I, indicating a 90% objective success rate (95% CI: 81.4-98.6%). Two patients had vaginal mesh extrusion (4.0%) both treated with conservative measures. No erosions occurred at any point postoperatively. De novo dyspareunia was reported in two of the 17 cases (11.8%) who reported being sexually active at follow-up. One of the two had also mesh extrusion and with appliance of the vaginal estrogen and the office excision of the exposed mesh the symptoms were resolved, while the other was treated with vaginal estrogen. Two cases (4.0%) reported de novo incontinence and both were treated with a TOT sling (monarc AMS) procedure three months after the cystocele repair. Three cases (6.0%) reported pain vaginal pain postoperatively and again our treatment of choice was vaginal estrogen cream for 4 weeks with the addition of antinflammatories for 10 days and their symptoms resolved. CONCLUSIONS The treatment of AVP with the use of Perigee™ TOT system can be both effective and safe. The goal is the improvement of the quality of life of the patients and is important to avoid or to keep as minimum as possible the complications. Main complications that the surgeon should bear in mind are the vaginal erosion, vaginal mesh extrusion, de novo dyspareunia, de novo incontinence and vaginal pain. Proper patient selection, the appliance vaginal estrogen cream pre- and postoperatively and following strict surgical principles are the mainstay of the success of the TOT operation. It is crucial for POP procedures to be performed by high-volume surgeons in this field, with extensive knowledge of the pelvic floor anatomy and the mesh's characteristics. Of course this is a small study and further clinical studies with larger number of patients are needed in order to further scientific evaluate the TOT operation.
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Affiliation(s)
- I Adamakis
- University Urology Clinic, Laiko Hospital,University of Athens, Athens, Greece -
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18
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Anastasiou I, Deligiannis D, Katafigiotis I, Skarmoutsos I, Karaolanis G, Palla VV, Nonni A, Mitropoulos D, Constantinides CA. Synchronous Bilateral Testicular Tumors with Different Histopathology. Case Rep Urol 2015; 2015:492183. [PMID: 26060594 PMCID: PMC4427818 DOI: 10.1155/2015/492183] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 04/09/2015] [Accepted: 04/15/2015] [Indexed: 11/17/2022] Open
Abstract
A 40-year-old male presented to our outpatient department with the chief complaint of a painless mass on his right testis with gradual size increase over the past two months. Physical examination and ultrasound revealed a firm and nontender mass both on the right and on the left testis. The only elevated biomarker was b-hcG (24,7 mIU/mL) and computer tomography (CT) did not reveal any pathology. Bilateral high orchiectomies were performed, without previous frozen storage of the sperm. Histology proved typical seminoma of the left testis and embryonal carcinoma of the right testis. He received two cycles of adjuvant combination chemotherapy with bleomycin, etoposide, and cisplatin. Six months after the operation no residual tumor or recurrence was observed.
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Affiliation(s)
- Ioannis Anastasiou
- 1st University Urology Clinic, Laiko Hospital, University of Athens, 17 Agiou Thoma Street, Attiki, 11527 Athens, Greece
| | - Dimitrios Deligiannis
- 1st University Urology Clinic, Laiko Hospital, University of Athens, 17 Agiou Thoma Street, Attiki, 11527 Athens, Greece
| | - Ioannis Katafigiotis
- 1st University Urology Clinic, Laiko Hospital, University of Athens, 17 Agiou Thoma Street, Attiki, 11527 Athens, Greece
| | - Ioannis Skarmoutsos
- 1st University Urology Clinic, Laiko Hospital, University of Athens, 17 Agiou Thoma Street, Attiki, 11527 Athens, Greece
| | - Georgios Karaolanis
- 2nd Department of Surgery, Laiko General Hospital, Medical School of Athens, 17 Agiou Thoma Street, Attiki, 11527 Athens, Greece
| | - Viktoria-Varvara Palla
- Department of Obstetrics and Gynecology, G. Gennimatas General Hospital, Mesogeion Avenue 154, Attiki, 11527 Athens, Greece
| | - Afrodite Nonni
- Department of Pathology, National and Kapodistrian University of Athens, 17 Agiou Thoma Street, Attiki, 11527 Athens, Greece
| | - Dionysios Mitropoulos
- 1st University Urology Clinic, Laiko Hospital, University of Athens, 17 Agiou Thoma Street, Attiki, 11527 Athens, Greece
| | - Constantinos A. Constantinides
- 1st University Urology Clinic, Laiko Hospital, University of Athens, 17 Agiou Thoma Street, Attiki, 11527 Athens, Greece
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Mitropoulos D, Artibani W, Biyani CS, Bjerggaard Jensen J, Remzi M, Rouprêt M, Truss M. Quality Assessment of Partial Nephrectomy Complications Reporting Using EAU Standardised Quality Criteria. Eur Urol 2014; 66:522-6. [DOI: 10.1016/j.eururo.2014.02.004] [Citation(s) in RCA: 19] [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: 01/30/2014] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
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Moschonas DP, Piperi C, Korkolopoulou P, Levidou G, Kavantzas N, Trigka EA, Vlachos I, Arapostathi C, Perrea D, Mitropoulos D, Diamanti-Kandarakis E, Papavassiliou AG. Impact of diet-induced obesity in male mouse reproductive system: The role of advanced glycation end product-receptor for advanced glycation end product axis. Exp Biol Med (Maywood) 2014; 239:937-947. [PMID: 24872429 DOI: 10.1177/1535370214531899] [Citation(s) in RCA: 6] [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: 11/17/2022] Open
Abstract
Obesity represents a route to broad physiological dysfunction affecting major organs including male urogenital system. Hyperglycemia, hyperlipidemia, and oxidative stress associated with obesity augment the formation of reactive metabolic by-products, namely advanced glycation end products (AGEs), leading to increased tissue deposition and damage. The exogenous intake and the endogenous accumulation of AGEs contribute to metabolic and reproductive abnormalities in both women and men. The present study assessed the effects of a diet high in saturated fatty acids (SAFA) on the lipid and metabolic profile (AGE levels, oxidative stress) as well as pathogenic (AGE, receptor for AGEs [RAGE] expression, apoptosis) and morphometric parameters of male reproductive system in vivo. Effects of switching to a diet rich in monounsaturated fatty acids (MUFA) or equal in the proportion MUFA to SAFA were further investigated. SAFA-fed animals were characterized by increased serum lipid concentrations (p < .05) compared to controls, but AGEs and peroxide levels were not significantly different across the different experimental groups. Elevated AGE deposition was detected for the first time in germ cells with a higher staining intensity in animals on the SAFA diet, compared to MUFA or MUFA-SAFA-fed animals or the control samples (p = .018). In Leydig cells, AGE localization was higher in the entire cohort of high-fat-fed animals compared to controls (p < .05). High-fat-fed mice displayed enhanced apoptosis compared to controls (p < .005). Furthermore, prostatic tissue demonstrated reduction in epithelial folding, an effect which was significantly reversed after MUFA diet administration. Our findings provide the basis for further investigation of AGE-RAGE axis in testicular and prostatic disturbances associated with diet-induced obesity. Simple dietetic intervention has beneficial effects on metabolic dysfunction of reproductive system before overt manifestations, indicating glycation as a promising therapeutic target.
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Affiliation(s)
- Dimitrios P Moschonas
- Department of Biological Chemistry, University of Athens Medical School, Athens 11527, Greece
| | - Christina Piperi
- Department of Biological Chemistry, University of Athens Medical School, Athens 11527, Greece
| | | | - Georgia Levidou
- 1 Department of Pathology, University of Athens Medical School, Athens 11527, Greece
| | - Nikolaos Kavantzas
- 1 Department of Pathology, University of Athens Medical School, Athens 11527, Greece
| | - Eleni-Andriana Trigka
- 1 Department of Pathology, University of Athens Medical School, Athens 11527, Greece
| | - Ioannis Vlachos
- Laboratory for Experimental Surgery and Surgical Research "N.S. Christeas," University of Athens Medical School, Athens 11527, Greece
| | - Christina Arapostathi
- Laboratory for Experimental Surgery and Surgical Research "N.S. Christeas," University of Athens Medical School, Athens 11527, Greece
| | - Despina Perrea
- Laboratory for Experimental Surgery and Surgical Research "N.S. Christeas," University of Athens Medical School, Athens 11527, Greece
| | | | - Evanthia Diamanti-Kandarakis
- Endocrine Unit, Third Department of Internal Medicine, University of Athens Medical School, Athens 11527, Greece
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Tsavaris N, Kosmas C, Skopelitis H, Dimitrakopoulos A, Kopteridis P, Bougas D, Stravodimos K, Mitropoulos D, Alamanis C, Giannopoulos A. Methotrexate-Paclitaxel-Epirubicin-Carboplatin (M-TEC) Combination Chemotherapy in Patients with Advanced Bladder Cancer: An Open Label Phase II Study. J Chemother 2013. [DOI: 10.1179/joc.2005.17.4.444] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Galanakis I, Spyropoulos E, Gkialas I, Nomikos A, Souka E, Mitropoulos D. ErbB2, ErbB3 and ErbB4 expression in urothelial tumors of the upper urinary tract and their prognostic significance. J BUON 2013; 18:653-659. [PMID: 24065479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE ErbB family represents a promising therapeutic target in upper urinary tract urothelial carcinoma (UUTUC). Our study aimed to correlate ErbB2, ErbB3 and ErbB4 expression in UUTUC with other clinicopathological parameters as well as patient outcome. METHODS ErbB2, ErbB3 and ErbB4 were immunohistochemically assessed in 99 consecutive UUTUC specimens. RESULTS With a median follow-up of 52.5 months (range 1-127) 28 patients (28.3%) died 1-95 months after the first surgical treatment and the mean survival was 18.9-24.2 months. ErbB2, ErbB3 and ErbB4 expression was positive in 64.8, 19.5, and 20.8% of the tumors, respectively. Combined expression of all 3 receptors was found in 7.9% of the tumors, combined expression of 2 receptors in 14.5% and 48.7% expressed at least one ErbB receptor. No ErbB expression was found in 28.9% of the tumors. We found no significant correlation between ErbB2, ErbB3 and ErbB4 expression with tumor stage, grade, recurrence or cancer specific survival apart from the inverse relation between ErbB2 expression and time to recurrence (p=0.027). CONCLUSION Of the 3 receptors evaluated, neither ErbB3 nor ErbB4 showed any prognostic significance in the UUTUC. ErbB2, however, was inversely associated with recurrence and needs further evaluation in well-designed, prospective, randomized trials.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/metabolism
- Carcinoma, Transitional Cell/metabolism
- Carcinoma, Transitional Cell/mortality
- Carcinoma, Transitional Cell/pathology
- ErbB Receptors/metabolism
- Female
- Follow-Up Studies
- Humans
- Immunoenzyme Techniques
- Male
- Middle Aged
- Neoplasm Grading
- Neoplasm Recurrence, Local/metabolism
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Staging
- Prognosis
- Receptor, ErbB-2/metabolism
- Receptor, ErbB-3/metabolism
- Receptor, ErbB-4
- Retrospective Studies
- Survival Rate
- Urologic Neoplasms/metabolism
- Urologic Neoplasms/mortality
- Urologic Neoplasms/pathology
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Affiliation(s)
- I Galanakis
- Urology Department, Athens Naval Hospital, Athens, Greece
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Bamias A, Tsantoulis P, Zilli T, Koutsoukos K, Caparrotti F, Liontos M, Roth A, Lykka M, Stravodimos K, Chrisofos M, Papatsoris A, Efstathiou E, Wirth GJ, Mitropoulos D, Constantinides CA, Deliveliotis C, Iselin CE, Miralbell R, Dietrich PY, Dimopoulos MA. Outcome of patients with nonmetastatic, muscle-invasive bladder cancer (MIBC), not undergoing cystectomy, after treatment with non-cisplatin-based chemotherapy and/or radiotherapy: A retrospective analysis. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e15619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15619 Background: Τransurethral resection of bladder tumor (TURBT), radiotherapy, chemotherapy or combinations can be used in patients with MIBC not undergoing cystectomy, but the optimal treatment is yet unknown. Cisplatin-based chemotherapy is the standard if systemic therapy is to be used. Nevertheless, unfitness for cystectomy is frequently associated with unfitness-for-cisplatin. We report the outcome of patients with MIBC who did not undergo cystectomy and did not receive cisplatin-based chemotherapy. Methods: Selection criteria: non-metastatic MIBC, no cystectomy, no cisplatin-based chemotherapy. Chemotherapy and/or radiotherapy should have been used apart from TURBT. Unfitness for Cisplatin was determined by: creatinine clearance < 50 ml/min, PS > 2, hearing loss, co-morbidities precluding adequate hydration. Carboplatin/gemcitabine was used in patients receiving chemotherapy. Tumor extent was evaluated by TURBT and CT. Patients consented to the use of their data. Results: 49 patients (median age 79), managed between 2/2003-2/2012 were included in this analysis (Table 1). 40 patients (82%) had T2 tumors. No factor for unfitness-for-cisplatin was present in 4 cases. During a median fup of 68 months 29 patients died (5 not due to disease). Treatment after TURBT and outcome are shown in the Table. Conclusions: Most patients with non-metastatic MIBC, not undergoing cystectomy, are also unfit-for-cisplatin, although comorbidities used as unfitness criteria do not always adhere to current guidelines. The outcome of these patients is poorer than that expected with cystectomy. Combining chemotherapy with radiotherapy produced numerically better outcomes and should be prospectively evaluated. [Table: see text]
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Affiliation(s)
- Aristotelis Bamias
- Department of Clinical Therapeutics, Athens University, Medical School, Athens, Greece
| | | | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | | | - Francesca Caparrotti
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Michael Liontos
- Deptartment of Clinical Therapeutics, University of Athens, Athens, Greece
| | - Arnaud Roth
- University Hospital Geneva, Geneva, Switzerland
| | - Maria Lykka
- Deptartment of Clinical Therapeutics, University of Athens, Athens, Greece
| | | | | | | | - Eleni Efstathiou
- Department of Clinical Therapeutics, University of Athens & Department of Genitourinary Medical Onology, The University of Texas MD Anderson Cancer Center, Athens, Greece
| | - Gregory J Wirth
- Urology Department, Geneva University Hospital, Geneva, Switzerland
| | | | | | | | | | - Raymond Miralbell
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Pierre-Yves Dietrich
- Geneva University Hospital, Department of Oncology and Centre de Recherche Clinique Dubois Ferrari, Geneva, Switzerland
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece
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Mitropoulos D, Artibani W, Graefen M, Remzi M, Rouprêt M, Truss M. [Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations]. Actas Urol Esp 2013; 37:1-11. [PMID: 22824080 DOI: 10.1016/j.acuro.2012.02.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 02/17/2012] [Indexed: 01/22/2023]
Abstract
CONTEXT The incidence of postoperative complications is still the most frequently used surrogate marker of quality in surgery, but no standard guidelines or criteria exist for reporting surgical complications in the area of urology. OBJECTIVE To review the available reporting systems used for urologic surgical complications, to establish a possible change in attitude towards reporting of complications using standardised systems, to assess systematically the Clavien-Dindo system when used for the reporting of complications related to urologic surgical procedures, to identify shortcomings in reporting complications, and to propose recommendations for the development and implementation of future reporting systems that are focused on patient-centred outcomes. EVIDENCE ACQUISITION Standardised systems for reporting and classification of surgical complications were identified through a systematic review of the literature. To establish a possible change in attitude towards reporting of complications related to urologic procedures, we performed a systematic literature search of all papers reporting complications after urologic surgery published in European Urology, Journal of Urology, Urology, BJU International, and World Journal of Urology in 1999-2000 and 2009-2010. Data identification for the systematic assessment of the Clavien-Dindo system currently used for the reporting of complications related to urologic surgical interventions involved a Medline/Embase search and the search engines of individual urologic journals and publishers using Clavien, urology, and complications as keywords. All selected papers were full-text retrieved and assessed; analysis was done based on structured forms. EVIDENCE SYNTHESIS The systematic review of the literature for standardised systems used for reporting and classification of surgical complications revealed five such systems. As far as the attitude of urologists towards reporting of complications, a shift could be seen in the number of studies using most of the Martin criteria, as well as in the number of studies using either standardised criteria or the Clavien-Dindo system. The latter system was not properly used in 72 papers (35.3%). CONCLUSIONS Uniformed reporting of complications after urologic procedures will aid all those involved in patient care and scientific publishing (authors, reviewers, and editors). It will also contribute to the improvement of the scientific quality of papers published in the field of urologic surgery. When reporting the outcomes of urologic procedures, the committee proposes a series of quality criteria.
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Mitropoulos D, Patris E, Deliconstantinos G, Kyroudi-Voulgari A, Anastasiou I, Perea D. Terazosin-induced alterations in catalase expression and lipid peroxidation in the rat seminal vesicles. Andrologia 2012; 45:128-34. [DOI: 10.1111/j.1439-0272.2012.01324.x] [Citation(s) in RCA: 3] [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] [Accepted: 05/03/2012] [Indexed: 11/26/2022] Open
Affiliation(s)
- D. Mitropoulos
- Department of Urology; University of Athens Medical School; Athens; Greece
| | - E. Patris
- Department of Urology; University of Thrace Medical School; Alexandroupolis; Greece
| | - G. Deliconstantinos
- Department of Experimental Physiology; University of Athens Medical School; Athens; Greece
| | - A. Kyroudi-Voulgari
- Department of Histology & Embryology; University of Athens Medical School; Athens; Greece
| | - I. Anastasiou
- Department of Urology; University of Athens Medical School; Athens; Greece
| | - D. Perea
- Department of Experimental Surgery & Surgical Research; University of Athens Medical School; Athens; Greece
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Tyritzis SI, Anastasiou I, Stravodimos KG, Alevizopoulos A, Kollias A, Balangas A, Katafigiotis I, Leotsakos I, Mitropoulos D, Constantinides CA. Radical cystectomy over the age of 75 is safe and increases survival. BMC Geriatr 2012; 12:18. [PMID: 22545786 PMCID: PMC3419099 DOI: 10.1186/1471-2318-12-18] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 04/30/2012] [Indexed: 11/26/2022] Open
Abstract
Background Radical cystectomy (RC) is probably underused in elderly patients due to a potential increased postoperative complication risk, as reflected by their considerable comorbidities. Our objective was to estimate the overall complication rate and investigate a potential benefit to patients over the age of 75 subjected to RC in terms of disease-free survival. Methods A total of 81 patients, 61 men and 20 women, from two urological departments, with a mean age of 79.2 ± 3.7 years, participated in the study. The mean follow-up period was 2.6 ± 1.6 years. All patients underwent RC with pelvic lymphadenectomy. An ileal conduit, an orthotopic ileal neobladder and cutaneous ureterostomies were formed in 48.1%, 6.2% and 45.7% of the patients, respectively. The perioperative and 90-day postoperative complications were recorded and classified according to the modified Clavien classification system. Survival plots were created based on the oncological outcome and several study parameters. Results The perioperative morbidity rate was 43.2%; the 90-day morbidity rate was 37%, while the 30-day, 90-day and overall mortality rates were 3.7%, 3.7% and 21%, respectively. Overall mortality rates were recorded at the final year of data gathering (2009). Increased age, increased body mass index (BMI), longer hospitalization and age-adjusted Charlson comorbidity index (ACCI) more than six, were associated with greater hazard for 90-day morbidity. The cumulative mortality / metastasis-free rates for one, two, three and five years were 88.7%, 77.5%, 70.4%, and 62.3%, respectively. Tumour stage and positive nodes were prognostic predictors for oncological outcome. Conclusions RC in patients over 75 is justified and feasible, due to acceptable complication rates and high 5-year cancer-specific survival, which support an aggressive approach. Prospective studies are needed for the verification of the above results.
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Affiliation(s)
- Stavros I Tyritzis
- Department of Urology, Athens University Medical School, LAIKO Hospital, Athens, Greece.
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Xanthopoulos G, Mitropoulos D, Lambrinos G. Estimation of Heat and Mass Transfer Coefficients During Air-Freezing of Cucumber. International Journal of Food Properties 2012. [DOI: 10.1080/10942911003778006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Adamakis I, Tyritzis SI, Koutalellis G, Tokas T, Stravodimos KG, Mitropoulos D, Constantinides CA. Early removal of nasogastric tube is beneficial for patients undergoing radical cystectomy with urinary diversion. Int Braz J Urol 2011; 37:42-8. [PMID: 21385479 DOI: 10.1590/s1677-55382011000100006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2010] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Examine the beneficial effect of early nasogastric tube (NGT) removal in patients undergoing radical cystectomy with urinary diversion. PATIENTS AND METHODS 43 consecutive patients underwent radical cystectomy with urinary diversion and were randomized into 2 groups. In the intervention group (n = 22), the NGT was removed 12 hours after the operation. Comparatively, in the control group (n = 21), the NGT remained in place until the appearance of the first flatus. The appearance of ileus, patient ambulation, time to regular diet, and hospital discharge of the two patient groups were assessed. Patient discomfort due to the NGT was also recorded. RESULTS The 2 groups showed statistical homogeneity of their baseline characteristics. Two patients (9.09%) from the intervention and 3 patients (14.3%) from the control group developed postoperative ileus and were treated conservatively. No significant differences in intraoperative, postoperative, bowel outcomes or other complications were found between the two groups. All patients preferred the NGT to be removed first in comparison to their other co-existing drains. CONCLUSIONS This is the first randomized, prospective study, to our knowledge, to assess early NGT removal after radical cystectomy. We advocate early removal, independently of the selected type of urinary diversion, since it is not correlated with ileus and is advantageous in terms of patient comfort and earlier ambulation.
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Affiliation(s)
- Ioannis Adamakis
- 1st Department of Urology, Athens University Medical School, LAIKO Hospital, Athens, Greece
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Anastasiou I, Tyritzis SI, Adamakis I, Mitropoulos D, Stravodimos KG, Katafigiotis I, Balangas A, Kollias A, Pavlakis K, Constantinides CA. Prognostic factors identifying biochemical recurrence in patients with positive margins after radical prostatectomy. Int Urol Nephrol 2010; 43:715-20. [DOI: 10.1007/s11255-010-9859-8] [Citation(s) in RCA: 10] [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: 09/04/2010] [Accepted: 09/29/2010] [Indexed: 11/29/2022]
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Aus G, Chapple C, Hanûs T, Irani J, Lobel B, Loch T, Mitropoulos D, Parsons K, Plass K, Schmid HP. The European Association of Urology (EAU) Guidelines Methodology: A Critical Evaluation. Eur Urol 2009; 56:859-64. [DOI: 10.1016/j.eururo.2008.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Accepted: 07/03/2008] [Indexed: 11/30/2022]
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Stravodimos KG, Petrolekas A, Kapetanakis T, Vourekas S, Koritsiadis G, Adamakis I, Mitropoulos D, Constantinides C. TRUS versus transabdominal ultrasound as a predictor of enucleated adenoma weight in patients with BPH. Int Urol Nephrol 2009; 41:767-71. [DOI: 10.1007/s11255-009-9554-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Accepted: 02/27/2009] [Indexed: 11/28/2022]
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Kyriakides ZS, Sbarouni E, Antoniadis A, Iliodromitis EK, Mitropoulos D, Kremastinos DT. Atrial natriuretic peptide augments coronary collateral blood flow: a study during coronary angioplasty. Clin Cardiol 2009; 21:737-42. [PMID: 9789694 PMCID: PMC6655780 DOI: 10.1002/clc.4960211008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND HYPOTHESIS In vitro studies have shown that atrial natriuretic peptide (ANP) causes relaxation of preconstricted blood vessel strips and inhibits the contraction of isolated vessels in response to norepinephrine and angiotensin II. The present study examined the effects of exogenous ANP on the coronary collateral blood flow during angioplasty. METHODS We studied 15 patients undergoing elective balloon angioplasty during the second and third balloon inflations. A Doppler flow guidewire was advanced distal to the lesion and used for the estimation of coronary blood flow velocity. After the second balloon inflation, 25 ng/kg/min of ANP were administered intracoronarily for 8 min. Electrocardiogram, pressure, and flow velocity were recorded immediately before each balloon deflation. Fourteen other patients served as controls and received normal saline infusion. RESULTS Velocity time integral increased from 65 +/- 40 to 79 +/- 46 mm (p < 0.05) during the third balloon inflation, whereas ST deviation decreased from 1.3 +/- 0.9 to 0.7 +/- 1.0 mV (p < 0.05). These variables did not change in the control group during the two tested balloon inflations. CONCLUSION Exogenous ANP augments coronary collateral blood flow and ameliorates myocardial ischemia during angioplasty.
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Affiliation(s)
- Z S Kyriakides
- Second Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
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Mihalakis A, Mygdalis V, Anastasiou I, Adamakis I, Zervas A, Mitropoulos D. PATIENT AWARENESS OF SMOKING AS A RISK FACTOR FOR BLADDER CANCER. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1569-9056(08)60268-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bamias A, Bozas G, Antoniou N, Poulias I, Katsifotis H, Skolarikos A, Mitropoulos D, Alamanis C, Alivizatos G, Deliveliotis H, Dimopoulos MA. Prognostic and Predictive Factors in Patients with Androgen-Independent Prostate Cancer Treated with Docetaxel and Estramustine: A Single Institution Experience. Eur Urol 2008; 53:323-31. [PMID: 17445976 DOI: 10.1016/j.eururo.2007.03.072] [Citation(s) in RCA: 17] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 03/28/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate potential prognostic and predictive factors in patients with androgen-independent prostate cancer (AIPC) treated with docetaxel chemotherapy. METHODS This analysis included 94 consecutive AIPC patients who were treated between March 2001 and May 2006 with biweekly docetaxel 45 mg/m(2) (day 2) and estramustine 140 mg three dimes daily (days 1-3). RESULTS Prostate-specific antigen (PSA) responses were observed in 45 of 84 evaluable patients (53%), whereas objective responses were observed in 16 of 40 patients with measurable disease (40%). Median survival (OS) was 16.2 mo (95% confidence interval [CI], 12.9-19.4) and median time to PSA progression (TTP) 5.0 mo (95%CI, 3.6-7.1). OS was independently associated with pain score baseline PSA and weight loss. Patients with only extraosseous disease had higher PSA response rate (87% vs. 49%, p=0.014) and superior TTP compared with patients with bone metastases with or without extraosseous disease (7.3 vs. 4.3 vs. 4 mo, p=0.002). Concurrent bone and extraosseous metastases were associated with worse prognosis compared with each site alone (median OS: 12.3 vs.19 vs.18.3 mo, p=0.007). CONCLUSIONS Among patients with AIPC treated with biweekly docetaxel and estramustine, baseline PSA >100, existence of pain, weight loss, and simultaneous extraosseous and bone disease were associated with worse prognosis. Extraosseous metastases seem to be more sensitive than bone disease to this chemotherapy.
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Affiliation(s)
- Aristotle Bamias
- Department of Clinical Therapeutics, University of Athens, School of Medicine, Athens, Greece.
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35
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Stravodimos KG, Mitropoulos D, Salvari A, Lampadariou A, Kapetanakis T, Zervas A. Levobupivacaine intravesical injection for superficial bladder tumor resection—possible, effective, and durable. Preliminary clinical data. Int Urol Nephrol 2007; 40:637-41. [DOI: 10.1007/s11255-007-9295-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 10/12/2007] [Indexed: 10/22/2022]
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36
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Alivizatos G, Ferakis N, Mitropoulos D, Skolarikos A, Livadas K, Kastriotis I. Feedback Microwave Thermotherapy With the ProstaLund Compact Device for Obstructive Benign Prostatic Hyperplasia: 12-Month Response Rates and Complications. J Urol 2006. [DOI: 10.1016/s0022-5347(05)00610-5] [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: 10/25/2022]
Affiliation(s)
- G. Alivizatos
- 2nd Urology Department, Athens Medical School, Sismanoglion Hospital, Athens, Greece
| | - N. Ferakis
- 2nd Urology Department, Athens Medical School, Sismanoglion Hospital, Athens, Greece
| | - D. Mitropoulos
- 2nd Urology Department, Athens Medical School, Sismanoglion Hospital, Athens, Greece
| | - A. Skolarikos
- 2nd Urology Department, Athens Medical School, Sismanoglion Hospital, Athens, Greece
| | - K. Livadas
- 2nd Urology Department, Athens Medical School, Sismanoglion Hospital, Athens, Greece
| | - I. Kastriotis
- 2nd Urology Department, Athens Medical School, Sismanoglion Hospital, Athens, Greece
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Mitropoulos D, Kiroudi-Voulgari A, Nikolopoulos P, Manousakas T, Zervas A. Accuracy of cystoscopy in predicting histologic features of bladder lesions. J Endourol 2006; 19:861-4. [PMID: 16190845 DOI: 10.1089/end.2005.19.861] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To correlate individual endoscopist impressions of the nature (benign/malignant) of a urothelial lesion and, in the case of malignancy, "clinical" grade and stage of bladder lesions with the histologic findings after transurethral biopsy/resection. Furthermore, we compared the assessments of trainees and experienced urologists. PATIENTS AND METHODS We considered 146 patients submitted to cystoscopy and transurethral excision of tumors or biopsy of suspect regions. Clinical and pathologic diagnoses were compared, and the agreement between reports was assessed by calculating kappa statistics. RESULTS Complete agreement between the cystoscopic and histologic diagnoses was found in 131 of 146 cases. Both specialists and trainees had a tendency to overdiagnose bladder cancer, and they were not effective in predicting the precise stage: complete agreement with the pathologic stage was observed in 66.1% and 64.5% of cases, respectively. Grade was assessed correctly in 55.1% and 54.3% of the cases. The two teams of surgeons expressed complete agreement in the prediction of stage in 78.7% of cases (kappa 0.658) and of grade in 73.2% of cases (kappa 0.584). CONCLUSIONS Our study confirms the diagnostic value of cystoscopy, given the high recognizability of the malignant nature of a lesion by both specialists and trainees. However, cystoscopy is less satisfactory for the characterization of the stage and grade of a cancer. The comparative assessment of the endoscopic and pathologic findings could prove useful to assess the effectiveness of training in endoscopy.
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Affiliation(s)
- D Mitropoulos
- First Department of Urology, Athens Medical School, Athens, Greece.
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Skolarikos A, Alivizatos G, Bamias A, Mitropoulos D, Ferakis N, Deliveliotis C, Dimopoulos MA. Bcl-2 protein and DNA ploidy in renal cell carcinoma: do they affect patient prognosis? Int J Urol 2005; 12:563-9. [PMID: 15985079 DOI: 10.1111/j.1442-2042.2005.01081.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The aim of the present study was to correlate bcl-2 protein expression and DNA-ploidy status with established prognostic parameters in renal cell carcinoma (RCC) and to examine their impact on disease progression and patient survival. METHODS Both parameters were prospectively measured in 50 consecutive radical nephrectomy specimens using flow cytometry. They were correlated with the tumor grade, stage and histological type. Kaplan-Meier survival analysis for all parameters was performed. RESULTS Bcl-2 protein expression was higher in RCC compared to normal renal tissue (P < 0.0001). Aneuploid tumors had higher bcl-2 expression compared to diploid tumors (P = 0.015). Bcl-2 expression and DNA content were not correlated with tumor histological types (P = 0.277/P = 0.419), grades (P = 0.690/P = 0.449), T categories (P = 0.637/P = 0.585) or stages (P = 0.726/P = 0.800). Median follow-up time was 46 months (range, 5-84) with a mean overall survival of 61.8 months (95% confidence interval, 53.7-69.9). Tumor stage was the only statistically important prognostic factor (P = 0.0045). CONCLUSION Although Bcl-2 expression was correlated with tumor DNA content, the prognostic value of these two parameters following radical nephrectomy was not established.
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Affiliation(s)
- Andreas Skolarikos
- First Department of Urology, University of Athens, School of Medicine, Athens, Greece.
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Tsavaris N, Kosmas C, Skopelitis H, Dimitrakopoulos A, Kopterides P, Kopteridis P, Bougas D, Stravodimos K, Mitropoulos D, Alamanis C, Giannopoulos A. Methotrexate-paclitaxel-epirubicin-carboplatin (M-TEC) combination chemotherapy in patients with advanced bladder cancer: an open label phase II study. J Chemother 2005; 17:441-8. [PMID: 16167525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The present phase II study aimed to define the application of a novel regimen incorporating methotrexate, paclitaxel, epirubicin, and carboplatin (M-TEC) in advanced bladder cancer, essentially as an M-VAC-like regimen, by substitution of cisplatin by carboplatin, doxorubicin by epirubicin and vinblastine by paclitaxel. Forty patients with advanced bladder cancer entered the study; 34 males/6 females, median age: 68 (range, 59-76), median PS (Karnovsky): 80, without receiving prior chemotherapy. Disease extention was as follows; 11/40 had local recurrence, 6/40 liver metastases, 14/40 lung metastases, bone and lymph node 8/40, bones-lymph node-lung metastases 4, lymph node and liver 4/40, lymph node-liver and lung metastases 2/40. Drug schedule and doses were as follows: paclitaxel 180 mg/m2, carboplatin AUC = 5 (according to creatinine clearance, based on Calvert's formula), and epirubicin 40 mg/m2 were administered during day 1, whereas methotrexate 30 mg/m2 and epirubicin 40 mg/m2 were administered on day 14. All patients were evaluable for response with 24/40 responding [response rate (RR) 60%]; 10/40 (25%) CR, 14/40 (35%) PR, 9/40 (22.5%) SD, and 7/40 (17.5%) PD. Symptomatic improvement was observed in 50% of patients. The median duration of response was 22 (14-32) weeks, median time-to-progression (TTP) 33 (12-44) weeks, and median survival was 56 (20-84) weeks. Toxicity was well accepted and was mainly neutropenia > grade 3: 17%, anemia >grade 3: 16%, thrombocytopenia > grade 2: 6%, nausea & vomiting mainly > grade 2: 31%, according to the administered chemotherapy cycles, whereas fatigue grade 2-3: 19%, neurotoxicity grade 1-2 13% of patients, and alopecia grade 2 was observed in all patients. The present pilot study indicates the feasibility of the M-TEC combination for bladder cancer with acceptable toxicity.
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Affiliation(s)
- N Tsavaris
- Department of Pathophysiology, Oncology Unit, Athens University School of Medicine, Laikon General Hospital, 115 27 Athens, Greece
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Alivizatos G, Ferakis N, Mitropoulos D, Skolarikos A, Livadas K, Kastriotis I. Feedback microwave thermotherapy with the ProstaLund Compact Device for obstructive benign prostatic hyperplasia: 12-month response rates and complications. J Endourol 2005; 19:72-8. [PMID: 15735388 DOI: 10.1089/end.2005.19.72] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of the ProstaLund Compact Device in the treatment of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS A series of 38 consecutive patients with a mean age of 72.6+/-8.2 years, 19 with an indwelling catheter, underwent transurethral microwave thermotherapy (TUMT) with the ProstaLund Compact Device. Pretreatment evaluation included transrectal ultrasonography (TRUS), urodynamics, and cystoscopy for all patients and flow rate (Qmax), postvoiding residual urine volume (PVR), International Prostate Symptom Score (IPSS), and quality-of-life (QoL) assessment for those without a catheter. The mean prostate volume was 63.5+/-30 cc. The Qmax, IPSS, and QoL studies were repeated at 3, 6, and 12 months, while urodynamics, cystoscopy, and TRUS were repeated at 6 and 12 months. RESULTS The treatment lasted a mean of 43.1+/-17.1 minutes, achieved a maximal intraprostatic temperature of 58.7+/-7.2 degrees C, and destroyed 18.4+/-14.3 g of prostatic tissue. Twelve months post-treatment, for the patients without a catheter preoperatively, the IPSS was improved from 21.5+/-6.3 to 6.5+/-3.1 (P<0.001), Qmax from 7.2+/-3.1 mL/sec to 18.1+/-7.4 mL/sec (P<0.001), detrusor pressure at Qmax from 87.5+/-15 cm H2O to 48.4+/-16.4 cm H2O (P<0.001), and PVR from 113.2+/-78.2 mL to 34.6+/-36.7 mL (P<0.01). The good-response rates for IPSS (<or=7 or >or=50% improvement), Qmax (>or=15 mL/sec or >or=50% improvement), PVR (<50 mL or >or=50% decrease), and QoL (<or=2) were 73.7%, 84.2%, 73.7%, and 94.7%, respectively. For the patients with a catheter preoperatively, the IPSS improved from 9.5+/-6 at 3 months to 5.1+/-5.3 (P<0.05) at the end of the follow-up period. The Qmax was 13.2+/-6.4 mL/sec at 3 months and remained stable throughout the follow-up period. Patient good-response rates for IPSS (<or=7), PVR (<150 mL), and QoL (<or=2) were 75%, 87.5% and 75%, respectively. Only two patients were unable to void after the treatment. Complications were similar to those presented in the literature, and bladder stone formation was noted as well (five patients). CONCLUSIONS ProstaLund thermotherapy is a highly promising alternative treatment for BPH, improving substantially both objective and subjective measures of bladder outflow obstruction.
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Affiliation(s)
- G Alivizatos
- 2nd Urology Department, Athens Medical School, Sismanoglion Hospital, Athens, Greece.
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Abstract
BACKGROUND The aim of the present study was to examine whether increased water load intake prior to ultrasound examination of the lower urinary tract, affects the measurement of postvoid residual urine volume. PATIENTS AND METHODS Ninety four male patients with postvoid residual volumes after increased water load diuresis of more than 100 mL (PVR1) were included in the present study. All patients underwent a second PVR measurement by an urologist with a portable transabdominal bladder ultrasound scan without having received an increased water load (PVR2). A comparison of the measurements was performed and the PVR values were also correlated with other parameters, such as age, International Prostate Symptom Score, prostate volume and serum prostate-specific antigen (PSA) values. RESULTS Postvoid residual urine volume after increased water load diuresis (PVR1) differed from that recorded after normal bladder filling and voiding at first desire (PVR2), with the former being larger than the later in every patient (P < 0.001). The PVR values, PVR1 and PVR2, were independent to patient age, symptom score prostate volume and PSA value. CONCLUSIONS Measurement of postvoid residual volume in a relaxed patient, who voids at first desire, represents everyday life and should be the correct method of testing.
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Affiliation(s)
- Gerasimos Alivizatos
- Second Department of Urology, Athens Medical School, Sismanoglio Hospital, Athens, Greece.
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Kontos M, Felekouras E, Drakos E, Pikoulis E, Mitropoulos D, Staikou C, Hatzianastasiou D, Sigala F, Papalois A, Papalambros E, Bastounis E. Radiofrequency tissue ablation in an experimental model of grade IV renal trauma: a preliminary report. Surg Endosc 2004; 19:249-53. [PMID: 15529190 DOI: 10.1007/s00464-003-9327-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2003] [Accepted: 07/16/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND The kidney is one of the most frequently injured intraabdominal organs. In this study, we investigated the efficacy and safety of radiofrequency ablation (RFA) as a kidney-preserving hemostatic technique for grade IV renal trauma. METHODS A grade IV injury was induced in the right kidney of 12 Landrace pigs. Then RFA was applied around the injury in 10 animals until hemostasis was achieved; two animals were not treated (control group). The treated animals were killed humanely on days 0, 3, 7, 14 and 21 and examined. The kidneys were subjected to histologic and radiologic examination. RESULTS The two untreated animals died from hypovolemic shock. Hemostasis was achieved in all treated animals. We had no operative deaths and no morbidity. No blood, pus, urine, or other fluid was found at the time of death. In one animal, a fistulous lesion leading to the collecting system was identified, but no urine leakage was observed. At histology, the ablated areas were found to consist of three zones: an inner necrotic one, a zone of neutrophils digesting necrotic tissue, and an outer zone with possibly reversible damage. CONCLUSIONS Radiofrequency ablation is an efficient and safe hemostatic method for grade IV renal trauma. Further study is needed to investigate the possible application of this method to humans and its percutaneous or laparoscopic use.
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Affiliation(s)
- M Kontos
- First Department of Surgery, University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece
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Papadoukakis S, Alamanis C, Mitropoulos D, Chountala A, Giannopoulos A. Morphologic findings and blood flow parameters of penile vasculature in patients with erectile dysfunction. World J Urol 2004; 22:285-8. [PMID: 15365751 DOI: 10.1007/s00345-004-0445-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2004] [Accepted: 07/06/2004] [Indexed: 10/26/2022] Open
Abstract
The objective was to study the risk factors in patients with erectile dysfunction in correlation with ultrasound findings of penile vasculature. Patients with erectile dysfunction were classified in four groups according to their risk factors. Group A (37 pts) who were heavy smokers, group B (40 pts) who suffered from diabetes mellitus, group C (30 pts) who suffered from hyperlipidemia and group D (40 pts) with no risk factors. The peak systolic velocity (PSV) was measured after the intracavernous injection of 10 mg alprostadile. Normal values were PSV>35 cm/s and endiastolic venous velocity<4 cm/s. It was found that the mean PSV in group A was 22.2+/-2.25 cm/s without venous leakage, in group B the mean PSV was 24.6+/-1.29 cm/s but there was a significant venous leakage (mean end-diastolic velocity 6.2+/-1.37 cm/s). Patients with hyperlipidemia (group C) had a mean PSV of 26.2+/-1.74 cm/s and insignificant venous leakage and patients in group D had a normal vascular profile. Patients with erectile dysfunction who are heavy smokers are predisposed to have penile arterial insufficiency, while diabetics have both arterial insufficiency and venous leakage.
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Bamias A, Aravantinos G, Deliveliotis C, Bafaloukos D, Kalofonos C, Xiros N, Zervas A, Mitropoulos D, Samantas E, Pectasides D, Papakostas P, Gika D, Kourousis C, Koutras A, Papadimitriou C, Bamias C, Kosmidis P, Dimopoulos MA. Docetaxel and Cisplatin With Granulocyte Colony-Stimulating Factor (G-CSF) Versus MVAC With G-CSF in Advanced Urothelial Carcinoma: A Multicenter, Randomized, Phase III Study From the Hellenic Cooperative Oncology Group. J Clin Oncol 2004; 22:220-8. [PMID: 14665607 DOI: 10.1200/jco.2004.02.152] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The combination of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) represents the standard regimen for inoperable or metastatic urothelial cancer, but its toxicity is significant. We previously reported a 52% response rate (RR) using a docetaxel and cisplatin (DC) combination. The toxicity of this regimen compared favorably with that reported for MVAC. We thus designed a randomized phase III trial to compare DC with MVAC. Patients and Methods Patients with inoperable or metastatic urothelial carcinoma; adequate bone marrow, renal, liver, and cardiac function; and Eastern Cooperative Oncology Group performance status ≤ 2 were randomly assigned to receive MVAC at standard doses or docetaxel 75 mg/m2 and cisplatin 75 mg/m2 every 3 weeks. All patients received prophylactic granulocyte colony-stimulating factor (G-CSF) support. Results Two hundred twenty patients were randomly assigned (MVAC, 109 patients; DC, 111 patients). Treatment with MVAC resulted in superior RR (54.2% v 37.4%; P = .017), median time to progression (TTP; 9.4 v 6.1 months; P = .003) and median survival (14.2 v 9.3 months; P = .026). After adjusting for prognostic factors, difference in TTP remained significant (hazard ratio [HR], 1.61; P = .005), whereas survival difference was nonsignificant at the 5% level (HR, 1.31; P = .089). MVAC caused more frequent grade 3 or 4 neutropenia (35.4% v 19.2%; P = .006), thrombocytopenia (5.7% v 0.9%; P = .046), and neutropenic sepsis (11.6% v 3.8%; P = .001). Toxicity of MVAC was considerably lower than that previously reported for MVAC administered without G-CSF. Conclusion MVAC is more effective than DC in advanced urothelial cancer. G-CSF-supported MVAC is well tolerated and could be used instead of classic MVAC as first-line treatment in advanced urothelial carcinoma.
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Affiliation(s)
- A Bamias
- Department of Clinical Therapeutics Urology, Hygiene and Epidemiology, University of Athens School of Medicine, Athens, Greece.
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Mitropoulos D, Ploumidou K, Kyroudi-Voulgari A, Perea D, Kittas C, Karayannacos P. Hypercholesterol diet (HD) alters serum lipid profile and ventral prostate structure in rats. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1569-9056(03)80078-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Although foreign bodies left in the abdominal cavity may remain asymptomatic for long periods, they may also cause serious complications. We present a case of gauze forgotten in the lower abdomen which remained asymptomatic for almost 1 year. When a granuloma had formed, it infiltrated the bladder wall giving the clinical and imaging appearance of an invasive bladder tumor.
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Affiliation(s)
- G Kyriakou
- Department of Urology, Athens Medical School, Athens, Greece
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Mitropoulos D, Deliconstantinos G, Zervas A, Giannopoulos A, Kyriakou G, Dimopoulos C. Oxidative stress of red blood cells during Bacillus Calmette-Guerin intravesical instillations. In Vivo 2000; 14:721-4. [PMID: 11204488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Although Bacillus Calmette-Guerin (BCG) intravesical instillation is widely accepted as a very effective modality in treating bladder carcinoma in situ, and in preventing superficial bladder cancer recurrence, its mechanism of action is not yet fully understood. The antitumor effects of BCG are mostly related to local immunological events but a systemic activation of the immune system cannot be excluded. The objective of the present study was to estimate the systemic production of oxidants during intravesical BCG treatment. Systemic production of oxidants was estimated by assessing the red blood cells (RBC) oxidative stress in twelve patients undergoing BCG immunotherapy for bladder carcinoma in situ. RBC oxidative stress induced by peroxynitrite was determined by luminol-enhanced chemiluminescence. During the treatment period, the RBC oxidative stress revealed a biphasic curve of changes: after an initial 5-fold increase, it dropped to pretreatment levels following the 4th instillation. Intravesical BCG administration induced systemic production of oxygen free radicals that may reflect a systemic activation of the immune system.
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Affiliation(s)
- D Mitropoulos
- Department of Urology, Athens Medical School, Greece
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Tsavaris N, Skarlos D, Bacoyiannis C, Aravantinos G, Kosmas C, Retalis G, Panopoulos C, Vadiaka M, Dimitrakopoulos A, Kostantinidis K, Mitropoulos D, Bougas D, Pantazopoulos D, Kosmidis P. Combined treatment with low-dose interferon plus vinblastine is associated with less toxicity than conventional interferon monotherapy in patients with metastatic renal cell carcinoma. J Interferon Cytokine Res 2000; 20:685-90. [PMID: 10954911 DOI: 10.1089/10799900050116381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The outcome of treatment of advanced renal cell carcinoma is disappointing. In interferon (IFN)-treated patients, the high incidence of adverse effects causes many patients to withdraw from treatment. This 12-week randomized study compared the incidence of toxicity associated with high-dose IFN monotherapy (15 x 10(6) U thrice weekly) and treatment with the combination of low-dose IFN (5 x 10(6) U thrice weekly) and 6 mg/m2 vinblastine (VBL) every 14 days in 100 consecutive patients. There was no significant difference in response rate between treatment arms (42% IFN vs. 34% IFN + VBL) or between subgroups (by tumor location). Combined treatment was associated with a significantly lower incidence of fever, fatigue, and weight loss but with a higher incidence of leukopenia. There was no significant difference in the incidence of other events. More patients treated with IFN monotherapy required bed rest, and overall treatment costs were 60% higher than for combined treatment. It is concluded that combined treatment with low-dose IFN and VBL, without loss of short-term efficacy, is better tolerated and less expensive than high-dose IFN monotherapy.
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Affiliation(s)
- N Tsavaris
- Department of Pathophysiology, Laiko General Hospital, University of Athens, Greece
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Pappas P, Stravodimos KG, Mitropoulos D, Kontopoulou C, Haramoglis S, Giannopoulou M, Tzortzis G, Giannopoulos A. Role of percutaneous urinary diversion in malignant and benign obstructive uropathy. J Endourol 2000; 14:401-5. [PMID: 10958560 DOI: 10.1089/end.2000.14.401] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES We evaluated the feasibility and effectiveness of percutaneous urinary diversion in patients with obstructive uropathy. PATIENTS AND METHODS A total of 206 percutaneous nephrostomies (PCNs) (right-sided in 54, left in 56, and bilateral in 48) were performed in 102 male and 57 female patients 18 to 94 years old. In 125 patients, malignancy was the underlying cause of the obstruction and in 30, benign disease. In four patients, the cause remained unknown. In most patients (N = 154), the access was guided with both ultrasound and fluoroscopy. RESULTS Percutaneous nephrostomy was successful in 158 patients (99%). Antegrade ureteral stenting was attempted in 48 patients with a success rate of 81%. Fifteen days postprocedure, the mean urea and creatinine concentrations had declined from 160.8 mg/mL to 63 mg/mL and from 6.9 mg/dL to 2.2 mg/dL, respectively. In 66% of the patients, renal function returned to normal. In 28%, it improved with no need for hemodialysis, while in 6%, there was no improvement. Advanced age and prostate cancer were negative predictive factors for the improvement of renal function, whereas the BUN and creatinine concentrations before the procedure and performance of unilateral v bilateral nephrostomies were not. We did not have severe complications. Three patients received transfusions, and in one patient, a urinoma was drained percutaneously. Patients with malignancy had a median survival of 227 days. CONCLUSION Percutaneous urinary diversion under radiologic guidance is a safe and effective procedure for patients with obstructive uropathy.
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Affiliation(s)
- P Pappas
- Department of Radiology, Laiko Hospital, Athens, Greece
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Giannopoulos A, Manousakas T, Mitropoulos D, Botsoli-Stergiou E, Constantinides C, Giannopoulou M, Choremi-Papadopoulou H. Comparative evaluation of the BTAstat test, NMP22, and voided urine cytology in the detection of primary and recurrent bladder tumors. Urology 2000; 55:871-5. [PMID: 10840098 DOI: 10.1016/s0090-4295(00)00489-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This prospective study was undertaken to evaluate the diagnostic efficacy of the BTAstat test and nuclear matrix protein (NMP22) compared with voided urine cytology (VUC) in the detection of primary and recurrent bladder cancer. METHODS A total of 147 patients provided a single voided urine sample for the BTAstat test, NMP22, and cytology prior to cystoscopy. Eighty-five of them had no bladder cancer history, whereas the remaining 62 were monitored for superficial bladder cancer. A group of 21 healthy age-matched volunteers were also enrolled in the study. RESULTS Bladder cancer was confirmed histologically in 99 patients, of which 62 had primary tumors and 37 had recurrent ones. The overall sensitivity and specificity were 71.7% and 56.5% for the BTAstat test, 62.6% and 73. 9% for NMP22, and 38.4% and 94.2% for VUC. The optimal threshold value for NMP22 calculated with receiver operating characteristics curve, was 8 U/mL. BTAstat test was significantly more sensitive than VUC in detecting bladder cancer in all stage and grade subgroups, except GIII. On the contrary, NMP22 was significantly more sensitive than VUC only in stage Ta, grade I and II patients. BTAstat test had higher but not significantly different sensitivity than NMP22. CONCLUSIONS Our data indicate a superiority of both BTAstat test and NMP22 over VUC in the detection of bladder cancer. Comparing BTAstat test with NMP22, the former proved to be more sensitive, whereas the latter was more specific. Ruling out diseases with potential interference can increase the overall specificity of both tests. False-positive results of either test in patients followed up for bladder cancer seem to correspond to future recurrences.
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Affiliation(s)
- A Giannopoulos
- Department of Urology, University of Athens Medical School, Athens, Greece
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