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Ayala L, Adler TJ, Seidlitz S, Wirkert S, Engels C, Seitel A, Sellner J, Aksenov A, Bodenbach M, Bader P, Baron S, Vemuri A, Wiesenfarth M, Schreck N, Mindroc D, Tizabi M, Pirmann S, Everitt B, Kopp-Schneider A, Teber D, Maier-Hein L. Spectral imaging enables contrast agent-free real-time ischemia monitoring in laparoscopic surgery. Sci Adv 2023; 9:eadd6778. [PMID: 36897951 PMCID: PMC10005169 DOI: 10.1126/sciadv.add6778] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
Laparoscopic surgery has evolved as a key technique for cancer diagnosis and therapy. While characterization of the tissue perfusion is crucial in various procedures, such as partial nephrectomy, doing so by means of visual inspection remains highly challenging. We developed a laparoscopic real-time multispectral imaging system featuring a compact and lightweight multispectral camera and the possibility to complement the conventional surgical view of the patient with functional information at a video rate of 25 Hz. To enable contrast agent-free ischemia monitoring during laparoscopic partial nephrectomy, we phrase the problem of ischemia detection as an out-of-distribution detection problem that does not rely on data from any other patient and uses an ensemble of invertible neural networks at its core. An in-human trial demonstrates the feasibility of our approach and highlights the potential of spectral imaging combined with advanced deep learning-based analysis tools for fast, efficient, reliable, and safe functional laparoscopic imaging.
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Affiliation(s)
- Leonardo Ayala
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Tim J. Adler
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Mathematics and Computer Science, Heidelberg University, Heidelberg, Germany
| | - Silvia Seidlitz
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Mathematics and Computer Science, Heidelberg University, Heidelberg, Germany
- Helmholtz Information and Data Science School for Health, Karlsruhe/Heidelberg, Germany
| | - Sebastian Wirkert
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Alexander Seitel
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan Sellner
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Mathematics and Computer Science, Heidelberg University, Heidelberg, Germany
- Helmholtz Information and Data Science School for Health, Karlsruhe/Heidelberg, Germany
| | | | | | - Pia Bader
- Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | | | - Anant Vemuri
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Manuel Wiesenfarth
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nicholas Schreck
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Diana Mindroc
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Minu Tizabi
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Pirmann
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Brittaney Everitt
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Dogu Teber
- Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Lena Maier-Hein
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty, Heidelberg University, Heidelberg, Germany
- Faculty of Mathematics and Computer Science, Heidelberg University, Heidelberg, Germany
- Helmholtz Information and Data Science School for Health, Karlsruhe/Heidelberg, Germany
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Holze S, Haney C, Lemaire E, Mende M, Neuhaus P, Arthanareeswaran VKA, Truss M, Do H, Dietel A, Teber D, Stützel K, Hohenfellner M, Rabenalt R, Albers P, Stolzenburg JU. Quality of life after robotic-assisted and laparoscopic radical prostatectomy: Results of a multicenter randomized controlled trial (LAP-01). EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02162-0] [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: 11/06/2022] Open
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Holze S, Lemaire E, Mende M, Neuhaus P, Arthanareeswaran VKA, Truss MC, Minh Do H, Dietel A, Teber D, Stützel KD, Hohenfellner M, Rabenalt R, Albers P, Stolzenburg JU. Quality of life after robotic-assisted and laparoscopic radical prostatectomy: Results of a multicenter randomized controlled trial (LAP-01). Prostate 2022; 82:894-903. [PMID: 35254665 DOI: 10.1002/pros.24332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 09/28/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND To explore cross-sectional and longitudinal differences in general health-related and prostate cancer-specific quality of life (QoL) after robotic-assisted (RARP) and laparoscopic (LRP) radical prostatectomy and to analyze predictive variables for QoL outcomes. METHODS In this multicenter, randomized controlled trial, prostate cancer patients were randomly assigned 3:1 to undergo either RARP or LRP. Patient-reported outcomes were prospectively collected before and 1, 3, 6, 12 months after radical prostatectomy and included QoL as a secondary outcome. Validated questionnaires were used to assess general health-related (EORTC QLQ-C30) and prostate cancer-specific (QLQ-PR25) QoL. Cross-sectional and longitudinal contrasts were analyzed through linear mixed models. Predictive variables for QoL outcomes were identified by general linear modeling. RESULTS Of 782 randomized patients, QoL was evaluable in 681 patients. In terms of general QoL, the cross-sectional analysis showed only small differences between study arms, whereas longitudinal comparison indicated an advantage of RARP on recovery: RARP patients reported an earlier return to baseline in global health status (3 vs. 6 months) and social functioning (6 vs. 12 months). In role functioning, only the RARP arm regained baseline scores. Regarding prostate-specific QoL, LRP patients experienced more urinary symptoms and reported 3.2 points (95% confidence interval 0.4-6, p = 0.024) higher mean scores at 1-month follow-up and in mean 2.9 points (0.1-5, p = 0.042) higher urinary symptoms scores at 3-month follow-up than RARP patients. There were no other significant differences between treatment groups. Urinary symptoms, sexual activity, and sexual function remained significantly worse compared with baseline at all time points in both arms. CONCLUSIONS Compared with LRP, the robotic approach led to an earlier return to baseline in several domains of general health-related QoL and better short-term recovery of urinary symptoms. Predictive variables such as the scale-specific baseline status and bilateral nerve-sparing were confirmed.
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Affiliation(s)
- Sigrun Holze
- Department of Urology, University Hospital Leipzig, Leipzig, Germany
| | - Emilie Lemaire
- Department of Urology, University Hospital Leipzig, Leipzig, Germany
| | - Meinhard Mende
- Clinical Trial Center Leipzig, Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany
| | - Petra Neuhaus
- Clinical Trial Center Leipzig, Leipzig University, Leipzig, Germany
| | | | | | - Hoang Minh Do
- Department of Urology, University Hospital Leipzig, Leipzig, Germany
- Department of Urology, Sana Hospital Borna, Borna, Germany
| | - Anja Dietel
- Department of Urology, University Hospital Leipzig, Leipzig, Germany
| | - Dogu Teber
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Urology, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | | | | | - Robert Rabenalt
- Department of Urology, University Hospital Duesseldorf, Duesseldorf, Germany
- Department of Urology, Marien Hospital Duesseldorf, Duesseldorf, Germany
| | - Peter Albers
- Department of Urology, University Hospital Duesseldorf, Duesseldorf, Germany
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4
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Holze S, Bräunlich M, Mende M, Arthanareeswaran VKA, Neuhaus P, Truss MC, Do HM, Dietel A, Franz T, Teber D, Heilsberg AK, Hohenfellner M, Rabenalt R, Albers P, Stolzenburg JU. Age-stratified outcomes after radical prostatectomy in a randomized setting (LAP-01): do younger patients have more to lose? World J Urol 2022; 40:1151-1158. [PMID: 35124734 PMCID: PMC9085667 DOI: 10.1007/s00345-022-03945-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/21/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Age is known to have an impact on outcomes after radical prostatectomy (RP). However, age differences can be investigated from a cross-sectional as well as from a longitudinal perspective. This study combines both perspectives. MATERIALS AND METHODS LAP-01 is the first multicenter randomized patient blinded trial comparing outcomes after robotic-assisted and laparoscopic RP. This study stratified the entire population that received nerve-sparing surgery and was potent at baseline by the following ages: ≤ 60 years, 61-65 years, and > 65 years. Potency was assessed using the IIEF-5. The EORTC QLQ-C30 was used for global health perception and the EORTC QLQ-PR25 for urinary symptoms. Continence was assessed by the number of pads used. Longitudinal change was assessed using either validated anchor-based criteria or the 1 or 0.5-standard-deviation criterion. Worsening of continence was measured by increasing numbers of pads. RESULTS 310 patients were included into this study. Older patients had a significantly higher risk for worsening of continence at 3 and 6 months (OR 2.21, 95% CI [1.22, 4.02], p = 0.009 and OR 2.00, 95% CI [1.16, 3.46], p = 0.013, respectively); at 12 months, the odds of worsening did not differ significantly between age groups. Potency scores were better in younger patients from a cross-sectional perspective, but longitudinal change did not differ between the age groups. In contrast, global health perception was better in older patients from a cross-sectional perspective and longitudinal decreases were significantly more common among the youngest patients, at 12 months (36.9% vs. 24.4%, p = 0.038). CONCLUSION From a cross-sectional perspective, function scores were better in younger patients, but from a longitudinal perspective, age differences were found in continence only. In contrast, global health scores were better in older patients from a cross-sectional and longitudinal perspective. TRIAL REGISTRATION The LAP-01 trial was registered with the U.S. National Library of Medicine clinical trial registry (clinicaltrials.gov), NCT number: NCT03682146, and with the German Clinical Trial registry (Deutsches Register Klinischer Studien), DRKS ID number: DRKS00007138.
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Affiliation(s)
- Sigrun Holze
- Department of Urology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Max Bräunlich
- Department of Urology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Meinhard Mende
- University of Leipzig, Clinical Trial Centre Leipzig, Härtelstraße 16-18, 04107, Leipzig, Germany
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Härtelstraße 16-18, 04107, Leipzig, Germany
| | | | - Petra Neuhaus
- University of Leipzig, Clinical Trial Centre Leipzig, Härtelstraße 16-18, 04107, Leipzig, Germany
| | - Michael C Truss
- Department of Urology, Klinikum Dortmund, Beurhausstr. 40, 44137, Dortmund, Germany
| | - Hoang Minh Do
- Department of Urology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
- Department of Urology, Sana Hospital Borna, Rudolf-Virchow-Straße 2, 04552, Borna, Germany
| | - Anja Dietel
- Department of Urology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Toni Franz
- Department of Urology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Dogu Teber
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
- Department of Urology, Staedtisches Klinikum Karlsruhe, Moltkestraße 90, 76133, Karlsruhe, Germany
| | | | - Markus Hohenfellner
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Robert Rabenalt
- Department of Urology, University of Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
- Department of Urology, Marien Hospital Duesseldorf, Rochusstraße 2, 40479, Düsseldorf, Germany
| | - Peter Albers
- Department of Urology, University of Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Jens-Uwe Stolzenburg
- Department of Urology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Maier-Hein L, Eisenmann M, Sarikaya D, März K, Collins T, Malpani A, Fallert J, Feussner H, Giannarou S, Mascagni P, Nakawala H, Park A, Pugh C, Stoyanov D, Vedula SS, Cleary K, Fichtinger G, Forestier G, Gibaud B, Grantcharov T, Hashizume M, Heckmann-Nötzel D, Kenngott HG, Kikinis R, Mündermann L, Navab N, Onogur S, Roß T, Sznitman R, Taylor RH, Tizabi MD, Wagner M, Hager GD, Neumuth T, Padoy N, Collins J, Gockel I, Goedeke J, Hashimoto DA, Joyeux L, Lam K, Leff DR, Madani A, Marcus HJ, Meireles O, Seitel A, Teber D, Ückert F, Müller-Stich BP, Jannin P, Speidel S. Surgical data science - from concepts toward clinical translation. Med Image Anal 2022; 76:102306. [PMID: 34879287 PMCID: PMC9135051 DOI: 10.1016/j.media.2021.102306] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 02/06/2023]
Abstract
Recent developments in data science in general and machine learning in particular have transformed the way experts envision the future of surgery. Surgical Data Science (SDS) is a new research field that aims to improve the quality of interventional healthcare through the capture, organization, analysis and modeling of data. While an increasing number of data-driven approaches and clinical applications have been studied in the fields of radiological and clinical data science, translational success stories are still lacking in surgery. In this publication, we shed light on the underlying reasons and provide a roadmap for future advances in the field. Based on an international workshop involving leading researchers in the field of SDS, we review current practice, key achievements and initiatives as well as available standards and tools for a number of topics relevant to the field, namely (1) infrastructure for data acquisition, storage and access in the presence of regulatory constraints, (2) data annotation and sharing and (3) data analytics. We further complement this technical perspective with (4) a review of currently available SDS products and the translational progress from academia and (5) a roadmap for faster clinical translation and exploitation of the full potential of SDS, based on an international multi-round Delphi process.
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Affiliation(s)
- Lena Maier-Hein
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Mathematics and Computer Science, Heidelberg University, Heidelberg, Germany; Medical Faculty, Heidelberg University, Heidelberg, Germany.
| | - Matthias Eisenmann
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Duygu Sarikaya
- Department of Computer Engineering, Faculty of Engineering, Gazi University, Ankara, Turkey; LTSI, Inserm UMR 1099, University of Rennes 1, Rennes, France
| | - Keno März
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Anand Malpani
- The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Hubertus Feussner
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stamatia Giannarou
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom
| | - Pietro Mascagni
- ICube, University of Strasbourg, CNRS, France; IHU Strasbourg, Strasbourg, France
| | | | - Adrian Park
- Department of Surgery, Anne Arundel Health System, Annapolis, Maryland, USA; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carla Pugh
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Swaroop S Vedula
- The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Kevin Cleary
- The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, D.C., USA
| | | | - Germain Forestier
- L'Institut de Recherche en Informatique, Mathématiques, Automatique et Signal (IRIMAS), University of Haute-Alsace, Mulhouse, France; Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| | - Bernard Gibaud
- LTSI, Inserm UMR 1099, University of Rennes 1, Rennes, France
| | - Teodor Grantcharov
- University of Toronto, Toronto, Ontario, Canada; The Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Makoto Hashizume
- Kyushu University, Fukuoka, Japan; Kitakyushu Koga Hospital, Fukuoka, Japan
| | - Doreen Heckmann-Nötzel
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hannes G Kenngott
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ron Kikinis
- Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nassir Navab
- Computer Aided Medical Procedures, Technical University of Munich, Munich, Germany; Department of Computer Science, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Sinan Onogur
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tobias Roß
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany; Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Raphael Sznitman
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Russell H Taylor
- Department of Computer Science, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Minu D Tizabi
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Wagner
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Gregory D Hager
- The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, Maryland, USA; Department of Computer Science, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany
| | - Nicolas Padoy
- ICube, University of Strasbourg, CNRS, France; IHU Strasbourg, Strasbourg, France
| | - Justin Collins
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, Leipzig, Germany
| | - Jan Goedeke
- Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Daniel A Hashimoto
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA; Surgical AI and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Luc Joyeux
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium; Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium; Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Kyle Lam
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Daniel R Leff
- Department of BioSurgery and Surgical Technology, Imperial College London, London, United Kingdom; Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom; Breast Unit, Imperial Healthcare NHS Trust, London, United Kingdom
| | - Amin Madani
- Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Hani J Marcus
- National Hospital for Neurology and Neurosurgery, and UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Ozanan Meireles
- Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Seitel
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dogu Teber
- Department of Urology, City Hospital Karlsruhe, Karlsruhe, Germany
| | - Frank Ückert
- Institute for Applied Medical Informatics, Hamburg University Hospital, Hamburg, Germany
| | - Beat P Müller-Stich
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Pierre Jannin
- LTSI, Inserm UMR 1099, University of Rennes 1, Rennes, France
| | - Stefanie Speidel
- Division of Translational Surgical Oncology, National Center for Tumor Diseases (NCT/UCC) Dresden, Dresden, Germany; Centre for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, Dresden, Germany
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6
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Görtz M, Byczkowski M, Rath M, Schütz V, Reimold P, Gasch C, Simpfendörfer T, März K, Seitel A, Nolden M, Ross T, Mindroc-Filimon D, Michael D, Metzger J, Onogur S, Speidel S, Mündermann L, Fallert J, Müller M, von Knebel Doeberitz M, Teber D, Seitz P, Maier-Hein L, Duensing S, Hohenfellner M. A Platform and Multisided Market for Translational, Software-Defined Medical Procedures in the Operating Room (OP 4.1): Proof-of-Concept Study. JMIR Med Inform 2022; 10:e27743. [PMID: 35049510 PMCID: PMC8814925 DOI: 10.2196/27743] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/25/2021] [Accepted: 11/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background Although digital and data-based technologies are widespread in various industries in the context of Industry 4.0, the use of smart connected devices in health care is still in its infancy. Innovative solutions for the medical environment are affected by difficult access to medical device data and high barriers to market entry because of proprietary systems. Objective In the proof-of-concept project OP 4.1, we show the business viability of connecting and augmenting medical devices and data through software add-ons by giving companies a technical and commercial platform for the development, implementation, distribution, and billing of innovative software solutions. Methods The creation of a central platform prototype requires the collaboration of several independent market contenders, including medical users, software developers, medical device manufacturers, and platform providers. A dedicated consortium of clinical and scientific partners as well as industry partners was set up. Results We demonstrate the successful development of the prototype of a user-centric, open, and extensible platform for the intelligent support of processes starting with the operating room. By connecting heterogeneous data sources and medical devices from different manufacturers and making them accessible for software developers and medical users, the cloud-based platform OP 4.1 enables the augmentation of medical devices and procedures through software-based solutions. The platform also allows for the demand-oriented billing of apps and medical devices, thus permitting software-based solutions to fast-track their economic development and become commercially successful. Conclusions The technology and business platform OP 4.1 creates a multisided market for the successful development, implementation, distribution, and billing of new software solutions in the operating room and in the health care sector in general. Consequently, software-based medical innovation can be translated into clinical routine quickly, efficiently, and cost-effectively, optimizing the treatment of patients through smartly assisted procedures.
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Affiliation(s)
- Magdalena Görtz
- Department of Urology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Mathias Rath
- Department of Urology, Heidelberg University Hospital, Heidelberg, Germany
| | - Viktoria Schütz
- Department of Urology, Heidelberg University Hospital, Heidelberg, Germany
| | - Philipp Reimold
- Department of Urology, Heidelberg University Hospital, Heidelberg, Germany
| | - Claudia Gasch
- Department of Urology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Keno März
- German Cancer Research Center, Heidelberg, Germany
| | | | - Marco Nolden
- German Cancer Research Center, Heidelberg, Germany
| | - Tobias Ross
- German Cancer Research Center, Heidelberg, Germany
| | | | | | | | - Sinan Onogur
- German Cancer Research Center, Heidelberg, Germany
| | | | | | | | | | - Magnus von Knebel Doeberitz
- Department of Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Dogu Teber
- Department of Urology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | | | | | - Stefan Duensing
- Section of Molecular Urooncology, Department of Urology, University of Heidelberg School of Medicine, Heidelberg, Germany
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7
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Stolzenburg JU, Holze S, Neuhaus P, Kyriazis I, Do HM, Dietel A, Truss MC, Grzella CI, Teber D, Hohenfellner M, Rabenalt R, Albers P, Mende M. Robotic-assisted Versus Laparoscopic Surgery: Outcomes from the First Multicentre, Randomised, Patient-blinded Controlled Trial in Radical Prostatectomy (LAP-01). Eur Urol 2021; 79:750-759. [PMID: 33573861 DOI: 10.1016/j.eururo.2021.01.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/19/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The LAP-01 trial was designed to address the lack of high-quality literature comparing robotic-assisted (RARP) and laparoscopic (LRP) radical prostatectomy. OBJECTIVE To compare the functional and oncological outcomes between RARP and LRP at 3 mo of follow-up. DESIGN, SETTING, AND PARTICIPANTS In this multicentre, randomised, patient-blinded controlled trial, patients referred for radical prostatectomy to four hospitals in Germany were randomly assigned (3:1) to undergo either RARP or LRP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was time to continence recovery at 3 mo based on the patient's pad diary. Secondary outcomes included continence and potency as well as quality of life in addition to oncological outcomes for up to 3 yr of follow-up. Time to continence was analysed by log-rank test and depicted by the Kaplan-Meier method. Continuous measurements were analysed by means of linear mixed models. RESULTS AND LIMITATIONS A total of 782 patients were randomised. The primary endpoint was evaluable in 718 patients (547 RARPs; full analysis set). At 3 mo, the difference in continence rates was 8.7% in favour of RARP (54% vs 46%, p = 0.027). RARP remained superior to LRP even after adjustment for the randomisation stratum nerve sparing and age >65 yr (hazard ratio = 1.40 [1.09-1.81], p = 0.008). A significant benefit in early potency recovery was also identified, while similar oncological and morbidity outcomes were documented. It is a limitation that the influence of different anastomotic techniques was not investigated in this study. CONCLUSIONS RARP resulted in significantly better continence recovery at 3 mo. PATIENT SUMMARY In this randomised trial, we looked at the outcomes following radical prostate surgery in a large German population. We conclude that patients undergoing robotic prostatectomy had better continence than those undergoing laparoscopic surgery when assessed at 3 mo following surgery. Age and the nerve-sparing technique further affected continence restoration.
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Affiliation(s)
| | - Sigrun Holze
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Petra Neuhaus
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Iason Kyriazis
- Department of Urology, University of Leipzig, Leipzig, Germany; Department of Urology, University Hospital of Patras, Rio, Greece
| | - Hoang Minh Do
- Department of Urology, University of Leipzig, Leipzig, Germany; Department of Urology, Sana Hospital Borna, Borna, Germany
| | - Anja Dietel
- Department of Urology, University of Leipzig, Leipzig, Germany
| | | | | | - Dogu Teber
- Department of Urology, University of Heidelberg, Heidelberg, Germany; Department of Urology, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | | | - Robert Rabenalt
- Department of Urology, University of Duesseldorf, Duesseldorf, Germany; Department of Urology, Marien Hospital Duesseldorf, Duesseldorf, Germany
| | - Peter Albers
- Department of Urology, University of Duesseldorf, Duesseldorf, Germany
| | - Meinhard Mende
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany; Institute for Medical Informatics, Statistics and Epidemiology University of Leipzig, Leipzig, Germany
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8
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Abstract
Urology has always been closely linked to technological progress. In the last few decades, we have witnessed increasing implementation of various technologies and innovations in subdisciplines of urology. While conventional laparoscopy is increasingly being replaced by robot-assisted procedures and the introduction of new robotic systems from various manufactures will continue for years, the field of endourolgy is still not dominated by robotic systems. However, new systems (e.g., autonomous, robot-controlled aquablation of the prostate) are becoming increasingly popular and numerous development projects will also probably change clinical care in coming years. In addition, further advancements in the combination of robotics with intraoperative navigation through the integration of imaging and augmented-reality (AR) and virtual reality (VR) technology can be expected. This combination of navigation and robotic technology is already being used successfully in prostate biopsy.
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Affiliation(s)
- D S Schoeb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - J Rassweiler
- Klinik für Urologie, SLK-Kliniken Heilbronn GmbH, Heilbronn, Deutschland
| | - A Sigle
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - C Engels
- Urologische Klinik, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
| | - A S Goezen
- Klinik für Urologie, SLK-Kliniken Heilbronn GmbH, Heilbronn, Deutschland
| | - D Teber
- Urologische Klinik, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland.
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9
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Abstract
The increasing networking of data systems in medicine is not only leading to modern interdisciplinarity in the sense of cooperation between different medical departments, but also poses new challenges regarding the building and room infrastructure. The surgical operating room of the future expands or augments its reality, away from the pure building characteristics, towards an intelligent and communicative space platform. The building infrastructure (operating theatre) serves as sensor and actuator. Thus, it is possible to inform about missing diagnostics as well as to register them directly in the contextualization of the planned surgical intervention or to integrate them into the processes. Integrated operating theatres represent a comprehensive computer platform based on a corresponding system architecture with software-based protocols. An underlying modular system consisting of various modules for image acquisition and analysis, interaction and visualization supports the integration and merging of heterogeneous data that are generated in a hospital operation. Integral building data (e.g., air conditioning, lighting control, device registration) are merged with patient-related data (age, type of illness, concomitant diseases, existing diagnostic CT and MRI images). New systems coming onto the market, as well as already existing systems will have to be measured by the extent to which they will be able to guarantee this integration of information-similar to the development from mobile phone to smartphone. Cost reduction should not be the only legitimizing argument for the market launch, but the vision of a new quality of surgical perception and action.
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Affiliation(s)
- D Teber
- Urologische Klinik, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland.
| | - C Engels
- Urologische Klinik, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
| | - L Maier-Hein
- Abteilung Computer-assistierte Medizinische Interventionen (CAMI), Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - L Ayala
- Abteilung Computer-assistierte Medizinische Interventionen (CAMI), Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - S Onogur
- Abteilung Computer-assistierte Medizinische Interventionen (CAMI), Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - A Seitel
- Abteilung Computer-assistierte Medizinische Interventionen (CAMI), Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - K März
- Abteilung Computer-assistierte Medizinische Interventionen (CAMI), Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
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10
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Ayala L, Seidlitz S, Vemuri A, Wirkert SJ, Kirchner T, Adler TJ, Engels C, Teber D, Maier-Hein L. Light source calibration for multispectral imaging in surgery. Int J Comput Assist Radiol Surg 2020; 15:1117-1125. [PMID: 32535848 PMCID: PMC7316688 DOI: 10.1007/s11548-020-02195-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/29/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE Live intra-operative functional imaging has multiple potential clinical applications, such as localization of ischemia, assessment of organ transplantation success and perfusion monitoring. Recent research has shown that live monitoring of functional tissue properties, such as tissue oxygenation and blood volume fraction, is possible using multispectral imaging in laparoscopic surgery. While the illuminant spectrum is typically kept constant in laparoscopic surgery and can thus be estimated from preoperative calibration images, a key challenge in open surgery originates from the dynamic changes of lighting conditions. METHODS The present paper addresses this challenge with a novel approach to light source calibration based on specular highlight analysis. It involves the acquisition of low-exposure time images serving as a basis for recovering the illuminant spectrum from pixels that contain a dominant specular reflectance component. RESULTS Comprehensive in silico and in vivo experiments with a range of different light sources demonstrate that our approach enables an accurate and robust recovery of the illuminant spectrum in the field of view of the camera, which results in reduced errors with respect to the estimation of functional tissue properties. Our approach further outperforms state-of-the-art methods proposed in the field of computer vision. CONCLUSION Our results suggest that low-exposure multispectral images are well suited for light source calibration via specular highlight analysis. This work thus provides an important first step toward live functional imaging in open surgery.
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Affiliation(s)
- Leonardo Ayala
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Silvia Seidlitz
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
- HIDSS4Health – Helmholtz Information and Data Science School for Health, Karlsruhe, Heidelberg, Germany
| | - Anant Vemuri
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian J. Wirkert
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Kirchner
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tim J. Adler
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Mathematics and Computer Science, Heidelberg University, Heidelberg, Germany
| | - Christina Engels
- Urologische Klinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Dogu Teber
- Urologische Klinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Lena Maier-Hein
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty, Heidelberg University, Heidelberg, Germany
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11
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Nientiedt C, Endris V, Jenzer M, Mansour J, Sedehi NTP, Pecqueux C, Volckmar AL, Leichsenring J, Neumann O, Kirchner M, Hoveida S, Lantwin P, Kaltenecker K, Dieffenbacher S, Gasch C, Hofer L, Franke D, Tosev G, Görtz M, Schütz V, Radtke JP, Nyarangi-Dix J, Hatiboglu G, Simpfendörfer T, Schönberg G, Isaac S, Teber D, Koerber SA, Christofi G, Czink E, Kreuter R, Apostolidis L, Kratochwil C, Giesel F, Haberkorn U, Debus J, Sültmann H, Zschäbitz S, Jäger D, Duensing A, Schirmacher P, Grüllich C, Hohenfellner M, Stenzinger A, Duensing S. High prevalence of DNA damage repair gene defects and TP53 alterations in men with treatment-naïve metastatic prostate cancer -Results from a prospective pilot study using a 37 gene panel. Urol Oncol 2020; 38:637.e17-637.e27. [PMID: 32280037 DOI: 10.1016/j.urolonc.2020.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/14/2020] [Accepted: 03/02/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Defects in DNA damage repair genes characterize a subset of men with prostate cancer and provide an attractive opportunity for precision oncology approaches. The prevalence of such perturbations in newly diagnosed, treatment-naïve patients with a high risk for lethal disease outcome, however, has not been sufficiently explored. PATIENTS AND METHODS Prostate cancer specimens from 67 men with newly diagnosed early onset, localized high-risk/locally advanced or metastatic prostate cancer were included in this prospective pilot study. Tumor samples, including 30 prostate biopsies, were analyzed by targeted next generation sequencing using a formalin-fixed, paraffin-embedded tissue-optimized 37 DNA damage repair and checkpoint gene panel. RESULTS The drop-out rate due to an insufficient quantity of DNA was 4.5% (3 of 67 patients). In the remaining 64 patients, the rate of pathogenic DNA damage repair gene mutations was 26.6%. The highest rate of pathogenic DNA damage repair and checkpoint gene mutations was found in men with treatment-naïve metastatic prostate cancer (38.9%). In addition, a high number of likely pathogenic mutations and gene deletions were detected. Altogether, one or more pathogenic mutation, likely pathogenic mutation or gene deletion affected 43 of 64 patients (67.2%) including 29 of 36 patients (80.6%) with treatment-naïve metastatic prostate cancer. Men with metastatic prostate cancer showed a high prevalence of alterations in TP53 (36.1%). CONCLUSIONS This pilot study demonstrates the feasibility, performance and clinical relevance of somatic targeted next generation sequencing using a unique 37 DNA damage repair and checkpoint gene panel under routine conditions. Our results indicate that this approach can detect actionable DNA repair gene alterations, uncommon mutations as well as mutations associated with therapy resistance in a high number of patients, in particular patients with treatment-naïve metastatic prostate cancer.
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Affiliation(s)
- Cathleen Nientiedt
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Heidelberg, Germany; Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Volker Endris
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Maximilian Jenzer
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Heidelberg, Germany; Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Josef Mansour
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Carine Pecqueux
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna-Lena Volckmar
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jonas Leichsenring
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Olaf Neumann
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Martina Kirchner
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Shirin Hoveida
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Philippa Lantwin
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Katrin Kaltenecker
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Claudia Gasch
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Luisa Hofer
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Desiree Franke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Georgi Tosev
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Magdalena Görtz
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Viktoria Schütz
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jan-Philipp Radtke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Gencay Hatiboglu
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Gita Schönberg
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Sanjay Isaac
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dogu Teber
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan A Koerber
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Georgia Christofi
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Elena Czink
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Rebecca Kreuter
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Leonidas Apostolidis
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg; Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frederik Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg; Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg; Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Holger Sültmann
- Cancer Genome Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Stefanie Zschäbitz
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Dirk Jäger
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Anette Duensing
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany; Cancer Therapeutics Program and Department of Pathology, University of Pittsburgh School of Medicine, Hillman Cancer Center, Pittsburgh, PA; Precision Oncology of Urological Malignancies, Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Schirmacher
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Carsten Grüllich
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | | | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Stefan Duensing
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Heidelberg, Germany; Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
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12
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Nyarangi-Dix JN, Tosev G, Damgov I, Reimold P, Aksoy C, Hatiboglu G, Teber D, Mansour J, Kuehhas FE, Radtke JP, Hohenfellner M. Recovery of pad-free continence in elderly men does not differ from younger men undergoing robot-assisted radical prostatectomy for aggressive prostate cancer. World J Urol 2019; 38:351-360. [PMID: 31079187 DOI: 10.1007/s00345-019-02797-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 03/17/2019] [Accepted: 04/30/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To analyze urinary continence outcome following robot-assisted radical prostatectomy (RARP) for aggressive prostate cancer in men aged ≥ 70 and < 70 years. METHODS Retrospective analyses of prospectively collected long-term data from a monocentric cohort of 350 men with D'Amico high-risk prostate cancer undergone robot-assisted radical prostatectomy at a single institution between 2005 and 2016. The association between time since operation and zero-pad urinary continence recovery was comparatively analyzed by separate pre-operative and post-operative Cox proportional-hazard regression models. RESULTS Median age in the age group ≥ 70 years was 73 years compared with 62 years in the < 70 year age group. Distribution of men receiving adjuvant and salvage radiotherapy/hormonal therapy was similar in both age groups. Urinary continence recovery rate at 12, 24, and 36 months after surgery of men aged ≥ 70 years was 66, 79 and 83%, respectively, and statistically similar to that of men < 70 years: 71, 81, and 85% (log-rank test p = 0.24). Multivariable analyses demonstrated no significant difference in return to continence between the two age groups (p = 0.28 and p = 0.17). In addition, clinical stage and type of nerve sparing (unilateral, bilateral or non-nerve sparing) were found to be independently predictive of pad-free continence recovery. CONCLUSIONS Regardless of age, return to continence in men with aggressive prostate cancer undergoing RARP continues to improve way beyond the first 12 months after surgery. Considering the dire effects of post-operative radiotherapy on continence in this aggressive cancer cohort, advanced age alone should not discourage recommending multimodal therapy involving RARP.
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Affiliation(s)
- Joanne Nyaboe Nyarangi-Dix
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Georgi Tosev
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Ivan Damgov
- Freelance Statistical Consultant, Sofia, Bulgaria
| | - Philipp Reimold
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Cem Aksoy
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Gencay Hatiboglu
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Dogu Teber
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Josef Mansour
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | | | - Jan Philipp Radtke
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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13
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Retz M, Bedke J, Bögemann M, Grimm MO, Zimmermann U, Müller L, Leiber C, Teber D, Wirth M, Bolenz C, van Alphen R, De Santis M, Beeker A, Lehmann J, Indorf M, Frank M, Bokemeyer C, Gschwend JE. SWITCH II: Phase III randomized, sequential, open-label study to evaluate the efficacy and safety of sorafenib-pazopanib versus pazopanib-sorafenib in the treatment of advanced or metastatic renal cell carcinoma (AUO AN 33/11). Eur J Cancer 2018; 107:37-45. [PMID: 30529901 DOI: 10.1016/j.ejca.2018.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 10/31/2018] [Accepted: 11/05/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE This trial compared the sequential therapy with the multikinase inhibitor sorafenib (So) followed by pazopanib (Pa) or vice versa in advanced/metastatic renal cell carcinoma (mRCC) patients. METHODS This multicenter, randomized phase 3 study assessed the sequential use of So-Pa versus Pa-So in patients with mRCC without prior systemic therapy. Pts were randomized to So 2 × 400 mg/day followed by Pa 1 × 800 mg/day in case of progression or intolerable toxicity or vice versa. Primary endpoint was total PFS (tPFS), defined as time from randomization to progression, or death during second-line therapy. Key secondary endpoints included overall survival (OS), first-line PFS, disease control rate (DCR) and safety. RESULTS A total of 377 pts were randomized (So-Pa, n = 189; Pa-So, n = 188). Recruitment of a total 544 pts was calculated, but actual accrual rate turned out to be lower than expected. The primary endpoint median tPFS was 8.6 mo (95% CI 7.7-10.2) for So-Pa and 12.9 mo (95% CI 10.8-15.2) for Pa-So with a hazard ratio (HR) of 1.36 (upper limit of one-sided 95% CI 1.68), which exceeded a predefined HR <1.225 as a one-sided 95% confidence interval. Non-inferiority of So-Pa regarding tPFS was not met. Secondary endpoints displayed marked statistical differences in favor of Pa-So in first-line PFS and DCR but not for OS and 2nd-line PFS. Side effect profiles were consistent with known toxicities of the respective multikinase-inhibitor including diarrhea, fatigue, hand-foot skin reaction and hypertension. CONCLUSIONS Non-inferiority of the primary endpoint tPFS could not be demonstrated for So-Pa. The results for first-line PFS and DCR favored the Pa-So sequence. TRIAL REGISTRATION NCT01613846, www.clinicaltrials.gov.
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Affiliation(s)
- Margitta Retz
- Dept. of Urology, Rechts der Isar Medical Center, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; AUO Study Group, Germany.
| | - Jens Bedke
- Dept. of Urology, Eberhard Karls University Tübingen, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
| | - Martin Bögemann
- Dept. of Urology, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Marc-Oliver Grimm
- Dept. of Urology, Universitätsklinikum Jena, Lessingstr. 1, 07743 Jena, Germany.
| | - Uwe Zimmermann
- Dept. of Urology, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Str., 17475 Greifswald, Germany.
| | - Lothar Müller
- Medical Oncology, Onkologie Leer-Emden-Papenburg, Annenestr. 11, 26789 Leer, Germany.
| | - Christian Leiber
- Dept. of Urology, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
| | - Dogu Teber
- Dept. of Urology, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
| | - Manfred Wirth
- Dept. of Urology, Universitätsklinikum Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Christian Bolenz
- Dept. of Urology, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
| | - Robbert van Alphen
- Dept. of Oncology, Elisabeth Tweesteden Ziekenhuis, Dr. Deelenlaan 5, 5042 AD Tilburg, Netherlands.
| | - Maria De Santis
- Dept. of Oncology, Kaiser-Franz-Josef-Spital and Department of Urology, Medical University of Vienna, Kundratstr. 3, 1100 Vienna, Austria.
| | - Aart Beeker
- Dept. of Oncology, Spaarne Ziekenhuis, Spaarnepoort 1, 2134 TM Hoofddorp, Netherlands.
| | - Jan Lehmann
- Dept. of Urology, Städtisches Krankenhaus Kiel, Chemnitzstr. 33, 24116 Kiel, Germany; AUO Study Group, Germany.
| | - Martin Indorf
- IOMEDICO AG, Hanferstr. 28, 79108 Freiburg, Germany.
| | - Melanie Frank
- IOMEDICO AG, Hanferstr. 28, 79108 Freiburg, Germany.
| | - Carsten Bokemeyer
- Center for Oncology, II. Medical Clinic and Polyclinic, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
| | - Jürgen E Gschwend
- Dept. of Urology, Rechts der Isar Medical Center, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; AUO Study Group, Germany.
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14
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Nyarangi-Dix J, Wiesenfarth M, Bonekamp D, Hitthaler B, Schütz V, Dieffenbacher S, Mueller-Wolf M, Roth W, Stenzinger A, Duensing S, Roethke M, Teber D, Schlemmer HP, Hohenfellner M, Radtke JP. Combined Clinical Parameters and Multiparametric Magnetic Resonance Imaging for the Prediction of Extraprostatic Disease-A Risk Model for Patient-tailored Risk Stratification When Planning Radical Prostatectomy. Eur Urol Focus 2018; 6:1205-1212. [PMID: 30477971 DOI: 10.1016/j.euf.2018.11.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 09/15/2018] [Revised: 10/19/2018] [Accepted: 11/10/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) facilitates the detection of significant prostate cancer. Therefore, addition of mpMRI to clinical parameters might improve the prediction of extraprostatic extension (EPE) in radical prostatectomy (RP) specimens. OBJECTIVE To investigate the accuracy of a novel risk model (RM) combining clinical and mpMRI parameters to predict EPE in RP specimens. DESIGN, SETTING, AND PARTICIPANTS We added prebiopsy mpMRI to clinical parameters and developed an RM to predict individual side-specific EPE (EPE-RM). Clinical parameters of 264 consecutive men with mpMRI prior to MRI/transrectal ultrasound fusion biopsy and subsequent RP between 2012 and 2015 were retrospectively analysed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariate regression analyses were used to determine significant EPE predictors for RM development. The prediction performance of the novel EPE-RM was compared with clinical T stage (cT), MR-European Society of Urogenital Radiology (ESUR) classification for EPE, two established nomograms (by Steuber et al and Ohori et al) and a clinical nomogram based on the coefficients of the established nomograms, and was constructed based on the data of the present cohort, using receiver operating characteristics (ROCs). For comparison, models' likelihood ratio (LR) tests and Vuong tests were used. Discrimination and calibration of the EPE-RM were validated based on resampling methods using bootstrapping. RESULTS AND LIMITATIONS International society of Urogenital Pathology grade on biopsy, ESUR criteria, prostate-specific antigen, cT, prostate volume, and capsule contact length were included in the EPE-RM. Calibration of the EPE-RM was good (error 0.018). The ROC area under the curve for the EPE-RM was larger (0.87) compared with cT (0.66), Memorial Sloan Kettering Cancer Center nomogram (0.73), Steuber nomogram (0.70), novel clinical nomogram (0.79), and ESUR classification (0.81). Based on LR and Vuong tests, the EPE-RM's model fit was significantly better than that of cT, all clinical models, and ESUR classification alone (p<0.001). Limitations include monocentric design and expert reading of MRI. CONCLUSIONS This novel EPE-RM, incorporating clinical and MRI parameters, performed better than contemporary clinical RMs and MRI predictors, therefore providing an accurate patient-tailored preoperative risk stratification of side-specific EPE. PATIENT SUMMARY Extraprostatic extension of prostate cancer can be predicted accurately using a combination of magnetic resonance imaging and clinical parameters. This novel risk model outperforms magnetic resonance imaging and clinical predictors alone and can be useful when planning nerve-sparing radical prostatectomy.
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Affiliation(s)
| | - Manuel Wiesenfarth
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Bertram Hitthaler
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Viktoria Schütz
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Svenja Dieffenbacher
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany; Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Maya Mueller-Wolf
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wilfried Roth
- Institute of Pathology Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Stefan Duensing
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Roethke
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dogu Teber
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Jan Philipp Radtke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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15
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Kesch C, Radtke JP, Wintsche A, Wiesenfarth M, Luttje M, Gasch C, Dieffenbacher S, Pecqueux C, Teber D, Hatiboglu G, Nyarangi-Dix J, Simpfendörfer T, Schönberg G, Dimitrakopoulou-Strauss A, Freitag M, Duensing A, Grüllich C, Jäger D, Götz M, Grabe N, Schweiger MR, Pahernik S, Perner S, Herpel E, Roth W, Wieczorek K, Maier-Hein K, Debus J, Haberkorn U, Giesel F, Galle J, Hadaschik B, Schlemmer HP, Hohenfellner M, Bonekamp D, Sültmann H, Duensing S. Correlation between genomic index lesions and mpMRI and 68Ga-PSMA-PET/CT imaging features in primary prostate cancer. Sci Rep 2018; 8:16708. [PMID: 30420756 PMCID: PMC6232089 DOI: 10.1038/s41598-018-35058-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 03/28/2018] [Accepted: 10/30/2018] [Indexed: 02/01/2023] Open
Abstract
Magnetic resonance imaging (MRI) and prostate specific membrane antigen (PSMA)- positron emission tomography (PET)/computed tomography (CT)-imaging of prostate cancer (PCa) are emerging techniques to assess the presence of significant disease and tumor progression. It is not known, however, whether and to what extent lesions detected by these imaging techniques correlate with genomic features of PCa. The aim of this study was therefore to define a genomic index lesion based on chromosomal copy number alterations (CNAs) as marker for tumor aggressiveness in prostate biopsies in direct correlation to multiparametric (mp) MRI and 68Ga-PSMA-PET/CT imaging features. CNA profiles of 46 biopsies from five consecutive patients with clinically high-risk PCa were obtained from radiologically suspicious and unsuspicious areas. All patients underwent mpMRI, MRI/TRUS-fusion biopsy, 68Ga-PSMA-PET/CT and a radical prostatectomy. CNAs were directly correlated to imaging features and radiogenomic analyses were performed. Highly significant CNAs (≥10 Mbp) were found in 22 of 46 biopsies. Chromosome 8p, 13q and 5q losses were the most common findings. There was an strong correspondence between the radiologic and the genomic index lesions. The radiogenomic analyses suggest the feasibility of developing radiologic signatures that can distinguish between genomically more or less aggressive lesions. In conclusion, imaging features of mpMRI and 68Ga-PSMA-PET/CT can guide to the genomically most aggressive lesion of a PCa. Radiogenomics may help to better differentiate between indolent and aggressive PCa in the future.
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Affiliation(s)
- Claudia Kesch
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120, Heidelberg, Germany
| | - Jan-Philipp Radtke
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120, Heidelberg, Germany
| | - Axel Wintsche
- Interdisciplinary Center for Bioinformatics, University of Leipzig, Härtelstrasse 16-18, D-04107, Leipzig, Germany
| | - Manuel Wiesenfarth
- Division of Biostatistics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Mariska Luttje
- Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX Utrecht, The Netherlands
| | - Claudia Gasch
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120, Heidelberg, Germany
| | - Svenja Dieffenbacher
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120, Heidelberg, Germany
| | - Carine Pecqueux
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120, Heidelberg, Germany
| | - Dogu Teber
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120, Heidelberg, Germany
| | - Gencay Hatiboglu
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120, Heidelberg, Germany
| | - Joanne Nyarangi-Dix
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120, Heidelberg, Germany
| | - Tobias Simpfendörfer
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120, Heidelberg, Germany
| | - Gita Schönberg
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120, Heidelberg, Germany
| | - Antonia Dimitrakopoulou-Strauss
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Martin Freitag
- Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Anette Duensing
- Cancer Therapeutics Program and Department of Pathology, Hillman Cancer Center, University of Pittsburgh School of Medicine, 5117 Centre Avenue, Pittsburgh, PA, 15213, USA
| | - Carsten Grüllich
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 460, D-69120, Heidelberg, Germany
| | - Dirk Jäger
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 460, D-69120, Heidelberg, Germany
| | - Michael Götz
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Niels Grabe
- Hamamatsu Tissue Imaging and Analysis Center (TIGA), BIOQUANT, University of Heidelberg, Im Neuenheimer Feld 267, D-69120, Heidelberg, Germany
| | - Michal-Ruth Schweiger
- Functional Epigenomics, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Robert-Koch-Strasse 21, D-50931, Cologne, Germany
| | - Sascha Pahernik
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120, Heidelberg, Germany.,Department of Urology, University Hospital Nuremberg, Nuremberg, Germany
| | - Sven Perner
- Pathology of the University Hospital Schleswig-Holstein, Campus Lübeck and the Research Center Borstel, Leibniz Lung Center, Ratzeburger Allee 160, D-23538 Lübeck and Parkallee 1-40, D-23845, Borstel, Germany
| | - Esther Herpel
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, D-69120, Heidelberg, Germany
| | - Wilfried Roth
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, D-69120, Heidelberg, Germany.,Institute of Pathology, University Hospital Mainz, Mainz, Germany
| | - Kathrin Wieczorek
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, D-69120, Heidelberg, Germany.,Pathology Rosenheim, Rosenheim, Germany
| | - Klaus Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Uwe Haberkorn
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany.,Department of Nuclear Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Frederik Giesel
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany.,Department of Nuclear Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Jörg Galle
- Interdisciplinary Center for Bioinformatics, University of Leipzig, Härtelstrasse 16-18, D-04107, Leipzig, Germany
| | - Boris Hadaschik
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120, Heidelberg, Germany.,Department of Urology, University Hospital Essen, Essen, Germany
| | - Heinz-Peter Schlemmer
- Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120, Heidelberg, Germany
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Holger Sültmann
- Cancer Genome Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Im Neuenheimer Feld 460, D-69120, Heidelberg, Germany.
| | - Stefan Duensing
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120, Heidelberg, Germany. .,Molecular Urooncology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120, Heidelberg, Germany.
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16
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Tosev G, Schuetz V, Nyarangi-Dix J, Stenzinger A, Stoegbauer F, Kulu Y, Radtke JP, Teber D, Hatzinger M, Springfeld C, Koehler BC, Hohenfellner M. Prostatic metastasis from intrahepatic cholangiocarcinoma. Urol Case Rep 2018; 20:90-91. [PMID: 30101074 PMCID: PMC6072907 DOI: 10.1016/j.eucr.2018.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/16/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Georgi Tosev
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - Viktoria Schuetz
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | | | | | - Fabian Stoegbauer
- Department of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Yakup Kulu
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Jan P Radtke
- Department of Urology, University of Heidelberg, Heidelberg, Germany.,Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Dogu Teber
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - Martin Hatzinger
- Department of Urology, Diakonissenkrankenhaus Mannheim, Mannheim, Germany
| | - Christoph Springfeld
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.,Liver Cancer Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Bruno C Koehler
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.,Liver Cancer Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
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17
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Ganzer R, Arthanareeswaran VKA, Ahmed HU, Cestari A, Rischmann P, Salomon G, Teber D, Liatsikos E, Stolzenburg JU, Barret E. Which technology to select for primary focal treatment of prostate cancer?-European Section of Urotechnology (ESUT) position statement. Prostate Cancer Prostatic Dis 2018; 21:175-186. [PMID: 29743538 DOI: 10.1038/s41391-018-0042-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/11/2018] [Accepted: 02/20/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND With growing interest in focal therapy (FT) of prostate cancer (PCa) there is an increasing armamentarium of treatment modalities including high-intensity focused ultrasound (HIFU), cryotherapy, focal laser ablation (FLA), irreversible electroporation (IRE), vascular targeted photodynamic therapy (VTP), focal brachytherapy (FBT) and stereotactic ablative radiotherapy (SABR). Currently there are no clear recommendations as to which of these technologies are appropriate for individual patient characteristics. Our intention was to review the literature for special aspects of the different technologies that might be of advantage depending on individual patient and tumour characteristics. METHODS The current literature on FT was screened for the following factors: morbidity, repeatability, tumour risk category, tumour location, tumour size and prostate volume and anatomical issues. The ESUT expert panel arrived at consensus regarding a position statement on a structured pathway for available FT technologies based on a combination of the literature and expert opinion. RESULTS Side effects were low across different studies and FT modalities with urinary continence rates of 90-100% and erectile dysfunction between 5 and 52%. Short to medium cancer control based on post-treatment biopsies were variable between ablative modalities. Expert consensus suggested that posterior lesions are better amenable to FT using HIFU. Cryotherapy provides best possible outcomes for anterior tumours. Apical lesions, when treated with FBT, may yield the least urethral morbidity. CONCLUSIONS Further prospective trials are required to assess medium to long term disease control of different ablative modalities for FT. Amongst different available FT modalities our ESUT expert consensus suggests that some may be better for diffe`rent tumour locations. Tumour risk, tumour size, tumour location, and prostate volume are all important factors to consider and might aid in designing future FT trials.
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Affiliation(s)
- Roman Ganzer
- Department of Urology, Asklepios Hospital Bad Tölz, Bad Tölz, Germany.
| | | | - Hashim U Ahmed
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Andrea Cestari
- Department of Urology, Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Pascal Rischmann
- Department of Urology, Rangueil University Hospital, Toulouse, France
| | - Georg Salomon
- Martini Clinic, Prostate Cancer Center, Hamburg, Germany
| | - Dogu Teber
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | | | | | - Eric Barret
- Department of Urology, Institut Montsouris, Paris, France
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18
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Nyarangi-Dix J, Wörner J, Kopp-Schneider A, Schütz V, Bonekamp D, Wiesenfarth M, Stenzinger A, Roth W, Hadaschik B, Schlemmer HP, Hatiboglu G, Teber D, Hohenfellner M, Radtke JP. MP20-07 PREOPERATIVE MRI AND CLINICAL PARAMETERS FOR ACCURATE PREDICTION OF CONTINENCE RECOVERY FOLLOWING RADICAL PROSTATECTOMY – MEMBRANOUS URETHRAL LENGTH ON MRI OUTPERFORMS PREDICTIVE MODELS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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19
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Radtke JP, Giganti F, Wiesenfarth M, Marenco J, Orczyk C, Kasivisvanathan V, Stabile A, Kesch C, Nyarangi-Dix J, Schütz V, Stenzinger A, Roth W, Teber D, Bonekamp D, Schlemmer HP, Hohenfellner M, Emberton M, Hadaschik B, Moore C. MP77-20 PREDICTION OF SIGNIFICANT PROSTATE CANCER IN BIOPSY-NAÏVE MEN: EXTERNAL VALIDATION OF A NOVEL RISK MODEL COMBINING MRI AND CLINICAL PARAMETERS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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20
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Kesch C, Radtke JP, Wintsche A, Wiesenfarth M, Luttje M, Gasch C, Dieffenbacher S, Teber D, Hatiboglu G, Nyarangi-Dix J, Simpfendörfer T, Dimitrakopoulou-Strauß A, Freitag M, Duensing A, Grüllich C, Götz M, Jäger D, Grabe N, Schweiger MR, Giesel FL, Roth W, Perner S, Galle J, Maier-Hein K, Hadaschik BA, Schlemmer HP, Hohenellner M, Bonekamp D, Sültmann H, Duensing S. PD47-04 CORRELATION BETWEEN GENOMIC INDEX LESIONS, MULTI-PARAMETRIC MRI AND 68GA-PSMA-PET/CT IMAGING FEATURES IN PRIMARY PROSTATE CANCER. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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21
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Baranski AC, Schäfer M, Bauder-Wüst U, Roscher M, Schmidt J, Stenau E, Simpfendörfer T, Teber D, Maier-Hein L, Hadaschik B, Haberkorn U, Eder M, Kopka K. PSMA-11–Derived Dual-Labeled PSMA Inhibitors for Preoperative PET Imaging and Precise Fluorescence-Guided Surgery of Prostate Cancer. J Nucl Med 2017; 59:639-645. [DOI: 10.2967/jnumed.117.201293] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 11/13/2017] [Indexed: 02/06/2023] Open
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22
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Hüttenbrink C, Hatiboglu G, Simpfendörfer T, Radtke JP, Becker R, Teber D, Hadaschik B, Pahernik S, Hohenfellner M. Incidental appendectomy during robotic laparoscopic prostatectomy-safe and worth to perform? Langenbecks Arch Surg 2017; 403:265-269. [PMID: 29098385 DOI: 10.1007/s00423-017-1630-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 02/21/2017] [Accepted: 10/06/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this study is to investigate the safety and patients' benefit of incidental appendectomy during robot-assisted laparoscopic radical prostatectomy (RALRP). METHODS Fifty-three patients, who had incidental appendectomy during RALRP between January 2012 and March 2014, were enrolled to this study. To evaluate the safety of the procedure, following parameters were evaluated: patient age, duration of surgery, perioperative complications (classified by Clavien-Dindo), time to bowel movement, and length of hospital stay. Furthermore, intraoperative visual appearance, location, and histopathological evaluation of the appendix were evaluated. Data was analyzed by descriptive statistics. RESULTS Mean age of patients was 61 years, the average hospital stay 5 days. No perioperative complications occurred. The appendix was unsuspicious in 39 patients (73.6%); 14 patients (26.4%) had macroscopically signs of inflammation. Of the 53 resected appendixes, the histopathological evaluation showed 33 (62.2%) inconspicuous appendices, 11 (20.8%) post-inflammatory changes, 4 (7.5%) with chronical signs of inflammation and 3 (5.7%) with signs of acute inflammation. In 2 patients (3.8%), low-grade mucinous neoplasms were found in the specimens. CONCLUSIONS Incidental appendectomy during RALRP is a feasible procedure. With regard to inflammation and neoplastic changes, incidental appendectomy can be considered for patients scheduled for robot-assisted prostate surgery.
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Affiliation(s)
- C Hüttenbrink
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - G Hatiboglu
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - T Simpfendörfer
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - J P Radtke
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - R Becker
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - D Teber
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - B Hadaschik
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - S Pahernik
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - M Hohenfellner
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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23
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Retz M, Bedke J, Herrmann E, Grimm MO, Zimmermann U, Müller L, Leiber C, Teber D, Wirth M, Bolenz C, van Alphen R, De Santis M, Beeker A, Frank M, Gschwend J. Phase III randomized, sequential, open-label study to evaluate the efficacy and safety of sorafenib-pazopanib versus pazopanib-sorafenib in the treatment of metastatic renal cell carcinoma (SWITCH-II). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Hatiboglu G, Simpfendörfer T, Uhlmann L, Bergero M, Macher-Goeppinger S, Pahernik S, Hadaschik B, Hohenfellner M, Teber D. A prospective randomized controlled trial for assessment of perineal hydrodissection technique for nervesparing robot assisted radical prostatectomy. Int J Med Robot 2017; 13. [DOI: 10.1002/rcs.1835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 03/14/2017] [Accepted: 04/05/2017] [Indexed: 11/12/2022]
Affiliation(s)
- G. Hatiboglu
- Department of Urology; University of Heidelberg, Im Neuenheimer Feld 110; Heidelberg Germany
| | - T. Simpfendörfer
- Department of Urology; University of Heidelberg, Im Neuenheimer Feld 110; Heidelberg Germany
| | - L. Uhlmann
- Department of Medical Biometry; University of Heidelberg, Im Neuenheimer Feld; Heidelberg Germany
| | - M.A. Bergero
- Department of Urology; University of Heidelberg, Im Neuenheimer Feld 110; Heidelberg Germany
- Department of Urology; Italian Hospital of Buenos Aires; Buenos Aires Argentina
| | - S. Macher-Goeppinger
- Institute of Pathology; University of Heidelberg, Im Neuenheimer Feld 220/221; Heidelberg Germany
| | - S. Pahernik
- Department of Urology; University of Heidelberg, Im Neuenheimer Feld 110; Heidelberg Germany
| | - B. Hadaschik
- Department of Urology; University of Heidelberg, Im Neuenheimer Feld 110; Heidelberg Germany
| | - M. Hohenfellner
- Department of Urology; University of Heidelberg, Im Neuenheimer Feld 110; Heidelberg Germany
| | - D. Teber
- Department of Urology; University of Heidelberg, Im Neuenheimer Feld 110; Heidelberg Germany
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25
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Nyarangi-Dix J, Hatiboglu G, Teber D, Duensing S, Hohenfellner M. MP64-18 LONG-TERM IMPACT OF POSITIVE SURGICAL MARGINS AFTER RADICAL PROSTATECTOMY: AN ANALYSIS OF A LARGE PROSPECTIVE COHORT. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Radtke JP, Hadaschik B, Kesch C, David B, Freitag M, Alt C, Hitthaler B, Roethke MC, Wieczorek K, Roth W, Duensing S, Schlemmer HP, Hohenfellner M, Teber D. MP03-07 COMBINED CLINICAL PARAMETERS AND MULTIPARAMETRIC MRI FOR PREDICTION OF SIDE-SPECIFIC EXTRAPROSTATIC DISEASE - A RISK-MODEL FOR PATIENT-TAILORED RISK STRATIFICATION BEFORE RADICAL PROSTATECTOMY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Radtke J, Bonekamp D, Kesch C, Freitag M, Alt C, Celik K, Distler F, Roth W, Wieczorek K, Duensing S, Roethke M, Teber D, Schlemmer H, Hohenfellner M, Hadaschik B. Kombination klinischer und MR-tomografischer Parameter zur Vorhersage signifikanter Prostatakarzinome und extrakapsulärer Tumorausdehnung. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- J Radtke
- Deutsches Krebsforschungszentrum, Abteilung Radiologie, Heidelberg
| | - D Bonekamp
- Deutsches Krebsforschungszentrum, Abteilung Radiologie, Heidelberg
| | - C Kesch
- Universitätsklinikum Heidelberg, Urologische Universitätsklinik, Heidelberg
| | - M Freitag
- Deutsches Krebsforschungszentrum, Abteilung Radiologie, Heidelberg
| | - C Alt
- Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf
| | - K Celik
- Universitätsklinikum Heidelberg, Urologische Universitätsklinik, Heidelberg
| | - F Distler
- Universitätsklinikum Heidelberg, Urologische Universitätsklinik, Heidelberg
| | - W Roth
- Ruprechts-Karl-Universität Heidelberg, Pathologisches Institut, Heidelberg
| | - K Wieczorek
- Ruprechts-Karl-Universität Heidelberg, Pathologisches Institut, Heidelberg
| | - S Duensing
- Universitätsklinikum Heidelberg, Urologische Universitätsklinik, Heidelberg
| | - M Roethke
- Deutsches Krebsforschungszentrum, Abteilung Radiologie, Heidelberg
| | - D Teber
- Universitätsklinikum Heidelberg, Urologische Universitätsklinik, Heidelberg
| | - H Schlemmer
- Deutsches Krebsforschungszentrum, Abteilung Radiologie, Heidelberg
| | - M Hohenfellner
- Universitätsklinikum Heidelberg, Urologische Universitätsklinik, Heidelberg
| | - B Hadaschik
- Universitätsklinikum Heidelberg, Urologische Universitätsklinik, Heidelberg
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Dieffenbacher SC, Popeneciu IV, Radtke JP, Teber D, Hohenfellner M, Hadaschik BA, Hatiboglu G. Diagnostic Accuracy of Transperineal MRI Fusion Biopsy in Comparison to Transrectal Biopsy with Regard to Incidental Histopathological Findings in Transurethral Resection of the Prostate. Urol Int 2017; 99:162-167. [PMID: 28190012 DOI: 10.1159/000456078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/07/2016] [Accepted: 01/09/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the diagnostic accuracy of transperineal MRI/transrectal ultrasound (TRUS) fusion prostate biopsy vs. transrectal prostate biopsy in transurethral resection (TUR) specimen of men undergoing TUR of the prostate (TURP) for symptomatic bladder outlet obstruction. MATERIAL AND METHODS From a database of 3,509 men receiving prostate biopsy, all those undergoing TURP and negative prostate biopsy (n = 95; 45 transrectal, 50 transperineal fusion) were analysed. TURP specimens were compared with regard to incidental prostate cancer. RESULTS Pre- and peri-interventional parameters in transrectal vs. fusion biopsy groups for age (65.2 ± 7.8 vs. 65.5 ± 7.3 years; p = 0.84), prostate specific antigen (10.7 ± 8.5 vs. 10.9 ± 8.7 ng/mL; p = 0.93), preoperative prostate volume (72.5 ± 26.1 vs. 71.8 ± 28.1 mL; p = 0.91) and resected weight (43.7 ± 21.9 vs. 41.4 ± 20.7 g; p = 0.61) showed no significant differences. Analysing the TURP specimen, 5 incidental T1a prostate cancers were found (3 Gleason 3 + 3 = 6; 2 Gleason 3 + 4 = 7, all in the transrectal biopsy group). Although, more biopsy cores were obtained in the MRI/TRUS fusion biopsy group (26 cores [interquartile range, IQR 24-28] vs. 14 cores [IQR 12-24], p < 0.01), there was no statistical impact of the obtained number of cores (p = 0.9) on diagnostic accuracy. Statistical analyses revealed significantly better diagnostic accuracy favoring image-guided fusion biopsy (p = 0.02). CONCLUSIONS Our findings showed that a combination of MRI-targeted and systematic transperineal prostate biopsy improves patient safety. This is associated with a combination of transperineal biopsy technique and pre-interventional MRI.
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Radtke JP, Korzeniewski N, Huber J, Alt CD, Pahernik S, Hadaschik BA, Hohenfellner M, Teber D. Ureterocystoneostomy in complex oncological cases with an “Uebelhoer” modified Boari bladder flap. Langenbecks Arch Surg 2017; 402:1271-1278. [DOI: 10.1007/s00423-017-1554-0] [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] [Received: 08/23/2016] [Accepted: 01/05/2017] [Indexed: 11/25/2022]
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Hatiboglu G, Popeneciu IV, Deppert M, Nyarangi-Dix J, Hadaschik B, Hohenfellner M, Teber D, Pahernik S. Quality of life and functional outcome after infravesical desobstruction and HIFU treatment for localized prostate cancer. BMC Urol 2017; 17:5. [PMID: 28077116 PMCID: PMC5225650 DOI: 10.1186/s12894-017-0198-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 01/05/2017] [Indexed: 12/26/2022] Open
Abstract
Background To evaluate quality of life, functional and oncological outcome after infravesical desobstruction and HIFU treatment for localized prostate cancer. Methods One hundred thirty-one patients, treated with TURP and HIFU in a single institution were followed up for oncological and functional outcome. Oncological outcome was quantified by biochemical recurrence free survival using the Stuttgart and Phoenix criteria. Quality of life was assessed by usage of standardized QLQ-C30 and QLQ-PR25 questionnaires. In addition, functional questionnaires such as IPSS and IIEF-5 were used. Complications were assessed by the Clavien-Dindo classification. Results One hundred thirty-one patients with a mean age of 72.8 years (SD: 6.0) underwent HIFU for prostate cancer (29.0% low risk, 58.8% intermediate risk, 12.2% high risk). PSA nadir was 0.6 ng/ml (SD: 1.2) after a mean of 4.6 months (SD: 5.7). Biochemical recurrence free survival defined by Stuttgart criteria was 73.7%, 84.4% and 62.5% for low-, intermediate- and high-risk patients after 22.2 months. Complications were grouped according to Clavien-Dindo and occurred in 10.7% (grade II) and 11.5% (grade IIIa) of cases. 35.1% of patients needed further treatment for bladder neck stricture. Regarding incontinence, 14.3%, 2.9% and 0% of patients had de novo urinary incontinence grade I°, II° and III° and 3.8% urge incontinence due to HIFU treatment. Patients were asked for the ability to have intercourse: 15.8%, 58.6% and 66.7% of patients after non-, onesided and bothsided nervesparing procedure were able to obtain sufficient erection for intercourse, respectively. Regarding quality of life, mean global health score according to QLQ-C30 was 69.4%. Conclusion HIFU treatment for localized prostate cancer shows acceptable oncological safety. Quality of life after HIFU is better than in the general population and ranges within those of standard treatment options compared to literature. HIFU seems a safe valuable treatment alternative for patients not suitable for standard treatment.
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Affiliation(s)
- G Hatiboglu
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - I V Popeneciu
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - M Deppert
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - J Nyarangi-Dix
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - B Hadaschik
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - M Hohenfellner
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - D Teber
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - S Pahernik
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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Hatiboglu G, Hohenfellner M, Arslan A, Hadaschik B, Teber D, Radtke JP, Hallscheidt P, Tolstov Y, Roth W, Grüllich C, Huesing J, Duensing S, Pahernik S. Effective downsizing but enhanced intratumoral heterogeneity following neoadjuvant sorafenib in patients with non-metastatic renal cell carcinoma. Langenbecks Arch Surg 2016; 402:637-644. [PMID: 28012035 DOI: 10.1007/s00423-016-1543-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 12/15/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To evaluate the safety and feasibility of sorafenib prior to surgery for downsizing tumors in patients with non-metastatic cT1-3 renal tumors together with a characterization of functional intratumoral heterogeneity (ITH). MATERIALS AND METHODS The effects of 4-week sorafenib prior to curative surgery were assessed in a prospective, single-center, randomized, placebo-controlled, double-blinded, pilot trial in patients with T1-3N0M0 renal cell carcinoma (RCC). Patients received sorafenib or placebo for 28 days prior to surgery. MRI was performed at baseline and prior to surgery to calculate tumor volume. The clinical responses were further characterized on the molecular level by immunohistochemical stainings for Ki-67, cleaved caspase-3, and CD31. RESULTS After enrolling 20 patients into the study, 14 patients were randomized, of which 12 patients were available for analysis. While no significant change in tumor volume was seen for placebo (range = -24.2-0.2%) a reduction of 29.0% (range = -4.9-61.1%) was detected for sorafenib (p < 0.05). Primary renal tumor diameter changed from 10.6 cm (range = 6.5-10.8) to 10.7 cm (range = 6.7-11.1) in the placebo group, and from 5.4 cm (range = 4.3-7.3) to 4.4 cm (range = 3.5-6.8) for the sorafenib group, at baseline vs. 28 days of treatment. Correlative assessment of proliferation, apoptosis, and microvessel density revealed an enhanced degree of functional ITH in treated patients suggesting adaptive and/or regenerative processes with potential relevance for the development of drug resistance. CONCLUSIONS Sorafenib in standard dosage, given preoperatively for 28 days, was clinically active in downsizing tumors in patients with locally confined, non-metastatic RCC together but led to an enhanced functional ITH in the residual tumor tissue.
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Affiliation(s)
- Gencay Hatiboglu
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Markus Hohenfellner
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Aysenur Arslan
- Molecular Urooncology, Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - Boris Hadaschik
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Dogu Teber
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Jan Philipp Radtke
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Peter Hallscheidt
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | - Yanis Tolstov
- Molecular Urooncology, Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - Wilfried Roth
- Institute for Pathology, University of Heidelberg, Heidelberg, Germany
| | - Carsten Grüllich
- Medical Oncology, National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Johannes Huesing
- Coordination Centre for Clinical Trials, University of Heidelberg, Heidelberg, Germany
| | - Stefan Duensing
- Molecular Urooncology, Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - Sascha Pahernik
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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Gözen AS, Badawy H, Teber D, Assem A, Rassweiler J. Outcome of laparoscopic upper pole heminephroureterectomy in children: A two-centre experience. Arab J Urol 2016; 14:287-291. [PMID: 27900219 PMCID: PMC5122799 DOI: 10.1016/j.aju.2016.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/07/2016] [Accepted: 08/09/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To report our multicentre experience and outcomes with laparoscopic transperitoneal and retroperitoneal upper pole heminephroureterectomy (HNU) in children with renal duplex systems and impaired upper pole. PATIENTS AND METHODS Laparoscopic HNU was performed in 22 children (15 girls, seven boys) with a mean age of 5.9 years. A retroperitoneal approach was used in 17 patients and a transperitoneal approach in the remaining five, between 2005 and 2010. Urinary tract infection was the initial presenting symptom in all children except for one with urinary retention caused by a large ureterocele. Voiding cystourethrography and renal scintigraphy revealed dual collecting systems on the right side in 11 and on the left in 11 cases. The upper pole collecting system was non-functioning in all cases. Postoperative ultrasonography was done at 1 and 3 months, with renal scintigraphy at 3 months, to check the remaining function of the lower moiety. RESULTS Overall, the mean operation time was 152 min (144 min for retroperitoneal and 160 min for transperitoneal). Blood loss was 10-50 mL and there were no intraoperative complications. The mean (SD) hospitalisation and postoperative follow-up were 3.5 (1.25) days and 22 (9.83) months, respectively. Postoperative recovery was uneventful and at the 3-month follow-up renal scintigraphy revealed no parenchymal loss of the remaining renal moiety. CONCLUSION Laparoscopic HNU in children can be performed via transperitoneal or retroperitoneal approach, both with low morbidity and with the typical benefits of laparoscopic surgery.
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Affiliation(s)
- Ali Serdar Gözen
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Haytham Badawy
- Unit of Pediatric Urology, Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Dogu Teber
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Akram Assem
- Unit of Pediatric Urology, Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Jens Rassweiler
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
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Simpfendörfer T, Li Z, Gasch C, Drosdzol F, Fangerau M, Müller M, Maier-Hein L, Hohenfellner M, Teber D. Three-Dimensional Reconstruction of Preoperative Imaging Improves Surgical Success in Laparoscopy. J Laparoendosc Adv Surg Tech A 2016; 27:181-185. [PMID: 27912031 DOI: 10.1089/lap.2016.0424] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To show the benefit of three-dimensional (3D) reconstructions of preoperative imaging for surgical performance. METHODS A laparoscopic training environment with 15 hidden lymph nodes was designed. Three of them were marked with radiographic contrast agent and were only distinguishable from unmarked nodes via CT imaging. Thirty-six surgeons were divided into two groups. To group 1 the unprocessed CT data were shown. Group 2 was additionally shown a 3D reconstruction of the anatomy. Time of studying the imaging was recorded. All surgeons had to find the three target lymph nodes laparoscopically. Time to fulfill this task and errors was measured. Afterward, the 3D reconstruction was also shown to group 1. Then, all participants completed a questionnaire. Furthermore, 3D reconstructions were used in 15 clinical cases of partial nephrectomy or lymphadenectomy, and surgeons' opinion was evaluated with an additional questionnaire. The imaging and 3D reconstructions were available on a mobile device. RESULTS The time of studying the imaging to gain confidence was significantly shorter with the 3D reconstruction. Laparoscopic intervention time was shortened and errors were reduced significantly within group 2. The clinical application of 3D reconstructions in difficult cases was believed to be helpful. CONCLUSIONS 3D reconstructions of preoperative imaging lead to better surgical performance in a difficult laparoscopic training environment. Surgeons gain a 3D impression of patients' individual anatomy easier, faster, and more reliable. Providing 3D reconstructions previous to surgery should be routinely implemented for patients with complex anatomical situations.
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Affiliation(s)
| | - Ziyao Li
- 1 Department of Urology, University of Heidelberg , Heidelberg, Germany .,2 Department of Urology, First Affiliated Hospital of Dalian Medical University , Dalian, China
| | - Claudia Gasch
- 1 Department of Urology, University of Heidelberg , Heidelberg, Germany
| | - Frederik Drosdzol
- 3 Computer-Assisted Interventions, German Cancer Research Center (DKFZ) , Heidelberg, Germany
| | - Markus Fangerau
- 3 Computer-Assisted Interventions, German Cancer Research Center (DKFZ) , Heidelberg, Germany
| | | | - Lena Maier-Hein
- 3 Computer-Assisted Interventions, German Cancer Research Center (DKFZ) , Heidelberg, Germany
| | | | - Dogu Teber
- 1 Department of Urology, University of Heidelberg , Heidelberg, Germany
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Du Y, Pahernik S, Hadaschik B, Teber D, Duensing S, Jäger D, Hohenfellner M, Grüllich C. Survival and prognostic factors of patients with renal cell cancer with bone metastasis in the era of targeted therapy: A single-institution analysis. Urol Oncol 2016; 34:433.e1-8. [DOI: 10.1016/j.urolonc.2016.05.017] [Citation(s) in RCA: 15] [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: 02/16/2016] [Revised: 04/17/2016] [Accepted: 05/16/2016] [Indexed: 12/23/2022]
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Simpfendörfer T, Gasch C, Hatiboglu G, Müller M, Maier-Hein L, Hohenfellner M, Teber D. Intraoperative Computed Tomography Imaging for Navigated Laparoscopic Renal Surgery: First Clinical Experience. J Endourol 2016; 30:1105-1111. [PMID: 27530774 DOI: 10.1089/end.2016.0385] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Laparoscopic partial nephrectomy (LPN) remains challenging in endophytic and complex kidney tumors as the clear understanding of tumor location and spreading depends on a precise analysis of available imaging. The purpose of this study was to investigate navigated kidney surgery using intraoperative cone-beam computed tomography (CBCT) images in conjunction with a previously proposed method for augmented reality (AR) guidance for safe LPN. MATERIALS AND METHODS The concept proposed is based on using an intraoperative CBCT scan for (1) marker-based AR guidance for fast and reliable tumor access and (2) enhancement of real-time fluoroscopy images for accurate tumor resection. Workflow and accuracy of the system were assessed using a porcine kidney model. Ten patients with complex or endophytic tumor localization and R.E.N.A.L. Nephrometry Score of at least nine scheduled for LPN were included in this study. Patients received an intraoperative CBCT after marker placement. Defining the resection line was assisted by AR. In addition, fluoroscopy imaging for depth perception was used for assistance during dissection. Feasibility and performance were assessed by histopathological results, peri- and postoperative data. RESULTS Surgery was performed successfully and negative margins were found in all cases. Segmental branches of the renal artery shifted as much as 10 mm in the vertical and 11 mm in the sagittal axis intraoperatively compared to preoperative imaging. Fluoroscopy to intraoperative computed tomography image fusion enabled enhanced depth perception during dissection in all cases. Radiation dose area product was 4.8 mGym2. CONCLUSIONS The application of the navigation system is feasible and allows for safe and direct access to complex or endophytic renal masses. Radiation limits the application to selected indications.
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Affiliation(s)
| | - Claudia Gasch
- 1 Department of Urology, University of Heidelberg , Heidelberg, Germany
| | - Gencay Hatiboglu
- 1 Department of Urology, University of Heidelberg , Heidelberg, Germany
| | | | - Lena Maier-Hein
- 3 Junior Group Computer-Assisted Interventions, German Cancer Research Center (DKFZ) , Heidelberg, Germany
| | | | - Dogu Teber
- 1 Department of Urology, University of Heidelberg , Heidelberg, Germany
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Du Y, Pahernik S, Hadaschik B, Teber D, Duensing S, Jäger D, Hohenfellner M, Grüllich C. Impact of resection and systemic therapy on the survival of patients with brain metastasis of metastatic renal cell carcinoma. J Neurooncol 2016; 130:221-228. [DOI: 10.1007/s11060-016-2238-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/09/2016] [Indexed: 12/22/2022]
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Hoefflin R, Lahrmann B, Warsow G, Hübschmann D, Spath C, Walter B, Chen X, Hofer L, Macher-Goeppinger S, Tolstov Y, Korzeniewski N, Duensing A, Grüllich C, Jäger D, Perner S, Schönberg G, Nyarangi-Dix J, Isaac S, Hatiboglu G, Teber D, Hadaschik B, Pahernik S, Roth W, Eils R, Schlesner M, Sültmann H, Hohenfellner M, Grabe N, Duensing S. Spatial niche formation but not malignant progression is a driving force for intratumoural heterogeneity. Nat Commun 2016; 7:ncomms11845. [PMID: 27291893 PMCID: PMC4910022 DOI: 10.1038/ncomms11845] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 01/21/2016] [Accepted: 05/04/2016] [Indexed: 01/19/2023] Open
Abstract
Intratumoural heterogeneity (ITH) is a major cause of cancer-associated lethality. Extensive genomic ITH has previously been reported in clear cell renal cell carcinoma (ccRCC). Here we address the question whether ITH increases with malignant progression and can hence be exploited as a prognostic marker. Unexpectedly, precision quantitative image analysis reveals that the degree of functional ITH is virtually identical between primary ccRCCs of the lowest stage and advanced, metastatic tumours. Functional ITH was found to show a stage-independent topological pattern with peak proliferative and signalling activities almost exclusively in the tumour periphery. Exome sequencing of matching peripheral and central primary tumour specimens reveals various region-specific mutations. However, these mutations cannot directly explain the zonal pattern suggesting a role of microenvironmental factors in shaping functional ITH. In conclusion, our results indicate that ITH is an early and general characteristic of malignant growth rather than a consequence of malignant progression. It has been increasingly recognised that tumours are not made up of a homogeneous population of cells. Here, the authors show heterogeneous expression of five protein markers in renal cell cancer and demonstrate that the progression of the tumour does not influence the degree of heterogeneity in the tumour.
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Affiliation(s)
- Rouven Hoefflin
- Section of Molecular Urooncology, Department of Urology, University of Heidelberg School of Medicine, Medical Faculty Heidelberg, Im Neuenheimer Feld 517, D-69120 Heidelberg, Germany
| | - Bernd Lahrmann
- Hamamatsu Tissue Imaging and Analysis (TIGA) Center, BioQuant, University of Heidelberg, Im Neuenheimer Feld 267, D-60120 Heidelberg, Germany
| | - Gregor Warsow
- Division of Theoretical Bioinformatics (B080), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany
| | - Daniel Hübschmann
- Division of Theoretical Bioinformatics (B080), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany.,Department for Bioinformatics and Functional Genomics, Institute for Pharmacy and Molecular Biotechnology (IPMB) and BioQuant, University of Heidelberg, Im Neuenheimer Feld 267, D-69120 Heidelberg, Germany.,Department of Pediatric Immunology, Hematology and Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 430, D-69120 Heidelberg, Germany
| | - Cathleen Spath
- National Center for Tumor Diseases, Department of Medical Oncology, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Britta Walter
- Department of Pathology, University of Heidelberg School of Medicine, Im Neuenheimer Feld 224, D-69120 Heidelberg, Germany
| | - Xin Chen
- Section of Molecular Urooncology, Department of Urology, University of Heidelberg School of Medicine, Medical Faculty Heidelberg, Im Neuenheimer Feld 517, D-69120 Heidelberg, Germany
| | - Luisa Hofer
- Department of Urology, University of Heidelberg School of Medicine, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.,Center for Kidney Tumors, National Center for Tumor Diseases and University of Heidelberg School of Medicine, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Stephan Macher-Goeppinger
- Department of Pathology, University of Heidelberg School of Medicine, Im Neuenheimer Feld 224, D-69120 Heidelberg, Germany
| | - Yanis Tolstov
- Section of Molecular Urooncology, Department of Urology, University of Heidelberg School of Medicine, Medical Faculty Heidelberg, Im Neuenheimer Feld 517, D-69120 Heidelberg, Germany
| | - Nina Korzeniewski
- Section of Molecular Urooncology, Department of Urology, University of Heidelberg School of Medicine, Medical Faculty Heidelberg, Im Neuenheimer Feld 517, D-69120 Heidelberg, Germany
| | - Anette Duensing
- University of Pittsburgh Cancer Institute, Cancer Therapeutics Program, 5117 Centre Avenue, Pittsburgh, Pennsylvania 15232, USA
| | - Carsten Grüllich
- National Center for Tumor Diseases, Department of Medical Oncology, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany.,Center for Kidney Tumors, National Center for Tumor Diseases and University of Heidelberg School of Medicine, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Dirk Jäger
- National Center for Tumor Diseases, Department of Medical Oncology, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany.,Center for Kidney Tumors, National Center for Tumor Diseases and University of Heidelberg School of Medicine, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Sven Perner
- Institute of Pathology, University Hospital Lübeck and Leibniz Research Center Borstel, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Gita Schönberg
- Department of Urology, University of Heidelberg School of Medicine, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.,Center for Kidney Tumors, National Center for Tumor Diseases and University of Heidelberg School of Medicine, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Joanne Nyarangi-Dix
- Department of Urology, University of Heidelberg School of Medicine, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.,Center for Kidney Tumors, National Center for Tumor Diseases and University of Heidelberg School of Medicine, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Sanjay Isaac
- National Center for Tumor Diseases, Department of Medical Oncology, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany.,Center for Kidney Tumors, National Center for Tumor Diseases and University of Heidelberg School of Medicine, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Gencay Hatiboglu
- Department of Urology, University of Heidelberg School of Medicine, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.,Center for Kidney Tumors, National Center for Tumor Diseases and University of Heidelberg School of Medicine, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Dogu Teber
- Department of Urology, University of Heidelberg School of Medicine, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.,Center for Kidney Tumors, National Center for Tumor Diseases and University of Heidelberg School of Medicine, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Boris Hadaschik
- Department of Urology, University of Heidelberg School of Medicine, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.,Center for Kidney Tumors, National Center for Tumor Diseases and University of Heidelberg School of Medicine, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Sascha Pahernik
- Department of Urology, University of Heidelberg School of Medicine, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.,Center for Kidney Tumors, National Center for Tumor Diseases and University of Heidelberg School of Medicine, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Wilfried Roth
- Department of Pathology, University of Heidelberg School of Medicine, Im Neuenheimer Feld 224, D-69120 Heidelberg, Germany
| | - Roland Eils
- Division of Theoretical Bioinformatics (B080), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany.,Department for Bioinformatics and Functional Genomics, Institute for Pharmacy and Molecular Biotechnology (IPMB) and BioQuant, University of Heidelberg, Im Neuenheimer Feld 267, D-69120 Heidelberg, Germany
| | - Matthias Schlesner
- Division of Theoretical Bioinformatics (B080), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany
| | - Holger Sültmann
- National Center for Tumor Diseases, German Cancer Research Center, Division of Cancer Genome Research, German Cancer Consortium (DKTK), Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University of Heidelberg School of Medicine, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.,Center for Kidney Tumors, National Center for Tumor Diseases and University of Heidelberg School of Medicine, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Niels Grabe
- Hamamatsu Tissue Imaging and Analysis (TIGA) Center, BioQuant, University of Heidelberg, Im Neuenheimer Feld 267, D-60120 Heidelberg, Germany
| | - Stefan Duensing
- Section of Molecular Urooncology, Department of Urology, University of Heidelberg School of Medicine, Medical Faculty Heidelberg, Im Neuenheimer Feld 517, D-69120 Heidelberg, Germany.,Department of Urology, University of Heidelberg School of Medicine, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.,Center for Kidney Tumors, National Center for Tumor Diseases and University of Heidelberg School of Medicine, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
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38
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Simpfendörfer T, Hatiboglu G, Hadaschik BA, Wild E, Maier-Hein L, Rassweiler MC, Rassweiler J, Hohenfellner M, Teber D. [Navigation in urological surgery: Possibilities and limits of current techniques]. Urologe A 2016; 54:709-15. [PMID: 25572970 DOI: 10.1007/s00120-014-3709-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Surgical navigation describes the concept of real-time processing and presentation of preoperative and intraoperative data from different sources to intraoperatively provide surgeons with additional cognitive support. Imaging methods such as 3D ultrasound, magnetic resonance imaging (MRI) and computed tomography (CT) and data from optical, electromagnetic or mechanical tracking methods are used. The resulting information of the navigation system will be presented by the means of visual methods. Mostly virtual reality or augmented reality visualization is used. There are different guidance systems for various disciplines introduced. Mostly it operates on rigid structures (bone, brain). For soft tissue navigation motion compensation and deformation detection are necessary. Therefore, marker-based tracking methods are used in several urological application examples; however, the systems are often still under development and have not yet arrived in the clinical routine.
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Affiliation(s)
- T Simpfendörfer
- Urologische Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland,
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39
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Höfflin R, Roth W, Sültmann H, Grüllich C, Hatiboglu G, Nyarangi-Dix J, Schönberg G, Teber D, Hadaschik B, Pahernik S, Hohenfellner M, Duensing S. [Intratumoral heterogeneity in renal cell carcinoma. Molecular basis and translational implications]. Urologe A 2016; 54:800-3. [PMID: 25758237 DOI: 10.1007/s00120-015-3800-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Advanced clear cell renal cell carcinoma is characterized by extensive intratumoral genomic heterogeneity and branched as well as convergent evolutionary traits with genomically different subclones evolving in parallel in the same tumor. Distinct driver mutations can be found in spatially separated subclones, which may hinder the development of novel targeted therapies. However, truncal mutations of the VHL tumor suppressor gene and chromosome 3p loss were ubiquitously detected and will hence continue to be a focus of future drug development. Nevertheless, genomic instability, enhanced tumor genome plasticity and intratumoral heterogeneity are likely to represent major challenges towards biomarker development and personalized patient care.
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Affiliation(s)
- R Höfflin
- Sektion Molekulare Uroonkologie, Urologische Universitätsklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 517, 69120, Heidelberg, Deutschland
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40
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Radtke JP, Teber D, Hohenfellner M, Hadaschik BA. The current and future role of magnetic resonance imaging in prostate cancer detection and management. Transl Androl Urol 2016; 4:326-41. [PMID: 26816833 PMCID: PMC4708229 DOI: 10.3978/j.issn.2223-4683.2015.06.05] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose Accurate detection of clinically significant prostate cancer (PC) and correct risk attribution are essential to individually counsel men with PC. Multiparametric MRI (mpMRI) facilitates correct localization of index lesions within the prostate and MRI-targeted prostate biopsy (TPB) helps to avoid the shortcomings of conventional biopsy such as false-negative results or underdiagnosis of aggressive PC. In this review we summarize the different sequences of mpMRI, characterize the possibilities of incorporating MRI in the biopsy workflow and outline the performance of targeted and systematic cores in significant cancer detection. Furthermore, we outline the potential of MRI in patients undergoing active surveillance (AS) and in the pre-operative setting. Materials and methods An electronic MEDLINE/PubMed search up to February 2015 was performed. English language articles were reviewed for inclusion ability and data were extracted, analyzed and summarized. Results Targeted biopsies significantly outperform conventional systematic biopsies in the detection of significant PC and are not inferior when compared to transperineal saturation biopsies. MpMRI can detect index lesions in app. 90% of cases as compared to prostatectomy specimen. The diagnostic performance of biparametric MRI (T2w + DWI) is not inferior to mpMRI, offering options to diminish cost- and time-consumption. Since app 10% of significant lesions are still MRI-invisible, systematic cores seem to be necessary. In-bore biopsy and MRI/TRUS-fusion-guided biopsy tend to be superior techniques compared to cognitive fusion. In AS, mpMRI avoids underdetection of significant PC and confirms low-risk disease accurately. In higher-risk disease, pre-surgical MRI can change the clinically-based surgical plan in up to a third of cases. Conclusions mpMRI and targeted biopsies are able to detect significant PC accurately and mitigate insignificant PC detection. As long as the negative predictive value (NPV) is still imperfect, systematic cores should not be omitted for optimal staging of disease. The potential to correctly classify aggressiveness of disease in AS patients and to guide and plan prostatectomy is evolving.
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Affiliation(s)
- Jan Philipp Radtke
- 1 Department of Urology, Heidelberg University Hospital, Heidelberg, Germany ; 2 Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Dogu Teber
- 1 Department of Urology, Heidelberg University Hospital, Heidelberg, Germany ; 2 Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Markus Hohenfellner
- 1 Department of Urology, Heidelberg University Hospital, Heidelberg, Germany ; 2 Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Boris A Hadaschik
- 1 Department of Urology, Heidelberg University Hospital, Heidelberg, Germany ; 2 Department of Radiology, German Cancer Research Center, Heidelberg, Germany
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41
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Radtke JP, Hadaschik BA, Wolf MB, Freitag MT, Schwab C, Alt C, Roth W, Duensing S, Pahernik SA, Roethke MC, Schlemmer HP, Hohenfellner M, Teber D. The Impact of Magnetic Resonance Imaging on Prediction of Extraprostatic Extension and Prostatectomy Outcome in Patients with Low-, Intermediate- and High-Risk Prostate Cancer: Try to Find a Standard. J Endourol 2015; 29:1396-405. [DOI: 10.1089/end.2015.0358] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Jan Philipp Radtke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Boris A. Hadaschik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Maya B. Wolf
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin T. Freitag
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Constantin Schwab
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Wilfried Roth
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Duensing
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Sascha A. Pahernik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias C. Roethke
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | - Dogu Teber
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
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42
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AL-Shareef AH, Akin Y, Almouhissen T, Rassweiler J, Alshehri MS, Gözen AS, Teber D. Effects of Previous Hernia Repair on Extraperitoneal Robot-Assisted Radical Prostatectomy: A Matched-Pair Analysis Study. J Endourol 2015; 29:1143-7. [DOI: 10.1089/end.2015.0112] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ahmed H. AL-Shareef
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Yigit Akin
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Turky Almouhissen
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Jens Rassweiler
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | | | - Ali Serdar Gözen
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Dogu Teber
- Department of Urology, University Hospital of Heidelberg, Heidelberg, Germany
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43
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Albisinni S, Oderda M, Fossion L, Varca V, Rassweiler J, Cathelineau X, Chlosta P, De la Taille A, Gaboardi F, Piechaud T, Rimington P, Salomon L, Sanchez-Salas R, Stolzenburg JU, Teber D, Van Velthoven R. The morbidity of laparoscopic radical cystectomy: analysis of postoperative complications in a multicenter cohort by the European Association of Urology (EAU)-Section of Uro-Technology. World J Urol 2015; 34:149-56. [PMID: 26135307 DOI: 10.1007/s00345-015-1633-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 04/03/2015] [Accepted: 06/24/2015] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To analyze postoperative complications after laparoscopic radical cystectomy (LRC) and evaluate its risk factors in a large prospective cohort built by the ESUT across European centers involved in minimally invasive urology in the last decade. METHODS Patients were prospectively enrolled, and data were retrospectively analyzed. Only oncologic cases were included. There were no formal contraindications for LRC: Also patients with locally advanced tumors (pT4a), serious comorbidities, and previous major abdominal surgery were enrolled. All procedures were performed via a standard laparoscopic approach, with no robotic assistance. Early and late postoperative complications were graded according to the modified Clavien-Dindo classification. Multivariate logistic regression was performed to explore possible risk factors for developing complications. RESULTS A total of 548 patients were available for final analysis, of which 258 (47%) experienced early complications during the first 90 days after LRC. Infectious, gastrointestinal, and genitourinary were, respectively, the most frequent systems involved. Postoperative ileus occurred in 51/548 (9.3%) patients. A total of 65/548 (12%) patients underwent surgical re-operation, and 10/548 (2%) patients died in the early postoperative period. Increased BMI (p = 0.024), blood loss (p = 0.021), and neoadjuvant treatment (p = 0.016) were significantly associated with a greater overall risk of experiencing complications on multivariate logistic regression. Long-term complications were documented in 64/548 (12%), and involved mainly stenosis of the uretero-ileal anastomosis or incisional hernias. CONCLUSIONS In this multicenter, prospective, large database, LRC appears to be a safe but morbid procedure. Standardized complication reporting should be encouraged to evaluate objectively a surgical procedure and permit comparison across studies.
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Affiliation(s)
- Simone Albisinni
- Department of Urology, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium. .,Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Boulevard de Waterloo 121, Brussels, Belgium.
| | - Marco Oderda
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Laurent Fossion
- Department of Urology, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - Virginia Varca
- Department of Urology, Ospedale Luigi Sacco, Milan, Italy
| | | | | | - Piotr Chlosta
- Department of Urology, Jagiellonian University, Kraków, Poland
| | | | | | - Thierry Piechaud
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Peter Rimington
- Department of Urology, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | | | | | | | - Dogu Teber
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - Roland Van Velthoven
- Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Boulevard de Waterloo 121, Brussels, Belgium
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Radtke JP, Müller-Wolf M, Freitag M, Schwab C, Hatiboglu G, Roth W, Roethke M, Schlemmer HP, Hohenfellner M, Hadaschik B, Teber D. PD46-10 STANDARDIZED MAGNETIC RESONANCE IMAGING READING FOR PREDICTION OF EXTRAPROSTATIC EXTENSION AND PROSTATECTOMY OUTCOME IN PATIENTS WITH LOW-, INTERMEDIATE- AND HIGH-RISK PROSTATE CANCER. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2741] [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: 10/23/2022]
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45
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Albisinni S, Rassweiler J, Abbou CC, Cathelineau X, Chlosta P, Fossion L, Gaboardi F, Rimington P, Salomon L, Sanchez-Salas R, Stolzenburg JU, Teber D, van Velthoven R. Long-term analysis of oncological outcomes after laparoscopic radical cystectomy in Europe: results from a multicentre study by the European Association of Urology (EAU) section of Uro-technology. BJU Int 2014; 115:937-45. [DOI: 10.1111/bju.12947] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Simone Albisinni
- Department of Urology; Hopital Erasme; Brussels Belgium
- Department of Urology; Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | | | | | | | - Piotr Chlosta
- Department of Urology; Jagiellonian University; Krakow Poland
| | - Laurent Fossion
- Department of Urology; Maxima Medisch Centrum; Eindhoven The Netherlands
| | | | - Peter Rimington
- Department of Urology; East Sussex Healthcare NHS Trust; Eastbourne UK
| | | | | | | | - Dogu Teber
- Department of Urology; University of Heidelberg; Heidelberg Germany
| | - Roland van Velthoven
- Department of Urology; Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
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46
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Hatiboglu G, Huber J, Herpel E, Popeneciu IV, Nyarangi-Dix J, Teber D, Hadaschik BA, Pahernik S, Duensing S, Hohenfellner M. [Structure of biobanks for urological research]. Urologe A 2014; 54:1256-60. [PMID: 25503899 DOI: 10.1007/s00120-014-3722-y] [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: 11/25/2022]
Abstract
Biomedical research plays an important role in the development of novel diagnostic procedures, drugs and treatment strategies with regard to cancerous and chronic inflammatory diseases. Biobanks are essential tools in this process. The complex structures and benefits of biobanks are presented in this article.
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Affiliation(s)
- G Hatiboglu
- Klinik und Poliklinik für Urologie, Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland,
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Kuru TH, Zhu J, Popeneciu IV, Rudhardt NS, Hadaschik BA, Teber D, Roethke M, Hohenfellner M, Zeier M, Pahernik SA. Volumetry may predict early renal function after nephron sparing surgery in solitary kidney patients. Springerplus 2014; 3:488. [PMID: 25202653 PMCID: PMC4156575 DOI: 10.1186/2193-1801-3-488] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/20/2014] [Indexed: 12/27/2022]
Abstract
We investigate the impact of the residual kidney volume measured by tumor volumetry on preoperative imaging in predicting post-operative renal function. Nephron sparing surgery (NSS) in renal cell carcinoma (RCC) is the standard treatment for T1 kidney tumors. Resection of kidney tumors in solidary kidneys needs precise preoperative counseling of patients regarding post-operative renal function. Patients planned for renal tumor surgery who underwent prior nephrectomy on the contralateral side were included. We identified 35 patients in our database that underwent NSS in solitary kidneys and met the inclusion criteria. Tumor volumetry was performed on computer tomography (CT) or magnetic resonance imaging (MRI) with the Medical Imaging Interaction Toolkit (MITK). Clinical and pathological data were assessed. Follow-up data included renal function over 3 years. Mean age was 64 ± 8.1 years. Mean tumor volume on imaging was 27.5 ± 48.6 cc. Mean kidney volume was 195.2 ± 62.8 cc and mean residual kidney volume was 173.4 ± 65.3 cc. We found a correlation between renal function (MDRD) and residual kidney volume on imaging 1-week post-surgery (p = 0.038). Mid- and long-term renal function was not associated with residual kidney volume. In conclusion, renal volumetry may predict early renal function after NSS.
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Affiliation(s)
- Timur H Kuru
- Department of Urology, UniversityHospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany ; Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Jie Zhu
- Department of Urology, UniversityHospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Ionel V Popeneciu
- Department of Urology, UniversityHospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Nora S Rudhardt
- Department of Urology, UniversityHospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Boris A Hadaschik
- Department of Urology, UniversityHospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Dogu Teber
- Department of Urology, UniversityHospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Matthias Roethke
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, UniversityHospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, UniversityHospital, Heidelberg, Germany
| | - Sascha A Pahernik
- Department of Urology, UniversityHospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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Schneider M, Schüler J, Höfflin R, Korzeniewski N, Grüllich C, Roth W, Teber D, Hadaschik B, Pahernik S, Hohenfellner M, Duensing S. Phenotypic drug screening and target validation for improved personalized therapy reveal the complexity of phenotype-genotype correlations in clear cell renal cell carcinoma. Urol Oncol 2014; 32:877-84. [PMID: 24929890 DOI: 10.1016/j.urolonc.2014.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/11/2014] [Accepted: 03/11/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Novel personalized therapeutic approaches are urgently needed for patients with metastatic clear cell renal cell carcinoma (ccRCC). METHODS AND MATERIALS We combined the development of a primary patient-derived ccRCC cell line with a phenotypic drug screen consisting of 101 approved anticancer compounds. RESULTS We identified the MNNG HOS transforming gene (MET)-anaplastic lymphoma receptor tyrosine kinase (ALK) inhibitor crizotinib as the top hit of our drug screen, whereas compounds targeting the vascular endothelial growth factor (VEGF) or mammalian target of rapamycin (mTOR) pathway showed no or only minor in vitro activity. Among the known major crizotinib targets MET, ALK, and ROS-1, only MET was expressed in our ccRCC cell line. Subsequent sequence analysis revealed a heterozygous R988C mutation of the MET gene and a VHL deletion in both the primary tumor and the tumor-derived ccRCC cell line. However, we were unable to show an activation of MET and, further, MET knockdown did not result in increased apoptosis or cytotoxicity. Therefore, our results suggest that MET R988C does not function as a major oncogenic driver mutation but rather represents a sequence variant. However, we provide evidence that the cytotoxic effect of crizotinib in our cell line model correlates with its ability to inhibit P-glycoprotein (ABCB1)-associated transport functions. CONCLUSIONS Our study shows that a phenotypic screen of a patient-derived tumor cell line can identify compounds with antitumor activity but with an unexpected mode of action. Our results underscore that target validation and phenotype-genotype correlations remain a major experimental challenge. The implications of our findings for a personalized management of patients with cancer are discussed.
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Affiliation(s)
- Meike Schneider
- Department of Urology, University of Heidelberg School of Medicine, Heidelberg, Germany; Molecular Urooncology, Department of Urology, University of Heidelberg School of Medicine, Heidelberg, Germany
| | | | - Rouven Höfflin
- Molecular Urooncology, Department of Urology, University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Nina Korzeniewski
- Molecular Urooncology, Department of Urology, University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Carsten Grüllich
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg, Germany; Center for Kidney Tumors, National Center for Tumor Disease and University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Wilfried Roth
- Center for Kidney Tumors, National Center for Tumor Disease and University of Heidelberg School of Medicine, Heidelberg, Germany; Department of Pathology, University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Dogu Teber
- Department of Urology, University of Heidelberg School of Medicine, Heidelberg, Germany; Center for Kidney Tumors, National Center for Tumor Disease and University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Boris Hadaschik
- Department of Urology, University of Heidelberg School of Medicine, Heidelberg, Germany; Center for Kidney Tumors, National Center for Tumor Disease and University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Sascha Pahernik
- Department of Urology, University of Heidelberg School of Medicine, Heidelberg, Germany; Center for Kidney Tumors, National Center for Tumor Disease and University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University of Heidelberg School of Medicine, Heidelberg, Germany; Center for Kidney Tumors, National Center for Tumor Disease and University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Stefan Duensing
- Department of Urology, University of Heidelberg School of Medicine, Heidelberg, Germany; Molecular Urooncology, Department of Urology, University of Heidelberg School of Medicine, Heidelberg, Germany; Center for Kidney Tumors, National Center for Tumor Disease and University of Heidelberg School of Medicine, Heidelberg, Germany.
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Hatiboglu G, Nyarangi-Dix J, Pahernik S, Teber D, Hadaschik B, Hohenfellner M. MP46-20 “RISK FACTORS” FOR IMMEDIATE CONTINENCE AFTER RADICAL PROSTATECTOMY. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Huber J, Teber D, Hatiboglu G, Popeneciu V, Jakobi H, Hallscheidt P, Pahernik S, Hohenfellner M. Does a venous tumor thrombus exclude renal transitional cell carcinoma? Implications for neo-adjuvant treatment strategies. Anticancer Res 2014; 34:1031-1035. [PMID: 24511051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND A venous tumor thrombus (VTT) is well-known in renal cell carcinoma, but we experienced a series of five patients with VTT due to renal transitional cell carcinoma (TCC). Our study aimed to determine the incidence and clinical relevance of this entity. PATIENTS AND METHODS From our prospectively-maintained tumor database, we identified 102 patients with renal TCC according to postoperative histology and analyzed the incidence of VTT in renal TCC from 1990 to 2010. RESULTS Five out of 102 patients with TCC (5%) had a VTT. None of these five patients experienced gross haematuria and we presumed correct diagnosis preoperatively in one out of five patients. Univariate analysis revealed that TNM stage and resection status were inferior in the VTT group. All five patients from the VTT group died from their disease, with a median survival of 8.9 months. With regard to all diagnosed VTT, the effective incidence of vena cava involvement in RCC was 48-fold higher than in renal TCC. CONCLUSION A VTT is very suggestive of renal cell carcinoma. However, before neo-adjuvant treatment, the diagnosis should be assured whenever there is doubt.
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Affiliation(s)
- Johannes Huber
- Department of Urology, Medical Faculty Carl Gustav Carus, TU of Dresden, Fetscherstr. 74, D-01307 Dresden, Germany.
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