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Gerald T, Joshi E, Gold SA, Woldu SL, Meng X, Bagrodia A, Gaston K, Margulis V. Impact of pathologic features on local recurrence in penile squamous cell carcinoma after penectomy. Surg Oncol 2024; 54:102066. [PMID: 38581916 DOI: 10.1016/j.suronc.2024.102066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/06/2024] [Accepted: 03/13/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Penile squamous cell carcinoma (PSCC) is a rare malignancy that may be cured in cases of local disease by resection of the primary tumor. Risk factors and patterns of local recurrence (LR) have not been well described in cases requiring partial or radical penectomy. In this study, we evaluated risk factors for LR and the impact of frozen and final margin assessment. MATERIALS AND METHODS We evaluated 119 patients with PSCC who had undergone partial or radical penectomy from 2007 to 2023. Data regarding clinical and pathologic features were collected by retrospective chart review. The primary outcome of interest was LR. Determinants of LR were analyzed by Student's t, Fisher's exact, chi-square and logistic regression analysis. Predictive statistics of frozen margin status on final margin were assessed and LR rates for subsets of frozen and final margin interaction were defined. Finally, all cases of positive margins and LR were described to highlight patterns of LR and the importance of margin status in these cases. RESULTS There were 8 (6.7%) cases of local recurrence. There were no significant predictors of LR, although a trend toward increased LR risk was observed among those with a positive final margin. Positive final margins were found in 15 (13%) cases. Frozen margin analysis was utilized in 79 cases, of which 10 (13%) were positive. The sensitivity, specificity, positive predictive value, and negative predictive value of frozen margin status for final margins were 44%, 92%, 40%, and 93%, respectively. There were no LR among cases in which frozen margin was not sent. Analysis of all cases with positive margin and/or LR identified three subsets of patients: CIS or focally positive margin resulting in either no LR or LR managed with minimal local intervention, bulky disease in which survival is determined by response to subsequent therapy rather than local recurrence, and clinically significant local recurrence requiring continued surveillance and intervention despite negative margins. CONCLUSIONS LR is rare, even in cases of larger, proximal tumors requiring partial or radical penectomy. In this study, no statistically significant risk factors for local recurrence were identified; however, analysis of frozen and final margins provided insight into the importance of margin status and patterns of local recurrence. When feasible, visibly intra-operative negative margins are an excellent predictor of low risk for LR, and, in cases of CIS or focally positive margins, further resection to achieve negative margins is unlikely to reduce the risk of clinically significant LR. Additionally, in cases of bulky disease, the goals of resection should be focused toward palliation and next line therapy.
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Affiliation(s)
- Thomas Gerald
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Eshan Joshi
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Samuel A Gold
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Solomon L Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Xiaosong Meng
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aditya Bagrodia
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Kris Gaston
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Bhattacharyay S, Rattray J, Wang M, Dziedzic PH, Calvillo E, Kim HB, Joshi E, Kudela P, Etienne-Cummings R, Stevens RD. Author Correction: Decoding accelerometry for classification and prediction of critically ill patients with severe brain injury. Sci Rep 2022; 12:1009. [PMID: 35027666 PMCID: PMC8758670 DOI: 10.1038/s41598-022-05237-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Shubhayu Bhattacharyay
- Laboratory of Computational Intensive Care Medicine, Johns Hopkins University, Baltimore, MD, USA. .,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK. .,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA. .,Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA.
| | - John Rattray
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew Wang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Peter H Dziedzic
- Laboratory of Computational Intensive Care Medicine, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Eusebia Calvillo
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Han B Kim
- Laboratory of Computational Intensive Care Medicine, Johns Hopkins University, Baltimore, MD, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Eshan Joshi
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Pawel Kudela
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Ralph Etienne-Cummings
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Robert D Stevens
- Laboratory of Computational Intensive Care Medicine, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
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Bhattacharyay S, Rattray J, Wang M, Dziedzic PH, Calvillo E, Kim HB, Joshi E, Kudela P, Etienne-Cummings R, Stevens RD. Decoding accelerometry for classification and prediction of critically ill patients with severe brain injury. Sci Rep 2021; 11:23654. [PMID: 34880296 PMCID: PMC8654973 DOI: 10.1038/s41598-021-02974-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/25/2021] [Indexed: 11/23/2022] Open
Abstract
Our goal is to explore quantitative motor features in critically ill patients with severe brain injury (SBI). We hypothesized that computational decoding of these features would yield information on underlying neurological states and outcomes. Using wearable microsensors placed on all extremities, we recorded a median 24.1 (IQR: 22.8-25.1) hours of high-frequency accelerometry data per patient from a prospective cohort (n = 69) admitted to the ICU with SBI. Models were trained using time-, frequency-, and wavelet-domain features and levels of responsiveness and outcome as labels. The two primary tasks were detection of levels of responsiveness, assessed by motor sub-score of the Glasgow Coma Scale (GCSm), and prediction of functional outcome at discharge, measured with the Glasgow Outcome Scale-Extended (GOSE). Detection models achieved significant (AUC: 0.70 [95% CI: 0.53-0.85]) and consistent (observation windows: 12 min-9 h) discrimination of SBI patients capable of purposeful movement (GCSm > 4). Prediction models accurately discriminated patients of upper moderate disability or better (GOSE > 5) with 2-6 h of observation (AUC: 0.82 [95% CI: 0.75-0.90]). Results suggest that time series analysis of motor activity yields clinically relevant insights on underlying functional states and short-term outcomes in patients with SBI.
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Affiliation(s)
- Shubhayu Bhattacharyay
- Laboratory of Computational Intensive Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA.
| | - John Rattray
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew Wang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Peter H Dziedzic
- Laboratory of Computational Intensive Care Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Eusebia Calvillo
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Han B Kim
- Laboratory of Computational Intensive Care Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Eshan Joshi
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Pawel Kudela
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Ralph Etienne-Cummings
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Robert D Stevens
- Laboratory of Computational Intensive Care Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
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Joshi E, Scalia G, Holt G, Fitzgerald B. Lifting the Curtain on Takotsubo Cardiomyopathy Revelations from the Takotsubo Index. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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