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Scheipner L, Tappero S, Piccinelli ML, Barletta F, Garcia CC, Incesu RB, Morra S, Baudo A, Tian Z, Saad F, Shariat SF, Terrone C, De Cobelli O, Briganti A, Chun FKH, Tilki D, Longo N, Carmignani L, Pichler M, Hutterer G, Ahyai S, Karakiewicz PI. Regional differences in clear cell metastatic renal cell carcinoma patients across the USA. World J Urol 2023; 41:2991-3000. [PMID: 37755519 PMCID: PMC10632241 DOI: 10.1007/s00345-023-04589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 08/20/2023] [Indexed: 09/28/2023] Open
Abstract
PURPOSE To test for regional differences in clear cell metastatic renal cell carcinoma (ccmRCC) patients across the USA. METHODS The Surveillance, Epidemiology, and End Results (SEER) database (2000-2018) was used to tabulate patient (age at diagnosis, sex, race/ethnicity), tumor (N stage, sites of metastasis) and treatment characteristics (proportions of nephrectomy and systemic therapy), according to 12 SEER registries. Multinomial regression models, as well as multivariable Cox regression models, tested the overall mortality (OM) adjusting for those patient, tumor and treatment characteristics. RESULTS In 9882 ccmRCC patients, registry-specific patient counts ranged from 4025 (41%) to 189 (2%). Differences across registries existed for sex (24-36% female), race/ethnicity (1-75% non-Caucasian), N stage (N1 25-35%, NX 3-13%), proportions of nephrectomy (44-63%) and systemic therapy (41-56%). Significant inter-registry differences remained after adjustment for proportions of nephrectomy (46-63%) and systemic therapy (35-56%). Unadjusted 5-year OM ranged from 73 to 85%. In multivariable analyses, three registries exhibited significantly higher OM (SEER registry 5: hazard ratio (HR) 1.20, p = 0.0001; SEER registry 7:HR 1.15, p = 0.008M SEER registry 10: HR 1.15, p = 0.04), relative to the largest reference registry (n = 4025). CONCLUSION Important regional differences including patient, tumor and treatment characteristics exist, when ccmRCC patients included in the SEER database are studied. Even after adjustment for these characteristics, important OM differences persisted, which may require more detailed analyses to further investigate these unexpected differences.
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Affiliation(s)
- Lukas Scheipner
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
- Department of Urology, Medical University of Graz, Auenbruggerpl. 1, 8036, Graz, Austria.
| | - Stefano Tappero
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Department of Urology, IRCCS Policlinico San Martino, Genoa, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy
| | - Mattia Luca Piccinelli
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Università Degli Studi di Milano, Milan, Italy
| | - Francesco Barletta
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Cristina Cano Garcia
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Reha-Baris Incesu
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Morra
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy
| | - Andrea Baudo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Carlo Terrone
- Department of Urology, IRCCS Policlinico San Martino, Genoa, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy
| | - Ottavio De Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Haemato-Oncology, Università degli studi di Milano, 20122, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Nicola Longo
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Luca Carmignani
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy
- Department of Urology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Martin Pichler
- Department of Oncology, Medical University of Graz, Graz, Austria
- Department of Hematology and Oncology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Georg Hutterer
- Department of Urology, Medical University of Graz, Auenbruggerpl. 1, 8036, Graz, Austria
| | - Sascha Ahyai
- Department of Urology, Medical University of Graz, Auenbruggerpl. 1, 8036, Graz, Austria
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
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Sadoghi B, Kränke B, Komericki P, Hutterer G. Sexually transmitted pathogens causing urethritis: A mini-review and proposal of a clinically based diagnostic and therapeutic algorithm. Front Med (Lausanne) 2022; 9:931765. [PMID: 36091700 PMCID: PMC9459106 DOI: 10.3389/fmed.2022.931765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/03/2022] [Indexed: 12/03/2022] Open
Abstract
The purpose of this mini-review was to provide the latest information and concepts on diagnosis and treatment of the most common sexually transmitted pathogens causing urethritis. The incidence of several sexually transmitted infections that cause urethritis is increasing, and this genitourinary syndrome is among the most common reason young men see clinical care. The authors performed a literature search including the currently valid guidelines, and an overview of the most relevant pathogens is given. Moreover, the authors developed a clinically applicable diagnostic and therapeutic algorithm, because early diagnosis and correct treatment can sometimes prevent infected individuals from significant morbidity. Future research will focus on new methods to combat pathogens that cause urethritis, including vaccination.
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Affiliation(s)
- Birgit Sadoghi
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Birger Kränke
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Peter Komericki
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Georg Hutterer
- Department of Urology, Medical University of Graz, Graz, Austria
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3
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Yuan P, Sun X, Liu X, Hutterer G, Pummer K, Hager B, Ye Z, Chen Z. Kaempferol alleviates calcium oxalate crystal-induced renal injury and crystal deposition via regulation of the AR/NOX2 signaling pathway. Phytomedicine 2021; 86:153555. [PMID: 33852977 DOI: 10.1016/j.phymed.2021.153555] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/03/2021] [Accepted: 03/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Calcium oxalate (CaOx) crystal deposition and crystal-induced renal tubular epithelial cell injury have been found to fundamentally contribute to the formation of CaOx nephrolithiasis. PURPOSE In the current work, we aim to study the role and mechanism of kaempferol in CaOx crystal kidney deposition and crystal-induced renal injury. STUDY DESIGN Mice models and HK-2 cells were used to investigate the effect of kaempferol in CaOx crystal-induced renal injury and crystal deposition in the kidney and its underlying mechanism by a series of experiments. METHODS CaOx crystal deposition in mice renal tubulars and tubular damage were evaluated. And crystal adhesion to HK-2 cells, as well as cellular injury were identified. Furthermore, the effect of kaempferol on the expression of androgen receptor (AR) in renal tubular epithelial cells was assessed. The interaction between AR and nicotinamide adenine dinucleotide phosphate oxidase 2 (NOX2), and the intrinsic molecular mechanism of how AR regulated NOX2 in HK-2 cells were dissected. Additionally, several different assays were applied to analyze the expression levels of various related genes in this study. RESULTS It was revealed that kaempferol reduced CaOx crystal deposition in renal tubulars and crystal adhesion to HK-2 cells. Meanwhile, the results of in vivo and in vitro experiments corroborated that crystal-associated cellular injury, oxidative stress, inflammation and over-expression of OPN and CD44 in the kidney were ameliorated by kaempferol. Moreover, kaempferol functioned on inhibiting the expression of AR in renal tubular epithelial cells, and AR was able to up-regulate the expression of NOX2 at the transcriptional level by directly binding to the promoter of NOX2. Kaempferol decreased crystal deposition and crystal-induced renal oxidative and inflammatory injury by the down-regulation of AR/NOX2 signaling pathway. CONCLUSION Taken together, our study findings suggest that kaempferol has a suppressive effect on renal AR expression, which can attenuate CaOx crystal deposition and crystal-induced kidney injury through repressing oxidative stress and inflammation in the kidney by modulating the AR/NOX2 signaling pathway. It demonstrates that kaempferol may have preventive and therapeutic potential for CaOx nephrolithiasis.
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Affiliation(s)
- Peng Yuan
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China; Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xifeng Sun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Department of Urology, Medical University of Graz, Graz, Austria
| | - Xiao Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Georg Hutterer
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Karl Pummer
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Boris Hager
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Lembeck AL, Puchas P, Hutterer G, Barth DA, Terbuch A, Bauernhofer T, Pichler M. MicroRNAs as Appropriate Discriminators in Non-Specific Alpha-Fetoprotein (AFP) Elevation in Testicular Germ Cell Tumor Patients. Noncoding RNA 2020; 6:ncrna6010002. [PMID: 31906360 PMCID: PMC7151547 DOI: 10.3390/ncrna6010002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/09/2019] [Accepted: 12/28/2019] [Indexed: 02/07/2023] Open
Abstract
Testicular germ cell tumors (TGCTs) are the most commonly diagnosed malignancies in younger men. The monitoring of disease course and recurrence is supported by traditional tumor markers, including α-fetoprotein (AFP). AFP is physiologically synthesized in the liver and can be detected at increased levels in testicular cancer patients as well as under other benign liver diseases, which have been reported as a misleading cause of interpretation of TGCTs clinical course. A cluster of stem cell-associated microRNAs has been reported to outperform traditional tumor markers in newly diagnosed TGCTs, but the value of these microRNAs to differentiate between specific and unspecific AFP elevations, has never been reported. We report here a patient with chronic hepatitis B and normal liver related blood values presenting with a surgically removed primary TGCT and elevated AFP levels. Clinical staging revealed a suspect retroperitoneal metastatic lymph node together with other risk factors and first line treatment with PEB chemotherapy was administered. During curative treatment significantly rising AFP levels led to the assumption of chemo-resistant disease, mandating the initiation of salvage chemotherapy and surgical removal of the putative lymph node metastases. The AFP levels continuously decreased with the interruption of chemotherapeutic agents, indicating a chemotherapy-induced liver toxicity on the basis of pre-existing liver disease. MiR-371a-3p serum levels were not detectable in serum samples with elevated AFP levels. In conclusion, miR-371a-3p may be a reliable biomarker to differentiate between non-specific AFP elevations in TGCTs patients.
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Affiliation(s)
- Anna L. Lembeck
- Division of Oncology, Medical University of Graz, 8036 Graz, Austria; (A.L.L.); (P.P.); (D.A.B.); (A.T.); (T.B.)
| | - Philip Puchas
- Division of Oncology, Medical University of Graz, 8036 Graz, Austria; (A.L.L.); (P.P.); (D.A.B.); (A.T.); (T.B.)
| | - Georg Hutterer
- Department of Urology, Medical University of Graz, 8036 Graz, Austria;
| | - Dominik A. Barth
- Division of Oncology, Medical University of Graz, 8036 Graz, Austria; (A.L.L.); (P.P.); (D.A.B.); (A.T.); (T.B.)
| | - Angelika Terbuch
- Division of Oncology, Medical University of Graz, 8036 Graz, Austria; (A.L.L.); (P.P.); (D.A.B.); (A.T.); (T.B.)
| | - Thomas Bauernhofer
- Division of Oncology, Medical University of Graz, 8036 Graz, Austria; (A.L.L.); (P.P.); (D.A.B.); (A.T.); (T.B.)
| | - Martin Pichler
- Division of Oncology and Research Unit for Non-Coding RNA and Genome Editing, Medical University of Graz, 8036 Graz, Austria
- Correspondence:
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5
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Distler FA, Pahernik S, Gakis G, Hutterer G, Lebentrau S, Rink M, Nuhn P, Brookman-May S, Burger M, Gratzke C, Wolff I, May M. Adherence to the EAU guideline recommendations for systemic chemotherapy in penile cancer: results of the E-PROPS study group survey. World J Urol 2019; 38:2523-2530. [PMID: 31834472 DOI: 10.1007/s00345-019-03052-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 07/09/2019] [Accepted: 12/06/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To validate the adherence of urologists to chemotherapy recommendations given in the EAU guidelines on PeCa. The European Association of Urology (EAU) guidelines on penile cancer (PeCa) are predominantly based on retrospective studies with low level of evidence. MATERIALS AND METHODS A 14-item-survey addressing general issues of PeCa treatment was developed and sent to 45 European hospitals. 557 urologists participated in the survey of which 43.5%, 19.3%, and 37.2% were in-training, certified, and in leading positions, respectively. Median response rate among participating departments was 85.7% (IQR 75-94%). Three of 14 questions addressed clinical decisions on neoadjuvant, adjuvant, and palliative chemotherapy. Survey results were analyzed by bootstrap-adjusted multivariate logistic-regression-analysis to identify predictors for chemotherapy recommendations consistent with the guidelines. RESULTS Neoadjuvant, adjuvant, and palliative chemotherapy was recommended according to EAU guidelines in 21%, 26%, and 48%, respectively. For neoadjuvant chemotherapy, urologists holding leading positions or performing chemotherapy were more likely to recommend guideline-consistent treatment (OR 1.85 and 1.92 with p(bootstrap) = 0.007 and 0.003, respectively). Supporting resources (i.e., guidelines, textbooks) were used by 23% of survey participants and significantly improved consistency between treatment recommendations and Guideline recommendations in all chemotherapy settings (p(bootstrap) = 0.010-0.001). Department size and university center status were no significant predictors for all three endpoints. CONCLUSIONS In this study, we found a very low rate of adherence to the EAU guidelines on systemic treatment for PeCa. Further investigations are needed to clarify whether this missing adherence is a consequence of limited individual knowledge level or of the low grade of guideline recommendations.
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Affiliation(s)
- F A Distler
- Department of Urology, Klinikum Nuremberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
| | - S Pahernik
- Department of Urology, Klinikum Nuremberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - G Gakis
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Würzburg, Germany
| | - G Hutterer
- Department of Urology, Medical University of Graz, Graz, Austria
| | - S Lebentrau
- Department of Urology, Brandenburg Medical School Theodor Fontane, Ruppiner Kliniken, Neuruppin, Germany
| | - M Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Nuhn
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - S Brookman-May
- Department of Urology, Großhadern, LMU Munich, Munich, Germany
| | - M Burger
- Department of Urology, St. Josef-Hospital Regensburg, Medical University Regensburg, Regensburg, Germany
| | - C Gratzke
- Department of Urology, University of Freiburg, Freiburg, Germany
| | - I Wolff
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - M May
- Department of Urology, St. Elisabeth-Hospital Straubing, Straubing, Germany
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Zastrow S, Krabbe LM, Wolff I, Capitanio U, Klatte T, Ecke T, Huck N, Borgmann H, Scavuzzo A, Cindolo L, Schips L, Surcel C, Mirvald C, Cabo AV, Musquera M, Hutterer G, Prochazkova K, Stief C, Wirth M, May M, Brookman-May S. External validation of a postoperative nomogram for the prediction of disease-specific survival in patients with papillary renal cell carcinoma using a large multicenter database. Int J Clin Oncol 2019; 25:145-150. [PMID: 31471787 DOI: 10.1007/s10147-019-01530-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Based on data retrieved from a comprehensive multicenter database, we externally validated a published postoperative nomogram for the prediction of disease-specific survival (DSS) in patients with papillary renal cell carcinoma (papRCC). METHODS A multicenter database containing data of 2325 patients with surgically treated papRCC was used as validation cohort. After exclusion of patients with missing data and patients included in the development cohort, 1372 patients were included in the final analysis. DSS-probabilities according to the nomogram were calculated and compared to actual DSS-probabilities. Subsequently, calibration plots and decision curve analyses were applied. RESULTS The median follow-up was 38 months (IQR 11.8-80.7). Median DSS was not reached. The c-index of the nomogram was 0.71 (95% CI 0.60-0.83). A sensitivity analysis including only patients operated after 1998 delivered a c-index of 0.84 (95% CI 0.77-0.92). Calibration plots showed slight underestimation of nomogram-predicted DSS in probability ranges below 90%: median nomogram-predicted 5-year DSS in the range below 90% was 55% (IQR 20-80), but the median actual 5-year DSS in the same group was 58% (95% CI 52-65). Decision-curve analysis showed a positive net-benefit for probability ranges between a DSS probability of 5% and 85%. CONCLUSIONS The nomogram performance was satisfactory for almost all DSS probabilities; hence it can be recommended for application in clinical routine and for counseling of patients with papRCC.
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Affiliation(s)
- Stefan Zastrow
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany. .,Department of Urology, Elblandklinikum Riesa, Weinbergstrasse 8, 01589, Riesa, Germany.
| | | | - Ingmar Wolff
- Department of Urology, University Hospital Greifswald, Greifswald, Germany
| | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Tobias Klatte
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Thorsten Ecke
- Department of Urology, Hospital Bad Saarow, Bad Saarow, Germany
| | - Nina Huck
- Department of Urology, University Hospital Mannheim, Mannheim, Germany
| | - Hendrik Borgmann
- Department of Urology, University Hospital Mainz, Mainz, Germany
| | - Anna Scavuzzo
- Department of Urology, Instituto Nacional de Cancerologia-INCan, Mexico City, Mexico
| | - Luca Cindolo
- Department of Urology, ASL Abruzzo2, "S. Pio da Pietrelcina" Hospital, Vasto, Italy
| | - Luigi Schips
- Department of Urology, ASL Abruzzo2, Chieti, Italy
| | - Cristian Surcel
- Centre of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Cristian Mirvald
- Centre of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | | | | | - Georg Hutterer
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Kristyna Prochazkova
- Department of Urology, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Christian Stief
- Department of Urology, LMU Munich, Grosshadern, Munich, Germany
| | - Manfred Wirth
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany.,Department of Urology, Elblandklinikum Riesa, Weinbergstrasse 8, 01589, Riesa, Germany
| | - Matthias May
- Department of Urology, Klinikum St. Elisabeth, Straubing, Germany
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Kardoust Parizi M, Iwata T, Kimura S, Janisch F, Abufaraj M, Karakiewicz PI, Enikeev D, Rapoport LM, Hutterer G, Shariat SF. Focal Neuroendocrine Differentiation of Conventional Prostate Adenocarcinoma as a Prognostic Factor after Radical Prostatectomy: A Systematic Review and Meta-Analysis. Int J Mol Sci 2019; 20:ijms20061374. [PMID: 30893781 PMCID: PMC6471399 DOI: 10.3390/ijms20061374] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 01/06/2023] Open
Abstract
The biologic and prognostic value of focal neuroendocrine differentiation (NED) in conventional prostate adenocarcinoma (PC) patients who undergo radical prostatectomy (RP) remains controversial. In this systematic review and meta-analysis, we assessed the association of focal NED in conventional PC with oncological outcomes after RP. A literature search using PubMed, Scopus, Web of Science, and Cochrane Library was conducted on December 2018 to find relevant studies according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. We used a fixed-effect model to analyze the impact of focal NED in RP specimen on progression-free survival defined by biochemical recurrence (BCR). A total of 16 studies with the outcomes of disease progression and survival were eligible. No patient in these studies received androgen deprivation therapy prior to RP. Eleven studies found no significant correlation between focal NED and outcomes of interest, while five studies reported a significant association of focal NED assessed by immunohistochemical chromogranin A or serotonin staining with BCR or survival. Focal NED was associated with higher BCR rates after RP with a pooled HR of 1.39 (95% CI 1.07‒1.81) in five studies. No heterogeneity was reported in this analysis (I2 = 21.7%, p = 0.276). In conclusion, focal NED in conventional PC is associated with worse prognosis after RP. Its presence should be reported in pathologic reports and its true clinical impact should be assessed in well-designed prospective controlled studies.
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Affiliation(s)
- Mehdi Kardoust Parizi
- Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria.
- Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Teheran 1411713135, Iran.
| | - Takehiro Iwata
- Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria.
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
| | - Shoji Kimura
- Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria.
- Department of Urology, Jikei University School of Medicine, Tokyo 105-8461, Japan.
| | - Florian Janisch
- Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria.
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria.
- Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman 11942, Jordan.
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC H3h 1s8, Canada.
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Institut du Cancer de Montréal, Montréal, QC H3h 1s8, Canada.
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow 119991, Russia.
| | - Leonid M Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow 119991, Russia.
| | - Georg Hutterer
- Department of Urology, Medical University Graz, A-8036 Graz, Austria.
| | - Shahrokh F Shariat
- Institute for Urology and Reproductive Health, Sechenov University, Moscow 119991, Russia.
- Department of Urology, Weill Cornell Medical College, New York, NY 10011, USA.
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
- Karl Landsteiner Institute of Urology and Andrology, A-1090 Vienna, Austria.
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Marra G, Brattoli M, Filippini C, Linares Espinos E, Martinez Salamanca J, Sphan M, Scherr DS, Delgado-Oliva F, Vera-Donoso CD, Lorentz AC, Viraj M, Mckiernan J, Libertino JA, Huang WC, Evans C, Capitanio U, Montorsi F, Hutterer G, Zigeuner R, Gontero P. MP48-19 ONCOLOGICAL AND FUNCTIONAL OUTCOMES IN MINIMALLY INVASIVE APPROACH FOR KIDNEY CANCER WITH VENOUS THROMBUS: A MULTICENTRIC STUDY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1518] [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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Wolff I, Scavuzzo A, Capitanio U, Klatte T, Shariat SF, Wagener N, Zastrow S, Borgmann H, Krabbe LM, Hutterer G, May M, Brookman-May SD. Organ Preservation Is Less Frequently Performed in Women Surgically Treated for Papillary Renal Cell Carcinoma-Results of a Comprehensive Multicenter Study. Urology 2017; 109:107-114. [PMID: 28802570 DOI: 10.1016/j.urology.2017.06.042] [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] [Received: 02/12/2017] [Revised: 06/10/2017] [Accepted: 06/27/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To analyze the impact of gender on the clinicopathologic features and survival of patients with surgically treated papillary renal cell carcinoma (papRCC) using a comprehensive international multicenter database. MATERIALS AND METHODS Data of 2325 patients undergoing surgery for unilateral papRCC between 1984 and 2015 in 17 European and North American centers were retrospectively collated. The impact of clinicopathologic features on the likelihood of nephron-sparing surgery (NSS) was evaluated using a multivariable logistic regression model. The influence on cancer-specific mortality (CSM) and other-cause mortality was analyzed by multivariable competing-risk regression models. Finally, subgroup analyses were conducted for organ-confined (n = 2075) and non-organ-confined tumors (n = 250). The median follow-up was 47 months. RESULTS The study cohort included 1782 (77%) male patients (male-to-female ratio 3.3:1.0). Considering age, symptoms at presentation, performance status, pathologic tumor size, stage, and grade, we observed that there were no significant gender-specific differences. In contrast, female patients underwent NSS significantly less frequently (P <.001). On multivariable analysis, the likelihood of NSS was 72% higher in male patients after adjusting for all relevant cofactors (P <.001). No significant gender-specific differences in terms of CSM and other-cause mortality were demonstrated, but CSM was 59% lower in female patients in the subgroup of organ-confined tumors (P = .001). CONCLUSION No impact of gender on survival was found analyzing this large cohort of patients undergoing surgery for papRCC. However, CSM appears to be lower in female patients with organ-confined disease. In this context, it is interesting that the likelihood of NSS seems to be significantly higher in male patients.
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Affiliation(s)
- Ingmar Wolff
- Department of Urology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | - Anna Scavuzzo
- Department of Urology, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Umberto Capitanio
- Department of Urology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Tobias Klatte
- Department of Urology, Karl-Landsteiner-Institute of Urology and Andrology, Medical University of Vienna, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Karl-Landsteiner-Institute of Urology and Andrology, Medical University of Vienna, Vienna, Austria
| | - Nina Wagener
- Department of Urology, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany
| | - Stefan Zastrow
- Department of Urology, Carl Gustav Carus University Dresden, University Hospital, Germany
| | - Hendrik Borgmann
- Department of Urology, University Hospital Mainz, Mainz, Germany
| | - Laura-Maria Krabbe
- Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Georg Hutterer
- Department of Urology, Medical University Graz, Graz, Austria
| | - Matthias May
- Department of Urology, Klinikum St. Elisabeth Straubing, Straubing, Germany
| | - Sabine D Brookman-May
- Department of Urology, Campus Grosshadern, Ludwig-Maximilians University (LMU) Munich, Munich, Germany.
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May M, Surcel C, Capitanio U, Dell'Oglio P, Klatte T, Shariat S, Ecke T, Wolff I, Vergho D, Wagener N, Huck N, Pahernik S, Zastrow S, Wirth M, Borgmann H, Haferkamp A, Musquera M, Krabbe LM, Herrmann E, Scavuzzo A, Mirvald C, Hutterer G, Zigeuner R, Stief CG, Waidelich R, Cindolo L, Kalusova K, Brookman-May SD. Prognostic and discriminative power of the 7th TNM classification for patients with surgically treated papillary renal cell carcinoma: results of a multi-institutional validation study (CORONA subtype project). Scand J Urol 2017; 51:269-276. [PMID: 28399699 DOI: 10.1080/21681805.2017.1300187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Studies on the prognostic reliability of the Union for International Cancer Control tumor, node, metastasis (TNM) staging system for renal cell carcinoma (RCC) predominantly focus on clear-cell RCC. Therefore, the aim of this study was to investigate whether the oncological prognosis of surgically treated papillary RCC (papRCC) patients is reliably given by the current TNM system, by analyzing the largest database reported to date. MATERIALS AND METHODS Data on 2325 papRCC patients who underwent surgical treatment in 1984- 2015 were collated from 17 international centers (median follow-up 47 months). Tumor stage was adapted to the 7th edition of the TNM system. Multivariable, bootstrap-corrected Cox regression models were applied to assess the independent impact of the TNM system on cancer-specific mortality (CSM) and all-cause mortality (ACM). RESULTS The median age at diagnosis was 63 years (interquartile range 54-70 years) and 77% of patients were male. Nephron-sparing surgery was performed in 42%, and 82% were with symptom free at diagnosis. In 6.7% (n = 156), organ metastasis (stage M1) was present at the time of surgery. On multivariable analysis, the TNM system and Fuhrman grade had an independent impact on both CSM and ACM, while patient age affected ACM only. The discriminative ability of the pT classification was significant for both endpoints: 5 year CSM rates were 5%, 17%, 36% and 56% for stages pT1, pT2, pT3 and pT4, respectively (each p < 0.001). The pT classification contributed significantly to the predictive accuracy of the CSM and ACM models by 6.3% and 2.5%, respectively (each p < 0.001). CONCLUSIONS The 2010 TNM staging system can be reliably applied to papRCC patients and allows certain prognostic discrimination.
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Affiliation(s)
- Matthias May
- a Department of Urology , Klinikum St. Elisabeth Straubing , Straubing , Germany
| | - Cristian Surcel
- b Centre of Urological Surgery, Dialysis and Renal Transplantation , Fundeni Clinical Institute , Bucharest , Romania
| | - Umberto Capitanio
- c Department of Urology , Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Paolo Dell'Oglio
- c Department of Urology , Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Tobias Klatte
- d Department of Urology , Medical University of Vienna , Vienna , Austria
| | - Shahrokh Shariat
- d Department of Urology , Medical University of Vienna , Vienna , Austria
| | - Thorsten Ecke
- e Department of Urology , Hospital Bad Saarow , Bad Saarow , Germany
| | - Ingmar Wolff
- f Department of Urology , Carl-Thiem-Klinikum Cottbus , Cottbus , Germany
| | - Daniel Vergho
- g Department of Urology and Paediatric Urology , Julius-Maximilians-University Medical Centre of Wuerzburg , Wuerzburg , Germany
| | - Nina Wagener
- h Department of Urology , University Hospital Mannheim , Mannheim , Germany
| | - Nina Huck
- h Department of Urology , University Hospital Mannheim , Mannheim , Germany
| | - Sascha Pahernik
- i Department of Urology , Klinikum Nürnberg , Nürnberg, Germany
| | - Stefan Zastrow
- j Department of Urology , Carl Gustav Carus University Dresden, University Hospital , Germany
| | - Manfred Wirth
- j Department of Urology , Carl Gustav Carus University Dresden, University Hospital , Germany
| | - Hendrik Borgmann
- k Department of Urology , University Hospital Mainz , Mainz , Germany
| | - Axel Haferkamp
- k Department of Urology , University Hospital Mainz , Mainz , Germany
| | - Mireia Musquera
- l Department of Nephrology and Urology , University of Barcelona , Barcelona , Spain
| | - Laura M Krabbe
- m Department of Urology , University of Muenster Medical Center , Muenster , Germany
| | - Edwin Herrmann
- m Department of Urology , University of Muenster Medical Center , Muenster , Germany
| | - Anna Scavuzzo
- n Department of Urology , Instituto Nacional de Cancerologia-INCan , Mexico City , Mexico
| | - Cristian Mirvald
- b Centre of Urological Surgery, Dialysis and Renal Transplantation , Fundeni Clinical Institute , Bucharest , Romania
| | - Georg Hutterer
- o Department of Urology , Medical University Graz , Graz , Austria
| | - Richard Zigeuner
- o Department of Urology , Medical University Graz , Graz , Austria
| | - Christian G Stief
- p Department of Urology , Ludwig-Maximilians University, Campus Grosshadern , Munich , Germany
| | - Raphaela Waidelich
- p Department of Urology , Ludwig-Maximilians University, Campus Grosshadern , Munich , Germany
| | - Luca Cindolo
- q Department of Urology , Pio Da Pietrelcina Hospital , Vasto , Italy
| | - Krystina Kalusova
- r Department of Urology , Faculty of Medicine, Charles University , Pilsen , Czech Republic
| | - Sabine D Brookman-May
- p Department of Urology , Ludwig-Maximilians University, Campus Grosshadern , Munich , Germany
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Rainer PP, Doleschal B, Kirk JA, Sivakumaran V, Saad Z, Groschner K, Maechler H, Hoefler G, Bauernhofer T, Samonigg H, Hutterer G, Kass DA, Pieske B, von Lewinski D, Pichler M. Sunitinib causes dose-dependent negative functional effects on myocardium and cardiomyocytes. BJU Int 2012; 110:1455-62. [PMID: 22508007 DOI: 10.1111/j.1464-410x.2012.11134.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To examine the acute effects of sunitinib on inotropic function, intracellular Ca(2+) transients, myofilament Ca(2+) sensitivity and generation of reactive oxygen species (ROS) in human multicellular myocardium and isolated mouse cardiomyocytes. To search for microRNAs as suitable biomarkers for indicating toxic cardiac effects. PATIENTS AND METHODS After exposure to sunitinib (0.1-10 µg/mL) developed force, diastolic tension and kinetic variables were assessed in isolated human myocardium. Changes in myocyte sarcomere length, whole-cell calcium transients, myofilament force-Ca(2+) relationship, and ROS generation were examined in isolated ventricular mouse cardiomyocytes. Microarray and realtime-PCR were used to screen for differentially expressed microRNAs in cultured cardiomyocytes that were exposed for 24 h to sunitinib. RESULTS We found that higher concentrations of sunitinib (1 and 10 µg/mL) decreased developed force at 30 minutes 76.9 + 2.8 and 54.5 + 6.3%, compared to 96.1 + 2.6% in controls (P < 0.01). Sunitinib exposure significantly decreased sarcomere shortening and Ca2+ transients. Myofilament Ca(2+) sensitivity was not altered, while ROS levels were significantly increased after exposure to the drug. MicroRNA expression patterns were not altered by sunitinib. CONCLUSIONS Sunitinib elicits a dose-dependent negative inotropic effect in myocardium, accompanied by a decline in intracellular Ca(2+) and increased ROS generation. In clinical practice, these cardiotoxic effects should be considered in cases where cardiac concentrations of sunitinib could be increased.
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Affiliation(s)
- Peter P Rainer
- Division of Cardiology, Department of Internal Medicine, Medical University Graz, Austria
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Fischereder K, Puchwein E, Hutterer G, Mohammad Al-Ali B, Novara G, Primus G. UP-01.072 Clinical Impact of Body Mass Index on the Outcome of the SPARC-Sling System for the Treatment of Female Stress Urinary Incontinence. Urology 2011. [DOI: 10.1016/j.urology.2011.07.624] [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: 10/16/2022]
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13
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Zigeuner R, Hutterer G, Chromecki T, Imamovic A, Kampel-Kettner K, Rehak P, Langner C, Pummer K. External Validation of the Mayo Clinic Stage, Size, Grade, and Necrosis (SSIGN) Score for Clear-Cell Renal Cell Carcinoma in a Single European Centre Applying Routine Pathology. Eur Urol 2010; 57:102-9. [DOI: 10.1016/j.eururo.2008.11.033] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Accepted: 11/19/2008] [Indexed: 11/29/2022]
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14
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Zigeuner R, Hutterer G, Chromecki T, Rehak P, Pummer K. Macroscopic versus microscopic vascular tumour invasion in patients with clear cell renal cell carcinoma: Does it make a difference? J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5093 Background: We evaluated the prognostic impact of macroscopic vs. microscopic vascular invasion on metastasis-free survival in a large European single centre series of patients with RCC over a period of 23 years. Methods: The pathology reports of 2333 consecutive patients operated between 01/1984 and 12/2006 were re-evaluated with regard to histological subtype, pT categories (TNM 2002), tumor grade, lymph node status, tumor size, presence of necrosis, and vascular invasion (defined as either absent, microscopic, or macroscopic). Only patients with unilateral clear cell (CC)-RCC and no distant metastases at operation were included. Metastasis-free survival probabilities for patients with absent, microscopic, or macroscopic invasion were evaluated using the Kaplan-Meier method and the log-rank test. For multivariate analysis, a Cox's proportional hazards model was used. Results: Out of 1797 CC-RCC-patients fulfilling the selection criteria, 1754 (97.6%) with complete data including follow-up were evaluated. Microscopic and macroscopic invasion was noted in 99 (5.6%) and 278 (15.8%) tumours, respectively. After a mean follow-up of 95 months, 375/1754 (21.4%) patients developed distant metastases. 10-year metastasis-free survival probabilities were 84%, 55%, and 42% in patients with absent, microscopic, and macroscopic invasion (p < 0.0001 overall; p = 0.13 for microscopic vs. macroscopic). Multivariate analysis proved pT-categories, grade, node status, size, necrosis and overall vascular invasion (p < 0.0001; RR = 2.09, 95%CI = 1.46–2.98) as independent predictors of metastatic disease. When microscopic and macroscopic invasion were differentiated, microscopic invasion remained significant (p < 0.0001; RR = 2.19, 95%CI = 1.54–3.12) whereas macroscopic invasion was not an independent predictor. Conclusions: Our data indicate that both macroscopic and microscopic vascular invasions are associated with poor outcome. Microscopic invasion was an independent predictor of metastatic disease, whereas macroscopic invasion which is directly related to categories pT3b/c was not. Vascular invasion should be considered in prognostic models for patients with RCC. No significant financial relationships to disclose.
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Affiliation(s)
| | | | | | - P. Rehak
- Medical University Graz, Graz, Austria
| | - K. Pummer
- Medical University Graz, Graz, Austria
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15
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Bhojani N, Perrotte P, Hutterer G, Suardi N, Jeldres C, Shariat SF, Capitanio U, Arjane P, Widmer H, Benard F, Peloquin F, Montorsi F, Karakiewicz P. Body Mass Index and its Association with Genitourinary Disorders in Men Undergoing Prostate Cancer Screening. J Sex Med 2008; 5:2141-51. [DOI: 10.1111/j.1743-6109.2008.00811.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Walz J, Suardi N, Shariat SF, Jeldres C, Perrotte P, Graefen M, Widmer H, Arjane P, Valiquette L, Hutterer G, Saad F, Karakiewicz PI. Accuracy of life tables in predicting overall survival in patients after radical prostatectomy. BJU Int 2008; 102:33-8. [DOI: 10.1111/j.1464-410x.2008.07614.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Gallina A, Chun FKH, Suardi N, Eastham JA, Perrotte P, Graefen M, Hutterer G, Huland H, Klein EA, Reuther A, Montorsi F, Briganti A, Shariat SF, Roehrborn CG, de la Taille A, Salomon L, Karakiewicz PI. Comparison of stage migration patterns between Europe and the USA: an analysis of 11 350 men treated with radical prostatectomy for prostate cancer. BJU Int 2008; 101:1513-8. [DOI: 10.1111/j.1464-410x.2008.07519.x] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Leibl S, Zigeuner R, Hutterer G, Chromecki T, Rehak P, Langner C. EGFR expression in urothelial carcinoma of the upper urinary tract is associated with disease progression and metaplastic morphology. APMIS 2008; 116:27-32. [PMID: 18254777 DOI: 10.1111/j.1600-0463.2008.00859.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
EGFR represents a promising therapeutic target in urothelial cancer (UC). Our study aimed to investigate the clinicopathological significance of EGFR in upper urinary tract UC. EGFR was immunohistochemically assessed (EGFR pharmDX kit(TM)) in 268 consecutive tumours using a tissue microarray technique and correlated with other histopathological parameters as well as patient outcome. EGFR immunoreactivity was observed in 140/253 (55%) evaluable UCs and was associated with high tumour stage (47% pTa/pT1 vs 66% pT2-pT4; p=0.003) and high tumour grade (45% low grade vs 67% high grade; p<0.001). In addition, EGFR expression was associated with metaplastic squamous and/or glandular differentiation (p<0.001). EGFR staining intensity was 1+ in 49%, 2+ in 31%, and 3+ in 20% of cases. EGFR 3+ staining intensity was associated with the occurrence of metastatic disease by univariate analysis (p=0.016). Multivariate analysis, however, proved only pT stage >1 (p<0.001) and high tumour grade (p<0.001) to be independent predictors of patient outcome. In conclusion, EGFR was significantly associated with advanced disease and metaplastic squamous and/or glandular differentiation. Since UCs with metaplastic morphology have been shown to be more resistant to conventional radiotherapy or chemotherapy, the strikingly strong EGFR expression in these tumours may offer a new perspective for affected patients.
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Affiliation(s)
- Sebastian Leibl
- Department of Pathology, Medical University of Graz, Graz, Austria
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Bhojani N, Perrotte P, Jeldres C, Suardi N, Hutterer G, Shariat SF, Karakiewicz PI. ORIGINAL RESEARCH—MEN'S SEXUAL HEALTH: The Effect of Comorbidities and Socioeconomic Status on Sexual and Urinary Function in Men Undergoing Prostate Cancer Screening. J Sex Med 2008; 5:668-76. [DOI: 10.1111/j.1743-6109.2007.00722.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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20
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Walz J, Perrotte P, Suardi N, Hutterer G, Jeldres C, Bénard F, Valiquette L, Graefen M, Montorsi F, Karakiewicz PI. Baseline Prevalence of Erectile Dysfunction in a Prostate Cancer Screening Population. J Sex Med 2008; 5:428-35. [DOI: 10.1111/j.1743-6109.2007.00662.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Bhojani N, Jeldres C, Patard JJ, Perrotte P, Suardi N, Hutterer G, Patenaude F, Oudard S, Karakiewicz PI. Toxicities associated with the administration of sorafenib, sunitinib, and temsirolimus and their management in patients with metastatic renal cell carcinoma. Eur Urol 2007; 53:917-30. [PMID: 18054825 DOI: 10.1016/j.eururo.2007.11.037] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Accepted: 11/13/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To provide a systematic review of the side effects associated with sorafenib, sunitinib, and temsirolimus and to provide an outline of possible preventive or therapeutic measures. METHODS We performed a PubMed-based systematic review of side effects associated with the three agents and relied on product monographs and prescribing information to provide an outline of treatments aimed at reducing these toxicities. RESULTS Side effects range from <1% to 72%. Grade 3/4 side effects are less common and range from <1% to 13% for sorafenib, <1% to 16% for sunitinib, and 1% to 20% for temsirolimus. Overall, sunitinib causes the most grade 3/4 side effects and sorafenib causes the fewest grade 3/4 side effects, although head-to-head trials are required to compare safety profiles of all three kinase inhibitors. Virtually all side effects can be managed effectively. CONCLUSION Prevention, recognition, and prompt management of side effects are of key importance and avoid unnecessary dose reductions, which may undermine treatment efficacy.
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Affiliation(s)
- Naeem Bhojani
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, QC, Canada
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22
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Walz J, Perrotte P, Hutterer G, Suardi N, Jeldres C, Bénard F, Valiquette L, Karakiewicz PI. Impact of chronic prostatitis-like symptoms on the quality of life in a large group of men. BJU Int 2007; 100:1307-11. [PMID: 17941922 DOI: 10.1111/j.1464-410x.2007.07250.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the prevalence of chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) symptoms in a large group of men, using the National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), and to evaluate which of the NIH-CPSI symptoms had the most detrimental effect on quality of life (QoL). SUBJECTS AND METHODS The NIH-CPSI was completed by 1273 men during a male-health promotion event. The presence of CP/CPPS-like symptoms was defined according to the NIH-CPSI criteria (perineal pain or ejaculatory pain and NIH-CPSI-pain score >/= 4). Finally, using linear regression analyses we evaluated the effect of each questionnaire symptom on the NIH-CPSI-QoL domain. RESULTS The mean (range) age of the men was 57.6 (40-89) years; 133 (10.5%) reported CP/CPPS-like symptoms, with 62 (4.9%) reporting mild and 71 (5.6%) reporting moderate to severe CP/CPPS-like symptoms. Men with CP/CPPS-like symptoms had higher NIH-CPSI-QoL scores, showing a greater detriment of QoL (4.9 vs 2.5; P < 0.001). Of all NIH-CPSI symptoms, urinary frequency was associated with the least favourable QoL, followed by incomplete bladder emptying, pain frequency and pain intensity. The individual pain location had no significant impact on the QoL. CONCLUSION In a large healthy population CP/CPPS-like symptoms are common and have an important impact on QoL. Functional CP/CPPS-like symptoms have a greater detrimental effect on QoL than pain symptoms. Therefore, these symptoms should represent the main therapeutic targets in affected patients.
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Affiliation(s)
- Jochen Walz
- Cancer Prognostics and Health Outcomes Unit, and Department of Urology, University of Montreal, Montreal, Quebec, Canada
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23
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Walz J, Gallina A, Hutterer G, Perrotte P, Shariat SF, Graefen M, McCormack M, Bénard F, Valiquette L, Saad F, Karakiewicz PI. Accuracy of life tables in predicting overall survival in candidates for radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2007; 69:88-94. [PMID: 17446004 DOI: 10.1016/j.ijrobp.2007.02.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2007] [Revised: 02/15/2007] [Accepted: 02/16/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To test the accuracy of life tables (LTs) in predicting survival in men treated with radiotherapy for localized prostate cancer. METHODS AND MATERIALS We selected the records of 3,176 patients treated with radiotherapy and who had no clinical evidence of disease relapse. Life table-derived life expectancy (LE) was defined for every individual using a population-specific LT. Age, Charlson Comorbidity Index (CCI), and LT-derived LE were then used as predictors of overall mortality in Cox regression models. Predictive accuracy (PA) was estimated with the Harrell's concordance index and was internally validated with 200 bootstrap resamples. RESULTS The actuarial median survival was 4.7 years (mean, 6.4 years). At radiotherapy, median age was 70.6 years, median CCI was 2, and median LT-derived LE was 12 years. All variables were statistically significant predictors of overall mortality (all p values <0.001). Age (PA, 60.2%), CCI (PA, 60.1%), and LT-derived LE (PA, 60.2%) were equally accurate. Finally, when age and CCI were combined (PA, 63.2%), both variables provided more accurate mortality predictions than either variable alone (all p values = 0.01). CONCLUSIONS Life tables have a limited ability to predict LE in patients treated with radiotherapy for prostate cancer. We, therefore, recommend the use of multivariate prognostic models that integrate several variables, such as at least age and comorbidities, to estimate LE. This might help to improve LE estimation during prostate cancer treatment decision making.
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Affiliation(s)
- Jochen Walz
- Cancer Prognostics and Health Outcomes Unit, University of Montréal, Montréal, Québec, Canada
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Hutterer G, Perrotte P, Gallina A, Walz J, Jeldres C, Traumann M, Suardi N, Saad F, Bénard F, Valiquette L, McCormack M, Graefen M, Montorsi F, Karakiewicz PI. Body mass index does not predict prostate-specific antigen or percent free prostate-specific antigen in men undergoing prostate cancer screening. Eur J Cancer 2007; 43:1180-7. [PMID: 17292604 DOI: 10.1016/j.ejca.2007.01.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Revised: 12/19/2006] [Accepted: 01/04/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Body mass index (BMI) may alter serum prostate specific antigen (PSA) and percent free PSA (%fPSA) and may mask the risk of prostate cancer. We investigated the relationship between BMI and PSA or %fPSA. MATERIALS AND METHODS Height, weight, PSA and %fPSA were assessed in 616 consecutive screened men without prostate cancer. Continuously coded and categorised BMI was studied. Statistical analyses consisted of ANOVA, linear regression, bivariate and partial correlations. RESULTS Median age was 57 years. Median PSA was 1.0 and median %fPSA was 26. Median BMI was 25.8 kg/m(2). Neither continuously coded nor categorised BMI correlated with either PSA or %fPSA in unadjusted or age-adjusted analyses (all p values > or = 0.3). CONCLUSIONS Body mass index does not affect PSA or %fPSA in men without known prostate cancer, who undergo prostate cancer screening. Therefore, PSA or %fPSA-based screening or early detection efforts do not require an adjustment for BMI.
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Affiliation(s)
- Georg Hutterer
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montréal, Que, Canada
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Zigeuner RE, Hutterer G, Chromecki T, Rehak P, Langner C. Bladder tumour development after urothelial carcinoma of the upper urinary tract is related to primary tumour location. BJU Int 2007; 98:1181-6. [PMID: 17125475 DOI: 10.1111/j.1464-410x.2006.06519.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To better define the predictors of bladder tumour development in patients operated for upper urinary tract urothelial cancer (UT-UC). PATIENTS AND METHODS Surgical specimens from 191 consecutive patients with no history of bladder cancer and operated for UT-UC were chosen for analysis. Bladder tumour development was assessed in relation to UT-UC location, tumour multiplicity, stage and grade, margin status, mode of operation, age and gender. RESULTS Overall, 51 of 191 (27%) patients developed subsequent bladder tumours, including 25 of 123 (20%) with pelvic, 19 of 47 (40%) with ureteric and seven of 21 (33%) with multifocal tumours (P = 0.04 for all subgroups; P = 0.01 for pelvic vs ureteric). There was no influence of the other variables. The median (mean, range) time to recurrence was 12 (18, 3-64) months. In a multivariate analysis, ureteric tumour location was an independent predictor (P = 0.02; risk ratio, RR, 2.0, 95% confidence interval, CI, 1.1-3.7). After excluding 68 patients with systemic disease progression, bladder tumour development was noted in 39 of 123 (32%), including 18 of 76 (24%) with pelvic, 16 of 34 (47%) with ureteric and five of 13 with multifocal tumours (P = 0.06 for all subgroups; P = 0.02 for pelvic vs ureteric). In a multivariate analysis, ureteric location (P = 0.03; RR 2.1, 95% CI 1.1-4.2) and high tumour grade (P = 0.04; RR 2.2, 95% CI 1.03-4.7) were independent predictors of subsequent bladder tumour development. CONCLUSION The risk of developing a bladder tumour after surgery for UT-UC is significantly related to ureteric tumour location and high tumour grade. Clinical trials to evaluate a possible reduction of bladder cancer risk by intraoperative ureteric ligation and/or peri-operative topical intravesical chemotherapy instillation are justified.
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Affiliation(s)
- Richard E Zigeuner
- Department of Surgery, Research Unit for Biomedical Engineering & Computing, Medical University Graz, Auenbruggerplatz 25, A-8036 Graz, Austria
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Winkler A, Zigeuner R, Rehak P, Hutterer G, Chromecki T, Langner C. CD24 expression in urothelial carcinoma of the upper urinary tract correlates with tumour progression. Virchows Arch 2006; 450:59-64. [PMID: 17111129 DOI: 10.1007/s00428-006-0316-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Accepted: 09/12/2006] [Indexed: 10/23/2022]
Abstract
Expression of the mucin-like adhesion molecule CD24 has been implicated in the progression of several types of cancer and has been identified as new prognostic factor. We evaluated CD24 expression in 268 consecutive cases of upper urinary tract urothelial carcinoma with respect to associations with tumour stage, grade, angioinvasion and infiltrative growth pattern using a tissue microarray technique and correlated data with patient outcome. CD24 expression was demonstrated in 161/259 (62%) evaluable tumours and was associated with high tumour stage [77/139 (55%) pTa/pT1 vs 84/120 (70%) pT2-pT4; P=0.02] and high tumour grade [68/139 (49%) low vs 93/120 (78%) high grade; P<0.001] as well as presence of angioinvasion (P=0.002) and infiltrative pattern of invasion (P=0.007). Patients with CD24-positive tumours tended to have a higher risk of disease progression (P=0.065). Multivariate analysis, however, proved pT stage >1 [P<0.001, risk ratio (RR)=5.87, 95% confidence interval (CI)=2.88-11.95] and high tumour grade (P<0.001, RR=3.30, 95% CI 1.75-6.22) as only independent predictors of metastatic disease. In conclusion, CD24 expression in upper urinary tract urothelial cancer is associated with advanced tumour stage and high tumour grade as well as histopathological features indicative of aggressive tumour behaviour, but it lacks independent impact on patient outcome.
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Affiliation(s)
- Alexandra Winkler
- Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, A-8036, Graz, Austria
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Chromecki T, Zigeuner R, Hutterer G, Rehak P, Langner C. UP-03.100. Urology 2006. [DOI: 10.1016/j.urology.2006.08.968] [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: 11/25/2022]
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Zigeuner R, Hutterer G, Chromecki T, Leibl S, Rehak P, Langner C. UP-01.92. Urology 2006. [DOI: 10.1016/j.urology.2006.08.740] [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: 10/24/2022]
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Zigeuner R, Hutterer G, Chromecki T, Leibl S, Rehak P, Langner C. UP-03.95. Urology 2006. [DOI: 10.1016/j.urology.2006.08.963] [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: 10/24/2022]
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Chromecki T, Zigeuner R, Hutterer G, Rehak P, Langner C. UP-03.99. Urology 2006. [DOI: 10.1016/j.urology.2006.08.967] [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: 11/25/2022]
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Zigeuner R, Hutterer G, Chromecki T, Rehak P, Langner C. UP-03.94. Urology 2006. [DOI: 10.1016/j.urology.2006.08.962] [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: 11/16/2022]
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Hutterer G, Zigeuner R, Chromecki T, Leibl S, Rehak P, Langner C. UP-03.96. Urology 2006. [DOI: 10.1016/j.urology.2006.08.964] [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: 11/27/2022]
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Langner C, Hutterer G, Chromecki T, Leibl S, Rehak P, Zigeuner R. Tumor necrosis as prognostic indicator in transitional cell carcinoma of the upper urinary tract. J Urol 2006; 176:910-3; discussion 913-4. [PMID: 16890651 DOI: 10.1016/j.juro.2006.04.019] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Indexed: 11/17/2022]
Abstract
PURPOSE The clinicopathological features predictive of outcome in patients with upper urinary tract transitional cell carcinoma are not clearly established. We analyzed the prognostic impact of tumor necrosis with respect to metastasis-free survival. MATERIALS AND METHODS The presence of focal (10% or less of the tumor area) and extensive (greater than 10% of the tumor area) coagulative tumor necrosis was retrospectively reevaluated in 268 cases of consecutive upper urinary tract transitional cell carcinoma and correlated with outcome. RESULTS Overall tumor necrosis was noted in 113 of 268 (42.2%) cases of transitional cell carcinoma with 63 (23.5%) showing focal and 50 (18.7%) showing extensive necrosis, respectively. Tumor necrosis was associated with high tumor stage (p <0.001) and high tumor grade (p <0.001). In addition, tumor necrosis was more common in pelvic tumors compared with ureteral tumors (p <0.001). Actuarial 5-year metastasis-free survival rates for patients with transitional cell carcinoma with extensive, focal and lacking necrosis were 24%, 45% and 78%, respectively (log rank test p <0.001). Multivariate analysis proved pT stage greater than 1 (p <0.001, RR 6.04, 95% CI 2.82-12.93), high tumor grade (p <0.001, RR 3.37, 95% CI 1.65-6.89) and extensive tumor necrosis as independent predictors of poor patient outcome (p = 0.02, RR 1.82, 95% CI 1.09-3.05). CONCLUSIONS The presence of extensive tumor necrosis proved to be an additional histological variable with an independent influence on metastasis-free survival in patients with upper urinary tract transitional cell carcinoma. Its assessment is readily applicable in routine sections and should thus be commented upon separately in the pathology report.
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Affiliation(s)
- Cord Langner
- Institute of Pathology, Medical University Graz, Auenbruggerplatz 25, A-8036 Graz, Austria.
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Zigeuner RE, Leibl S, Hutterer G, Chromecki T, Rehak P, Langner C. 735: EGFR Expression in Urothelial Carcinoma of the Upper Urinary Tract Correlates with Disease Progression and Metaplastic Morphology. J Urol 2006. [DOI: 10.1016/s0022-5347(18)32971-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Zigeuner RE, Leibl S, Hutterer G, Chromecki T, Rehak P, Langner C. 405: Alpha-Methylacyl-CoA Racemase (AMACR/P504S) Protein Expression in Urothelial Carcinoma of the Upper Urinary Tract Correlates with Tumour Progression. J Urol 2006. [DOI: 10.1016/s0022-5347(18)32661-2] [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: 11/29/2022]
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Zigeuner RE, Hutterer G, Chromecki T, Leibl S, Rehak P, Langner C. 1093: Tumor Necrosis as Prognostic Indicator in Urothelial Carcinoma of the Upper Urinary Tract. J Urol 2006. [DOI: 10.1016/s0022-5347(18)33318-4] [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: 10/17/2022]
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Zigeuner RE, Hutterer G, Chromecki T, Leibl S, Rehak P, Langner C. 1094: Impact of Tumor Stage, Tumor Grade, and Vascular Invasion on Metastasis-Free Survival of Patients with Urothelial Carcinoma of the Upper Urinary Tract. J Urol 2006. [DOI: 10.1016/s0022-5347(18)33319-6] [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: 10/17/2022]
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Langner C, Hutterer G, Chromecki T, Leibl S, Rehak P, Zigeuner R. TUMOUR NECROSIS AS PROGNOSTIC INDICATOR IN UROTHELIAL CARCINOMA OF THE UPPER URINARY TRACT. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s1569-9056(06)60463-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zigeuner R, Hutterer G, Chromecki T, Rehak P, Langner C. BIOLOGICAL SIGNIFICANCE OF SQUAMOUS AND GLANDULAR DIFFERENTIATION IN UROTHELIAL CELL CARCINOMA OF THE UPPER URINARY TRACT. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s1569-9056(06)60462-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Langner C, Hutterer G, Chromecki T, Rehak P, Zigeuner R. Patterns of invasion and histological growth as prognostic indicators in urothelial carcinoma of the upper urinary tract. Virchows Arch 2006; 448:604-11. [PMID: 16525827 DOI: 10.1007/s00428-006-0150-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 12/22/2005] [Accepted: 12/22/2005] [Indexed: 10/24/2022]
Abstract
The biological significance of squamous and glandular differentiation and different patterns of invasion in upper urinary tract urothelial carcinoma is unclear. We reviewed 268 cases of consecutive upper urinary tract carcinomas with respect to the presence of squamous and/or glandular differentiation and different patterns of invasion (nodular, trabecular, and infiltrative) and correlated data with patient outcome. Squamous or glandular differentiation occurred in 47/268 (18%) tumors and its presence correlated with high tumor stage (P<0.001) and grade (P<0.001). Invasive patterns were nodular in 49/227 (22%), trabecular in 95/227 (42%), and infiltrative in 83/227 (37%) tumors. The nodular pattern prevailed in low stage (P<0.001) and low-grade (P<0.001) tumors, whereas the infiltrative pattern prevailed in high stage (P<0.001) and high-grade (P<0.001) tumors. Multivariate analysis proved that tumor stage (P<0.001) and the infiltrative pattern (P<0.001) are independent predictors of metastasis-free survival, whereas tumor grade and squamous and glandular differentiation lacked independent influence on patient outcome. In conclusion, the infiltrative pattern of invasion significantly correlated with advanced disease and poor patient outcome. In contrast, the presence of squamous and/or glandular invasion did not prove independent influence on patient outcome. The pattern of invasion should be commented upon separately in the pathology report.
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Affiliation(s)
- C Langner
- Institute of Pathology, Medical University Graz, Auenbruggerplatz 25, Graz, 8036, Austria.
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Langner C, Hutterer G, Chromecki T, Winkelmayer I, Rehak P, Zigeuner R. pT classification, grade, and vascular invasion as prognostic indicators in urothelial carcinoma of the upper urinary tract. Mod Pathol 2006; 19:272-9. [PMID: 16424895 DOI: 10.1038/modpathol.3800529] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Clinicopathologic features predictive of patient outcome in upper urinary tract urothelial carcinoma are not well defined. The aim of this study was to assess the role of pT classification, tumor grade, and vascular invasion in predicting metastasis-free survival. A total of 190 consecutive invasive upper urinary tract urothelial cancers operated between 01/1984 and 12/2004 were re-evaluated with respect to pT classification, tumor grade (according to the three-tiered WHO 1973 and the recent two-tiered grading system following the WHO/ISUP consensus classification), as well as presence of lymph and/or blood vessel invasion. Prognostic impact was analyzed using the Kaplan-Meier method and the Log-Rank test. For multivariate testing, a Cox's proportional hazards regression model was used. pT1 was present in 81 (43%), pT2 in 29 (15%), pT3 in 73 (38%), and pT4 in seven (4%) cases. There were 12 (6%) G1, 96 (51%) G2, and 82 (43%) G3 tumors or 84 (44%) low-grade and 106 (56%) high-grade tumors according to the two-tiered system. The presence of vascular invasion in 72/190 (38%) tumors was associated with high pT classification (P<0.001) and high tumor grade (P<0.001). Disease progression occurred in 39% of patients, with 5- and 10-year metastasis-free survival rates of 56 and 45%, respectively. On univariate analysis, all investigated parameters showed prognostic significance. The negative influence of vascular invasion on patient outcome was strikingly strong in high pT classification and high-grade cancers. On multivariate analysis, pT classification (P<0.001) and vascular invasion (P<0.001) proved to be independent prognostic factors, whereas tumor grade according to the two-tiered system missed statistical significance (P=0.06). In conclusion, pT classification and vascular invasion are independent prognostic factors with respect to metastasis-free survival and should be used to guide adjuvant therapy strategies in affected patients. Presence (or absence) of vascular invasion should be commented upon separately in the pathology report.
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Affiliation(s)
- Cord Langner
- Institute of Pathology, Medical University Graz, Graz, Austria.
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Bauer M, Hutterer G, Eder M, Majer S, Leshane E, Johnson KL, Peter I, Bianchi DW, Pertl B. A prospective analysis of cell-free fetal DNA concentration in maternal plasma as an indicator for adverse pregnancy outcome. Prenat Diagn 2006; 26:831-6. [PMID: 16832830 DOI: 10.1002/pd.1513] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate whether cell-free fetal (cff) DNA in maternal plasma during the second trimester is a marker for developing pregnancy-associated complications. Two PCR techniques for the detection and quantitation of fetal DNA were compared. METHODS Plasma samples were prospectively collected from 84 pregnant women carrying male fetuses before amniocentesis (14-29 weeks). We later recorded 26 pregnancies with complicated outcomes, including five cases of fetal chromosomal abnormalities. For statistical analysis, two overlapping subgroups A and B were made. Each group was separately compared for total and fetal DNA with a corresponding group considered normal using Wilcoxon rank sum test. Male fetal DNA concentration in maternal plasma was quantified using real-time quantitative polymerase chain reaction (PCR) of SRY sequences. The samples were also analyzed by quantitative fluorescent PCR (QF-PCR) using highly polymorphic short tandem repeat DNA sequences (STRs), and the percentage of relative fetal allele concentration in maternal alleles was calculated and compared to the fetal/total DNA ratio obtained by real-time PCR. RESULTS Quantities of total and fetal circulating DNA were significantly correlated (r(2) = 0.44, P < 0.0001) with a median total DNA concentration of 522 GE/mL (range 51-3047) and a median fetal DNA concentration of 8 GE/mL (range 0-879). Neither level was correlated with gestational age in pregnancies with normal (r(2) = -0.05; P = 0.66, and r(2) = 0.02; P = 0.88, respectively) and abnormal (r(2) = 0.45; P = 0.17, and r(2) = 0.11; P = 0.76, respectively) outcomes. Although both total and fetal DNA levels were always higher in women carrying pregnancies with chromosomal aberrations or having other pregnancy complications (P-values range from 0.028 to 0.267), these differences reached statistical significance only for total DNA levels between the group A and corresponding normal pregnancies (P = 0.028). The correlation between the fetal/total DNA ratio obtained by real-time PCR and the percentage of relative fetal allele concentration in maternal alleles obtained by QF-PCR was not found to be statistically significant (r(2) = 0.04; P = 0.76). CONCLUSION Our results confirm the clinical value of fetal DNA measurement in maternal plasma during the second trimester as a supplement for the diagnosis of aneuploidies. Its use as a screening instrument for complications that develop later in pregnancy seems to be limited but needs further investigation. Although the QF-PCR assay has the advantage of being applicable to both female and male fetuses, this approach cannot be used for quantitation of cff DNA in maternal plasma samples.
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Affiliation(s)
- Margit Bauer
- Department of Obstetrics and Gynaecology, Medical University Graz, Auenbruggerplatz 14, A-8036 Graz, Austria
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Langner C, Rupar G, Leibl S, Hutterer G, Chromecki T, Hoefler G, Rehak P, Zigeuner R. Alpha-methylacyl-CoA racemase (AMACR/P504S) protein expression in urothelial carcinoma of the upper urinary tract correlates with tumour progression. Virchows Arch 2005; 448:325-30. [PMID: 16315020 DOI: 10.1007/s00428-005-0129-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Accepted: 10/27/2005] [Indexed: 11/27/2022]
Abstract
Alpha-methylacyl-CoA racemase (AMACR/P504S) is a useful biomarker of prostate cancer. We evaluated the expression of AMACR in upper urinary tract urothelial carcinomas with respect to associations with tumour stage, grade and metastasis-free survival. A total of 268 tumours were investigated immunohistochemically using a tissue microarray technique. AMACR expression was noted in 127 of 261 (48.7%) evaluated tumours and was associated with high tumour stage [58 of 139 (41.7%) pTa/pT1 vs. 69 of 122 (56.6%) pT2-pT4, P=0.019] and high tumour grade [44 of 137 (32.1%) low vs. 83 of 124 (66.9%) high grade, P<0.001]. In addition, AMACR expression was associated with the presence of tumour necrosis (P<0.001) and marked stromal desmoplasia (P=0.0026). This correlation indicates that increased AMACR expression might be related to hypoxia-induced changes in cancer cell metabolism, such as increased dependence on fatty acid oxidation for energy generation. Progressive disease was observed in 73 of 183 (39.9%) patients with solitary invasive carcinomas and was associated with AMACR expression (P=0.017). Multivariate analysis, however, proved only pT-stage >1 (P<0.001) and high tumour grade (P<0.001) to be independent predictors of patient outcome. In conclusion, AMACR expression correlated with advanced tumour stage and grade and may serve as an additional prognostic indicator in upper urinary tract urothelial cancer.
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Affiliation(s)
- Cord Langner
- Institute of Pathology, Medical University Graz, Auenbruggerplatz 25, Graz, Austria.
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Schips L, Lipsky K, Hebel P, Hutterer G, Gidaro S, Petritsch PH, Zigeuner RE. Laparoscopic fenestration of lymphoceles after kidney transplantation with diaphanoscopic guidance. Urology 2005; 66:185-7. [PMID: 15992897 DOI: 10.1016/j.urology.2005.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2004] [Revised: 01/31/2005] [Accepted: 02/18/2005] [Indexed: 10/25/2022]
Abstract
In laparoscopic fenestration of lymphoceles after kidney transplantation, identification of the correct site of incision is sometimes difficult. We developed a new technique, using diaphanoscopy in 3 patients. After ultrasound-guided puncture and dilation, the correct incision site is identified by white light with a cystoscope inserted into the lymphocele cavity.
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Affiliation(s)
- Luigi Schips
- Department of Urology, University Hospital, Medical University of Graz, Graz, Austria.
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Hutterer G, Bauer M, Häusler M, Orescovic I, Winter R, Bianchi DW, Eder M, Pertl B. Fetale DNA im mütterlichen Plasma: Ein neuer Marker für Schwangerschaftskomplikationen. Z Geburtshilfe Neonatol 2004. [DOI: 10.1055/s-2003-818079] [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: 10/20/2022]
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