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Lee S, Yoon Y, Suh J, You D, Hong B, Hong JH, Ahn H, Jeong IG, Lim B. Association of preoperative sarcopenia with the long-term prognosis of patients with bladder cancer undergoing radical cystectomy. J Cancer Res Clin Oncol 2024; 150:173. [PMID: 38568255 PMCID: PMC10991012 DOI: 10.1007/s00432-024-05705-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE This retrospective study aimed to assess the correlation between preoperative sarcopenia and long-term oncologic outcomes in patients undergoing radical cystectomy for bladder cancer. METHODS We included 528 patients who underwent radical cystectomy for bladder cancer between 2000 and 2010 at Asan Medical Center, Seoul, Korea. Preoperative skeletal muscle mass was quantified by analyzing computed tomography images at the third lumbar vertebra. Sarcopenia was defined based on the skeletal muscle index. We evaluated various clinical and pathological factors to analyze the association between sarcopenia and long-term oncologic outcomes. RESULTS The median follow-up time was 104 months. Sarcopenia was identified in 37.9% of the patients. Although no significant differences were observed in traditional pathological factors between the sarcopenic and non-sarcopenic groups, sarcopenia was significantly associated with worse oncologic outcomes. Compared to the non-sarcopenic groups, the sarcopenic group had lower overall survival rates (52.0% vs. 67.1% at 5 years, 35.5% vs. 52.7% at 10 years) and higher cancer-specific mortality (63.3% vs. 74.3% at 5 years, 50.7% vs. 67.4% at 10 years). Multivariable Cox regression analysis demonstrated that sarcopenia was an independent predictor of cancer-specific survival (hazard ratio: 1.49, 95% confidence interval: 1.11-2.01, p = 0.008), alongside body mass index, tumor stage, lymph node metastasis, and lymphovascular invasion. CONCLUSION Sarcopenia was significantly associated with poor cancer-specific survival in patients undergoing radical cystectomy for bladder cancer. Detecting sarcopenia may assist in preoperative risk stratification and long-term management after radical cystectomy.
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Affiliation(s)
- Sangmin Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Youngjoon Yoon
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jungyo Suh
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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Park I, Suh J, Lim B, Song C, You D, Jeong IG, Hong JH, Ahn H, Cho YM, Lee J, Hong B. Effectiveness of Adjuvant Chemotherapy in Variant Histology Upper Tract Urothelial Carcinoma Following Radical Nephroureterectomy: Stabilized Inverse Probability Treatment Weighting Analysis of Single Center Experience. Clin Genitourin Cancer 2024:102069. [PMID: 38580522 DOI: 10.1016/j.clgc.2024.102069] [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: 12/14/2023] [Revised: 01/04/2024] [Accepted: 02/21/2024] [Indexed: 04/07/2024]
Abstract
PURPOSE The study aimed to investigate the impact of adjuvant chemotherapy on time to recurrence (TTR) and overall survival (OS) in patients with histologic variants of upper tract urothelial carcinoma (VUTUC) following radical nephroureterectomy (RNU). MATERIALS AND METHODS A retrospective review of 131 VUTUC patients' medical records, from a pool of 368 non-metastatic localized or locally advanced UTUC cases, treated at a single tertiary referral center between January 2011 and January 2021. The intervention was adjuvant chemotherapy administration post-RNU. TTR and OS were evaluated using Kaplan-Meier and Cox proportional hazard regression, covariates adjusted for age, postoperative GFR, history of neoadjuvant chemotherapy, T and N stage with stabilized inverse probability of treatment weighting (sIPTW). RESULTS The application of adjuvant chemotherapy showed a significant extension in TTR (P = .01), but no substantial impact on OS (P = .19) after sIPTW adjustment for covariates. Multivariate analysis revealed adjuvant chemotherapy, tumor size, and lymphovascular invasion as significant prognostic factors for TTR. In contrast, only tumor size and perineural invasion were significant for OS. Adjuvant chemotherapy reduced the progression risk in certain VUTUC subtypes (squamous or glandular/micropapillary), but not in sarcomatoid variants. CONCLUSIONS Adjuvant chemotherapy appears to improve TTR, albeit without a significant effect on OS, in nonmetastatic localized and locally advanced VUTUC patients post-RNU. While beneficial to some VUTUC subtypes, it did not yield significant advantages for sarcomatoid variants. Despite adjustments for known confounders, the study's findings may be subject to potential selection bias and unmeasured confounding factors.
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Affiliation(s)
- Inkeun Park
- Department of Oncology, Asian Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Jungyo Suh
- Department of Urology, Asian Medical Center, Ulsan University College of Medicine, Seoul, South Korea.
| | - Bumjin Lim
- Department of Urology, Asian Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Cheryn Song
- Department of Urology, Asian Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Dalsan You
- Department of Urology, Asian Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - In Gab Jeong
- Department of Urology, Asian Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Jun Hyuk Hong
- Department of Urology, Asian Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Hanjong Ahn
- Department of Urology, Asian Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Yong Mee Cho
- Department of Pathology, Asian Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Jaelyun Lee
- Department of Oncology, Asian Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Bumsik Hong
- Department of Urology, Asian Medical Center, Ulsan University College of Medicine, Seoul, South Korea
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Gwak CH, Suh J, Lim B, Song C, You D, Jeong IG, Hong JH, Hong B, Ahn H. Preoperative C-reactive protein to albumin ratio as a novel prognostic biomarker for the oncological outcomes of radical nephroureterectomy. Urol Oncol 2024; 42:30.e17-30.e23. [PMID: 38072737 DOI: 10.1016/j.urolonc.2023.10.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/19/2023] [Accepted: 10/23/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE This study aimed to evaluate the prognostic impact of the preoperative C-reactive protein to albumin ratio (CAR) on progression-free survival (PFS) and cancer-specific survival (CSS) in patients with upper urinary tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). METHODS A retrospective analysis was conducted using data from a single-center nephroureterectomy registry between January 2011 and December 2017. Participants were categorized into high and low CAR groups based on the optimal CAR cut-off value determined using the Youden index. The primary endpoint was PFS, the time from RNU to metastasis or disease recurrence. The secondary endpoint was CSS, the time from RNU to UTUC-related death. Median PFS and CSS were compared between the high and low CAR groups using Kaplan-Meier analysis and log-rank test. Multivariable Cox proportional hazard regression analysis was performed to assess the prognostic significance of CAR, adjusting for known prognostic factors. RESULTS We included 491 patients with UTUC in the analysis. The optimal CAR cut-off value was determined to be 0.036, which resulted in classifying 49.3% (242/491) of patients into the high CAR group. The high CAR group had older patients (69.8 vs. 67.4, p-value = 0.01), advanced T and N stages (p-value<0.001), high-grade tumor (p-value = 0.03), and a higher incidence of preoperative hydronephrosis (p-value < 0.01) than the low CAR group. The high CAR group demonstrated significantly inferior median PFS (78.3 vs. 100.3 months, p-value < 0.01) and CSS (73.2 vs. 96.1 months, p-value < 0.01) than the low CAR group. Moreover, high CAR independently increased the risk of disease progression (hazard ratio [HR]: 1.80, 95% confidence interval [CI]: 1.23-2.64, p < 0.01) and UTUC-related mortality (HR: 1.79, 95% CI: 1.15, p < 0.01). CONCLUSION Pre-operative CAR is independently associated with poor PFS and CSS in patients with UTUC undergoing RNU. Moreover, CAR may be an independent UTUC prognostic factor, offering a cost-effective and minimally invasive marker. However, further validation through large-scale, multi-center studies is necessary to confirm these findings and determine the optimal CAR cut-off value.
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Affiliation(s)
- Chan Hoon Gwak
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Jungyo Suh
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea.
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
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Suh J, Jeong IG, Jeon HG, Jeong CW, Lee S, Jeon SS, Byun SS, Kwak C, Ahn H. Bilateral Seminal Vesicle Invasion as a Strong Prognostic Indicator in T3b Prostate Cancer Patients Following Radical Prostatectomy: A Comprehensive, Multi-Center, Long-Term Follow-Up Study. Cancer Res Treat 2024:crt.2023.1264. [PMID: 38186239 DOI: 10.4143/crt.2023.1264] [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: 11/29/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024] Open
Abstract
Purpose Pathologic T3b (pT3b) prostate cancer, characterized by seminal vesicle invasion (SVI), exhibits variable oncological outcomes post-radical prostatectomy (RP). Identifying prognostic factors is crucial for patient-specific management. This study investigates the impact of bilateral SVI on prognosis in pT3b prostate cancer. Materials and Methods We evaluated the medical records of a multi-institutional cohort of men who underwent RP for prostate cancer with SVI between 2000 and 2012. Univariate and multivariable analyses were performed using Kaplan-Meier analysis and covariate-adjusted Cox-proportional hazard regression for biochemical recurrence (BCR), clinical progression (CP), and cancer-specific survival (CSS). Results Among 770 men who underwent RP without neo-adjuvant treatment, median follow-up was 85.7 months. Patients with bilateral SVI had higher preoperative prostate-specific antigen levels and clinical T stage (all p<0.001). Extracapsular extension, tumor volume, lymph node metastasis (p<0.001), pathologic Gleason grade group (p<0.001), and resection margin positivity (p<0.001) were also higher in patients with bilateral SVI. The 5-, 10-, and 15-year BCR-free survival rates were 23.9%, 11.7%, and 8.5%; CP-free survival rates were 82.8%, 62.5%, and 33.4%; and CSS rates were 96.4%, 88.1%, and 69.5%, respectively. The bilateral SVI group demonstrated significantly lower BCR, CP-free survival rates, and CSS rates all (p<0.001). Bilateral SVI was independently associated with BCR (HR 1.197, 95% CI 1p=0.049), CP (p=0.022), and CSS (p=0.038) in covariate-adjusted Cox regression. Conclusion Bilateral SVI is a robust, independent prognostic factor for poor oncological outcomes in pT3b prostate cancer.
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Affiliation(s)
- Jungyo Suh
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yang EH, Shin S, Kim YH, Jeong IG, Hong B, Baek CH, Kim H, Kim SB. No difference in follow-up estimated glomerular filtration rate between hypertensive and matched nonhypertensive kidney donors. Nefrologia 2024; 44:32-39. [PMID: 36494286 DOI: 10.1016/j.nefroe.2022.11.022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/21/2021] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND According to current guidelines, kidney donor candidates with controlled hypertension using 1 or 2 antihypertensive drugs may be considered as donor. However, this recommendation is based on the study that antihypertensive drug was initiated in mainly "after donor registration" and this may be white-coat hypertension because of donation-related anxiety. We compared the follow-up eGFR between kidney donors with preexisting hypertension and matched nonhypertensive donors. METHODS This single-center retrospective study classified 97 living hypertensive donors previously receiving antihypertensive drugs into two groups: 1 drug group (61 donors) and 2 drugs group (36 donors). We compared the follow-up eGFR between each donor previously receiving antihypertensive drugs and three matched nonhypertensive donors in terms of age, sex, and follow-up duration. RESULTS At a mean (range) of 51 months (12-214) in the 1 drug group, and 54 months (12-175) in the 2 drugs group after donation, there was no significant difference in follow-up eGFR between hypertensive donors previously receiving antihypertensive drugs and matched controls in each group and in total donors. There was no difference in the incidence of the patients with follow-up eGFR<45mL/min/m2 in each group and their matched controls. Multiple linear regression analysis showed that baseline eGFR was the only independent predictor for the final follow-up eGFR in the total donors. CONCLUSION Our results support the current guidelines that donor candidates with controlled hypertension using 1 or 2 antihypertensive drugs may be considered as donors, and may increase the strength of this recommendation.
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Affiliation(s)
- Eun Hye Yang
- Division of Nephrology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sung Shin
- Division of Kidney and Pancreas Transplantation, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Young Hoon Kim
- Division of Kidney and Pancreas Transplantation, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - In Gab Jeong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Bumsik Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Chung Hee Baek
- Division of Nephrology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hyosang Kim
- Division of Nephrology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Soon Bae Kim
- Division of Nephrology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
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Kim D, You D, Jeong IG, Hong JH, Ahn H, Hong B. Kidney sparing surgery in upper tract urothelial carcinoma: paradigm change in surgical treatment for ureter cancer. J Cancer Res Clin Oncol 2023; 149:13717-13725. [PMID: 37522922 DOI: 10.1007/s00432-023-05207-x] [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: 05/24/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE To extend the indications of kidney-sparing surgery (KSS) for ureter cancer by comparing the oncological outcomes between patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU) or KSS. METHODS We retrospectively reviewed 708 patients with UTUC who underwent RNU (N = 646) or KSS (N = 62) between 2011 and 2019 to analyze the oncologic outcomes and prognostic factors. Subgroup analyses were performed for patients with unifocal ureteral urothelial carcinoma (UC). RESULTS No significant difference was observed in the overall survival (OS) or cancer-specific survival (CSS) between RNU and KSS (distal ureterectomy with reimplantation (N = 33), ureterectomy with ileal ureter (N = 14), ureteroscopic tumor resection (N = 10), and ureterectomy with ureteroureterostomy (N = 5)). Among 269 (38.0%) patients with unifocal ureteral UC, 219 and 50 patients underwent RNU and KSS, respectively. OS and CSS were not significantly different between these two groups. Pathologic stage was a significant risk factor in multivariate analysis (hazard ratio = 2.621; p = 0.000). Among 646 RNU patients, 219 (33.9%) had unifocal ureteral UC, 40 (18.3%) with low-grade tumors. Among these, 13 (5.9%) patients with unifocal, low-grade and small (< 2 cm) tumors received nephroureterectomy. CONCLUSION Kidney-sparing surgery should be regarded as an important alternative to RNU for patients with unifocal ureteral UC thought to have noninvasive disease to preserve renal function and reduce overtreatment.
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Affiliation(s)
- Dongsu Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 43 Gil 88, Olympic-Road, Songpa-Gu, 05505, Seoul, Republic of Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 43 Gil 88, Olympic-Road, Songpa-Gu, 05505, Seoul, Republic of Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 43 Gil 88, Olympic-Road, Songpa-Gu, 05505, Seoul, Republic of Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 43 Gil 88, Olympic-Road, Songpa-Gu, 05505, Seoul, Republic of Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 43 Gil 88, Olympic-Road, Songpa-Gu, 05505, Seoul, Republic of Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 43 Gil 88, Olympic-Road, Songpa-Gu, 05505, Seoul, Republic of Korea.
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Kim D, Lim B, Suh J, You D, Jeong IG, Hong JH, Ahn H. Clinical Significance of Radical Prostatectomy in Clinical Lymph Node Metastasis in Prostate Cancer. Ann Surg Oncol 2023; 30:7903-7909. [PMID: 37689608 DOI: 10.1245/s10434-023-14137-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/26/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND This study aimed to investigate the role of radical prostatectomy (RP) among clinical nodal metastasis prostate cancer and whether histological confirmation of lymph node metastasis through surgery can help with treatment. PATIENTS AND METHODS After excluding patients with distant metastatic prostate cancer or neoadjuvant androgen deprivation therapy, 42 patients with clinical nodal metastasis who underwent RP at our institution were included in the study. We classified them as having or not having pathological lymph node metastasis. Clinicopathologic data were analyzed in this retrospective chart review. Kaplan-Meier analysis was used to calculate the estimated castration-resistant prostate cancer (CRPC)-free survival, biochemical recurrence (BCR)-free survival, and cancer-specific survival (CSS). RESULTS There is no significant difference in age, presence of diabetes mellitus, hypertension, BCR time, CRPC time, overall survival, salvage RT rate, and initial prostate-specific antigen level between the two groups. However, there is a significant difference in the pathology N1 group in terms of pathological T stage, pathologic Gleason score, BCR rate, CRPC rate, and CSS. A multivariate Cox proportional hazard regression analysis was used to identify predictors of CRPC-free survival. Patients with pathological lymph node metastasis had a shorter CRPC-free survival [hazard ratio (HR) 4.87; 95% confidence interval (CI) 1.25-19.00, p = 0.02]. CONCLUSION Radical prostatectomy can confirm lymph node metastasis. Although pathologic diagnosis has no effect on time to BCR and CPRC, because it affects BCR rate, CRPC rate, and CSS, an accurate pathological diagnosis obtained through surgery is beneficial in the treatment of clinical lymph node metastasis prostate cancer.
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Affiliation(s)
- Dongwon Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Jungyo Suh
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim D, Nam W, Kyung YS, You D, Jeong IG, Hong B, Hong JH, Ahn H, Lim B. Effect of decreased renal function on poor oncological outcome after radical cystectomy. Investig Clin Urol 2023; 64:346-352. [PMID: 37417559 DOI: 10.4111/icu.20230063] [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: 02/21/2023] [Revised: 04/04/2023] [Accepted: 04/18/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE To evaluate the impact of preoperative renal impairment on the oncological outcomes of patients with urothelial carcinoma who underwent radical cystectomy. MATERIALS AND METHODS We retrospectively reviewed the medical records of patients with urothelial carcinoma who underwent radical cystectomy from 2004 to 2017. All patients who underwent preoperative 99mTc-diethylenetriaminepentaacetic acid renal scintigraphy (DTPA) were identified. We divided the patients into two groups according to their glomerular filtration rates (GFRs): GFR group 1, GFR≥90 mL/min/1.73 m²; GFR group 2, 60≤GFR<90 mL/min/1.73 m². We included 89 patients in GFR group 1 and 246 patients in GFR group 2 and compared the clinicopathological characteristics and oncological outcomes between the two groups. RESULTS The mean time required for recurrence was 125.5±8.0 months in GFR group 1 and 85.7±7.4 months in GFR group 2 (p=0.030). The mean cancer-specific survival was 131.7±7.8 months in GFR group 1 and 95.5±6.9 months in GFR group 2 (p=0.051). The mean overall survival was 123.3±8.1 months in GFR group 1 and 79.5±6.6 months in GFR group 2 (p=0.004). CONCLUSIONS Preoperative GFR values in the range of 60≤GFR<90 mL/min/1.73 m² are independent prognostic factors for poor recurrence-free survival, cancer-specific survival, and overall survival in patients after radical cystectomy compared with GFR values of ≥90 mL/min/1.73 m².
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Affiliation(s)
- Dongsu Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wook Nam
- Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Yoon Soo Kyung
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Suh J, Shin TJ, You D, Jeong IG, Hong JH, Kim CS, Ahn H. The association between serum lipid profile and the prostate cancer risk and aggressiveness. Front Oncol 2023; 13:1113226. [PMID: 37256171 PMCID: PMC10225643 DOI: 10.3389/fonc.2023.1113226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/18/2023] [Indexed: 06/01/2023] Open
Abstract
Purpose This study aims to evaluate the association of serum lipid profile on prostate cancer (PC) risk and aggressiveness. Methods Men who underwent prostate biopsy between January 2005 and December 2015 were retrospectively analyzed. The association between lipid profile and the risk, stage, and Gleason grade group (GG) of the PC were investigated. Sensitivity analysis was conducted using univariate and multivariate quantile analysis for lipide profile on the risk and stage of PC. Results Of the 1740 study populations, 720 men (41.4%) were diagnosed as PC. From multivariate logistic regression analysis, age, prostate specific antigen, triglyceride (odds ratio (OR):1.05, confidence interval (CI):1.03-1.07, p-value<0.001) significantly increased PC risk, while total cholesterol (OR:0.96, CI:0.92-0.99, p-value=0.011) significantly decreased the PC risk. The increase of serum triglyceride increased the risk of both of locally advanced (OR:1.03, CI:1.00-1.07, p-value=0.025) and metastatic PC (OR:1.14, CI:1.04-1.25, p-value=0.004). The increase of serum triglyceride increased the risk of GG2-3 (OR:1.03, CI:1.00-1.06, p-value=0.027) and GG4-5 (OR:1.04, CI:1.01-1.08, p-value=0.027). Univariate quartile analysis founded serum triglyceride increasing risk of locally advanced disease than organ confined disease. (OR: 1.00, 1.25, 2.04, 4.57 for 1st, 2nd, 3rd and 4th quartile, p-value<0.001). Adjusted multivariate quartile analysis confirmed statistically significant increasing PC risk of triglyceride (OR: 1.00, 1.25, 2.04, 4.57 for 1st, 2nd, 3rd and 4th quartile, p-value<0.001). Conclusions This study findings suggested increased in triglyceride level increased the risk PC. Increased in triglyceride level also associated with aggressive presentation of PC, with higher stage and GG.
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Affiliation(s)
- Jungyo Suh
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Teak Jun Shin
- Department of Urology, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Dalsan You
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - In Gab Jeong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jun Hyuk Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Choung-Soo Kim
- Department of Urology, Ewha Womans Medical Center, Seoul, Republic of Korea
| | - Hanjong Ahn
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Kim J, Lim B, Jeong IG, Ro JY, Go H, Cho YM, Park KJ. Biopsy-Integrated 3D Magnetic Resonance Imaging Modeling of Prostate Cancer and Its Application for Gleason Grade and Tumor Laterality Assessment. Arch Pathol Lab Med 2023; 147:159-166. [PMID: 35512234 DOI: 10.5858/arpa.2021-0256-oa] [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] [Accepted: 12/09/2021] [Indexed: 02/05/2023]
Abstract
CONTEXT.— Grade Group assessed using Gleason combined score and tumor extent is a main determinant for risk stratification and therapeutic planning of prostate cancer. OBJECTIVE.— To develop a 3-dimensional magnetic resonance imaging (MRI) model regarding Grade Group and tumor extent in collaboration with uroradiologists and uropathologists for optimal treatment planning for prostate cancer. DESIGN.— We studied the data from 83 patients with prostate cancer who underwent multiparametric MRI and subsequent MRI-transrectal ultrasound fusion biopsy and radical prostatectomy. A 3-dimensional MRI model was constructed by integrating topographic information of MRI-based segmented lesions, biopsy paths, and histopathologic information of biopsy specimens. The multiparametric MRI-integrated Grade Group and laterality were assessed by using the 3-dimensional MRI model and compared with the radical prostatectomy specimen. RESULTS.— The MRI-defined index tumor was concordant with radical prostatectomy in 94.7% (72 of 76) of cases. The multiparametric MRI-integrated Grade Group revealed the highest agreement (weighted κ, 0.545) and a significantly higher concordance rate (57.9%) than the targeted (47.8%, P = .008) and systematic (39.4%, P = .01) biopsies. The multiparametric MRI-integrated Grade Group showed significantly less downgrading rates than the combined biopsy (P = .001), without significant differences in upgrading rate (P = .06). The 3-dimensional multiparametric MRI model estimated tumor laterality in 66.2% (55 of 83) of cases, and contralateral clinically significant cancer was missed in 9.6% (8 of 83) of cases. The tumor length measured by multiparametric MRI best correlated with radical prostatectomy as compared with the biopsy-defined length. CONCLUSIONS.— The 3-dimensional model incorporating MRI and MRI-transrectal ultrasound fusion biopsy information easily recognized the spatial distribution of MRI-visible and MRI-nonvisible cancer and provided better Grade Group correlation with radical prostatectomy specimens but still requires validation.
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Affiliation(s)
- Jisup Kim
- From the Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea (Kim)
| | - Bumjin Lim
- From the Department of Urology (Lim, Jeong), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- From the Department of Urology (Lim, Jeong), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Y Ro
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Medical College of Cornell University, Houston, Texas (Ro)
| | - Heounjeong Go
- From the Department of Pathology (Go, Cho), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Mee Cho
- From the Department of Pathology (Go, Cho), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kye Jin Park
- From the Department of Radiology (Park), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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11
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An DH, Han JH, Jang MJ, Aum J, Kim YS, Jeong IG, Hong B, You D. Solo-surgeon pure laparoscopic donor nephrectomy using passive camera holder: IDEAL stage 2a study. BMC Urol 2022; 22:44. [PMID: 35337318 PMCID: PMC8957188 DOI: 10.1186/s12894-022-00996-8] [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: 05/20/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Solo-surgery can be defined as a practice of a surgeon operating alone using a camera holder, without other surgical members except for a scrub nurse. This study was designed to evaluate the feasibility and safety of solo-surgeon pure laparoscopic donor nephrectomy. METHODS The study protocol was approved by the Institutional Review Board of Asan Medical Center, Seoul, Korea. The brief study protocol was registered on the Clinical Research Information Service site of the Korea Centers for Disease Control and Prevention. Candidates fulfilling all inclusion and exclusion criteria were enrolled in the clinical trial and underwent solo-surgeon pure laparoscopic donor nephrectomy. The feasibility was assessed by the proportion of subjects who could undergo solo-surgeon pure laparoscopic donor nephrectomy without difficulty. The perioperative complications were identified to assess the safety of solo-surgeon pure laparoscopic donor nephrectomy. RESULTS Of the 47 potential candidates from November 2018 to August 2019, 40 were enrolled in the clinical trial and seven excluded due to declining participation. The feasibility of solo-surgeon pure laparoscopic donor nephrectomy was 100%, without an occasion of any difficulty requiring conversion to the human assisted pure laparoscopic donor nephrectomy. Fourteen intraoperative complications occurred in 10 patients. The most common intraoperative complication was spleen injury. Two of three cases classified as the Satava classification grade II were due to the incomplete stapling of endoscopic stapler. Seventy-eight postoperative complications occurred in 34 patients. The most common postoperative complication was nausea/vomiting and followed by aspartate aminotransferase/alanine aminotransferase elevation. Most postoperative complication was independent of the solo-surgery itself. CONCLUSIONS Solo-surgeon pure laparoscopic donor nephrectomy using passive camera holder is technically feasible. In terms of safety, it is necessary to adjust the scope of surgery performed alone. Trial Registration CRIS, KCT0003458. Registered 30/01/2019, Retrospectively registered, https://cris.nih.go.kr/cris/search/detailSearch.do/15868 .
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Affiliation(s)
- Dong Hyeon An
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hyeon Han
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Myoung Jin Jang
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Joomin Aum
- Department of Urology, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Yu Seon Kim
- Department of Urology, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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Yang EH, Shin S, Kim YH, Jeong IG, Hong B, Baek CH, Kim H, Kim SB. No difference in follow-up estimated glomerular filtration rate between hypertensive and matched nonhypertensive kidney donors. Nefrologia 2021. [DOI: 10.1016/j.nefro.2021.10.004] [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: 10/19/2022] Open
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13
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Lee J, Suh J, Song C, You D, Jeong IG, Hong B, Hong JH, Kim CS, Ahn H. ASO Visual Abstract: Association Between Sarcopenia and the Survival of Patients with Organ-Confined Renal Cell Carcinoma After Radical Nephrectomy. Ann Surg Oncol 2021. [PMID: 34689267 DOI: 10.1245/s10434-021-10951-w] [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: 11/18/2022]
Affiliation(s)
- Jongpil Lee
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jungyo Suh
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheryn Song
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Dalsan You
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Choung Soo Kim
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Lee J, Suh J, Song C, You D, Jeong IG, Hong B, Hong JH, Kim CS, Ahn H. Association Between Sarcopenia and Survival of Patients with Organ-Confined Renal Cell Carcinoma after Radical Nephrectomy. Ann Surg Oncol 2021; 29:2473-2479. [PMID: 34625877 DOI: 10.1245/s10434-021-10881-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/13/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND We aimed to describe the effect of preoperative sarcopenia on oncologic outcomes of organ-confined renal cell carcinoma (RCC) after radical nephrectomy. PATIENTS AND METHODS A total of 632 patients with pT1-2 RCC who underwent radical nephrectomy between 2004 and 2014 were retrospectively analyzed. From preoperative computerized tomography (CT) scans, skeletal muscle index (SMI) was measured and gender-specific cutoff values at third lumbar vertebra of 52.4 cm2/m2 for men and 38.5 cm2/m2 for women were used to define sarcopenia. Survivals were compared and associations with sarcopenia were analyzed using Kaplan-Meier log rank tests and Cox proportional hazard regression models. Median follow-up was 83 months. RESULTS Of 632 patients, 268 (42.4%) were classified as sarcopenic. The sarcopenic group was more advanced in age (57 versus 53 years) and more predominantly male (71.3% versus 59.9%). Sarcopenic patients had lower body mass index (BMI, 23.0 versus 25.9 kg/m2), but there was no difference in tumor size, stage, or nuclear grade. Sarcopenia was associated with poorer overall survival (OS) and cancer-specific survival (CSS; OS 94.0% versus 82.1%; p < 0.001 and CSS 97.5% versus 91.8%; p < 0.001). On multivariate analysis, sarcopenia was an independent risk factor for all-cause mortality [hazard ratio (HR) 2.58; 95% CI 1.02-6.54] and cancer-specific mortality (HR 3.07; 95% CI 1.38-6.83). CONCLUSIONS Sarcopenia at diagnosis was an independent risk factor for all-cause and cancer-specific mortality after radical nephrectomy for pT1-2 RCC. These findings underscore the importance of assessing presence of sarcopenia for risk stratification even among surgical candidates.
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Affiliation(s)
- Jongpil Lee
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jungyo Suh
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Cheryn Song
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Dalsan You
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - In Gab Jeong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Bumsik Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jun Hyuk Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Choung Soo Kim
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hanjong Ahn
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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15
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Jeong IG, Lim B, Yun SC, Lim JH, Hong JH, Kim CS. Adjuvant Low-dose Statin Use after Radical Prostatectomy: The PRO-STAT Randomized Clinical Trial. Clin Cancer Res 2021; 27:5004-5011. [PMID: 34011557 DOI: 10.1158/1078-0432.ccr-21-0480] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/25/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Statin use is reportedly associated with the risk of prostate cancer, outcomes after treatment, and prostate cancer-specific mortality. We sought to determine the efficacy of adjuvant atorvastatin in prostate cancer after radical prostatectomy. PATIENTS AND METHODS In this randomized, double-blind trial, we assigned patients with pathologic high-risk prostate cancer to receive either low-dose atorvastatin (20 mg/day, n = 183) or placebo (n = 181) for 1 year after radical prostatectomy. The primary endpoint was the 1-year biochemical recurrence rate. The secondary endpoints included the 5-year biochemical recurrence-free survival and changes in lipid, testosterone, and sex hormone binding globulin levels. RESULTS From October 2012 through January 2019, a total of 364 patients underwent randomization. Among 59 total primary end points, 30 (16.4%) and 29 (16.0%) occurred in the atorvastatin and placebo groups, respectively. Atorvastatin did not significantly reduce the primary endpoint of 1-year biochemical recurrence [HR, 0.96; 95% confidence interval (CI), 0.58-1.60]. During a median follow-up of 24 months, 131 patients experienced biochemical recurrence (68 in the atorvastatin group and 63 in the placebo group), representing Kaplan-Meier estimated event rates of 24.0% and 25.4% in the atorvastatin and placebo groups, respectively, at 24 months (HR, 1.00; 95% CI, 0.71-1.41). We observed no significant between-group differences in the testosterone and sex hormone binding globulin levels. CONCLUSIONS Among patients with high-risk pathologic features after radical prostatectomy for prostate cancer, 1-year adjuvant use of atorvastatin was not associated with a lower risk of disease recurrence compared with that for placebo. (ClinicalTrials.gov number, NCT01759836).See related commentary by Murtola and Siltari, p. 4947.
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Affiliation(s)
- In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of South Korea
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of South Korea
| | - Sung-Cheol Yun
- Division of Biostatistics, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of South Korea
| | - Ju Hyun Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of South Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of South Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of South Korea.
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Lim B, Lee W, Kyung YS, You D, Jeong IG, Hong JH, Ahn H, Kim CS. Biopsy-detected Gleason grade 5 tumor is an additional prognostic factor in metastatic hormone-sensitive prostate cancer. J Cancer Res Clin Oncol 2021; 148:727-734. [PMID: 33948720 DOI: 10.1007/s00432-021-03642-2] [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: 12/08/2020] [Accepted: 04/13/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE A Gleason score ≥ 8, metastatic tumor burden, and visceral metastasis are known prognostic factors for patients with metastatic hormone-sensitive prostate cancer (mHSPC). Notably, however, these indicators have not been fully validated internationally. We aimed in this present study to further analyze the factors that influence the prognosis of mHSPC. METHODS In this retrospective study, we identified 201 patients with newly diagnosed mHSPC between 2008 and 2014 and collected their clinical information. Cox proportional hazard regression models were used to identify prognostic factors in mHSPC. RESULTS The mean age of the patients at presentation was 70 years (interquartile range (IQR), 64-76 years). The prostate-specific antigen level was 141 ng/mL (IQR, 58.8-464.5 ng/mL). Of the 201 study patients, 191 (94.5%) and 131 (65.2%) cases had a biopsy Gleason score ≥ 8 and grade 5, respectively. More than 4 metastases were detected in 134 patients. Castration-resistant prostate cancer (CRPC) was evident in 160 cases after a mean follow-up period of 46.6 months. By multivariable analysis, a Gleason grade of 5 and bone metastasis lesion count ≥ 4 were found to be significantly associated with CRPC-free survival (hazard ratio (HR), 1.45; 95% confidence interval (CI), 1.01-2.07) and (HR 2.02; 95% CI 1.39-2.92) and overall survival (HR 1.67 95%; CI 1.16-2.42) and (HR 1.67 95%; CI 1.16-2.41). CONCLUSIONS Bone metastases ≥ 4 and a Gleason grade 5 are independent prognostic factors for CRPC-free and overall survival in mHSPC. A Gleason grade 5 is therefore a new prognostic indicator in mHSPC.
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Affiliation(s)
- Bumjin Lim
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, 138-736, Korea
| | - Wonchul Lee
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, 138-736, Korea
| | - Yoon Soo Kyung
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, 138-736, Korea
| | - Dalsan You
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, 138-736, Korea
| | - In Gab Jeong
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, 138-736, Korea
| | - Jun Hyuk Hong
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, 138-736, Korea
| | - Hanjong Ahn
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, 138-736, Korea
| | - Choung-Soo Kim
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, 138-736, Korea.
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Pak S, Lee DE, You D, Jeong IG, Joung JY, Lee KH, Hong JH, Kim CS, Ahn H. Validation of the European association of urology biochemical recurrence risk groups after radical prostatectomy in an Asian cohort and suggestions for refinement. Urol Oncol 2021; 39:298.e1-298.e6. [DOI: 10.1016/j.urolonc.2020.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/17/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
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Kim H, Park S, Jeong IG, Song SH, Jeong Y, Kim CS, Lee KH. Noninvasive Precision Screening of Prostate Cancer by Urinary Multimarker Sensor and Artificial Intelligence Analysis. ACS Nano 2021; 15:4054-4065. [PMID: 33296173 DOI: 10.1021/acsnano.0c06946] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Screening for prostate cancer relies on the serum prostate-specific antigen test, which provides a high rate of false positives (80%). This results in a large number of unnecessary biopsies and subsequent overtreatment. Considering the frequency of the test, there is a critical unmet need of precision screening for prostate cancer. Here, we introduced a urinary multimarker biosensor with a capacity to learn to achieve this goal. The correlation of clinical state with the sensing signals from urinary multimarkers was analyzed by two common machine learning algorithms. As the number of biomarkers was increased, both algorithms provided a monotonic increase in screening performance. Under the best combination of biomarkers, the machine learning algorithms screened prostate cancer patients with more than 99% accuracy using 76 urine specimens. Urinary multimarker biosensor leveraged by machine learning analysis can be an important strategy of precision screening for cancers using a drop of bodily fluid.
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Affiliation(s)
- Hojun Kim
- Biomaterials Research Center, Korea Institute of Science and Technology (KIST), Seoul 02792, Republic of Korea
| | - Sungwook Park
- Biomaterials Research Center, Korea Institute of Science and Technology (KIST), Seoul 02792, Republic of Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center (AMC), University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Sang Hoon Song
- Department of Urology, Asan Medical Center (AMC), University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Youngdo Jeong
- Biomaterials Research Center, Korea Institute of Science and Technology (KIST), Seoul 02792, Republic of Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center (AMC), University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Kwan Hyi Lee
- Biomaterials Research Center, Korea Institute of Science and Technology (KIST), Seoul 02792, Republic of Korea
- KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul 02841, Republic of Korea
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Park KJ, Choi SH, Kim M, Kim JK, Jeong IG. Performance of Prostate Imaging Reporting and Data System Version 2.1 for Diagnosis of Prostate Cancer: A Systematic Review and
Meta‐Analysis. J Magn Reson Imaging 2021; 54:103-112. [DOI: 10.1002/jmri.27546] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 02/01/2023] Open
Affiliation(s)
- Kye Jin Park
- Department of Radiology and Research Institute of Radiology University of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology University of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
| | - Mi‐hyun Kim
- Department of Radiology and Research Institute of Radiology University of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
| | - Jeong Kon Kim
- Department of Radiology and Research Institute of Radiology University of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
| | - In Gab Jeong
- Department of Urology University of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
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Lim B, Choi SY, Kyung YS, You D, Jeong IG, Hong JH, Ahn H, Kim CS. Value of clinical parameters and MRI with PI-RADS V2 in predicting seminal vesicle invasion of prostate cancer. Scand J Urol 2020; 55:17-21. [PMID: 33349092 DOI: 10.1080/21681805.2020.1833981] [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] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the usefulness of magnetic resonance imaging (MRI) with Prostate Imaging Reporting and Data System version 2 (PI-RADSV2) and clinical parameters in predicting seminal vesicle invasion (SVI). MATERIAL AND METHODS In this retrospective study, we identified 569 prostate cancer patients who underwent radical prostatectomy with MRI before surgery. SVI was interpreted with PI-RADSV2. Clinical parameters such as the prostate-specific antigen (PSA) and Gleason score (GS) were analyzed for the prediction of SVI. Logistic regression models and receiver operating characteristic (ROC) curves were used to evaluate SVI based on clinical parameters and MRI with PI-RADSV2. RESULTS The median age at presentation was 67 years (43-85 years). The median PSA level was 6.1 ng/mL (2.2-72.8 ng/mL). There were 113 patients with a biopsy GS of ≥ 8. A total of 34 patients (6.0%) were interpreted to have SVI by MRI of which 20 were true positive, and 52 patients (9.1%) had true SVI in the final pathologic analysis. In multivariable analysis, PSA (HR: 1.03, 95% CI: 1.00-1.07), biopsy GS ≥ 8 (HR: 4.14, 95% CI: 2.12-8.09), and MRI with PI-RADSV2 (HR: 14.67, 95% CI: 6.34-33.93) were significantly associated with pathologic SVI. The area under the curve of the model based on the clinical parameters PSA and GS plus MRI (0.862) was significantly larger than that of the model based on clinical parameters alone (0.777, p < 0.001). CONCLUSIONS MRI with PI-RADSV2 using the clinical parameters PSA and GS was effective in predicting SVI.
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Affiliation(s)
- Bumjin Lim
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Young Choi
- Department of Urology Chung, ANG University Hospital, Seoul, Korea
| | - Yoon Soo Kyung
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dalsan You
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lee J, Song C, Lee D, Kim JK, You D, Jeong IG, Hong B, Hong JH, Kim CS, Ahn H. Differential contribution of the factors determining long-term renal function after partial nephrectomy over time. Urol Oncol 2020; 39:196.e15-196.e20. [PMID: 33309296 DOI: 10.1016/j.urolonc.2020.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/05/2020] [Accepted: 11/02/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To define how much of renal function was determined by the preserved renal parenchymal volume and the ischemic insult during partial nephrectomy (PN) long after surgery. METHODS We analyzed the data of 530 consecutive patients who had undergone PN. For all patients, renal function was measured preoperatively and again at 3 postoperative months, then annually using 99mTc-diethylenetriaminepentaacetic acid renal scan. Perioperative variables potentially affecting the long-term ipsilateral glomerular filtration rate (GFR) and their time-varying contribution were assessed using a linear mixed model. RESULTS The mean preoperative ipsilateral GFR was 42.9 ml/min, which decreased by 27.3% at 3 months but began to recover thereafter continuing until 4 years (Δ% GFR at 1, 2, 3, 4, and 5 years: 22.3%, 18.5%, 14.7%, 10.0%, and 9.6%, respectively). Parenchymal volume reduction and ischemic time were significantly associated with postoperative ipsilateral GFR throughout observation period unvarying with time. Diabetes and proteinuria were not significant determinants of ipsilateral function at 3 months but became significant at 5 years. In multivariate analysis regarding recovery slope, volume reduction (β = -0.026, SE 0.006, P < 0.0001), preoperative ipsilateral GFR (β = -0.021, SE 0.007, P = 0.0012), proteinuria (β = -0.942, SE 0.372, P = 0.0116), and diabetes (β = -0.396, SE 0.197, P = 0.0447) were independently significant. CONCLUSION Ipsilateral renal function continued to improve until 5 years after PN. Parenchymal volume loss was the major determinant and its impact on long-term ipsilateral renal function remained constant while ischemic time affected early GFR reduction with its impact diminishing over time. Patient-related factors including diabetes and proteinuria gained significance over time and became independent determinants of recovery slope.
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Affiliation(s)
- Jongpil Lee
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheryn Song
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Donghyun Lee
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Keun Kim
- Department of Urology, Hallym University(,) Dongtan Sacred Heart hospital, Hwaseong, Korea
| | - Dalsan You
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Park MY, Park KJ, Lim B, Kim MH, Jeong IG, Kim JK. Comparison of biopsy strategies for prostate biopsy according to lesion size and PSA density in MRI-directed biopsy pathway. Abdom Radiol (NY) 2020; 45:4166-4177. [PMID: 32737545 DOI: 10.1007/s00261-020-02667-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/09/2020] [Accepted: 07/16/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE To investigate whether the detection of clinically significant prostate cancer (csPCa) and the added value of focal saturation biopsy and systematic biopsy (SBx) differ according to index lesion size, and to compare the current guidelines for csPCa detection. METHODS This retrospective study included consecutive men who underwent MRI and subsequent SBx and MRI-targeted biopsy (TBx) for a suspicious lesion between April 2019 and February 2020. Lesion visibility on transrectal ultrasound (US) and added value of focal saturation biopsy and SBx were compared according to index lesion size using chi-square and McNemar tests. csPCa detection rates and the proportion of biopsy-indicated men were compared among four biopsy strategies based on current guidelines. RESULTS Of 313 men evaluated (median age, 65; interquartile range 60‒71), csPCa was detected in 110 (35%). In lesions < 10 mm, greater US invisibility (42.7% of lesions < 10 mm versus 20.0% of lesions ≥ 10 mm; p < 0.001) and higher added value of focal saturation biopsy and SBx (11.1% and 17.1% in lesions < 10 mm versus 4.2% and 6.3% in lesions ≥ 10 mm) were observed, compared with lesions ≥ 10 mm. Consideration of prostate-specific antigen (PSA) density > 0.15 ng/mL/mL as a cutoff in unsuspicious MRI led to a 14% reduction (44/313) in men who needed biopsy. CONCLUSION Determination of the biopsy strategy in terms of the need for focal saturation biopsy or SBx should be made considering lesion size. The use of PSA density in non-suspicious MRI can lead to a reduction in biopsy-indicated men.
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Lee S, Lim B, You D, Hong B, Hong JH, Kim CS, Ahn H, Jeong IG. Association of Bacillus Calmette-Guerin shortages with bladder cancer recurrence: A single-center retrospective study. Urol Oncol 2020; 38:851.e11-851.e17. [PMID: 32800440 DOI: 10.1016/j.urolonc.2020.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/29/2020] [Accepted: 07/12/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the association between Bacillus Calmette-Guerin (BCG) shortage and bladder cancer recurrence in high-risk non-muscle-invasive bladder cancer (NMIBC) patients. MATERIALS AND METHODS This retrospective study included 333 BCG-naive patients who underwent transurethral resection of bladder tumor for high-risk NMIBC between January 2014 and December 2017. The primary outcome was disease recurrence after operation. The secondary outcomes were trends in BCG shortages and differences in post-transurethral resection of bladder tumor intravesical treatments according to shortage. Multivariable Cox regression modeling was used to assess outcomes. RESULTS Among 333 patients (median age, 67 years; men, 270 [81.1%]), 94 (28.2%) experienced BCG shortage (BCG shortage group). Eleven episodes of BCG shortage occurred during the study period (median 10 days, range 2-97 days). Although we observed no statistically significant differences in clinical and pathological characteristics, there were significant differences in post-transurethral resection of bladder tumor intravesical treatments between the shortage and control groups (BCG: 28.7% vs. 68.1%, mitomycin/epirubicin: 27.7% vs. 1.7%, P < 0.001). The 3-year recurrence-free survival rate was significantly lower in the shortage group than that in the control group (38.0% vs. 60.2%, log-rank test, P = 0.010). In multivariable analysis, shortage (hazard ratio [HR] = 1.55, 95% confidence interval [CI] 1.09-2.21, P = 0.016) and tumor multiplicity (HR = 1.55, 95% CI 1.05-2.29, P = 0.028) were independent factors associated with the recurrence of bladder cancer. CONCLUSIONS High-risk NMIBC patients who experienced BCG shortage had a high risk of bladder cancer recurrence. Clinical trials of alternative treatment strategies and efforts to increase BCG supply are required.
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Affiliation(s)
- Sangmin Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Pak S, You D, Jeong IG, Lee DE, Kim SH, Joung JY, Lee KH, Hong JH, Kim CS, Ahn H. Cause of Mortality after Radical Prostatectomy and the Impact of Comorbidity in Men with Prostate Cancer: A Multi-institutional Study in Korea. Cancer Res Treat 2020; 52:1242-1250. [PMID: 32632083 PMCID: PMC7577814 DOI: 10.4143/crt.2020.286] [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: 04/07/2020] [Accepted: 07/01/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aimed to examine the causes of death in Korean patients who underwent radical prostatectomy for prostate cancer and investigate the relationship between comorbidity and mortality. Materials and Methods We conducted a retrospective multicenter cohort study including 4,064 consecutive patients who had prostate cancer and underwent radical prostatectomy between January 1998 and June 2013. The primary endpoint of this study was all-cause mortality, and the secondary endpoints were cancer-specific mortality (CSM) and other-cause mortality (OCM). Charlson comorbidity index (CCI) was calculated to assess the comorbidities of each patient. Results Of 4,064 patients, 446 (11.0%) died during follow-up. The cause of death was prostate cancer in 132 patients (29.6%), other cancers in 121 patients (27.1%), and vascular disease in 57 patients (12.8%) in our cohort. The overall 10-year CSM rate was lower than the OCM rate (4.6% vs. 10.5%). The 10-year CSM rate was lower than the OCM rate in low- to intermediate-risk group patients (1.2% vs. 10.6%), whereas they were similar in high-risk group patients (11.8% vs. 10.1%). In the multivariable analysis, CCI was independently associated with all-cause mortality after radical prostatectomy, regardless of age and pathologic features. Conclusion Death from prostate cancer was rare in Korean men who underwent radical prostatectomy. Clinicians should be aware of the possibility of overtreatment of low-risk prostate cancer in men with significant comorbidity. Our findings may help to facilitate counseling and plan management in this patient group.
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Affiliation(s)
- Sahyun Pak
- Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Eun Lee
- Biostatistics Collaboration Team, Research Core Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sung Han Kim
- Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, Korea
| | - Jae Young Joung
- Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, Korea
| | - Kang-Hyun Lee
- Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim JH, Jeong IG. Re: Veeru Kasivisvanathan, Armando Stabile, Joana B. Neves, et al. Magnetic Resonance Imaging-targeted Biopsy Versus Systematic Biopsy in the Detection of Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol 2019;76:284-303: Threshold Indication for Magnetic Resonance Imaging-targeted Biopsy in the Detection of Prostate Cancer. Eur Urol 2020; 77:e134-e135. [PMID: 31980314 DOI: 10.1016/j.eururo.2020.01.016] [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] [Received: 11/21/2019] [Accepted: 01/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Jae Heon Kim
- Department of Urology, Soonchunhyang University Hospital, Soonchuhyang University Medical College, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Choi SY, Chi BH, Lim B, Kyung YS, You D, Jeong IG, Song C, Hong JH, Ahn H, Kim CS. Percent tumor volume vs American Joint Committee on Cancer staging system subclassification for predicting biochemical recurrence in patients with pathologic T2 prostate cancer. J Cancer Res Clin Oncol 2020; 146:537-543. [PMID: 31915914 DOI: 10.1007/s00432-019-03085-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/15/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Here, we re-checked the American Joint Committee on Cancer 7th edition subclassification and confirmed the possibility of percent tumor volume as a prognostic factor for biochemical recurrence in the 8th edition subclassification. METHODS A total of 1073 patients with pathologic T2 stage disease who underwent radical prostatectomy were included. Exclusion criteria were neoadjuvant therapy and pathologic T3 and N1 disease. Biochemical recurrence-free survival was estimated using the Kaplan-Meier method. Cox hazard regression was used to predict biochemical recurrence. RESULTS According to the 7th edition subclassification, 141 patients (13.1%) had T2a, 43 (4.0%) had T2b, and 889 (82.9%) had T2c disease. The 7th edition subclassification did not differ significantly on Kaplan-Meier analysis (p = 0.502). Mean percent tumor volume was 8.7 ± 8.0% (interquartile range, 5-10%). Percent tumor volume was positively correlated with initial prostate-specific antigen, grade group, surgical margin, and T2 subclassification (all p < 0.001). The 7th edition subclassification was not a significant factor, whereas percent tumor volume was (hazard ratio, 1.023; 95% confidence interval, 1.005-1.041; p = 0.0128) on multivariate analysis. On Kaplan-Meier analysis, percent tumor volume (> 7.5% vs ≤ 7.5%) differed significantly for biochemical recurrence-free survival (p < 0.001). CONCLUSIONS The 7th edition pathologic T2 subclassification had poor prognostic value for biochemical recurrence in our cohort. Elimination of the 8th edition subclassification was suitable. Percent tumor volume classified biochemical recurrence prognosis in pathologic T2 stage. Therefore, percent tumor volume can be a candidate factor for the next T2 subclassification.
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Affiliation(s)
- Se Young Choi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Korea
| | - Byung Hoon Chi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Korea
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Yoon Soo Kyung
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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Park KH, Yoon JA, Kim HS, Kim H, Park SK, Kim YH, Hong B, You D, Jeong IG, Baek CH. Clinical features and outcomes in kidney transplant recipients with renal cell carcinoma: a single-center study. Kidney Res Clin Pract 2019; 38:517-524. [PMID: 31826389 PMCID: PMC6913591 DOI: 10.23876/j.krcp.19.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/22/2019] [Revised: 10/24/2019] [Accepted: 10/27/2019] [Indexed: 01/20/2023] Open
Abstract
Background Previous studies have recommended a 2- to 5-year waiting time prior to kidney transplantation (KT) in patients with end-stage renal disease (ESRD) and symptomatic renal cell carcinoma (RCC) and no delay for incidental early-stage RCC. Data on Asian KT recipients are unavailable. Methods This is a Korean single-center retrospective study on 35 KT recipients with ESRD and RCC. Patients were classified into two groups: early KT (KT performed within 1 year after nephrectomy for RCC, including KT with simultaneous nephrectomy) and delayed KT (KT performed over than 1 year after nephrectomy for RCC). Patient survival, graft survival, and cancer recurrence were compared between both groups. Results There were no statistically significant differences in patient survival (P = 0.388), graft survival (P = 0.317), or graft rejection rate (P = 0.207) between the early and delayed KT groups. Additionally, there were no differences in pathological characteristics or RCC stage other than cancer histology: acquired cystic disease-associated RCC (47.4%) was the most common RCC type in the early KT group, whereas clear cell type (62.5%) was the most common RCC type in the delayed KT group. No RCC recurrence was observed. Conclusion Patients with early-stage and asymptomatic RCC do not require a mandatory observational period prior to KT after curative nephrectomy.
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Affiliation(s)
- Keun Hoi Park
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Rebublic of Korea
| | - Jung A Yoon
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Rebublic of Korea
| | - Hak Soo Kim
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Rebublic of Korea
| | - Hyosang Kim
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Rebublic of Korea
| | - Su-Kil Park
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Rebublic of Korea
| | - Young Hoon Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Rebublic of Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Rebublic of Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Rebublic of Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Rebublic of Korea
| | - Chung Hee Baek
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Rebublic of Korea
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You D, Kim Y, Jang MJ, Lee C, Jeong IG, Cho YM, Hwang JJ, Hong JH, Ahn H, Kim CS. Correction: KML001 Induces Apoptosis and Autophagic Cell Death in Prostate Cancer Cells via Oxidative Stress Pathway. PLoS One 2019; 14:e0225087. [PMID: 31693709 PMCID: PMC6834255 DOI: 10.1371/journal.pone.0225087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kyung YS, Kim N, Jeong IG, Hong JH, Kim CS. Application of 3-D Printed Kidney Model in Partial Nephrectomy for Predicting Surgical Outcomes: A Feasibility Study. Clin Genitourin Cancer 2019; 17:e878-e884. [DOI: 10.1016/j.clgc.2019.05.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 01/17/2023]
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Kim H, Pak S, Park KJ, Kim MH, Kim JK, Kim M, You D, Jeong IG, Song C, Hong JH, Kim CS, Ahn H. Utility of Multiparametric Magnetic Resonance Imaging With PI-RADS, Version 2, in Patients With Prostate Cancer Eligible for Active Surveillance: Which Radiologic Characteristics Can Predict Unfavorable Disease? Clin Genitourin Cancer 2019; 18:50-55. [PMID: 31640913 DOI: 10.1016/j.clgc.2019.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND We investigated the utility of multiparametric magnetic resonance imaging (mpMRI) using Prostate Imaging Reporting and Data System, version 2 (PI-RADSv2), scoring in patients with prostate cancer eligible for active surveillance (AS). MATERIALS AND METHODS The medical records of the patients who had undergone mpMRI before radical prostatectomy from 2014 to 2018 were reviewed. All the patients had met the Prostate Cancer Research International AS criteria. PI-RADSv2 scores were assigned to 12 prostate regions. Unfavorable disease was stratified using the American Joint Committee on Cancer (AJCC) prognostic scale as stage IIB (Gleason score [GS], 3+4 and pathologic stage T2) and IIC-III (GS, ≥ 4+3 or pathologic stage T3). RESULTS Of 376 eligible patients, 184 (48.9%), 129 (34.3%), and 63 (16.8%) had AJCC stage I, IIB, and IIC-III disease, respectively. The patients with IIC-III disease were older and had a higher prostate-specific antigen density than those with stage I or IIB disease. PI-RADS 5 lesions were more frequent in patients with stage IIC-III than in patients with stage I or IIB disease. Multivariable analysis revealed that ≥ 2 lesions with a PI-RADS 5 score was an independent predictor for unfavorable disease (hazard ratio [HR], 3.612; P < .001 for IIB; HR, 6.562; P < .001 for IIC-III), and PI-RADS score of ≥ 4 was limited for predicting AJCC stage IIB disease (HR, 2.387; P = .01). CONCLUSION mpMRI with PI-RADSv2 showed high negative predictive value for patients with prostate cancer eligible for AS. Multiple PI-RADS 4-5 lesions were associated with unfavorable disease compared with solitary lesions. Multiple PI-RADS 5 lesions were strongly associated with GS ≥ 4+3 or pathologic T3 disease. Targeted biopsy or radical treatment should be considered for these patients.
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Affiliation(s)
- Hwiwoo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sahyun Pak
- Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Kye Jin Park
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Hyun Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Kon Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myong Kim
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Kim SJ, You D, Jeong IG, Song C, Hong B, Kim CS, Ahn H, Hong JH. Prognosis of carcinoma in situ according to the presence of papillary bladder tumors after bacillus Calmette–Guérin immunotherapy. J Cancer Res Clin Oncol 2019; 145:2131-2140. [DOI: 10.1007/s00432-019-02956-6] [Citation(s) in RCA: 4] [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] [Received: 03/22/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
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Pak S, You D, Jeong IG, Song C, Lee JL, Hong B, Hong JH, Kim CS, Ahn H. Adjuvant chemotherapy versus observation after radical cystectomy in patients with node-positive bladder cancer. Sci Rep 2019; 9:8305. [PMID: 31165753 PMCID: PMC6549178 DOI: 10.1038/s41598-019-44504-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/17/2019] [Indexed: 11/15/2022] Open
Abstract
This retrospective study compared adjuvant chemotherapy (AC) versus observation after radical cystectomy (RC) in patients with node-positive bladder cancer (pN+). Outcomes were reviewed in patients with pTanyN1-3M0 bladder cancer who underwent RC with or without AC between 1995 and 2017. Baseline characteristics between the two groups were controlled with inverse probability of treatment weighting (IPTW)-adjusted analyses. Of 281 enrolled patients, the 3-year IPTW-adjusted rates of overall survival was higher in the AC group than the RC group (46.4% vs. 33.7%, p = 0.024). AC was an independent predictor of overall survival (hazard ratio = 0.48; P < 0.0001). When patients were subdivided by lymph node density (LND), the 3-year overall survival rates were similar between the AC and RC groups in patients with LND < 9%, but higher in the AC group in patients with LND 9–25% (53.4% vs. 23.7%) and LND ≥ 25% (27.4% vs. 16.1%). The numbers needed to treat to prevent one death at 3 years were three and nine in patients with LND 9–25% and ≥25%, respectively. In conclusion, AC after RC was associated with improved overall survival in patients with node-positive bladder cancer. Patients with an intermediate nodal burden may benefit most from AC.
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Affiliation(s)
- Sahyun Pak
- Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Lyun Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Pak S, You D, Jeong IG, Kim YS, Hong JH, Kim CS, Ahn H. Time to biochemical relapse after radical prostatectomy and efficacy of salvage radiotherapy in patients with prostate cancer. Int J Clin Oncol 2019; 24:1238-1246. [PMID: 31087170 DOI: 10.1007/s10147-019-01463-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/02/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND To investigate the prognostic and therapeutic implications of time to biochemical relapse (BCR) in patients with prostate cancer after radical prostatectomy. METHODS The records of 3210 consecutive men with prostate cancer who underwent radical prostatectomy between January 1998 and June 2013 were retrospectively reviewed. Patients with BCR were divided into three groups based on quartiles of time to BCR, namely an early group (first quartile), an intermediate group (second and third quartiles) and late group (fourth quartile). RESULTS 817 (25.5%) patients experienced BCR at a median of 24.9 months after surgery. The 8-year rate of distant metastasis-free survival (64.3% vs. 41.3%, p = 0.002) and cancer-specific survival (86.6% vs. 63.4%, p < 0.001) was higher in the salvage radiotherapy (SRT) group than the androgen deprivation therapy (ADT) group in patients with early BCR, whereas those rates (91.3% vs. 87.9%, p = 0.607 and 100.0% vs. 93.1%, p = 0.144, respectively) were similar in patients with late BCR. In the intermediate BCR group, the impact of SRT over ADT on 8-year cancer-specific survival was modest (91.9% vs. 82.3%, p = 0.057) and was limited to patients with pT2 or pT3a disease. CONCLUSIONS SRT may decrease the risk of distant metastasis and cancer-specific mortality in patients with early BCR. However, a survival benefit for those with late BCR was not apparent. For patients with intermediate BCR, SRT was associated with a cancer-specific survival benefit in patients with pT2 or pT3a disease. Novel genomic tests and imaging modalities may support clinical decision-making in these patients.
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Affiliation(s)
- Sahyun Pak
- Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, South Korea
| | - Dalsan You
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - In Gab Jeong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Young Seok Kim
- Department of Radiation Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jun Hyuk Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Choung-Soo Kim
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hanjong Ahn
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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Hwang JJ, Kim YS, Kim T, Kim MJ, Jeong IG, Lee JH, Choi J, Jang S, Ro S, Kim CS. Correction to: A novel histone deacetylase inhibitor, CG200745, potentiates anticancer effect of docetaxel in prostate cancer via decreasing Mcl-1 and Bcl- XL. Invest New Drugs 2019; 37:796. [PMID: 30937691 DOI: 10.1007/s10637-019-00746-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The blots of control and docetaxel for caspase-9, caspase-3, caspase-8, Bcl-XL, and tubulin in the Figure 4f were reused from Figure 4 of our previous paper published in Journal of Urology in 2010 ( https://doi.org/10.1016/j.juro.2010.07.035 ).
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Affiliation(s)
- Jung Jin Hwang
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 05505, South Korea.,Institute for Innovative Cancer Research, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 05505, South Korea
| | - Yong Sook Kim
- Institute for Innovative Cancer Research, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 05505, South Korea
| | - Taelim Kim
- Institute for Innovative Cancer Research, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 05505, South Korea
| | - Mi Joung Kim
- Institute for Innovative Cancer Research, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 05505, South Korea
| | - In Gab Jeong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Je-Hwan Lee
- Department of Internal Medicine & Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 05505, South Korea
| | - Jene Choi
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 05505, South Korea
| | - Sejin Jang
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 05505, South Korea
| | - Seonggu Ro
- PiMedBio, Inc., Seoul, 06367, South Korea
| | - Choung-Soo Kim
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea.
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Choi SY, Jung H, You D, Jeong IG, Song C, Hong B, Hong JH, Ahn H, Kim C. Robot‐assisted partial nephrectomy is associated with early recovery of renal function: Comparison of open, laparoscopic, and robot‐assisted partial nephrectomy using DTPA renal scintigraphy. J Surg Oncol 2019; 119:1016-1023. [DOI: 10.1002/jso.25429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/07/2019] [Accepted: 02/11/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Se Young Choi
- Department of Urology, Chung‐Ang University HospitalChung‐Ang University College of MedicineSeoul Korea
- Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Han Jung
- Department of UrologyGachon University College of MedicineSeongnam Korea
| | - Dalsan You
- Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Cheryn Song
- Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Choung‐Soo Kim
- Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
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Choi SY, Ryu J, You D, Jeong IG, Hong JH, Ahn H, Kim CS. Prognostic factors of oncologic outcomes in metastatic chemotherapy-naïve castration-resistant prostate cancer treated with enzalutamide in actual clinical practice in East Asia. Urol Oncol 2018; 36:401.e11-401.e18. [PMID: 30274641 DOI: 10.1016/j.urolonc.2018.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 06/05/2018] [Accepted: 06/09/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We aimed to evaluate the prognostic factors for chemotherapy-naïve castration-resistant prostate cancer (CRPC) treated with enzalutamide in actual clinical practice using easily accessible clinical variables. METHODS AND MATERIALS We retrospectively reviewed the following data from 113 patients with chemotherapy-naïve CRPC treated with enzalutamide: serum levels of prostate-specific antigen (PSA), testosterone, hemoglobin, total protein, albumin, and alkaline phosphatase (ALP); platelet, neutrophil, and lymphocyte counts; neutrophil-to-lymphocyte ratios (NLRs); and liver profiles. PSA progression-free survival (PFS), radiological PFS, and overall survival were estimated by Cox regression analysis. RESULTS Compared with baseline levels, laboratory values at 2 months showed significantly lower PSA (160.2 ± 351.5 ng/ml vs. 47.4 ± 117.1 ng/ml) and ALP levels (201.86 ± 223.77 IU/l vs. 148.25 ± 146.81 IU/l) and a significantly higher percentage of lymphocytes (28.1% ± 10.6% vs. 31.2% ± 9.7%); those at 1 month showed a significantly lower percentage of neutrophils (61.0% ± 11.0% vs. 57.1% ± 12.5%). In the multivariate analysis, poor prognostic factors for PSA PFS were Gleason score ≥ 9 (hazard ratio [HR] 2.022; P = 0.0250); visceral metastasis (HR 3.143; P = 0.0002); high NLR (HR 1.205; P = 0.0126); and high ALP (HR 1.002; P = 0.0015). For radiological PFS, high NLR (HR 1.249; P = 0.0002) and high ALP (HR 1.002; P = 0.0001) were associated with poor outcomes. The predictors of poor overall survival were visceral metastasis (HR 3.155; P < 0.0001); high NLR (HR 1.341; P < 0.0001); and high ALP (HR 1.001; P = 0.0017). CONCLUSION Enzalutamide is less effective in patients with metastatic chemotherapy-naïve CRPC with Gleason scores ≥ 9, visceral metastasis, high NLR, and high ALP.
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Affiliation(s)
- Se Young Choi
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
| | - Jeman Ryu
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea.
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Lee W, Choi SY, Lee C, Yoo S, You D, Jeong IG, Song C, Kim KS, Hong B, Hong JH, Ahn H, Kim CS. Does epithelioid angiomyolipoma have poorer prognosis, compared with classic angiomyolipoma? Investig Clin Urol 2018; 59:357-362. [PMID: 30402567 PMCID: PMC6215778 DOI: 10.4111/icu.2018.59.6.357] [Citation(s) in RCA: 11] [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: 07/09/2018] [Accepted: 08/27/2018] [Indexed: 01/19/2023] Open
Abstract
Purpose Classic angiomyolipoma (AML) is common benign kidney tumor. However, some studies have claimed that epithelioid angiomyolipoma (EAML) has malignant potential. We compared the patient characteristics and prognosis of EAML and classic AML to demonstrate predicting factors and poorer prognosis of EAML. Materials and Methods The medical records of 231 patients who were diagnosed with EAML (n=27, 11.7%) or classic AML (n=204, 88.3%), were reviewed. All patients underwent computed tomography (CT) scans before operation or needle biopsy. We assessed the age, sex, tumor size, body mass index, comorbidities, and Hounsfield unit (HU) according to each CT phase. We defined the unfavorable group as patients with recurrence, metastasis and death due to tumor progression. Logistic regression analysis was used to predict EAML. Results EAML patients were younger (41.2 years vs. 49.1 years, p=0.001), predominantly male (55.6% vs. 28.4%, p=0.005), and had a larger tumor (7.5 cm vs. 4.2 cm, p<0.001). The median pre-contrast HU was not significantly different between EAML and classic AML (29.9±23.7 vs. 14.7±41.0, p=0.071). In multivariable analysis, younger age (odds ratio [OR], 0.96; p=0.032), male sex (OR, 3.33; p=0.013), and tumor larger than 4 cm (OR, 3.8; p=0.009) were significant predictive factors. Five patients (18.5%) had unfavorable outcomes, two patients had lymph node metastasis, and three patients had lung metastasis. Conclusions Patient and tumor characteristics can be helpful in determining the type of AML preoperatively. Younger age, male sex, and larger tumor mass may increase the possibility of diagnosing EAML. EAML has malignant potential and requires careful follow-up.
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Affiliation(s)
- Wonchul Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Young Choi
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chanwoo Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sangjun Yoo
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kun Suk Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim M, Kim JW, Kim JK, Lee SM, Song C, Jeong IG, Hong JH, Kim C, Ahn H. Association between serum levels of insulin-like growth factor-1, bioavailable testosterone, and pathologic Gleason score. Cancer Med 2018; 7:4170-4180. [PMID: 29992746 PMCID: PMC6089192 DOI: 10.1002/cam4.1681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 03/08/2018] [Accepted: 06/22/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We evaluated the association between serum levels of insulin-like growth factor-1 (IGF-1), bioavailable testosterone, and surgical Gleason score (GS). METHODS We analyzed 793 patients who underwent radical prostatectomy and 272 men with negative prostate biopsy. Serum levels of IGF-1 and testosterone were measured before surgery or biopsy. RESULTS The mean IGF-1 levels of prostate cancer patients and men with a negative biopsy were 143.8 and 118.9 ng/mL, respectively (P < 0.001). Men with high serum IGF-1 were more likely to have prostate cancer (highest vs lowest quartile, odds ratio [OR] = 3.35; Ptrend < 0.001). However, among men with prostate cancer, the mean IGF-1 levels of those with low (GS ≤ 6), intermediate (GS = 7), and high surgical GS (GS ≥8) were 151.7, 144.1, and 132.9 ng/mL, respectively (P < 0.001). Using quartile analysis, high serum IGF-1 levels were shown to be associated with a low risk of high surgical GS (OR = 0.464; Ptrend = 0.006). Serum bioavailable testosterone concentration was positively correlated with serum IGF-1 level (r = 0.157, P < 0.001). High bioavailable testosterone level was also associated with a low risk of high surgical GS in patients without diabetes mellitus (OR = 0.569; Ptrend = 0.040). Among men with biopsy GS ≤ 3 + 4 (n = 460), upgrading to high surgical GS was more frequent in patients with low IGF-1 level (≤116.0 ng/mL; 9.9%) or low bioavailable testosterone level (≤0.85 ng/mL; 9.3%) than in patients with normal IGF-1 and bioavailable testosterone levels (2.6%; P = 0.004). CONCLUSIONS Serum levels of IGF-1 and bioavailable testosterone show inverse associations with high surgical GS. This suggests that high-grade prostate cancer develops independently of these two substances.
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Affiliation(s)
- Myong Kim
- Department of UrologyAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Jong Won Kim
- Department of UrologyKorea Cancer Center HospitalSeoulKorea
| | - Jong Keun Kim
- Department of UrologyAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Sang Mi Lee
- Department of UrologyAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Cheryn Song
- Department of UrologyAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - In Gab Jeong
- Department of UrologyAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Jun Hyuk Hong
- Department of UrologyAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Choung‐Soo Kim
- Department of UrologyAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Hanjong Ahn
- Department of UrologyAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
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Kong YG, Park JH, Park JY, Yu J, Lee J, Park SU, Jeong IG, Hwang JH, Kim HY, Kim YK. Effect of intraoperative mannitol administration on acute kidney injury after robot-assisted laparoscopic radical prostatectomy: A propensity score matching analysis. Medicine (Baltimore) 2018; 97:e11338. [PMID: 29953025 PMCID: PMC6039691 DOI: 10.1097/md.0000000000011338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mannitol, an osmotic diuretic, has been used to prevent acute kidney injury (AKI). However, studies have found divergent effects of intraoperative mannitol administration on postoperative AKI. We therefore evaluated the effects of intraoperative mannitol administration on AKI after robot-assisted laparoscopic radical prostatectomy (RALP) in prostate cancer patients.A total of 864 patients who underwent RALP were divided into mannitol (administered at 0.5 g/kg) and no-mannitol groups. Demographics, cancer-related data, preoperative laboratory values, intraoperative data, and postoperative outcomes such as AKI, chronic kidney disease at 12 months postoperation, duration of hospital stay, and intensive care unit admission rate and duration of stay were compared between the 2 groups using propensity score matching analysis. To determine the risk factors for AKI after RALP, univariate and multivariate logistic regression analyses were performed. Postoperative AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria.After performing 1:1 propensity score matching, the mannitol and no-mannitol groups included 234 patients each. The overall incidence of AKI after RALP was 5.1% and was not significantly different between the no-mannitol and mannitol groups in the propensity score-matched patients (13 [5.6%] vs. 11 [4.7%], P = .832). Univariate logistic regression analysis revealed that body mass index and operative time were associated with AKI in 864 patients who underwent RALP. However, intraoperative mannitol administration was not associated with AKI after RALP (P = .284). Multivariate logistic regression analysis revealed that operative time was significantly associated with AKI after RALP (odds ratio = 1.013, P = .001). The incidence of chronic kidney disease (13 [5.6%] vs. 12 [5.1%], P = 1.000) and other postoperative outcomes were not also significantly different between the no-mannitol and mannitol groups in the propensity score-matched patients.Intraoperative mannitol administration has no beneficial effect on the prevention of AKI after RALP in prostate cancer patients. This result provides useful information for clinical practice guidelines regarding intraoperative mannitol use.
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Affiliation(s)
- Yu-Gyeong Kong
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine
| | - Ji Hyun Park
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine
| | | | - Jihion Yu
- Department of Anesthesiology and Pain Medicine
| | - Joonho Lee
- Department of Anesthesiology and Pain Medicine
| | - Se-Ung Park
- Department of Anesthesiology and Pain Medicine
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Hee Yeong Kim
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine
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Yoo S, You D, Song C, Hong B, Hong JH, Kim CS, Ahn H, Jeong IG. Declining incidence of benign lesions among small renal masses treated with surgery: Effect of diagnostic tests for characterization. Urol Oncol 2018; 36:362.e9-362.e15. [PMID: 29866577 DOI: 10.1016/j.urolonc.2018.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 04/26/2018] [Accepted: 05/01/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE We evaluated the changes in the incidence of benign lesions in surgically removed small renal masses (SRMs) and the effect of diagnostic tests for characterizing SRMs. METHODS We included 2,707 patients receiving surgery for SRMs (<4cm). Trends in the incidence of benign histology were evaluated according to the surgery year (period 1: 2001-2005, 2: 2006-2010, and 3: 2011-2015). Multivariable logistic regression analysis was performed to identify factors associated with benign lesions. Additionally, the number of surgeries prevented due to benign histological findings on renal mass biopsies (RMB) done on 206 patients with SRM during study period was evaluated. RESULTS Benign histology was identified in 192 (7.1%) patients. Incidence of benign histology was 9.7%, 7.0%, and 6.3% for period 1, 2 and 3, respectively. The uses of multiphase computed tomography and magnetic resonance imaging were more common in periods 2 and 3 than in period 1 (P<0.001). The use of RMB in period 3 was higher than in periods 1 and 2 (0.8 vs. 0.9 vs. 9.0%, P<0.001). In multivariable analysis, older age, male sex, larger tumor size, and recent surgery year (period 3 vs. 1, odds ratio = 0.62, P = 0.028) were independently associated with decreased odds of benign lesions. The number of prevented surgeries by performing RMB was 0, 10, and 39 in periods 1, 2, and 3, respectively. CONCLUSIONS Incidence of benign histology after surgery for SRMs declined during recent years, which might be associated with the recent increased use of RMB.
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Affiliation(s)
- Sangjun Yoo
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Urology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Nam W, Choi SY, Ryu J, Kyung YS, Moon KH, Park S, Chae HK, Lee W, Lee J, Choi W, You D, Jeong IG, Hong JH, Ahn H, Kim CS. MP87-17 FACTORS ASSOCIATED WITH TESTOSTERONE RECOVERY AFTER ANDROGEN DEPRIVATION THERAPY IN PATIENTS WITH PROSTATE CANCER. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2917] [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: 11/24/2022]
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Affiliation(s)
- In Gab Jeong
- Department of Urology, Asan Medical Center, Seoul, Korea
| | - Yash S Khandwala
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, California
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Kim M, Song C, Jeong IG, Choi SK, Park M, Shim M, Kim YS, You D, Hong JH, Kim CS, Ahn H. Androgen deprivation therapy during and after post-prostatectomy radiotherapy in patients with prostate cancer: a case control study. BMC Cancer 2018. [PMID: 29523103 PMCID: PMC5845289 DOI: 10.1186/s12885-018-4189-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Indexed: 12/03/2022] Open
Abstract
Background Here we assessed the influence of androgen deprivation therapy (ADT) during and/or after post-prostatectomy radiotherapy (RT) on biochemical recurrence (BCR) and radiographic progression in patients with prostate cancer. Methods Patients with prostate cancer who underwent post-prostatectomy RT were analyzed. BCR and radiographic progression after RT were compared according to the concurrent or salvage ADT. Cox regression analyses were used to identify risk factors for BCR and radiographic progression. Results Of the 227 patients who underwent post-prostatectomy RT, 95 (41.9%) received concurrent ADT for a median of 17.0 months. Despite more aggressive disease characteristics in the concurrent ADT group than in the RT-only group, the former had a better 5-year BCR-free survival rate than the latter (66.1 vs. 53.9%; p = 0.016), whereas the radiographic progression rate was not significantly different between two groups. On the other hand, salvage ADT after post-RT BCR significantly delayed radiographic progression (5-year radiographic progression-free survival; 75.2 vs. 44.5%; p = 0.002). Conclusions Concurrent ADT improved BCR-free survival, and salvage ADT after post-RT BCR improved radiographic progression-free survival. To maximize the oncological benefit, ADT of sufficient duration should be implemented.
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Affiliation(s)
- Myong Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Seung-Kwon Choi
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Myungchan Park
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Myungsun Shim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Nam W, Choi SY, Yoo SJ, Ryu J, Lee J, Kyung YS, Han JH, You D, Jeong IG, Hong JH, Ahn H, Kim CS. Factors associated with testosterone recovery after androgen deprivation therapy in patients with prostate cancer. Investig Clin Urol 2017; 59:18-24. [PMID: 29333510 PMCID: PMC5754577 DOI: 10.4111/icu.2018.59.1.18] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 07/04/2017] [Accepted: 10/18/2017] [Indexed: 12/02/2022] Open
Abstract
Purpose We investigated factors affecting testosterone recovery after androgen deprivation therapy (ADT) withdrawal in patients with prostate cancer. Materials and Methods The medical records of patients who underwent radical prostatectomy with ADT were retrospectively reviewed. In all, 221 patients were included in the analysis. Testosterone recovery was defined as supra-castration (SC) (testosterone levels in serum >50 ng/dL) or out of hypogonadism (OH) (>300 ng/dL) after ADT withdrawal. Kaplan-Meier analyses were used to estimate testosterone recovery after ADT cessation. Cox regression analyses were used to determine the factors affecting the recovery of testosterone. Results After ADT, 206 patients (93.2%) recovered to the SC level and 122 patients (55.2%) recovered to the OH level. Patients treated with ADT for ≤18 months recovered to OH in a mean of 6.8 months (74.6%), but patients treated with ADT for >18 months recovered in a mean of 9.7 months (27.5%). In multivariate analyses, age (hazard ratio [HR], 0.915; p<0.001), serum level of sex hormone-binding globulin (SHBG) (HR, 1.015; p=0.002), initial testosterone level (HR, 1.002; p=0.002), and ADT duration (HR, 0.915; p<0.001) were associated with recovery to the OH level after ADT withdrawal, and hypertension (HR, 0.697; p=0.029) and duration of ADT (HR, 0.979; p=0.012) were significantly associated with recovery to SC. Conclusions In patients treated with ADT for ≤18 months, testosterone recovers to the OH level more often and faster after ADT cessation. Age, SHBG level, initial testosterone level, and ADT duration are associated with testosterone recovery.
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Affiliation(s)
- Wook Nam
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Young Choi
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Jun Yoo
- Department of Urology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jeman Ryu
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaehoon Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon Soo Kyung
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hyeon Han
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Jeong IG, Khandwala YS, Kim JH, Han DH, Li S, Wang Y, Chang SL, Chung BI. Association of Robotic-Assisted vs Laparoscopic Radical Nephrectomy With Perioperative Outcomes and Health Care Costs, 2003 to 2015. JAMA 2017; 318:1561-1568. [PMID: 29067427 PMCID: PMC5818800 DOI: 10.1001/jama.2017.14586] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/20/2017] [Indexed: 01/06/2023]
Abstract
IMPORTANCE Use of robotic surgery has increased in urological practice over the last decade. However, the use, outcomes, and costs of robotic nephrectomy are unknown. OBJECTIVES To examine the trend in use of robotic-assisted operations for radical nephrectomy in the United States and to compare the perioperative outcomes and costs with laparoscopic radical nephrectomy. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used the Premier Healthcare database to evaluate outcomes of patients who had undergone robotic-assisted or laparoscopic radical nephrectomy for renal mass at 416 US hospitals between January 2003 and September 2015. Multivariable regression modeling was used to assess outcomes. EXPOSURES Robotic-assisted vs laparoscopic radical nephrectomy. MAIN OUTCOMES AND MEASURES The primary outcome of the study was the trend in use of robotic-assisted radical nephrectomy. The secondary outcomes were perioperative complications, based on the Clavien classification system, and defined as any complication (Clavien grades 1-5) or major complications (Clavien grades 3-5, for which grade 5 results in death); resource use (operating time, blood transfusion, length of hospital stay); and direct hospital cost. RESULTS Among 23 753 patients included in the study (mean age, 61.4 years; men, 13 792 [58.1%]), 18 573 underwent laparoscopic radical nephrectomy and 5180 underwent robotic-assisted radical nephrectomy. Use of robotic-assisted surgery increased from 1.5% (39 of 2676 radical nephrectomy procedures in 2003) to 27.0% (862 of 3194 radical nephrectomy procedures) in 2015 (P for trend <.001). In the weighted-adjusted analysis, there were no significant differences between robotic-assisted and laparoscopic radical nephrectomy in the incidence of any (Clavien grades 1-5) postoperative complications (adjusted rates, 22.2% vs 23.4%, difference, -1.2%; 95% CI, -5.4 to 3.0%) or major (Clavien grades 3-5) complications (adjusted rates, 3.5% vs 3.8%, difference, -0.3%; 95% CI, -1.0% to 0.5%). The rate of prolonged operating time (>4 hours) for patients undergoing the robotic-assisted procedure was higher than for patients receiving the laparoscopic procedure in the adjusted analysis (46.3% vs 25.8%; risk difference, 20.5%; 95% CI, 14.2% to 26.8%). Robotic-assisted radical nephrectomy was associated with higher mean 90-day direct hospital costs ($19 530 vs $16 851; difference, $2678; 95% CI, $838 to $4519), mainly accounted for operating room ($7217 vs $5378; difference, $1839; 95% CI, $1050 to $2628) and supply costs ($4876 vs $3891; difference, $985; 95% CI, $473 to $1498). CONCLUSIONS AND RELEVANCE Among patients undergoing radical nephrectomy for renal mass between 2003 and 2015, the use of robotic-assisted surgery increased substantially. The use of robotic-assistance was not associated with increased risk of any or major complications but was associated with prolonged operating time and higher hospital costs compared with laparoscopic surgery.
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Affiliation(s)
- In Gab Jeong
- Department of Urology, Stanford University Medical Center, Stanford, California
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yash S. Khandwala
- Department of Urology, Stanford University Medical Center, Stanford, California
- University of California, San Diego School of Medicine
| | - Jae Heon Kim
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Deok Hyun Han
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Shufeng Li
- Department of Urology and Dermatology, Stanford University Medical Center, Stanford, California
| | - Ye Wang
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Steven L. Chang
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin I. Chung
- Department of Urology, Stanford University Medical Center, Stanford, California
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Khandwala YS, Jeong IG, Kim JH, Han DH, Li S, Wang Y, Chang SL, Chung BI. The incidence of unsuccessful partial nephrectomy within the United States: A nationwide population-based analysis from 2003 to 2015. Urol Oncol 2017; 35:672.e7-672.e13. [PMID: 28889920 DOI: 10.1016/j.urolonc.2017.08.014] [Citation(s) in RCA: 14] [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: 04/27/2017] [Revised: 08/07/2017] [Accepted: 08/14/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE Partial nephrectomy (PN) remains underutilized within the United States and few reports have attempted to explain this trend. The aim of this study is to evaluate the nationwide incidence of unsuccessful PN and factors that predict its occurrence. METHODS Using the Premier Healthcare Database, we retrospectively analyzed a weighted sample of 66,432 patients undergoing curative surgery for renal mass between 2003 and 2015. PN intent was denoted by presence of insurance claims for the administration of mannitol. Unsuccessful PN was defined as an event in which patients were administered mannitol but received radical nephrectomy. A multivariate logistic regression model was generated to identify factors predicting unsuccessful PN. RESULTS Overall rates of unsuccessful PN declined from 33.5% to 14.5% since 2003. Conversion to radical nephrectomy occurred most frequently during laparoscopic (34.7%) and least frequently during robotic approach (13.6%). There was significant difference in the rate of unsuccessful PN between very high and very low volume surgeons (open: 39.4% vs. 13.3%, laparoscopic: 51.2% vs. 32.2%, and robot assisted: 27.1% vs. 9.4%, all P<0.001). After adjustment for patient- and hospital-related factors, surgical approach (laparoscopic vs. open, odds ratio = 1.74, 95% CI: 1.31-2.30, P<0.001) and annual surgeon volume (very high vs. very low, odds ratio = 0.27, 95% CI: 0.21-0.34 P<0.001) were associated with unsuccessful PN. CONCLUSIONS Although the rate of unsuccessful PN appears to be declining, it still remains common for low volume surgeons and with the laparoscopic surgical approach. Further evaluation of its effect on health care outcomes is necessary.
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Affiliation(s)
- Yash S Khandwala
- Department of Urology, Stanford University Medical Center, Stanford, CA; San Diego School of Medicine, University of California, San Diego, CA
| | - In Gab Jeong
- Department of Urology, Stanford University Medical Center, Stanford, CA; Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Jae Heon Kim
- Department of Urology, Stanford University Medical Center, Stanford, CA
| | - Deok Hyun Han
- Department of Urology, Stanford University Medical Center, Stanford, CA
| | - Shufeng Li
- Department of Urology and Dermatology, Stanford University Medical Center, Stanford, CA
| | - Ye Wang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA
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Jeun M, Park S, Kim Y, Choi J, Song SH, Jeong IG, Kim CS, Lee KH. Prostate Cancer: Self-Normalized Detection of ANXA3 from Untreated Urine of Prostate Cancer Patients without Digital Rectal Examination (Adv. Healthcare Mater. 17/2017). Adv Healthc Mater 2017. [DOI: 10.1002/adhm.201770092] [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: 11/07/2022]
Affiliation(s)
- Minhong Jeun
- Center for Biomaterials; Biomedical Research Institute; Korea Institute of Science and Technology (KIST); 5 Hwarang-ro 14-gil Seongbuk-gu Seoul 02792 Republic of Korea
| | - Sungwook Park
- Center for Biomaterials; Biomedical Research Institute; Korea Institute of Science and Technology (KIST); 5 Hwarang-ro 14-gil Seongbuk-gu Seoul 02792 Republic of Korea
- Department of Biomedical Engineering; Korea University of Science and Technology (UST); 217 Gajeong-ro Yuseong-gu Daejeon 34113 Republic of Korea
| | - Yongdeok Kim
- Center for Biomaterials; Biomedical Research Institute; Korea Institute of Science and Technology (KIST); 5 Hwarang-ro 14-gil Seongbuk-gu Seoul 02792 Republic of Korea
| | - Jaewon Choi
- Center for Biomaterials; Biomedical Research Institute; Korea Institute of Science and Technology (KIST); 5 Hwarang-ro 14-gil Seongbuk-gu Seoul 02792 Republic of Korea
- Department of Biomedical Engineering; Korea University of Science and Technology (UST); 217 Gajeong-ro Yuseong-gu Daejeon 34113 Republic of Korea
| | - Sang Hoon Song
- Department of Urology; Asan Medical Center; University of Ulsan College of Medicine; 88 Olympic-ro 43-gil Songpa-gu Seoul 05505 Republic of Korea
| | - In Gab Jeong
- Department of Urology; Asan Medical Center; University of Ulsan College of Medicine; 88 Olympic-ro 43-gil Songpa-gu Seoul 05505 Republic of Korea
| | - Choung-Soo Kim
- Department of Urology; Asan Medical Center; University of Ulsan College of Medicine; 88 Olympic-ro 43-gil Songpa-gu Seoul 05505 Republic of Korea
| | - Kwan Hyi Lee
- Center for Biomaterials; Biomedical Research Institute; Korea Institute of Science and Technology (KIST); 5 Hwarang-ro 14-gil Seongbuk-gu Seoul 02792 Republic of Korea
- Department of Biomedical Engineering; Korea University of Science and Technology (UST); 217 Gajeong-ro Yuseong-gu Daejeon 34113 Republic of Korea
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Jeun M, Park S, Kim Y, Choi J, Song SH, Jeong IG, Kim CS, Lee KH. Self-Normalized Detection of ANXA3 from Untreated Urine of Prostate Cancer Patients without Digital Rectal Examination. Adv Healthc Mater 2017; 6. [PMID: 28703915 DOI: 10.1002/adhm.201700449] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/22/2017] [Indexed: 12/19/2022]
Abstract
A noninvasive quantitative assay that is capable of identifying prostate cancer biomarkers in untreated urine is an attractive diagnosis tool, but this method is subject to various obstacles. Difficulties presented by untreated urine include varying salt concentrations, and pH levels that may be different even though they are from the same patient. Untreated urine also presents interference from other biomolecules and possesses a fewer number of cancer biomarkers than can be found in serum. As a result, urine preconditioning processes and digital rectal examination (DRE) to increase biomarker secretion are mandatory in current urine assays. To address these challenges, an ion-responsive urine sensor (IRUS) that measures differential electrical signals is proposed as a self-normalized detection method. The proposed IRUS is based on a FET biosensor with a disposable sensing gate and has the capability to detect the prostate cancer antigen ANXA3 in untreated patient urine. The IRUS can detect ANXA3 at <1 fg mL-1 with high reliability. In addition, it is found that ANXA3 levels in urine show clinically significant correlation with real tumor volumes. This paper provides a guideline in developing a clinically ready accurate noninvasive platform, which is capable of predicting prostate cancer using untreated urine without DRE.
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Affiliation(s)
- Minhong Jeun
- Center for Biomaterials; Biomedical Research Institute; Korea Institute of Science and Technology (KIST); 5 Hwarang-ro 14-gil Seongbuk-gu Seoul 02792 Republic of Korea
| | - Sungwook Park
- Center for Biomaterials; Biomedical Research Institute; Korea Institute of Science and Technology (KIST); 5 Hwarang-ro 14-gil Seongbuk-gu Seoul 02792 Republic of Korea
- Department of Biomedical Engineering; Korea University of Science and Technology (UST); 217 Gajeong-ro Yuseong-gu Daejeon 34113 Republic of Korea
| | - Yongdeok Kim
- Center for Biomaterials; Biomedical Research Institute; Korea Institute of Science and Technology (KIST); 5 Hwarang-ro 14-gil Seongbuk-gu Seoul 02792 Republic of Korea
| | - Jaewon Choi
- Center for Biomaterials; Biomedical Research Institute; Korea Institute of Science and Technology (KIST); 5 Hwarang-ro 14-gil Seongbuk-gu Seoul 02792 Republic of Korea
- Department of Biomedical Engineering; Korea University of Science and Technology (UST); 217 Gajeong-ro Yuseong-gu Daejeon 34113 Republic of Korea
| | - Sang Hoon Song
- Department of Urology; Asan Medical Center; University of Ulsan College of Medicine; 88 Olympic-ro 43-gil Songpa-gu Seoul 05505 Republic of Korea
| | - In Gab Jeong
- Department of Urology; Asan Medical Center; University of Ulsan College of Medicine; 88 Olympic-ro 43-gil Songpa-gu Seoul 05505 Republic of Korea
| | - Choung-Soo Kim
- Department of Urology; Asan Medical Center; University of Ulsan College of Medicine; 88 Olympic-ro 43-gil Songpa-gu Seoul 05505 Republic of Korea
| | - Kwan Hyi Lee
- Center for Biomaterials; Biomedical Research Institute; Korea Institute of Science and Technology (KIST); 5 Hwarang-ro 14-gil Seongbuk-gu Seoul 02792 Republic of Korea
- Department of Biomedical Engineering; Korea University of Science and Technology (UST); 217 Gajeong-ro Yuseong-gu Daejeon 34113 Republic of Korea
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Khandwala YS, Jeong IG, Kim JH, Han DH, Li S, Wang Y, Chang SL, Chung BI. The Impact of Surgeon Volume on Perioperative Outcomes and Cost for Patients Receiving Robotic Partial Nephrectomy. J Endourol 2017; 31:851-857. [DOI: 10.1089/end.2017.0207] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yash S. Khandwala
- Department of Urology, Stanford University Medical Center, Stanford, California
- San Diego School of Medicine, University of California, San Diego, California
| | - In Gab Jeong
- Department of Urology, Stanford University Medical Center, Stanford, California
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Heon Kim
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Deok Hyun Han
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Shufeng Li
- Department of Urology and Dermatology, Stanford University Medical Center, Stanford, California
| | - Ye Wang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Steven L. Chang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin I. Chung
- Department of Urology, Stanford University Medical Center, Stanford, California
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Lee H, Lee D, Park JH, Song SH, Jeong IG, Kim CS, Searson PC, Lee KH. High throughput differential identification of TMPRSS2-ERG fusion genes in prostate cancer patient urine. Biomaterials 2017; 135:23-29. [DOI: 10.1016/j.biomaterials.2017.04.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 12/18/2022]
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