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Affiliation(s)
- Vikas Satyananda
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kiran Gollapudi
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ashkan Moazzez
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
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2
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Li KD, Saigal CS, Tandel MD, Kwan L, Inkelas M, Alden DL, Frencher SK, Gollapudi K, Blumberg J, Nabhani J, Bergman J. Differences in Implementation Outcomes of a Shared Decision-Making Program for Men with Prostate Cancer between an Academic Medical Center and County Health Care System. Med Decis Making 2021; 41:120-132. [PMID: 33435816 DOI: 10.1177/0272989x20982533] [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: 11/16/2022]
Abstract
BACKGROUND Shared decision making (SDM) has long been advocated as the preferred way for physicians and men with prostate cancer to make treatment decisions. However, the implementation of formal SDM programs in routine care remains limited, and implementation outcomes for disadvantaged populations are especially poorly described. We describe the implementation outcomes between academic and county health care settings. METHODS We administered a decision aid (DA) for men with localized prostate cancer at an academic center and across a county health care system. Our implementation was guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. We assessed the effectiveness of the DA through a postappointment patient survey. RESULTS Sites differed by patient demographic/clinical characteristics. Reach (DA invitation rate) was similar and insensitive to implementation strategies at the academic center and county (66% v. 60%, P = 0.37). Fidelity (DA completion rate) was also similar at the academic center and county (77% v. 80%, P = 0.74). DA effectiveness was similar between sites, except for higher academic center ratings for net promoter for the doctor (77% v. 37%, P = 0.01) and the health care system (77% v. 35%, P = 0.006) and greater satisfaction with manner of care (medians 100 v. 87.5, P = 0.04). Implementation strategies (e.g., faxing of patients' records and meeting patients in the clinic to complete the DA) represented substantial practice changes at both sites. The completion rate increased following the onset of reminder calls at the academic center and the creation of a Spanish module at the county. CONCLUSIONS Successful DA implementation efforts should focus on patient engagement and access. SDM may broadly benefit patients and health care systems regardless of patient demographic/clinical characteristics.
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Affiliation(s)
- Kevin D Li
- Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.,University of California San Francisco, School of Medicine, San Francisco, CA, USA
| | - Christopher S Saigal
- Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Megha D Tandel
- Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Lorna Kwan
- Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Moira Inkelas
- University of California Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA
| | - Dana L Alden
- University of Hawai'i at Manoa Shidler College of Business, Marketing, Honolulu, HI, USA
| | - Stanley K Frencher
- Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.,Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Kiran Gollapudi
- Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.,Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Jeremy Blumberg
- Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.,Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Jamal Nabhani
- Los Angeles County Department of Health Services, Los Angeles, CA, USA.,USC Keck School of Medicine, Department of Urology, Los Angeles, CA, USA
| | - Jonathan Bergman
- Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.,Los Angeles County Department of Health Services, Los Angeles, CA, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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3
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Lec PM, Venkataramana A, Lenis AT, Fero KE, Sharma V, Golla V, Gollapudi K, Blumberg J, Chamie K. Trends in management of ureteral urothelial carcinoma and effects on survival: a hospital-based registry study. Urol Oncol 2020; 39:194.e17-194.e24. [PMID: 33012575 DOI: 10.1016/j.urolonc.2020.08.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/11/2020] [Accepted: 08/23/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND High-risk ureteral tumors represent an understudied subset of upper tract urothelial carcinoma, whose surgical management can range from a radical nephroureterectomy (NU) to segmental ureterectomy (SU). OBJECTIVES To evaluate contemporary trends in the management of high-risk ureteral tumors, the utilization of lymphadenectomy and peri-operative chemotherapy, and their impact on overall survival (OS). DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective cohort study of patients in the National Cancer Database from years 2006 to 2013 with clinically localized high-risk ureteral tumors treated with NU or SU. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Chi-squared tests were utilized to assess differences in clinicodemographic features and peri-operative treatment delivery between SU and NU cohorts. Cochran-Armitage tests and linear regressions were performed to evaluate temporal trends in treatment utilization. Multivariable logistic regression models were employed to assess predictors of treatment delivery. Multivariable Cox proportional hazards models evaluated associations with OS. RESULTS Of the 1,962 patients included, NU was more commonly performed than SU (72.4%, 1,421/1,962 vs. 27.6%, 541/1,962). Only 22.7% (446/1,962) of the population underwent lymphadenectomy, and 24.8% (271/1,092) of those with advanced pathology (≥pT2 or pN+) received adjuvant chemotherapy. Lymphadenectomy was associated with improved OS in NU patients when more than 3 nodes were removed (hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.39-0.89). Receipt of adjuvant chemotherapy for advanced pathology had no impact OS in both the NU (HR 1.10, 95% CI 0.84-1.44) and SU (HR 0.94, 95% CI 0.61-1.46) cohorts. Performance of SU was not associated with poorer OS on multivariable analysis (HR 1.02, 95% CI 0.89-1.21, P = 0.83). CONCLUSION Our study suggests that SU may be an appropriate alternative to NU for the management of high-risk ureteral tumors. Further, lymphadenectomy may play an important role at the time of NU, and adjuvant chemotherapy is infrequently utilized in patients with advanced pathology.
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Affiliation(s)
- Patrick M Lec
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA.
| | - Abhishek Venkataramana
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Andrew T Lenis
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Katherine E Fero
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Vidit Sharma
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Vishnukamal Golla
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Kiran Gollapudi
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - Jeremy Blumberg
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - Karim Chamie
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
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Michel J, Lenis AT, Lec PM, Golla V, Johnson DC, Gollapudi K, Blumberg J, Shuch BM, Chamie K. Analysis of guideline recommended use of renal mass biopsy and association with treatment. Can J Urol 2020; 27:10285-10293. [PMID: 32861253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Renal mass biopsy (RMB) may not be indicated when the results are unlikely to impact management, such as in young and/or healthy patients and in elderly and/or frail patients. We analyzed the utility of RMB in three patient cohorts stratified by age-adjusted Charlson comorbidity index score (ACCI). MATERIALS AND METHODS We identified patients with cT1a renal tumors in the National Cancer Database from 2004-2014. We combined age and Charlson-Deyo scores to identify young and/or healthy patients ('healthy-ACCI'), elderly and/or frail patients ('frail-ACCI'), and a reference cohort. We performed multivariable logistic regression to identify predictors of RMB and treatment. We evaluated the impact of RMB on management by analyzing the proportion of high-grade disease on final pathology as a surrogate for risk stratification. RESULTS We identified 36,720 healthy-ACCI, 2,516 frail-ACCI, and 18,989 reference-ACCI patients. Healthy-ACCI patients were less likely to undergo RMB (7.5% versus 10.8%; p < 0.001) while frail-ACCI patients underwent RMB at similar rates (11.8% versus 10.8%; p = 0.14) compared with reference-ACCI patients. On multivariable logistic regression, in both healthy-ACCI and frail-ACCI patients, RMB was associated with decreased odds of surgical treatment, and increased odds of ablation and surveillance (all p < 0.01). In the frail-ACCI patients, higher grade disease at surgery was identified in the RMB cohort (32.9% versus 23.5%, p = 0.05). CONCLUSIONS RMB is performed less frequently in healthy-ACCI patients compared with the reference cohort. RMB is associated with decreased odds of surgical treatment and increased odds of surveillance and ablation in all cohorts. In frail-ACCI patients who underwent surgery, RMB may provide additional risk stratification as these patients had lower rates of low-grade disease.
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Affiliation(s)
- Joaquin Michel
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Lenis AT, Lec PM, Michel J, Brisbane W, Golla V, Sharma V, Gollapudi K, Blumberg J, Chamie K. Predictors of adequate lymph node dissection in patients with non-muscle invasive bladder cancer undergoing radical cystectomy and effect on survival. Urol Oncol 2020; 38:796.e7-796.e14. [PMID: 32446641 DOI: 10.1016/j.urolonc.2020.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/27/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Radical cystectomy (RC) is the standard of care for refractory high-risk non-muscle invasive bladder cancer (NMIBC). We aim to identify predictors of adequate lymph node dissection (LND) in a cohort of NMIBC patients undergoing RC, as well as its impact on clinical outcomes. METHODS The National Cancer Database was queried for patients who underwent RC for urothelial cell carcinoma for clinical stage Tis/a/1 N0M0 disease between 2004 and 2013. Patients were stratified by LND: none, inadequate (<10) or adequate (≥10 nodes). Factors associated with LND were analyzed. Inverse-probability weighted propensity score matching was used to assess the impact of adequate LND on overall survival. RESULTS The final cohort of 3,226 patients had a median follow-up of 39.0 months, had a mean age of 65.3 years, was 70% male, and was 81% Caucasian. Overall, 16.6% received no LND, 28.5% inadequate LND, and 55.0% adequate LND. Treatment at an academic facility, Charlson-Deyo Comorbidity score of 1, and later year of treatment were significantly associated with adequate LND. Overall survival was significantly higher with adequate LND compared to a matched-cohort of inadequate LND patients (68.7% vs. 60.6% at 5 years, P < 0.01). CONCLUSIONS Nearly half of NMIBC patients undergoing RC do not receive an adequate LND, despite an association with increased overall survival. Treatment at an academic facility was associated with increased likelihood of adequate LND. Initiatives to improve adequate LND in this population may be warranted.
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Affiliation(s)
- Andrew T Lenis
- Department of Urology, David Geffen School of Medicine, Institute of Urologic Oncology (IUO), University of California, Los Angeles, CA.
| | - Patrick M Lec
- Department of Urology, David Geffen School of Medicine, Institute of Urologic Oncology (IUO), University of California, Los Angeles, CA
| | - Joaquin Michel
- Department of Urology, David Geffen School of Medicine, Institute of Urologic Oncology (IUO), University of California, Los Angeles, CA
| | - Wayne Brisbane
- Department of Urology, David Geffen School of Medicine, Institute of Urologic Oncology (IUO), University of California, Los Angeles, CA
| | - Vishnukamal Golla
- Department of Urology, David Geffen School of Medicine, Institute of Urologic Oncology (IUO), University of California, Los Angeles, CA
| | - Vidit Sharma
- Department of Urology, David Geffen School of Medicine, Institute of Urologic Oncology (IUO), University of California, Los Angeles, CA
| | - Kiran Gollapudi
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - Jeremy Blumberg
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - Karim Chamie
- Department of Urology, David Geffen School of Medicine, Institute of Urologic Oncology (IUO), University of California, Los Angeles, CA
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Lec PM, Lenis AT, Brisbane W, Sharma V, Golla V, Gollapudi K, Blumberg J, Drakaki A, Bergman J, Chamie K. Trends in palliative care interventions among patients with advanced bladder, prostate, or kidney cancer: A retrospective cohort study. Urol Oncol 2020; 38:854.e1-854.e9. [PMID: 32430252 DOI: 10.1016/j.urolonc.2020.04.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/02/2020] [Accepted: 04/25/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Palliative care has an established role in improving the quality of life in patients with advanced cancer, but little is known regarding its delivery among patients with urologic malignancies. OBJECTIVE To determine trends in the utilization of palliative interventions among patients with advanced bladder, prostate, and kidney cancer. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective cohort study of patients from years 2004 to 2013 in the National Cancer Database diagnosed with stage IV bladder (n = 17,997), prostate (n = 23,322), and kidney (n = 34,697) cancer, after excluding those with missing disease stage, treatment, and outcomes data. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Descriptive statistics and logistic regression were performed to evaluate utilization of palliative care intervention. Utilization was analyzed by cancer type and by overall survival strata (<6, 6-24, and >24 months). Kaplan-Meier and Cox proportional hazards models analyzed overall survival. RESULTS AND LIMITATIONS Palliative interventions were utilized in 12.5% (2,257/17,997), 14.7% (3,442/23,322), and 19.9% (6,935/34,697) of advanced bladder, prostate, and kidney cancer patients, respectively. Older age and longer survival were associated with lower odds of palliative intervention utilization in each malignancy, as was minority race in kidney and bladder cancer patients. Palliative radiation was used most commonly, and utilization of any palliative intervention was associated with poorer overall survival. Limitations largely stem from imperfect data abstraction, and the analysis of interventions' incomplete reflection of palliative care. CONCLUSIONS Palliative interventions were seldom used among patients with advanced urologic malignancies. Palliative interventions were less frequently used in older patients and minority races. Further study is warranted to define the role of palliative interventions in advanced urologic malignancies and guide their utilization.
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Affiliation(s)
- Patrick M Lec
- Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA.
| | - Andrew T Lenis
- Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Wayne Brisbane
- Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Vidit Sharma
- Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Vishnukamal Golla
- Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Kiran Gollapudi
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - Jeremy Blumberg
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - Alexandra Drakaki
- Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA; Division of Hematology/Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Jonathan Bergman
- Los Angeles County Department of Health Services, Los Angeles, CA
| | - Karim Chamie
- Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA
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Levitske C, Gollapudi K, Pak S, Liang L. Repair of iatrogenic ureteral injury secondary to breast cancer metastasis. Urol Case Rep 2020; 28:101024. [PMID: 31641604 PMCID: PMC6796656 DOI: 10.1016/j.eucr.2019.101024] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/18/2019] [Indexed: 12/02/2022] Open
Abstract
We present a case of unforeseen ureteral metastasis from a primary breast cancer. A ureteral injury leak was postoperatively recognized after a hysterectomy and bilateral oophorectomy were performed. Subsequent repair with a psoas hitch ureteral re-implant was performed and breast cancer metastasis was discovered in the ureteral stump specimen.
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Affiliation(s)
- Cassandra Levitske
- Ross University School of Medicine, 2300 SW 145th Ave #200, Miramar, FL, 33027, USA
- Corresponding author.
| | - Kiran Gollapudi
- Habor UCLA Medical Center, Urology Department, 1000 West Carson Street, Torrance, CA, 90509, USA
| | - Sophia Pak
- Keck School of Medicine of University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
| | - Leonard Liang
- Habor UCLA Medical Center, Urology Department, 1000 West Carson Street, Torrance, CA, 90509, USA
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Pooli A, Salmasi A, Johnson DC, Lenis AT, Faiena I, Lebacle C, Golla V, Drakaki A, Gollapudi K, Blumberg J, Pantuck AJ, Chamie K. Positive surgical margins at radical prostatectomy in the United States: Institutional variations and predictive factors. Urol Oncol 2019; 38:1.e17-1.e23. [PMID: 31537483 DOI: 10.1016/j.urolonc.2019.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/12/2019] [Accepted: 08/20/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Positive surgical margins (PSMs) are associated with treatment failure after radical prostatectomy (RP) for patients with prostate cancer (CaP). We investigated institutional variations in PSM after RP, as well as clinical and demographic factors predicting PSM. PATIENTS AND METHODS Patients undergoing RP for clinically localized CaP were identified in the National Cancer Database in 2010 to 2013 and clinicodemographics were recorded. Treating institution was defined as academic (AMC) or nonacademic medical centers (nAMC). The primary outcome was the PSM rate. Multivariable logistic regression and propensity matching with inverse probability treatment weighing were used to both compare outcomes between AMC and nAMC and to identify predictors of PSM following RP. RESULTS A total of 167,260 patients met our inclusion criteria. PSM rate was significantly lower in patients treated at AMC (13,435, 18.9%) compared with 22,145 (23.0%) in those treated at nAMC (P < 0.01). The difference between PSM rate in AMC and nAMC was more pronounced in lower volume centers while it was not significant in higher volume centers. On multivariable analysis, age, race, prostate-specific antigen (PSA), biopsy Gleason score, comorbidity profile, insurance type, income, and treatment facility were significantly associated with PSM rate. CONCLUSION PSM rates appear to be lower at AMC and higher volume facilities, which can potentially reflect institutional differences in surgical quality. In addition, we identified several socioeconomic and demographic factors that contribute to the likelihood of PSM following RP for localized CaP, suggesting potential systematic variation in the quality of surgical care. The cause of this variation warrants further investigation and evaluation.
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Affiliation(s)
- Aydin Pooli
- Institute of Urologic Oncology (IUO) at UCLA, Department a of Urology, David Geffen School of Medicine, Los Angeles, CA.
| | - Amirali Salmasi
- Department of Urology, University of California, San Diego, CA
| | - David C Johnson
- Institute of Urologic Oncology (IUO) at UCLA, Department a of Urology, David Geffen School of Medicine, Los Angeles, CA; Department of Veterans Affairs/UCLA National Clinician Scholars Program, Los Angeles, CA
| | - Andrew T Lenis
- Institute of Urologic Oncology (IUO) at UCLA, Department a of Urology, David Geffen School of Medicine, Los Angeles, CA
| | - Izak Faiena
- Institute of Urologic Oncology (IUO) at UCLA, Department a of Urology, David Geffen School of Medicine, Los Angeles, CA
| | - Cedric Lebacle
- Institute of Urologic Oncology (IUO) at UCLA, Department a of Urology, David Geffen School of Medicine, Los Angeles, CA; Department of Urology, University Hospital Bicetre, APHP, University Paris-Saclay, Le Kremlin Bicetre, France
| | - Vishnukamal Golla
- Institute of Urologic Oncology (IUO) at UCLA, Department a of Urology, David Geffen School of Medicine, Los Angeles, CA
| | - Alexandra Drakaki
- Institute of Urologic Oncology (IUO) at UCLA, Department a of Urology, David Geffen School of Medicine, Los Angeles, CA; Department of Hematology and Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Kiran Gollapudi
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - Jeremy Blumberg
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - Allan J Pantuck
- Institute of Urologic Oncology (IUO) at UCLA, Department a of Urology, David Geffen School of Medicine, Los Angeles, CA
| | - Karim Chamie
- Institute of Urologic Oncology (IUO) at UCLA, Department a of Urology, David Geffen School of Medicine, Los Angeles, CA
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Lenis AT, Burton CS, Golla V, Pooli A, Faiena I, Johnson DC, Salmasi A, Drakaki A, Gollapudi K, Blumberg J, Pantuck AJ, Chamie K. Cytoreductive nephrectomy in patients with metastatic renal cell carcinoma and venous thrombus-Trends and effect on overall survival. Urol Oncol 2019; 37:577.e9-577.e16. [PMID: 30930099 DOI: 10.1016/j.urolonc.2019.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/21/2019] [Accepted: 03/10/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Patients with metastatic renal cell carcinoma (mRCC) commonly present with tumor thrombi in the renal vein and inferior vena cava (IVC). The benefit of cytoreductive nephrectomy (CN) in this population is unclear and the effect on overall survival (OS) has been incompletely evaluated. MATERIALS AND METHODS We queried the National Cancer Database from 2010 to 2013 for patients diagnosed with mRCC and tumor thrombi, which was defined as renal vein, infradiaphragmatic IVC, or supradiaphragmatic IVC. Descriptive statistics were performed and associations between clinicopathologic variables and utilization of CN were analyzed. Patients were matched on the receipt of CN and Kaplan-Meier analyses and multivariable Cox proportional hazards models were used to estimate survival. RESULTS In total, 8,629 patients were found to have mRCC during the study period. Approximately 27% (n = 2,376) had tumor thrombus. Tumor thrombus was associated with increased rates of CN utilization, however rates decreased as thrombus level increased. In a matched Kaplan-Meier analysis, CN was associated with improved OS in patients without thrombus, and with renal vein or infradiaphragmatic thrombus (all P < 0.01). Patients with supradiaphragmatic thrombus did not benefit from CN (P = 0.46). This effect was confirmed in a Cox proportional hazards model. CONCLUSIONS Tumor thrombus is common in patients with mRCC. OS is poor, and patient and tumor specific factors influence the use of CN. Despite discrepancies in utilization, CN is associated with improved OS, although this effect appears to be limited to those with mRCC and tumor thrombus limited to the renal vein and infradiaphragmatic IVC.
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Affiliation(s)
- Andrew T Lenis
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Claire S Burton
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Vishnukamal Golla
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Aydin Pooli
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Izak Faiena
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - David C Johnson
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Amirali Salmasi
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Alexandra Drakaki
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Hematology and Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA
| | - Kiran Gollapudi
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - Jeremy Blumberg
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - Allan J Pantuck
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA
| | - Karim Chamie
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA.
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Faiena I, Salmasi A, Mendhiratta N, Lenis AT, Pooli A, Drakaki A, Gollapudi K, Blumberg J, Pantuck AJ, Chamie K. Overall survival in patients with residual disease after radical cystectomy and neoadjuvant chemotherapy. World J Urol 2018; 36:1825-1833. [PMID: 29752514 DOI: 10.1007/s00345-018-2327-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/05/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) has been shown to improve survival in patients with urothelial carcinoma (UC). However, there are a subset of patients who do not respond or progress despite systemic treatment. METHODS Data from the National Cancer Database on patients who underwent a radical cystectomy (RC) with or without NAC from 2006 to 2013 were abstracted. Covariates were balanced using inverse probability weighting methods. The primary outcome of overall survival in patients with residual disease by stage was evaluated using 90-day conditional landmark analysis and Cox proportional hazards modeling. Secondary outcome of predictors of residual disease was evaluated using multivariable logistic regression analysis. RESULTS A total of 20,128 patients met our inclusion criteria; 16,058 patients underwent RC only (80%) and 4070 underwent RC with NAC (20%). Patients who received NAC were younger and healthier, treated at an academic center, and presented with higher stage. NAC was associated with improved overall survival amongst patients with cT3-4aN0 (HR 0.84 95% CI 0.73-0.97; p = 0.02) and cN+ (HR 0.70, 95% CI 0.58-0.86; p = 0.001). Predictors of no residual disease were NAC (OR 0.17, 95% CI 0.14-0.21; p < 0.001) and treatment at an academic facility (OR 0.47, 95% CI 0.37-0.60; p < 0.001). Patients with cT3-4a or cN+ had increased odds of having residual UC (OR 2.01, 95% CI 1.53-2.64; p < 0.001, and OR 2.14, 95% CI 1.43-3.21; p < 0.001, respectively) compared with cT2. CONCLUSION In patients with residual UC, NAC is associated with a significant survival benefit in higher stage disease only. Furthermore, those treated with NAC or at an academic center were less likely to have residual disease. Given the toxicity of NAC, more prudent patient selection for NAC is warranted and requires further study.
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Affiliation(s)
- Izak Faiena
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, USA.
- Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, USA.
- , 300 Stein Plaza, Suite 348, Los Angeles, CA, 90095, USA.
| | - Amirali Salmasi
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, USA
- Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, USA
| | - Neil Mendhiratta
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, USA
| | - Andrew T Lenis
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, USA
| | - Aydin Pooli
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, USA
- Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, USA
| | - Alexandra Drakaki
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, USA
- Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, USA
- Division of Hematology and Oncology, David Geffen School of Medicine at University of California, Los Angeles, USA
| | - Kiran Gollapudi
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jeremy Blumberg
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Allan J Pantuck
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, USA
- Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, USA
| | - Karim Chamie
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, USA
- Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, USA
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Lenis A, Burton C, Faiena I, Salmasi A, Pooli A, Johnson D, Drakaki A, Gollapudi K, Blumberg J, Pantuck A, Chamie K. MP28-09 CYTOREDUCTIVE NEPHRECTOMY IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA AND TUMOR THROMBUS – TRENDS AND EFFECT ON OVERALL SURVIVAL. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lenis AT, Salmasi AH, Donin NM, Faiena I, Johnson DC, Drakaki A, Gollapudi K, Blumberg J, Belldegrun AS, Pantuck AJ, Chamie K. Trends in usage of cytoreductive partial nephrectomy and effect on overall survival in patients with metastatic renal cell carcinoma. Urol Oncol 2018; 36:78.e21-78.e28. [DOI: 10.1016/j.urolonc.2017.09.030] [Citation(s) in RCA: 5] [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: 06/15/2017] [Revised: 09/12/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
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Henning SM, Galet C, Gollapudi K, Byrd JB, Liang P, Li Z, Grogan T, Elashoff D, Magyar CE, Said J, Cohen P, Aronson WJ. Phase II prospective randomized trial of weight loss prior to radical prostatectomy. Prostate Cancer Prostatic Dis 2017; 21:212-220. [PMID: 29203893 PMCID: PMC5986584 DOI: 10.1038/s41391-017-0001-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/01/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Obesity is associated with poorly differentiated and advanced prostate cancer and increased mortality. In preclinical models, caloric restriction delays prostate cancer progression and prolongs survival. We sought to determine if weight loss (WL) in men with prostate cancer prior to radical prostatectomy affects tumor apoptosis and proliferation, and if WL effects other metabolic biomarkers. METHODS In this Phase II prospective trial, overweight and obese men scheduled for radical prostatectomy were randomized to a 5–8 week WL program consisting of standard structured energy-restricted meal plans (1200–1500 Kcal/day) and physical activity or to a control group. The primary endpoint was apoptotic index in the radical prostatectomy malignant epithelium. Secondary endpoints were proliferation (Ki67) in the radical prostatectomy tissue, body weight, body mass index (BMI), waist to hip ratio, body composition, and serum PSA, insulin, triglyceride, cholesterol, testosterone, estradiol, leptin, adiponectin, interleukin 6, interleukin 8, insulin-like growth factor 1, and IGF binding protein 1. RESULTS Twenty-three patients were randomized to the WL intervention and twenty-one patients to the control group. Subjects in the intervention group had significantly more weight loss (WL:−3.7 ± 0.5 kg; Control:−1.6 ± 0.5 kg; p=0.007) than the control group and total fat mass was significantly reduced (WL:−2.1 ± 0.4; Control: 0.1 ± 0.3; p=0.015). There was no significant difference in apoptotic or proliferation index between the groups. Among the other biomarkers, triglyceride and insulin levels were significantly decreased in the WL compared to the control group. CONCLUSIONS In summary, this short-term WL program prior to radical prostatectomy resulted in significantly more WL in the intervention vs. the control group and was accompanied by significant reductions in body fat mass, circulating triglycerides, and insulin. However, no significant changes were observed in malignant epithelium apoptosis or proliferation. Future studies should consider a longer term or more intensive weight loss intervention.
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Affiliation(s)
- Susanne M Henning
- Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, 90095-1738, USA
| | - Colette Galet
- Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, 90095-1738, USA
| | - Kiran Gollapudi
- Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, 90095-1738, USA
| | - Joshua B Byrd
- Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, 90095-1738, USA
| | - Pei Liang
- Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, 90095-1738, USA
| | - Zhaoping Li
- Center for Human Nutrition, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, 90024-2703, USA
| | - Tristan Grogan
- Statistics Core, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, 90095-1738, USA
| | - David Elashoff
- Statistics Core, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, 90095-1738, USA
| | - Clara E Magyar
- Department of Pathology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, 90095-1738, USA
| | - Jonathan Said
- Department of Pathology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, 90095-1738, USA
| | - Pinchas Cohen
- USC Davis School of Gerontology, Ethel Percy Andrus Gerontology Center University of Southern California, Los Angeles, 90089-0191, CA, USA
| | - William J Aronson
- Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, 90095-1738, USA. .,VA Medical Center Greater Los Angeles Healthcare System, 11301 Whilshire Blvd, Los Angeles, 90073-1003, CA, USA.
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Blumberg JM, Gollapudi K. Blood in Urine. Surgery 2015. [DOI: 10.1007/978-1-4939-1726-6_54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Prado K, Gollapudi K, King C, Steinberg ML, Chin AI. Bladder preservation in the treatment of muscle-invasive bladder cancer. Bladder (San Franc) 2014. [DOI: 10.14440/bladder.2014.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Gollapudi K, Galet C, Grogan T, Zhang H, Said JW, Huang J, Elashoff D, Freedland SJ, Rettig M, Aronson WJ. Association between tumor-associated macrophage infiltration, high grade prostate cancer, and biochemical recurrence after radical prostatectomy. Am J Cancer Res 2013; 3:523-529. [PMID: 24224130 PMCID: PMC3816972] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 09/03/2013] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Tumor-associated macrophages (TAMs) are a key component of the inflammatory microenvironment. Their role in prostate cancer development and progression remains unclear. We examined whether the amount of TAMs in prostate cancer is: 1) higher than prostatic intraepithelial neoplasia (PIN) and benign tissue 2) associated with poorly differentiated disease, and 3) predictive of biochemical recurrence among surgically treated men. METHODS A tissue microarray (TMA) of prostatectomy specimens from 332 patients was stained for CD68, a TAM marker. A separate TMA was used for validation. Associations between mean TAMs in cancer cores and PSA recurrence were determined by Cox proportional hazards models after adjusting for age, preoperative PSA, race, body mass index, pathologic Gleason sum, seminal vesicle invasion, extracapsular extension, and margin status. RESULTS Mean TAM number was higher in cancer versus PIN and benign tissue (p<0.0001). Mean TAM number was higher in Gleason grade 4 cores vs. Gleason grade 3 cores (p=0.003). On multivariable analysis, no association was observed between mean TAM number per cancer core and biochemical recurrence in either cohort. CONCLUSION Mean TAM number was higher in cancer cores vs. PIN and benign tissue, and higher in high grade prostate cancer supporting the potential role of TAMs in prostate cancer development. However, TAMs were not associated with biochemical recurrence after radical prostatectomy suggesting TAM counts do not provide independent prognostic value among surgically treated men. Further studies are required to elucidate the functional significance of TAMs in the prostate cancer microenvironment.
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Affiliation(s)
- Kiran Gollapudi
- Department of Urology, School of Medicine, University of California-Los AngelesLos Angeles, California
| | - Colette Galet
- Department of Urology, School of Medicine, University of California-Los AngelesLos Angeles, California
| | - Tristan Grogan
- Department of Medicine Statistics Core, School of Medicine, University of California-Los AngelesLos Angeles, California
| | - Hong Zhang
- Department of Pathology, School of Medicine, University of California-Los AngelesLos Angeles, Californiad
- Dr Zhang’s current affiliation: Department of Pathology, Anhui Medical UniversityHefei, Anhui Province, P.R China
| | - Jonathan W Said
- Department of Pathology, School of Medicine, University of California-Los AngelesLos Angeles, Californiad
| | - Jiaoti Huang
- Department of Pathology, School of Medicine, University of California-Los AngelesLos Angeles, Californiad
| | - David Elashoff
- Department of Medicine Statistics Core, School of Medicine, University of California-Los AngelesLos Angeles, California
| | - Stephen J Freedland
- Department of Surgery, Durham Veterans Affairs Medical Center and Division of Urologic Surgery and Duke Prostate Center, Departments of Surgery and Pathology, Duke University Medical CenterDurham, Nce
| | - Matthew Rettig
- Division of Hematology/Oncology, Department of Medicine, VA Greater Los Angeles Healthcare SystemLos Angeles, California
| | - William J Aronson
- Department of Urology, School of Medicine, University of California-Los AngelesLos Angeles, California
- Urology Section, Department of Surgery, VA Greater Los Angeles Healthcare SystemLos Angeles, California
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Galet C, Gollapudi K, Stepanian S, Byrd JB, Henning SM, Grogan T, Elashoff D, Heber D, Said J, Cohen P, Aronson WJ. Effect of a low-fat fish oil diet on proinflammatory eicosanoids and cell-cycle progression score in men undergoing radical prostatectomy. Cancer Prev Res (Phila) 2013; 7:97-104. [PMID: 24169960 DOI: 10.1158/1940-6207.capr-13-0261] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We previously reported that a 4- to 6-week low-fat fish oil (LFFO) diet did not affect serum insulin-like growth factor (IGF)-1 levels (primary outcome) but resulted in lower omega-6 to omega-3 fatty acid ratios in prostate tissue and lower prostate cancer proliferation (Ki67) as compared with a Western diet. In this post hoc analysis, the effect of the LFFO intervention on serum pro-inflammatory eicosanoids, leukotriene B4 (LTB4) and 15-S-hydroxyeicosatetraenoic acid [15(S)-HETE], and the cell-cycle progression (CCP) score were investigated. Serum fatty acids and eicosanoids were measured by gas chromatography and ELISA. CCP score was determined by quantitative real-time reverse transcriptase PCR (RT-PCR). Associations between serum eicosanoids, Ki67, and CCP score were evaluated using partial correlation analyses. BLT1 (LTB4 receptor) expression was determined in prostate cancer cell lines and prostatectomy specimens. Serum omega-6 fatty acids and 15(S)-HETE levels were significantly reduced, and serum omega-3 levels were increased in the LFFO group relative to the Western diet group, whereas there was no change in LTB4 levels. The CCP score was significantly lower in the LFFO compared with the Western diet group. The 15(S)-HETE change correlated with tissue Ki67 (R = 0.48; P < 0.01) but not with CCP score. The LTB4 change correlated with the CCP score (r = 0.4; P = 0.02) but not with Ki67. The LTB4 receptor BLT1 was detected in prostate cancer cell lines and human prostate cancer specimens. In conclusion, an LFFO diet resulted in decreased 15(S)-HETE levels and lower CCP score relative to a Western diet. Further studies are warranted to determine whether the LFFO diet antiproliferative effects are mediated through the LTB4/BLT1 and 15(S)-HETE pathways.
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Affiliation(s)
- Colette Galet
- Department of Urology, University of California-Los Angeles, Box 951738, Los Angeles, CA 90095-1738;
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Byrd JB, Galet C, Stepanian S, Gollapudi K, Henning SM, Grogan T, Elashoff D, Heber D, Cohen P, Aronson WJ. 313 LOW FAT FISH OIL (LFFO) DIET DECREASES PRO-INFLAMMATORY EICOSANOIDS AND PROSTATE CANCER CELL CYCLE PROGRESSION (CCP) SCORE IN MEN UNDERGOING RADICAL PROSTATECTOMY. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gollapudi K, Galet C, Grogan T, Zhang H, Huang J, Elashoff D, Gerber L, Freedland S, Rettig M, Aronson W. 479 IS INFILTRATION OF TUMOR-ASSOCIATED MACROPHAGES PREDICTIVE OF BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY? J Urol 2012. [DOI: 10.1016/j.juro.2012.02.548] [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: 11/28/2022]
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Gore JL, Gollapudi K, Bergman J, Kwan L, Krupski TL, Litwin MS. Correlates of bother following treatment for clinically localized prostate cancer. J Urol 2010; 184:1309-15. [PMID: 20723914 DOI: 10.1016/j.juro.2010.06.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE We determined factors associated with bother, the distress patients experience as a result of functional detriments after treatment for localized prostate cancer. MATERIALS AND METHODS A prospective cohort of men treated for clinically localized prostate cancer completed a questionnaire comprising the UCLA-PCI, Medical Outcomes Study Short Form-36, American Urological Association Symptom Index and Memorial Anxiety Scale for Prostate Cancer fear of recurrence subscale. We used nonlinear mixed models to identify factors associated with severe urinary, sexual and bowel bother. RESULTS Worse function scores were associated with severe urinary, sexual and bowel bother following treatment (OR 0.88-0.94, p <0.001). Worse American Urological Association Symptom Index score was associated with severe urinary bother (OR 1.22, 95% CI 1.16-1.28). Time since treatment was inversely associated with urinary (OR 0.68, 95% CI 0.54-0.83) and bowel bother (OR 0.63, 95% CI 0.47-0.80) early after treatment but not for the entire 48-month study period. Receipt of concomitant androgen deprivation therapy was not associated with bother 48 months after radiation. CONCLUSIONS Addressing functional detriment may confer improvement in urinary, sexual and bowel bother. Patient distress related to dysfunction improves with time. Measuring health related quality of life after prostate cancer treatment should incorporate functional and bother assessments.
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Affiliation(s)
- John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, Washington 98195, USA.
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Janjanin S, Djouad F, Shanti RM, Baksh D, Gollapudi K, Prgomet D, Rackwitz L, Joshi AS, Tuan RS. Human palatine tonsil: a new potential tissue source of multipotent mesenchymal progenitor cells. Arthritis Res Ther 2008; 10:R83. [PMID: 18662393 PMCID: PMC2575631 DOI: 10.1186/ar2459] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 05/27/2008] [Accepted: 07/28/2008] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Mesenchymal progenitor cells (MPCs) are multipotent progenitor cells in adult tissues, for example, bone marrow (BM). Current challenges of clinical application of BM-derived MPCs include donor site morbidity and pain as well as low cell yields associated with an age-related decrease in cell number and differentiation potential, underscoring the need to identify alternative sources of MPCs. Recently, MPC sources have diversified; examples include adipose, placenta, umbilicus, trabecular bone, cartilage, and synovial tissue. In the present work, we report the presence of MPCs in human tonsillar tissue. METHODS We performed comparative and quantitative analyses of BM-MPCs with a subpopulation of adherent cells isolated from this lymphoid tissue, termed tonsil-derived MPCs (T-MPCs). The expression of surface markers was assessed by fluorescent-activated cell sorting analysis. Differentiation potential of T-MPCs was analyzed histochemically and by reverse transcription-polymerase chain reaction for the expression of lineage-related marker genes. The immunosuppressive properties of MPCs were determined in vitro in mixed lymphocyte reactions. RESULTS Surface epitope analysis revealed that T-MPCs were negative for CD14, CD31, CD34, and CD45 expression and positive for CD29, CD44, CD90, and CD105 expression, a characteristic phenotype of BM-MPCs. Similar to BM-MPCs, T-MPCs could be induced to undergo adipogenic differentiation and, to a lesser extent, osteogenic and chondrogenic differentiation. T-MPCs did not express class II major histocompatibility (MHC) antigens, and in a similar but less pronounced manner compared with BM-MPCs, T-MPCs were immunosuppressive, inhibiting the proliferation of T cells stimulated by allogeneic T cells or by non-specific mitogenic stimuli via an indoleamine 2,3-dioxygenase-dependent mechanism. CONCLUSION Human palatine T-MPCs represent a new source of progenitor cells, potentially applicable for cell-based therapies.
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Affiliation(s)
- Sasa Janjanin
- Cartilage Biology and Orthopaedics Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Department of Health and Human Services, 9000 Rockville Pike, Bethesda, MD 20892, USA
- Department of Otorhinolaryngology, Head & Neck Surgery, Zagreb Clinical Hospital Center, Zagreb University School of Medicine, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Farida Djouad
- Cartilage Biology and Orthopaedics Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Department of Health and Human Services, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Rabie M Shanti
- Cartilage Biology and Orthopaedics Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Department of Health and Human Services, 9000 Rockville Pike, Bethesda, MD 20892, USA
- Howard Hughes Medical Institute-National Institutes of Health, Research Scholars Program, 1 Cloister Court, Bethesda, MD 20814-1460, USA
| | - Dolores Baksh
- Cartilage Biology and Orthopaedics Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Department of Health and Human Services, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Kiran Gollapudi
- Cartilage Biology and Orthopaedics Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Department of Health and Human Services, 9000 Rockville Pike, Bethesda, MD 20892, USA
- Howard Hughes Medical Institute-National Institutes of Health, Research Scholars Program, 1 Cloister Court, Bethesda, MD 20814-1460, USA
| | - Drago Prgomet
- Department of Otorhinolaryngology, Head & Neck Surgery, Zagreb Clinical Hospital Center, Zagreb University School of Medicine, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Lars Rackwitz
- Cartilage Biology and Orthopaedics Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Department of Health and Human Services, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Arjun S Joshi
- Division of Otolaryngology – Head and Neck Surgery, George Washington University, 2150 Pennsylvania Ave. N.W., Washington, DC 20037, USA
| | - Rocky S Tuan
- Cartilage Biology and Orthopaedics Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Department of Health and Human Services, 9000 Rockville Pike, Bethesda, MD 20892, USA
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Janjanin S, Djouad F, Prgomet D, Shanti RM, Baksh D, Gollapudi K, Joshi AS, Tuan RS. R032: Mesenchymal Stem Cells Derived from Human Palatine Tonsils. Otolaryngol Head Neck Surg 2007. [DOI: 10.1016/j.otohns.2007.06.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
INTRODUCTION Both advanced and delayed bone age relative to chronological age have been described in non ambulatory children with moderate to severe cerebral palsy (CP). The purpose of our study was to assess skeletal maturation in an ambulatory CP population and determine the affects of body mass index (BMI), type of CP, and Gross Motor Function Classification System (GMFCS) on skeletal maturity. METHODS A retrospective chart and radiograph review was performed on 51 patients with ambulatory CP. A control group of 50 patients was also analyzed. Age, sex, height, weight, type of CP, and GMFCS were recorded from the chart. The height and weight were used to calculate BMI. Bone age was determined using the Oxford method. Statistical analysis for the data included descriptive statistics with bivariate and multivariate regression analyses. Significance was determined as P < 0.05. RESULTS There were 26 boys and 25 girls. All CP patients were independent ambulators. The mean chronological age was 7.1 years for boys and 8.6 years for girls. The mean bone age was 9.9 years for boys and 10.6 years for girls. Overall, 48 (94%) of 51 patients had advanced bone age compared with chronological age. Bone age was significantly advanced compared with chronological age for boys (P = 0.033) and showed a trend toward significance in girls (P = 0.079). Bone age was advanced compared with our control population in both sexes. In multivariate analysis, quadriplegic CP type showed a trend toward significance (P = 0.066), and GMFCS III was significantly associated with advanced bone age in boys (P = 0.011). In girls, quadriplegic CP type and BMI of less than 15 were significantly associated with advanced bone age (P < 0.05 in both). CONCLUSION Our results demonstrated that most of the ambulatory CP patients had advanced bone age compared with chronological age. Quadriplegic CP type in boys and girls contributed to advanced bone age. GMFCS III and a low BMI also contributed to advanced bone age in boys and girls, respectively. Understanding factors that lead to either delayed or advanced skeletal maturation is important in planning the appropriate timing for orthopaedic surgical intervention.
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Affiliation(s)
- Kiran Gollapudi
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California at Los Angeles, USA
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Abstract
Malnutrition is a common problem in children with cerebral palsy. Although malnutrition is often recognized in patients with severe cerebral palsy, it can be unrecognized in less severely affected patients. The consequences of malnutrition are serious, and include decreased muscle strength, poor immune status, and depressed cerebral functioning. Low body mass index has been used as a marker for malnutrition. The purpose of this study was to determine which patients in an ambulatory cerebral palsy patient population were at risk for low body mass index. A retrospective chart review was performed on 75 patients. Age, sex, height, weight, type of cerebral palsy, and functional status [gross motor functional classification system (GMFCS) level] was recorded from the chart. Descriptive statistics with bivariate and multivariate regression analyses were performed. Thirty-eight boys and 37 girls with an average age of 8.11 years were included in the study. Unique to our patient population, all cerebral palsy patients were independent ambulators. Patients with quadriplegic cerebral palsy had a significantly lower body mass index than those with diplegic and hemiplegic cerebral palsy. Patients with a GMFCS III had significantly lower body mass index than those with GMFCS I and II. When multivariate regression analysis to control for age and sex was performed, low body mass index remained associated with quadriplegic cerebral palsy and GMFCS III. Malnutrition is a common health problem in patients with cerebral palsy, leading to significant morbidity in multiple organ systems. We found that in an ambulatory cerebral palsy population, patients with lower functional status or quadriplegia had significantly lower body mass index, suggesting that even highly functioning ambulatory cerebral palsy patients are at risk for malnutrition.
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Affiliation(s)
- Brian T Feeley
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Gollapudi K, Krutzik SR, Sieling PA. 297 BACTERIAL FLAGELLIN ACTS AS A COSTIMULATORY SIGNAL FOR HUMAN T CELL RECEPTOR ACTIVATION. J Investig Med 2005. [DOI: 10.2310/6650.2005.00005.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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