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Cerrato C, Crocerossa F, Marchioni M, Giannarini G, Gupta S, Albiges L, Brouwer O, Albersen M, Fankhauser C, Grimm MO, Gandaglia G, Roupret M, Mir MC. Effect of Sex on the Oncological Outcomes in Response to Immunotherapy and Antibody-drug Conjugates in Patients with Urothelial and Kidney Cancer: A Systematic Review and a Network Meta-analysis. Eur Urol Oncol 2024:S2588-9311(24)00096-8. [PMID: 38644155 DOI: 10.1016/j.euo.2024.03.014] [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: 01/28/2024] [Revised: 03/03/2024] [Accepted: 03/26/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND AND OBJECTIVE Immune checkpoint inhibitors (ICIs) and antibody-drug conjugates (ADCs) herald a transformative era in metastatic renal cell carcinoma (RCC) and transitional cell carcinoma (TCC) treatment, amid acknowledged sex-based disparities in these cancers. We conducted a systematic review and network meta-analysis (NMA) to identify sex-specific differences in the efficacy of ICI/ADC monotherapy or combination therapies for RCC and TCC survival, in metastatic and adjuvant settings. METHODS A systematic search was conducted up to October 2023 for English articles on ICIs and ADCs as systemic therapies (ICIs in first-line and adjuvant treatment for RCC, ICIs and ADCs in first- and second-line treatment for TCC). Randomised clinical trials were considered. The primary objective was overall survival (OS) of ICIs and ADCs between males and females. The secondary outcomes included progression-free survival, overall response rate, disease-free survival, and recurrence-free survival. Treatment efficacy was evaluated by sex via odds ratios (ORs) and confidence intervals compared with controls. Log ORs were used for creating a frequentist NMA. This meta-analysis was registered on PROSPERO (CRD42023468632). KEY FINDINGS AND LIMITATIONS Eighteen articles met the inclusion criteria. Females had an advantage for RCC-adjuvant treatment for atezolizumab (log OR [SE] = -0.57 ± 0.25, p = 0.024) in OS. Males showed a survival advantage in TCC second-line treatment for ADC-Nectin 4 (log OR [SE] = 0.65 ± 0.28, p = 0.02). No other significant results were shown. CONCLUSIONS AND CLINICAL IMPLICATIONS The NMA revealed gender-specific variations in ICI and ADC responses for RCC and TCC, offering insights for personalised cancer care and addressing disparities in cancer care and outcomes. PATIENT SUMMARY In this systematic review, we looked at the sex differences for metastatic renal cell carcinoma (RCC) and transitional cell carcinoma (TCC) for antibody-drug conjugates and immune checkpoint inhibitors. In our analysis, female and male sex has better overall survival for adjuvant and second-line therapies for RCC and TCC, respectively. Urgent research on gender-specific cancer therapies is imperative.
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Affiliation(s)
- Clara Cerrato
- University Hospital Southampton NHS Trust, Southampton, UK
| | - Fabio Crocerossa
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Gianluca Giannarini
- Urology Unit, "Santa Maria della Misericordia" University Hospital, Udine, Italy
| | - Shilpa Gupta
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Oscar Brouwer
- The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Christian Fankhauser
- Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland; University of Lucerne, Lucerne, Switzerland; University of Zurich, Zurich, Switzerland
| | | | - Giorgio Gandaglia
- Department of Urology, Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Morgan Roupret
- GRC 5 Predictive Onco-Uro, Department of Urology, AP-HP, Pitié Salpétrière Hospital, Sorbonne University, Paris, France
| | - Maria Carmen Mir
- Department of Urology, Hospital Universitario La Ribera, Valencia, Spain.
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Benderska-Söder N, Ecke T, Kleinlein L, Roghmann F, Bismarck E, van Rhijn BWG, Stenzl A, Witjes JA, Todenhöfer T, Hakenberg OW, Grimm MO, Goebell PJ, Burger M, Jensen JB, Schmitz-Dräger BJ. Simulation of the effects of molecular urine markers in follow-up of patients with high-risk non-muscle invasive bladder cancer. Urol Oncol 2024:S1078-1439(24)00041-3. [PMID: 38403529 DOI: 10.1016/j.urolonc.2024.01.025] [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: 11/26/2023] [Revised: 01/05/2024] [Accepted: 01/25/2024] [Indexed: 02/27/2024]
Abstract
A plethora of urine markers for the management of patients with bladder cancer has been developed and studied in the past. However, the clinical impact of urine testing on patient management remains obscure. The goal of this manuscript is to identify scenarios for the potential use of molecular urine markers in the follow-up of patients with high-risk non-muscle-invasive BC (NMIBC) and estimate potential risks and benefits. Information on the course of disease of patients with high-risk NMIBC and performance data of a point-of-care test (UBC rapid™), an MCM-5 directed ELISA (ADXBLADDER™), and 2 additional novel assays targeting alterations of mRNA expression and DNA methylation (Xpert bladder cancer monitor™, Epicheck™) were retrieved from high-quality trials and/or meta-analyses. In addition, the sensitivity of white light cystoscopy (WLC) and the impact of a urine marker result on the performance of WLC were estimated based on fluorescence cystoscopy data and information from the CeFub trial. This information was applied to different scenarios in patient follow-up and sensitivity, estimated number of cystoscopies, and the numbers needed to diagnose were calculated. The sensitivity of guideline-based regular follow-up (SOC) at 1 year was calculated at 96%. For different marker-supported strategies sensitivities ranging from 77% to 97.9% were estimated. Calculations suggest that several strategies are effective for the SOC. While for the SOC 24.6 WLCs were required to diagnose 1 tumor recurrence (NND), this NND dropped below 5 in some marker-supported strategies. Based on the results of this simulation, a marker-supported follow-up of patients with HR NMIBC is safe and offers the option to significantly reduce the number of WLCs. Further research focusing on prospective randomized trials is needed to finally find a way to implement urine markers into clinical decision-making.
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Affiliation(s)
| | - Thorsten Ecke
- Department of Urology, Helios Klinikum, Bad Saarow, Germany; Department of Urology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lisa Kleinlein
- Urologie 24, St. Theresienkrankenhaus, Nürnberg, Germany
| | - Florian Roghmann
- Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Germany
| | | | - Bas W G van Rhijn
- Department Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, University of Regensburg, Caritas-Hospital St. Josef, Regensburg, Germany
| | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls-University of Tübingen, Tübingen, Germany
| | | | | | | | | | - Peter J Goebell
- Department of Urology, Friedrich-Alexander University, Erlangen, Germany
| | - Maximilian Burger
- Department of Urology, University of Regensburg, Caritas-Hospital St. Josef, Regensburg, Germany
| | | | - Bernd J Schmitz-Dräger
- Urologie 24, St. Theresienkrankenhaus, Nürnberg, Germany; Studienpraxis Urologie, Nürtingen, Germany.
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Bürckenmeyer F, Diamantis I, Kriechenbauer T, Lehmann T, Franiel T, Malouhi A, Grimm MO, Teichgräber U, Aschenbach R. Prostatic Artery Embolization: Influence of Cone-Beam Computed Tomography on Radiation Exposure, Procedure Time, and Contrast Media Use. Cardiovasc Intervent Radiol 2021; 44:1089-1094. [PMID: 33660064 PMCID: PMC8190013 DOI: 10.1007/s00270-021-02787-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/23/2021] [Indexed: 12/13/2022]
Abstract
Purpose To evaluate the effect of cone-beam computed tomography (CBCT) on radiation exposure, procedure time, and contrast media (CM) use in prostatic artery embolization (PAE). Materials and Methods Seventy-eight patients were enrolled in this retrospective, single-center study. All patients received PAE without (group A; n = 39) or with (group B; n = 39) CBCT. Total dose-area product (DAPtotal; Gycm2), total entrance skin dose (ESDtotal; mGy), and total effective dose (EDtotal; mSv) were primary outcomes. Number of digital subtraction angiography (DSA) series, CM use, fluoroscopy time, and procedure time were secondary outcomes. PAE in group A was performed by a single radiologist with 15 years experience, PAE in group B was conducted by four radiologists with 4 to 6 years experience. Results For groups A vs. B, respectively, median (IQR): DAPtotal 236.94 (186.7) vs. 281.20 (214.47) Gycm2(p = 0.345); EDtotal 25.82 (20.35) vs. 39.84 (23.75) mSv (p = < 0.001); ESDtotal 2833 (2278) vs. 2563 (3040) mGy(p = 0.818); number of DSA series 25 (15) vs. 23 (10)(p = 0.164); CM use 65 (30) vs. 114 (40) mL(p = < 0.001); fluoroscopy time 23 (20) vs. 28 (25) min(p = 0.265), and procedure time 70 (40) vs.120 (40) min(p = < 0.001). Bilateral PAE was achieved in 33/39 (84.6%) group A and 32/39 (82.05%) group B(p = 0.761), all other patients received unilateral PAE. There were no significant differences between clinical parameters and origins of the prostatic arteries (PA) (p = 0.206–1.00). Conclusion Operators with extensive expertise on PAE may not benefit from addition of CBCT to DSA runs, whereas for operators with less expertise, CBCT when used alongside with DSA runs increased the overall radiation exposure.
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Affiliation(s)
- F Bürckenmeyer
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - I Diamantis
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - T Kriechenbauer
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - T Lehmann
- Center for Clinical Studies, University Hospital Jena, Jena, Germany
| | - T Franiel
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - A Malouhi
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - M O Grimm
- Clinic for Urology, University Hospital Jena, Jena, Germany
| | - U Teichgräber
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - R Aschenbach
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
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4
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Hesse-Macabata J, Morgner B, Morgenstern S, Grimm MO, Elsner P, Hipler UC, Wiegand C. Innate immune response of human epidermal keratinocytes and dermal fibroblasts to in vitro incubation of Trichophyton benhamiae DSM 6916. J Eur Acad Dermatol Venereol 2019; 33:1177-1188. [PMID: 30720896 DOI: 10.1111/jdv.15472] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/14/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Superficial cutaneous infection caused by the zoophilic dermatophyte Trichophyton benhamiae is often associated with a highly inflammatory immune response. As non-professional immune cells, epidermal keratinocytes and dermal fibroblasts contribute to the first line of defence by producing pro-inflammatory cytokines and antimicrobial peptides (AMP). OBJECTIVE Purpose of this study was to gain a deeper understanding of the pathogenesis and the fungal-host interaction as not much is known about the innate immune response of these cutaneous cells against T. benhamiae. METHODS Using a dermatophytosis model of fibroblasts and keratinocytes incubated with T. benhamiae DSM 6916, analyses included determination of cell viability and cytotoxicity, effects on the innate immune response including expression and secretion of pro-inflammatory cytokines/chemokines and expression of AMP, as well as alterations of genes involved in cell adhesion. RESULTS Trichophyton benhamiae DSM 6916 infection led to severe cell damage and direct induction of a broad spectrum of pro-inflammatory cytokines and chemokines in both cutaneous cells. Only keratinocytes differentially up-regulated AMP genes expression after T. benhamiae DSM 6916 infection. Expression of AMPs in fibroblasts was not inducible by fungal infection, whereas their absences potentially contributed to a continuous increase in the fungal biomass on fibroblasts, which in turn was reduced in keratinocytes possibly due to the antimicrobial actions of induced AMPs. On mRNA level, T. benhamiae DSM 6916 infection altered cell-cell contact proteins in keratinocytes, indicating that targeting specific cell-cell adhesion proteins might be part of dermatophytes' virulence strategy. CONCLUSION This study showed that in addition to immune cells, keratinocytes and fibroblasts could participate in antimicrobial defence against an exemplary infection with T. benhamiae DSM 6916.
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Affiliation(s)
- J Hesse-Macabata
- Department of Dermatology, Jena University Hospital, Jena, Germany
| | - B Morgner
- Department of Dermatology, Jena University Hospital, Jena, Germany
| | - S Morgenstern
- Department of Urology, Jena University Hospital, Jena, Germany
| | - M O Grimm
- Department of Urology, Jena University Hospital, Jena, Germany
| | - P Elsner
- Department of Dermatology, Jena University Hospital, Jena, Germany
| | - U C Hipler
- Department of Dermatology, Jena University Hospital, Jena, Germany
| | - C Wiegand
- Department of Dermatology, Jena University Hospital, Jena, Germany
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5
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Abstract
Hematuria is the main symptom of many urological and nephrological diseases. In the differential diagnostics a distinction is made between painful and pain-free and between macrohematuria which is visible to the naked eye and microhematuria which is not visible. The reasons for hematuria are basically renal (glomerular) and non-renal (non-glomerular) causes. In order not to overlook early symptoms of malignant and relevant benign diseases and also to avoid excessive diagnostic tests, a differentiated approach is necessary.
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Affiliation(s)
- M Horstmann
- Klinik und Poliklinik für Urologie, Universität Jena, Lessingstr. 1, 07743, Jena, Deutschland,
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Franiel T, Horstmann M, Waginger M, Grimm MO, Teichgräber U. Embolisation der Aa. prostaticae dauerkatheterisierter BPH Hochrisikopatienten. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373063] [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: 10/25/2022]
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7
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Ploussard G, Epstein JI, Montironi R, Carroll PR, Wirth M, Grimm MO, Bjartell AS, Montorsi F, Freedland SJ, Erbersdobler A, van der Kwast TH. The contemporary concept of significant versus insignificant prostate cancer. Int Braz J Urol 2011. [DOI: 10.1590/s1677-55382011000300021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- G Ploussard
- Saint-Louis Hospital, France; University Paris 12, France
| | - JI Epstein
- Saint-Louis Hospital, France; University Paris 12, France
| | - R Montironi
- Saint-Louis Hospital, France; University Paris 12, France
| | - PR Carroll
- Saint-Louis Hospital, France; University Paris 12, France
| | - M Wirth
- Saint-Louis Hospital, France; University Paris 12, France
| | - MO Grimm
- Saint-Louis Hospital, France; University Paris 12, France
| | - AS Bjartell
- Saint-Louis Hospital, France; University Paris 12, France
| | - F Montorsi
- Saint-Louis Hospital, France; University Paris 12, France
| | - SJ Freedland
- Saint-Louis Hospital, France; University Paris 12, France
| | - A Erbersdobler
- Saint-Louis Hospital, France; University Paris 12, France
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8
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Herrmann E, Marschner N, Grimm MO, Ohlmann CH, Hutzschenreuter U, Overkamp F, Groschek M, Blumenstengel K, Pühse G, Steiner T. Sequential therapies with sorafenib and sunitinib in advanced or metastatic renal cell carcinoma. World J Urol 2011; 29:361-6. [PMID: 21461939 DOI: 10.1007/s00345-011-0673-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 03/08/2011] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To investigate whether patients with metastatic renal cell carcinoma benefit from sequential therapies with the tyrosine kinase inhibitors (TKIs) sorafenib and sunitinib. PATIENTS AND METHODS A total of 89 patients were treated in nine German centres between 2002 and 2009. The TKI sequence started as first-, second- or third-line therapy after prior chemo- or immunotherapy. When progression was diagnosed, treatment was switched to the second TKI until further progression. RESULTS Overall progression-free survival (PFS) of patients receiving sunitinib followed by sorafenib shows no statistically significant difference to patients receiving sorafenib followed by sunitinib (15.4 months vs. 12.1 months). The secondary use of sorafenib resulted in a median PFS of 3.8 months if the TKI sequence had been started as a first-line treatment and of 3.5 months if the TKI sequence had been started second-line treatment. The secondary use of sunitinib resulted in a median PFS of 3.4 and 4.0 months, respectively. OS was 28.8 months for all patients, without a statistically significant difference between the two groups. CONCLUSIONS This study endorses the notion of a clinical benefit of the sequential use of sorafenib and sunitinib and supports observations from previous studies. In terms of the optimal succession of the two TKIs, the study does not allow a definite answer.
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Affiliation(s)
- E Herrmann
- Department of Urology, University of Münster, Albert-Schweitzer Strasse 33, 48149 Münster, Germany.
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Kunze D, Füssel S, Meye A, Wuttig D, Krämer K, Kotzsch M, Toma M, Schwenzer B, Kausch I, Jocham D, Hakenberg OW, Grimm MO, Wirth MP. [In vitro and in vivo evaluation of inhibitory nucleic acid constructs for specific therapy of human urinary bladder carcinoma]. Urologe A 2008; 46:1289. [PMID: 17665160 DOI: 10.1007/s00120-007-1499-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D Kunze
- Klinik für Urologie, Medizinische Fakultät, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden.
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Ramp U, Mahotka C, Heikaus S, Shibata T, Grimm MO, Willers R, Gabbert HE. Expression of heat shock protein 70 in renal cell carcinoma and its relation to tumor progression and prognosis. Histol Histopathol 2007; 22:1099-107. [PMID: 17616937 DOI: 10.14670/hh-22.1099] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Heat shock proteins (HSPs) play an important role in the cellular response to environmental stress and exert a cytoprotective effect. Especially HSP70 is an effective inhibitor of apoptosis, suggesting a role of HSP70 in carcinogenesis and tumor progression. To explore the relevance of HSP70 in renal cell carcinomas (RCCs), we analyzed nuclear and cytoplasmic HSP70 protein expression in formalin-fixed tissue from 145 clear cell RCCs by immunohistochemistry as well as Western blot analysis. Nuclear HSP70 expression was found in all RCCs and 75% of the tumors also exhibited a cytoplasmic HSP70 staining. Importantly, RCCs showed significantly reduced cytoplasmic (p=0.001) and combined nuclear/cytoplasmic (p=0.0022) HSP70 expression when compared with their cells of origin. A significant (p=0.0176) decrease of nuclear HSP70 expression became evident from well to poorly differentiated clear cell RCCs. Quite similarly, a trend (p=0.0558) for reduced combined nuclear/cytoplasmic HSP70 expression was shown from early (pT1) to advanced (pT3) tumor stages. Nevertheless, no correlation between HSP70 expression and patients survival became evident. In conclusion, our investigation demonstrates a significant decrease of antiapoptotic HSP70 protein expression during carcinogenesis and during progression from well (G1) to poorly (G3) differentiated clear cell RCCs. Our results suggest that HSP70-mediated inhibition of apoptosis seems to be of minor importance for carcinogenesis and tumor progression in RCCs.
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Affiliation(s)
- U Ramp
- Institute of Pathology, Heinrich-Heine University Hospital, Duesseldorf, Germany.
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Fleisch MC, Pantke P, Beckmann MW, Schnuerch HG, Ackermann R, Grimm MO, Bender HG, Dall P. Predictors for long-term survival after interdisciplinary salvage surgery for advanced or recurrent gynecologic cancers. J Surg Oncol 2007; 95:476-84. [PMID: 17192947 DOI: 10.1002/jso.20686] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES We wanted to identify factors which allow predicting long-term survival after pelvic exenteration (PE) for locally advanced or recurrent gynecologic malignancies. METHODS All patients undergoing PE at our institution from 1983 to 2002 were screened. In 203 cases data were obtainable and analyzed with respect to factors predicting outcome considering morbidity, mortality, and survival. Follow-up data and data concerning late complications not documented in our records were obtained by telephone interviews. RESULTS Mean age was 55 (22-77) years. PE was performed for locally advanced (36%) or recurrent (64%) cervical (n = 133), endometrial (n = 26), vaginal (n = 23), vulvar (n = 10), and ovarian cancer (n = 11, cases with rectum and/or bladder resections). In 13.4% (n = 26) the intent of the procedure was palliation in the remaining cure. Procedures performed were anterior (n = 91), posterior (45), or total (n = 67) PE. 53% of patients underwent preoperative radio-chemotherapy, 11.8% as a neoadjuvant treatment. Mean OR time was 8.1 hr, an average of 5.6 units of packed red blood cells were perioperatively transfused. Microscopically complete resection was achievable in n = 69 patients. Perioperative mortality was 1% (n = 2). Seventy-one percent (n = 144) of patients were available for follow-up. Five-year overall survival in patients treated with a curative intent was 21%, 5-year survival in those patients with complete resection was 32%. Forty-two percent of patients with a complete resection without lymph node involvement, age 30-50, curative intention, and the absence of a pelvic sidewall infiltration survived 5 years or longer. CONCLUSION In our series a 5-year survival rate of over 40% could be achieved for nodal-negative patients without pelvic sidewall infiltration when treated with curative intent and after complete resection.
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Affiliation(s)
- M C Fleisch
- Universitaets-Frauenklinik, Heinrich-Heine-Universitaet, Duesseldorf, Germany.
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Voegeli TA, Kurtz A, Grimm MO, Effert P, Eckardt KU. Anemia under androgen deprivation: influence of flutamide, cyproteroneacetate and orchiectomy on the erythropoietin system. Horm Metab Res 2005; 37:89-93. [PMID: 15778925 DOI: 10.1055/s-2005-861172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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] [Indexed: 10/25/2022]
Abstract
OBJECTIVE There is a high incidence of anemia in patients with advanced prostate cancer (PC) under androgen deprivation. Pathophysiology of this anemia remains unclear. Erythropoietin (EPO) is the main growth factor inducing erythropoesis in response to hypoxia. In this study, function of the EPO-system following androgen deprivation was tested in standardized animal model. METHODS Animals were pretreated by either orchiectomy, injection of cyproteroneacetate or flutamide. After hypoxic stimulation, EPO mRNA expression and EPO serum levels were studied. RESULTS In all animals, EPO mRNA expression and EPO serum levels were increased following hypoxic stimulation. Compared to the control group, this increase was even more pronounced after androgen deprivation. None of the different forms of androgen deprivation had a negative stimulating effect on EPO expression. CONCLUSION Unexpectedly, androgen deprivation did not suppress EPO mRNA expression and EPO serum concentrations. Instead, stimulation of the EPO system was even more pronounced after androgen deprivation. A deficient EPO system does not appear to contribute to the clinically observed anemia in patients treated by androgen deprivation.
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Affiliation(s)
- T-A Voegeli
- Department of Urology, University of Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany.
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14
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Ackermann R, Grimm MO, Bender HG, Dall P, Fleisch MC, Hohenberger W, Göhl J, Merkel S. [Interdisciplinary aspects of surgery of the pelvis minor and retroperitoneum]. Chirurg 2004; 75:379-89. [PMID: 15034672 DOI: 10.1007/s00104-004-0851-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Surgery of diseases of the pelvis minor and retroperitoneum such as inflammatory disease, malignant tumours, or trauma of pelvic organs need the close interdisciplinary collaboration of visceral surgeons, gynaecologists, and urologists. This collaboration begins in planning diagnostic and therapeutic procedures. It has to be clear who performs which operative step and when. Excellent long-term results in malignant disease show that the greater effort is worthwhile. The rate of postoperative morbidity after these multivisceral resections is high also in specialised centers, but mortality is below 5%. Because of the growing number of long-term survivors, preservation of quality of life becomes more and more important.
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Affiliation(s)
- R Ackermann
- Klinik für Urologie der Heinrich-Heine-Universität Düsseldorf
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15
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Abstract
To assess the rate of residual cancer after transurethral resection (TUR) of superficial bladder cancer, a prospective study was carried out. All patients with transitional cell cancer (TCC) stage pTa-pT1 underwent a repeat TUR (ReTUR) within 6-8 weeks. Sites and rates of tumors found during ReTUR were documented as well as the morbidity of the ReTUR. Of a total of 192 TUR, superficial TCC was found in 124 cases; 83 underwent ReTUR according to the study protocol. Residual tumor was detected in 27% of pTa and 53% of pT1 tumors. Worsening of grading or T stage was found in 8%. Of the tumors detected by ReTUR, 81% were localized at the site of the first TUR. In this prospective study, residual tumor formation was detected in a high percentage. Routine ReTUR is therefore recommended in superficial bladder cancer except solitary pTaGI lesions.
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Affiliation(s)
- T A Vögeli
- Urologische Klinik, Heinrich-Heine-Universität, Moorenstrasse 5, 40225 Düsseldorf
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Abstract
BACKGROUND AND OBJECTIVES During the last 15 years, a second and a third generation of lithotripters have been developed. We present the results achieved by primary extracorporeal shockwave lithotripsy (SWL) of ureteral calculi treated with the new Multiline Lithotripter (Siemens). PATIENTS AND METHODS From April 1996 until February 1997, 50 men and 17 women ages 19 to 82 (mean 50.9) years, underwent SWL as a primary treatment of ureteral stones at the Department of Urology, University of Düsseldorf. Data were analyzed retrospectively. More than half (60%) of the 67 patients had left ureteral stones. The most frequent site was proximal (46%) followed by distal (37%). The mean stone diameter was 9 mm. A total of 118 treatments were performed. RESULTS The success rates of SWL monotherapy for upper, mid, and lower ureteral calculi were 71%, 82%, and 72%, respectively. Although in 62% of the cases, complete, and in 33% partial, stone disintegration was achieved, auxiliary procedures (ureteral stenting, nephrostomy, and ureteroscopy) were necessary in 43% of the patients. Renal hematoma occurred in two patients, who were treated for upper ureteral calculi. Two thirds of the patients were discharged from the hospital free of stones. CONCLUSIONS Primary SWL treatment of ureteral stones with the new Multiline showed good results in about 84% of cases, although 43% of patients required auxiliary procedures. The occurrence of renal hematoma after the treatment of upper ureteral stones is an unexpected complication and makes reduction of the applied energy necessary if the kidney lies within the field of shockwave application.
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Affiliation(s)
- M L Bendhack
- Department of Urology, School of Medicine, Heinrich-Heine University of Düsseldorf, Germany
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17
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Clasen S, Schulz WA, Gerharz CD, Grimm MO, Christoph F, Schmitz-Dräger BJ. Frequent and heterogeneous expression of cyclin-dependent kinase inhibitor WAF1/p21 protein and mRNA in urothelial carcinoma. Br J Cancer 1998; 77:515-21. [PMID: 9484805 PMCID: PMC2149915 DOI: 10.1038/bjc.1998.84] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The inhibitor of cyclin-dependent kinases WAF1/p21 has been shown to mediate cell cycle arrest by p53 and other factors. We have studied its expression in urothelial carcinoma. Immunohistochemistry of paraffin-embedded tissues revealed no detectable p21 protein in normal mucosa, whereas 8 of 17 (47%) carcinomata in situ, 41 of 62 (66%) pTa, 14 of 30 (47%) pT1 and 5 of 15 (33%) muscle-invasive tumours stained positive, usually with a heterogeneous pattern. Expression of p21 was associated with low grade tumours. In contrast, the frequency of p53 accumulation increased with grade and stage as did the frequency of staining for the proliferation marker Ki67. The level of WAF1 mRNA was determined relative to beta-actin mRNA by quantitative reverse transcriptase polymerase chain reaction (RT-PCR) in 15 freshly frozen invasive tumours. In eight samples obtained from normal bladder mucosa, the values ranged from 0.93 to 2.19 arbitrary units (AU) (mean 1.54+/-0.37 AU), but varied widely from non-detectable to 16.21 AU (mean 3.02+/-4.44 AU) in the tumour specimens. In accord with the immunohistochemical findings, WAF1 mRNA expression was elevated over the range found in normal mucosa in 5 of 15 advanced tumours. In addition, RNA analysis revealed a decrease in expression in six tumours. No mutations were observed in the WAF1/p21 gene in these tumours, but two were heterozygous for the codon 31 polymorphism. These data indicate that p21 is frequently expressed in superficial, well differentiated urothelial carcinomas, but less often in muscle-invasive urothelial carcinomas, irrespective of their p53 status. The expression of p21 and its prevalence in low-stage tumours may reflect residual growth-regulatory influences potentially impeding but not necessarily inhibiting tumour development.
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Affiliation(s)
- S Clasen
- Urologische Klinik, Heinrich-Heine-Universität, Düsseldorf, Germany
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18
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Grimm MO, Jürgens B, Schulz WA, Decken K, Makri D, Schmitz-Dräger BJ. Inactivation of tumor suppressor genes and deregulation of the c-myc gene in urothelial cancer cell lines. Urol Res 1995; 23:293-300. [PMID: 8839385 DOI: 10.1007/bf00300017] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Recent investigations have demonstrated p53 and Rb alterations in a subset of transitional cell carcinoma (TCC). Further genetic changes during tumor progression include overexpression of the c-myc gene in a significant number of mainly invasive bladder tumors. To study the possible interactions between these genes in TCC, urothelial cancer cell lines were chosen as an in vitro model. Expression and mutation of p53 was studied in 15 bladder cancer cell lines by immunocytochemistry, Western blot, polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) analysis and direct sequencing of double stranded PCR products of exons 4, 5, 7 and 8 of genomic DNA. C-myc expression and gene structure were studied using Northern and Southern blot techniques Rb protein expression was analyzed by Western blot. Twelve of 15 cell lines showed either p53 mutations or abnormal protein expression. Consistent with previous studies, five cell lines did not express Rb protein. None of the cell lines studied retained both tumor suppressor genes in a functional form. The c-myc gene appeared to be intact in all cell lines and copy numbers were close to normal. Northern analysis demonstrated that all cell lines expressed c-myc mRNA but evidence for altered regulation was found in at least two cell lines. Our data suggest that amplification or translocation are not the underlying mechanism for c-myc overexpression in urothelial tumors. No correlation between loss of Rb protein and c-myc expression was observed. The results presented here for the cell lines match well those obtained in vivo. Thus, these cell lines may provide a suitable model for further analysis of molecular alterations in urothelial cancer.
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Affiliation(s)
- M O Grimm
- Department of Urology, Heinrich-Heine University, Düsseldorf, Germany
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19
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Schmitz-Dräger BJ, van Roeyen CR, Grimm MO, Gerharz CD, Decken K, Schulz WA, Bültel H, Makri D, Ebert T, Ackermann R. P53 accumulation in precursor lesions and early stages of bladder cancer. World J Urol 1994; 12:79-83. [PMID: 8087143 DOI: 10.1007/bf00184241] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Recent investigations have demonstrated alterations of the p53 tumor-suppressor gene in a considerable number of transitional-cell carcinoma (TCC) specimens. Thus far, these investigations have been restricted to either papillary TCC or invasive bladder cancer. To obtain further information on a possible involvement of p53 in bladder cancer development or tumor progression, investigations of precursor lesions and early stages of this disease are required. Immunohistochemical examination of 6 dysplasias and 24 carcinomas in situ (TIS) showed p53 accumulation, which is suggestive of p53 inactivation, in 2 (33%) and 9 (38%) of these specimens, respectively. This ratio was similar in 9 T1 lesions (33%) and in 14 cases of muscle-infiltrative disease (35%). In papillary tumors, p53 accumulation was observed exclusively in 3/10 moderately differentiated or high-grade lesions but not in 1 Ta G1 tumor. The expression of p53 accumulation was a consistent finding. The examination of tumor recurrences yielded either the presence or the absence of p53 overexpression in the primary and recurrent tumors of 7/8 patients. Similarly, in multifocal TCC, p53 accumulation was also either present or absent in 10/11 cases examined. These results suggest the existence of at least two different subgroups of TCC, with p53 accumulation being present in one of these groups. The observation of p53 accumulation in dysplasia and in TIS is a prerequisite for a possible involvement of p53 in bladder cancer carcinogenesis, although it does not prove this assumption.
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