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Eminaga O, Abbas M, Kunder C, Tolkach Y, Han R, Brooks JD, Nolley R, Semjonow A, Boegemann M, West R, Long J, Fan RE, Bettendorf O. Critical evaluation of artificial intelligence as a digital twin of pathologists for prostate cancer pathology. Sci Rep 2024; 14:5284. [PMID: 38438436 PMCID: PMC10912767 DOI: 10.1038/s41598-024-55228-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024] Open
Abstract
Prostate cancer pathology plays a crucial role in clinical management but is time-consuming. Artificial intelligence (AI) shows promise in detecting prostate cancer and grading patterns. We tested an AI-based digital twin of a pathologist, vPatho, on 2603 histological images of prostate tissue stained with hematoxylin and eosin. We analyzed various factors influencing tumor grade discordance between the vPatho system and six human pathologists. Our results demonstrated that vPatho achieved comparable performance in prostate cancer detection and tumor volume estimation, as reported in the literature. The concordance levels between vPatho and human pathologists were examined. Notably, moderate to substantial agreement was observed in identifying complementary histological features such as ductal, cribriform, nerve, blood vessel, and lymphocyte infiltration. However, concordance in tumor grading decreased when applied to prostatectomy specimens (κ = 0.44) compared to biopsy cores (κ = 0.70). Adjusting the decision threshold for the secondary Gleason pattern from 5 to 10% improved the concordance level between pathologists and vPatho for tumor grading on prostatectomy specimens (κ from 0.44 to 0.64). Potential causes of grade discordance included the vertical extent of tumors toward the prostate boundary and the proportions of slides with prostate cancer. Gleason pattern 4 was particularly associated with this population. Notably, the grade according to vPatho was not specific to any of the six pathologists involved in routine clinical grading. In conclusion, our study highlights the potential utility of AI in developing a digital twin for a pathologist. This approach can help uncover limitations in AI adoption and the practical application of the current grading system for prostate cancer pathology.
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Affiliation(s)
| | - Mahmoud Abbas
- Department of Pathology, Prostate Center, University Hospital Muenster, Muenster, Germany.
| | - Christian Kunder
- Department of Pathology, Stanford University School of Medicine, Stanford, USA
| | - Yuri Tolkach
- Department of Pathology, Cologne University Hospital, Cologne, Germany
| | - Ryan Han
- Department of Computer Science, Stanford University, Stanford, USA
| | - James D Brooks
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Rosalie Nolley
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Axel Semjonow
- Department of Urology, Prostate Center, University Hospital Muenster, Muenster, Germany
| | - Martin Boegemann
- Department of Urology, Prostate Center, University Hospital Muenster, Muenster, Germany
| | - Robert West
- Department of Pathology, Cologne University Hospital, Cologne, Germany
| | - Jin Long
- Department of Pediatrics, Stanford University School of Medicine, Stanford, USA
| | - Richard E Fan
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
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Eminaga O, Lee TJ, La V, Breil B, Xing L, Liao JC. Electronic Documentation of Intraoperative Observation of Cystoscopic Procedures Using the cMDX Information System. JCO Clin Cancer Inform 2024; 8:e2300114. [PMID: 38484216 PMCID: PMC10954066 DOI: 10.1200/cci.23.00114] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/02/2023] [Accepted: 01/31/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE Accurate documentation of lesions during transurethral resection of bladder tumors (TURBT) is essential for precise diagnosis, treatment planning, and follow-up care. However, optimizing schematic documentation techniques for bladder lesions has received limited attention. MATERIALS AND METHODS This prospective observational study used a cMDX-based documentation system that facilitates graphical representation, a lesion-specific questionnaire, and heatmap analysis with a posterization effect. We designed a graphical scheme for bladder covering bladder landmarks to visualize anatomic features and to document the lesion location. The lesion-specific questionnaire was integrated for comprehensive lesion characterization. Finally, spatial analyses were applied to investigate the anatomic distribution patterns of bladder lesions. RESULTS A total of 97 TURBT cases conducted between 2021 and 2023 were included, identifying 176 lesions. The lesions were distributed in different bladder areas with varying frequencies. The distribution pattern, sorted by frequency, was observed in the following areas: posterior, trigone, lateral right and anterior, and lateral left and dome. Suspicious levels were assigned to the lesions, mostly categorized either as indeterminate or moderate. Lesion size analysis revealed that most lesions fell between 5 and 29 mm. CONCLUSION The study highlights the potential of schematic documentation techniques for informed decision making, quality assessment, primary research, and secondary data utilization of intraoperative data in the context of TURBT. Integrating cMDX and heatmap analysis provides valuable insights into lesion distribution and characteristics.
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Affiliation(s)
| | - Timothy Jiyong Lee
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Vinh La
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Bernhard Breil
- Faculty of Health Care, Health Informatics, Hochschule Niederrhein, University of Applied Sciences, Krefeld, Germany
| | - Lei Xing
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Joseph C. Liao
- Department of Urology, Stanford University School of Medicine, Stanford, CA
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Eminaga O, Leyh-Bannurah SR, Shariat SF, Krabbe LM, Lau H, Xing L, Abbas M. Artificial Intelligence Reveals Distinct Prognostic Subgroups of Muscle-Invasive Bladder Cancer on Histology Images. Cancers (Basel) 2023; 15:4998. [PMID: 37894365 PMCID: PMC10605516 DOI: 10.3390/cancers15204998] [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: 08/07/2023] [Revised: 09/12/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
Muscle-invasive bladder cancer (MIBC) is a highly heterogeneous and costly disease with significant morbidity and mortality. Understanding tumor histopathology leads to tailored therapies and improved outcomes. In this study, we employed a weakly supervised learning and neural architecture search to develop a data-driven scoring system. This system aimed to capture prognostic histopathological patterns observed in H&E-stained whole-slide images. We constructed and externally validated our scoring system using multi-institutional datasets with 653 whole-slide images. Additionally, we explored the association between our scoring system, seven histopathological features, and 126 molecular signatures. Through our analysis, we identified two distinct risk groups with varying prognoses, reflecting inherent differences in histopathological and molecular subtypes. The adjusted hazard ratio for overall mortality was 1.46 (95% CI 1.05-2.02; z: 2.23; p = 0.03), thus identifying two prognostic subgroups in high-grade MIBC. Furthermore, we observed an association between our novel digital biomarker and the squamous phenotype, subtypes of miRNA, mRNA, long non-coding RNA, DNA hypomethylation, and several gene mutations, including FGFR3 in MIBC. Our findings underscore the risk of confounding bias when reducing the complex biological and clinical behavior of tumors to a single mutation. Histopathological changes can only be fully captured through comprehensive multi-omics profiles. The introduction of our scoring system has the potential to enhance daily clinical decision making for MIBC. It facilitates shared decision making by offering comprehensive and precise risk stratification, treatment planning, and cost-effective preselection for expensive molecular characterization.
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Affiliation(s)
| | - Sami-Ramzi Leyh-Bannurah
- Department of Urology, Pediatric Urology and Uro-Oncology, Prostate Center Northwest, St. Antonius-Hospital, 33705 Gronau, Germany
| | - Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria;
| | - Laura-Maria Krabbe
- Department of Urology, University Hospital of Muenster, 48419 Muenster, Germany
| | - Hubert Lau
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA 94305, USA;
- Department of Pathology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Lei Xing
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Mahmoud Abbas
- Department of Pathology, University Hospital of Muenster, 48419 Muenster, Germany
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Eminaga O, Lee TJ, Laurie M, Ge TJ, La V, Long J, Semjonow A, Bogemann M, Lau H, Shkolyar E, Xing L, Liao JC. Efficient Augmented Intelligence Framework for Bladder Lesion Detection. JCO Clin Cancer Inform 2023; 7:e2300031. [PMID: 37774313 PMCID: PMC10569784 DOI: 10.1200/cci.23.00031] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/23/2023] [Accepted: 08/16/2023] [Indexed: 10/01/2023] Open
Abstract
PURPOSE Development of intelligence systems for bladder lesion detection is cost intensive. An efficient strategy to develop such intelligence solutions is needed. MATERIALS AND METHODS We used four deep learning models (ConvNeXt, PlexusNet, MobileNet, and SwinTransformer) covering a variety of model complexity and efficacy. We trained these models on a previously published educational cystoscopy atlas (n = 312 images) to estimate the ratio between normal and cancer scores and externally validated on cystoscopy videos from 68 cases, with region of interest (ROI) pathologically confirmed to be benign and cancerous bladder lesions (ie, ROI). The performance measurement included specificity and sensitivity at frame level, frame sequence (block) level, and ROI level for each case. RESULTS Specificity was comparable between four models at frame (range, 30.0%-44.8%) and block levels (56%-67%). Although sensitivity at the frame level (range, 81.4%-88.1%) differed between the models, sensitivity at the block level (100%) and ROI level (100%) was comparable between these models. MobileNet and PlexusNet were computationally more efficient for real-time ROI detection than ConvNeXt and SwinTransformer. CONCLUSION Educational cystoscopy atlas and efficient models facilitate the development of real-time intelligence system for bladder lesion detection.
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Affiliation(s)
- Okyaz Eminaga
- AI Vobis, Palo Alto, CA
- Center for Artificial Intelligence in Medicine and Imaging, Stanford University School of Medicine, Stanford, CA
| | - Timothy Jiyong Lee
- Department of Urology, Stanford University School of Medicine, Stanford, CA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Mark Laurie
- Department of Urology, Stanford University School of Medicine, Stanford, CA
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - T. Jessie Ge
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Vinh La
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Jin Long
- Center for Artificial Intelligence in Medicine and Imaging, Stanford University School of Medicine, Stanford, CA
| | - Axel Semjonow
- Department of Urology, Muenster University Hospital, Muenster, Germany
| | - Martin Bogemann
- Department of Urology, Muenster University Hospital, Muenster, Germany
| | - Hubert Lau
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Eugene Shkolyar
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Lei Xing
- Center for Artificial Intelligence in Medicine and Imaging, Stanford University School of Medicine, Stanford, CA
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Joseph C. Liao
- Center for Artificial Intelligence in Medicine and Imaging, Stanford University School of Medicine, Stanford, CA
- Department of Urology, Stanford University School of Medicine, Stanford, CA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
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Jia X, Shkolyar E, Laurie MA, Eminaga O, Liao JC, Xing L. Tumor detection under cystoscopy with transformer-augmented deep learning algorithm. Phys Med Biol 2023; 68:10.1088/1361-6560/ace499. [PMID: 37548023 PMCID: PMC10697018 DOI: 10.1088/1361-6560/ace499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023]
Abstract
Objective.Accurate tumor detection is critical in cystoscopy to improve bladder cancer resection and decrease recurrence. Advanced deep learning algorithms hold the potential to improve the performance of standard white-light cystoscopy (WLC) in a noninvasive and cost-effective fashion. The purpose of this work is to develop a cost-effective, transformer-augmented deep learning algorithm for accurate detection of bladder tumors in WLC and to assess its performance on archived patient data.Approach.'CystoNet-T', a deep learning-based bladder tumor detector, was developed with a transformer-augmented pyramidal CNN architecture to improve automated tumor detection of WLC. CystoNet-T incorporated the self-attention mechanism by attaching transformer encoder modules to the pyramidal layers of the feature pyramid network (FPN), and obtained multi-scale activation maps with global features aggregation. Features resulting from context augmentation served as the input to a region-based detector to produce tumor detection predictions. The training set was constructed by 510 WLC frames that were obtained from cystoscopy video sequences acquired from 54 patients. The test set was constructed based on 101 images obtained from WLC sequences of 13 patients.Main results.CystoNet-T was evaluated on the test set with 96.4 F1 and 91.4 AP (Average Precision). This result improved the benchmark of Faster R-CNN and YOLO by 7.3 points in F1 and 3.8 points in AP. The improvement is attributed to the strong ability of global attention of CystoNet-T and better feature learning of the pyramids architecture throughout the training. The model was found to be particularly effective in highlighting the foreground information for precise localization of the true positives while favorably avoiding false alarmsSignificance.We have developed a deep learning algorithm that accurately detects bladder tumors in WLC. Transformer-augmented AI framework promises to aid in clinical decision-making for improved bladder cancer diagnosis and therapeutic guidance.
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Affiliation(s)
- Xiao Jia
- School of Control Science and Engineering, Shandong University, Jinan, People’s Republic of China
- Department of Radiation Oncology, Stanford University, Stanford, CA, United States of America
- Equal contribution
| | - Eugene Shkolyar
- Department of Urology, Stanford University, Stanford, CA, United States of America
- VA Palo Alto Health Care System, Palo Alto, CA, United States of America
- Equal contribution
| | - Mark A Laurie
- Department of Radiation Oncology, Stanford University, Stanford, CA, United States of America
- Department of Urology, Stanford University, Stanford, CA, United States of America
| | - Okyaz Eminaga
- Department of Urology, Stanford University, Stanford, CA, United States of America
- VA Palo Alto Health Care System, Palo Alto, CA, United States of America
| | - Joseph C Liao
- Department of Urology, Stanford University, Stanford, CA, United States of America
- VA Palo Alto Health Care System, Palo Alto, CA, United States of America
| | - Lei Xing
- Department of Radiation Oncology, Stanford University, Stanford, CA, United States of America
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Chang TC, Shkolyar E, Del Giudice F, Eminaga O, Lee T, Laurie M, Seufert C, Jia X, Mach KE, Xing L, Liao JC. Real-time Detection of Bladder Cancer Using Augmented Cystoscopy with Deep Learning: a Pilot Study. J Endourol 2023. [PMID: 37432899 DOI: 10.1089/end.2023.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Detection of bladder tumors under white light cystoscopy (WLC) is challenging yet impactful on treatment outcomes. Artificial intelligence (AI) holds the potential to improve tumor detection; however, its application in the real-time setting remains unexplored. AI has been applied to previously recorded images for post hoc analysis. In this study, we evaluate the feasibility of real-time AI integration during clinic cystoscopy and transurethral resection of bladder tumor (TURBT) on live, streaming video. METHODS Patients undergoing clinic flexible cystoscopy and TURBT were prospectively enrolled. A real-time alert device system (real-time CystoNet) was developed and integrated with standard cystoscopy towers. Streaming videos were processed in real time to display alert boxes in sync with live cystoscopy. The per-frame diagnostic accuracy was measured. RESULTS AND LIMITATIONS Real-time CystoNet was successfully integrated in the operating room during TURBT and clinic cystoscopy in 50 consecutive patients. There were 55 procedures that met the inclusion criteria for analysis including 21 clinic cystoscopies and 34 TURBTs. For clinic cystoscopy, real-time CystoNet achieved per-frame tumor specificity of 98.8% with a median error rate of 3.6% (range: 0 - 47%) frames per cystoscopy. For TURBT, the per-frame tumor sensitivity was 52.9% and the per-frame tumor specificity was 95.4% with an error rate of 16.7% for cases with pathologically confirmed bladder cancers. CONCLUSIONS The current pilot study demonstrates the feasibility of using a real-time AI system (real-time CystoNet) during cystoscopy and TURBT to generate active feedback to the surgeon. Further optimization of CystoNet for real-time cystoscopy dynamics may allow for clinically useful AI-augmented cystoscopy.
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Affiliation(s)
- Timothy Chan Chang
- Stanford University School of Medicine, Department of Urology, 453 Quarry Road, Urology - 5656, Palo Alto, California, United States, 94304;
| | - Eugene Shkolyar
- Stanford University School of Medicine, 10624, Urology, 300 Pasteur Dr, Stanford, California, United States, 94305;
| | - Francesco Del Giudice
- Sapienza Rome University, Department of Maternal-Child and Urological Sciences, Rome, Italy;
| | - Okyaz Eminaga
- Stanford University School of Medicine, 10624, Urology, Stanford, California, United States;
| | - Timothy Lee
- Stanford University School of Medicine, 10624, Urology, Stanford, California, United States;
| | - Mark Laurie
- Stanford University School of Medicine, 10624, Urology, Stanford, California, United States;
| | - Caleb Seufert
- Stanford University School of Medicine, 10624, Urology, Stanford, California, United States;
| | - Xiao Jia
- Stanford University School of Medicine, 10624, Radiation Oncology, Stanford, California, United States;
| | - Kathleen E Mach
- Stanford University School of Medicine, Urology, Stanford, California, United States;
| | - Lei Xing
- Stanford University School of Medicine, 10624, Radiation Oncology, Stanford, California, United States;
| | - Joseph C Liao
- Stanford, Urology, 300 Pasteur Dr., S-287, Stanford, California, United States, 94305-5118;
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Eminaga O, Lee TJ, Ge J, Shkolyar E, Laurie M, Long J, Hockman LG, Liao JC. Conceptual framework and documentation standards of cystoscopic media content for artificial intelligence. J Biomed Inform 2023; 142:104369. [PMID: 37088456 PMCID: PMC10643098 DOI: 10.1016/j.jbi.2023.104369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 04/03/2023] [Accepted: 04/18/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The clinical documentation of cystoscopy includes visual and textual materials. However, the secondary use of visual cystoscopic data for educational and research purposes remains limited due to inefficient data management in routine clinical practice. METHODS A conceptual framework was designed to document cystoscopy in a standardized manner with three major sections: data management, annotation management, and utilization management. A Swiss-cheese model was proposed for quality control and root cause analyses. We defined the infrastructure required to implement the framework with respect to FAIR (findable, accessible, interoperable, reusable) principles. We applied two scenarios exemplifying data sharing for research and educational projects to ensure compliance with FAIR principles. RESULTS The framework was successfully implemented while following FAIR principles. The cystoscopy atlas produced from the framework could be presented in an educational web portal; a total of 68 full-length qualitative videos and corresponding annotation data were sharable for artificial intelligence projects covering frame classification and segmentation problems at case, lesion, and frame levels. CONCLUSION Our study shows that the proposed framework facilitates the storage of visual documentation in a standardized manner and enables FAIR data for education and artificial intelligence research.
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Affiliation(s)
- Okyaz Eminaga
- Department of Urology, Stanford University School of Medicine, Stanford, USA; Center for Artificial Intelligence and Medical Imaging, Stanford University School of Medicine, Stanford, CA, USA.
| | - Timothy Jiyong Lee
- Department of Urology, Stanford University School of Medicine, Stanford, USA
| | - Jessie Ge
- Department of Urology, Stanford University School of Medicine, Stanford, USA
| | - Eugene Shkolyar
- Department of Urology, Stanford University School of Medicine, Stanford, USA
| | - Mark Laurie
- Department of Urology, Stanford University School of Medicine, Stanford, USA
| | - Jin Long
- Center for Artificial Intelligence and Medical Imaging, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Joseph C Liao
- Department of Urology, Stanford University School of Medicine, Stanford, USA; Center for Artificial Intelligence and Medical Imaging, Stanford University School of Medicine, Stanford, CA, USA.
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8
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Eminaga O, Abbas M, Shen J, Laurie M, Brooks JD, Liao JC, Rubin DL. PlexusNet: A neural network architectural concept for medical image classification. Comput Biol Med 2023; 154:106594. [PMID: 36753979 DOI: 10.1016/j.compbiomed.2023.106594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 01/12/2023] [Accepted: 01/22/2023] [Indexed: 01/27/2023]
Abstract
State-of-the-art (SOTA) convolutional neural network models have been widely adapted in medical imaging and applied to address different clinical problems. However, the complexity and scale of such models may not be justified in medical imaging and subject to the available resource budget. Further increasing the number of representative feature maps for the classification task decreases the model explainability. The current data normalization practice is fixed prior to model development and discounting the specification of the data domain. Acknowledging these issues, the current work proposed a new scalable model family called PlexusNet; the block architecture and model scaling by the network's depth, width, and branch regulate PlexusNet's architecture. The efficient computation costs outlined the dimensions of PlexusNet scaling and design. PlexusNet includes a new learnable data normalization algorithm for better data generalization. We applied a simple yet effective neural architecture search to design PlexusNet tailored to five clinical classification problems that achieve a performance noninferior to the SOTA models ResNet-18 and EfficientNet B0/1. It also does so with lower parameter capacity and representative feature maps in ten-fold ranges than the smallest SOTA models with comparable performance. The visualization of representative features revealed distinguishable clusters associated with categories based on latent features generated by PlexusNet. The package and source code are at https://github.com/oeminaga/PlexusNet.git.
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Affiliation(s)
- Okyaz Eminaga
- Center for Artificial Intelligence in Medicine & Imaging and Department of Urology, Stanford School of Medicine, Stanford, CA, 94305, USA; Department of Urology, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Mahmoud Abbas
- Department of Pathology, University of Muenster, Muenster, Germany.
| | - Jeanne Shen
- Department of Pathology, Stanford School of Medicine, Stanford, CA, 94305, USA.
| | - Mark Laurie
- Department of Computer Science, Stanford University, Stanford, CA, 94305, USA.
| | - James D Brooks
- Department of Urology, Stanford School of Medicine, Stanford, CA, 94305, USA.
| | - Joseph C Liao
- Department of Urology, Stanford School of Medicine, Stanford, CA, 94305, USA.
| | - Daniel L Rubin
- Department of Biomedical Data Science, Stanford School of Medicine, Stanford, CA, 94305, USA.
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9
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Eminaga O, Lee TJ, Ge J, Shkolyar E, Laurie M, Long J, Hockman LG, Liao JC. Conceptual Framework and Documentation Standards of Cystoscopic Media Content for Artificial Intelligence. ArXiv 2023:arXiv:2301.05991v2. [PMID: 36713258 PMCID: PMC9882574] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The clinical documentation of cystoscopy includes visual and textual materials. However, the secondary use of visual cystoscopic data for educational and research purposes remains limited due to inefficient data management in routine clinical practice. METHODS A conceptual framework was designed to document cystoscopy in a standardized manner with three major sections: data management, annotation management, and utilization management. A Swiss-cheese model was proposed for quality control and root cause analyses. We defined the infrastructure required to implement the framework with respect to FAIR (findable, accessible, interoperable, re-usable) principles. We applied two scenarios exemplifying data sharing for research and educational projects to ensure the compliance with FAIR principles. RESULTS The framework was successfully implemented while following FAIR principles. The cystoscopy atlas produced from the framework could be presented in an educational web portal; a total of 68 full-length qualitative videos and corresponding annotation data were sharable for artificial intelligence projects covering frame classification and segmentation problems at case, lesion and frame levels. CONCLUSION Our study shows that the proposed framework facilitates the storage of the visual documentation in a standardized manner and enables FAIR data for education and artificial intelligence research.
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Affiliation(s)
- Okyaz Eminaga
- Department of Urology, Stanford University School of Medicine, Stanford
- Center for Artificial Intelligence and Medical Imaging, Stanford University School of Medicine, Stanford, CA
| | | | - Jessie Ge
- Department of Urology, Stanford University School of Medicine, Stanford
| | - Eugene Shkolyar
- Department of Urology, Stanford University School of Medicine, Stanford
| | - Mark Laurie
- Department of Urology, Stanford University School of Medicine, Stanford
| | - Jin Long
- Center for Artificial Intelligence and Medical Imaging, Stanford University School of Medicine, Stanford, CA
| | | | - Joseph C. Liao
- Department of Urology, Stanford University School of Medicine, Stanford
- Center for Artificial Intelligence and Medical Imaging, Stanford University School of Medicine, Stanford, CA
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Eminaga O, Ge TJ, Shkolyar E, Laurie MA, Lee TJ, Hockman L, Jia X, Xing L, Liao JC. An Efficient Framework for Video Documentation of Bladder Lesions for Cystoscopy: A Proof-of-Concept Study. J Med Syst 2022; 46:73. [PMID: 36190581 PMCID: PMC10751224 DOI: 10.1007/s10916-022-01862-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/07/2022] [Indexed: 10/10/2022]
Abstract
Processing full-length cystoscopy videos is challenging for documentation and research purposes. We therefore designed a surgeon-guided framework to extract short video clips with bladder lesions for more efficient content navigation and extraction. Screenshots of bladder lesions were captured during transurethral resection of bladder tumor, then manually labeled according to case identification, date, lesion location, imaging modality, and pathology. The framework used the screenshot to search for and extract a corresponding 10-seconds video clip. Each video clip included a one-second space holder with a QR barcode informing the video content. The success of the framework was measured by the secondary use of these short clips and the reduction of storage volume required for video materials. From 86 cases, the framework successfully generated 249 video clips from 230 screenshots, with 14 erroneous video clips from 8 screenshots excluded. The HIPPA-compliant barcodes provided information of video contents with a 100% data completeness. A web-based educational gallery was curated with various diagnostic categories and annotated frame sequences. Compared with the unedited videos, the informative short video clips reduced the storage volume by 99.5%. In conclusion, our framework expedites the generation of visual contents with surgeon's instruction for cystoscopy and potential incorporation of video data towards applications including clinical documentation, education, and research.
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Affiliation(s)
- Okyaz Eminaga
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Urology, Stanford University School of Medicine, 453 Quarry Road, Mail Code 5656, Palo Alto, CA, 94304, USA.
| | - T Jessie Ge
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Eugene Shkolyar
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mark A Laurie
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Timothy J Lee
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lukas Hockman
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Xiao Jia
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lei Xing
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Joseph C Liao
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Urology, Stanford University School of Medicine, 453 Quarry Road, Mail Code 5656, Palo Alto, CA, 94304, USA.
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Eminaga O, Shkolyar E, Breil B, Semjonow A, Boegemann M, Xing L, Tinay I, Liao JC. Artificial Intelligence-Based Prognostic Model for Urologic Cancers: A SEER-Based Study. Cancers (Basel) 2022; 14:cancers14133135. [PMID: 35804904 PMCID: PMC9264864 DOI: 10.3390/cancers14133135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/21/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 12/11/2022] Open
Abstract
Simple Summary We describe a risk profile reconstruction model for cancer-specific survival estimation for continuous time points after urologic cancer diagnosis. We used artificial intelligence (AI)-based algorithms, a national cancer registry data, and accessible clinical parameters for the risk-profile reconstruction. We derived a risk stratification model and estimated the minimum follow-up duration and the likelihood for risk stability in prostate, kidney, and testicular cancers. The estimated follow-up duration was in alignment with recognized clinical guidelines for these cancers. Moreover, the estimated follow-up duration was differed by the cancer origin and the disease dissemination status. Overall, the reconstruction of the population’s risk profile for the cancer-specific prognostic score estimation is feasible using AI and has potential application in clinical settings to improve risk stratification and surveillance management. Abstract Background: Prognostication is essential to determine the risk profile of patients with urologic cancers. Methods: We utilized the SEER national cancer registry database with approximately 2 million patients diagnosed with urologic cancers (penile, testicular, prostate, bladder, ureter, and kidney). The cohort was randomly divided into the development set (90%) and the out-held test set (10%). Modeling algorithms and clinically relevant parameters were utilized for cancer-specific mortality prognosis. The model fitness for the survival estimation was assessed using the differences between the predicted and observed Kaplan–Meier estimates on the out-held test set. The overall concordance index (c-index) score estimated the discriminative accuracy of the survival model on the test set. A simulation study assessed the estimated minimum follow-up duration and time points with the risk stability. Results: We achieved a well-calibrated prognostic model with an overall c-index score of 0.800 (95% CI: 0.795–0.805) on the representative out-held test set. The simulation study revealed that the suggestions for the follow-up duration covered the minimum duration and differed by the tumor dissemination stages and affected organs. Time points with a high likelihood for risk stability were identifiable. Conclusions: A personalized temporal survival estimation is feasible using artificial intelligence and has potential application in clinical settings, including surveillance management.
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Affiliation(s)
- Okyaz Eminaga
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA; (E.S.); (J.C.L.)
- Correspondence:
| | - Eugene Shkolyar
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA; (E.S.); (J.C.L.)
| | - Bernhard Breil
- Faculty of Health Care, Hochschule Niederrhein, University of Applied Sciences, 47805 Krefeld, Germany;
| | - Axel Semjonow
- Prostate Center, Department of Urology, University Hospital Muenster, 48149 Muenster, Germany; (A.S.); (M.B.)
| | - Martin Boegemann
- Prostate Center, Department of Urology, University Hospital Muenster, 48149 Muenster, Germany; (A.S.); (M.B.)
| | - Lei Xing
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Ilker Tinay
- Department of Urology, Marmara University School of Medicine, Istanbul 34854, Turkey;
| | - Joseph C. Liao
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA; (E.S.); (J.C.L.)
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O'Sullivan S, Janssen M, Holzinger A, Nevejans N, Eminaga O, Meyer CP, Miernik A. Explainable artificial intelligence (XAI): closing the gap between image analysis and navigation in complex invasive diagnostic procedures. World J Urol 2022; 40:1125-1134. [PMID: 35084542 PMCID: PMC8791809 DOI: 10.1007/s00345-022-03930-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/30/2021] [Indexed: 12/24/2022] Open
Abstract
Literature review Cystoscopy is the gold standard for initial macroscopic assessments of the human urinary bladder to rule out (or diagnose) bladder cancer (BCa). Despite having guidelines, cystoscopic findings are diverse and often challenging to classify. The extent of the false negatives and false positives in cystoscopic diagnosis is currently unknown. We suspect that there is a certain degree of under-diagnosis (like the failure to detect malignant tumours) and over-diagnosis (e.g. sending the patient for unnecessary transurethral resection of bladder tumors with anesthesia) that put the patient at risk. Conclusions XAI robot-assisted cystoscopes would help to overcome the risks/flaws of conventional cystoscopy. Cystoscopy is considered a less life-threatening starting point for automation than open surgical procedures. Semi-autonomous cystoscopy requires standards and cystoscopy is a good procedure to establish a model that can then be exported/copied to other procedures of endoscopy and surgery. Standards also define the automation levels—an issue for medical product law. These cystoscopy skills do not give full autonomy to the machine, and represent a surgical parallel to ‘Autonomous Driving’ (where a standard requires a human supervisor to remain in the ‘vehicle’). Here in robotic cystoscopy, a human supervisor remains bedside in the ‘operating room’ as a ‘human‐in‐the‐loop’ in order to safeguard patients. The urologists will be able to delegate personal- and time-consuming cystoscopy to a specialised nurse. The result of automated diagnostic cystoscopy is a short video (with pre-processed photos from the video), which are then reviewed by the urologists at a more convenient time.
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Affiliation(s)
- S O'Sullivan
- Department of Urology, University Hospital of Münster (UKM), Muenster, Germany.
| | - M Janssen
- Department of Urology, University Hospital of Münster (UKM), Muenster, Germany
| | - Andreas Holzinger
- Human-Centered AI Lab, Institute for Medical Informatics/Statistics, Medical University of Graz, Graz, Austria
- xAI Lab, Alberta Machine Intelligence Institute, University of Alberta, Edmonton, Canada
| | - Nathalie Nevejans
- AI Responsible Chair, Research Center in Law, Ethics and Procedures, Faculty of Law of Douai, University of Artois, Arras, France
| | - O Eminaga
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
- Center for Artificial Intelligence in Medicine and Imaging, Stanford University School of Medicine, Stanford, CA, USA
| | - C P Meyer
- Urology Clinic, Ruhr‑University of Bochum, Bochum, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
- RaVeNNA 4Pi-Consortium of the German Federal Ministry of Education and Research (BMBF), Freiburg, Germany
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Alvarez JB, Bibault JE, Burgun A, Cai J, Cao Z, Chang K, Chen JH, Chen WC, Cho M, Cho PJ, Cornish TC, Costa A, Dekker A, Drukker K, Dunn J, Eminaga O, Erickson BJ, Fournier L, Gambhir SS, Gennatas ED, Giger ML, Halilaj I, Harrison AP, He B, Hong JC, Jin D, Jin MC, Jochems A, Kalpathy-Cramer J, Kapp DS, Karimzadeh M, Karnes W, Lambin P, Langlotz CP, Lee J, Li H, Liao JC, Lin AL, Lin RY, Liu Y, Lu L, Magnus D, McIntosh C, Miao S, Min JK, Neill DB, Oermann EK, Ouyang D, Peng L, Phene S, Poirot MG, Quon JL, Ranti D, Rao A, Raskar R, Rombaoa C, Rubin DL, Samarasena J, Seekins J, Seetharam K, Shearer E, Sibley A, Singh K, Singh P, Sordo M, Suraweera D, Valliani AAA, van Wijk Y, Vepakomma P, Wang B, Wang G, Wang N, Wang Y, Warner E, Welch M, Wong K, Wu Z, Xing F, Xing L, Yan K, Yan P, Yang L, Yeom KW, Zachariah R, Zeng D, Zhang L, Zhang L, Zhang X, Zhou L, Zou J. List of contributors. Artif Intell Med 2021. [DOI: 10.1016/b978-0-12-821259-2.00035-1] [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: 11/26/2022]
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14
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Chang TC, Seufert C, Eminaga O, Shkolyar E, Hu JC, Liao JC. Current Trends in Artificial Intelligence Application for Endourology and Robotic Surgery. Urol Clin North Am 2020; 48:151-160. [PMID: 33218590 DOI: 10.1016/j.ucl.2020.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Indexed: 02/07/2023]
Abstract
With the advent of electronic medical records and digitalization of health care over the past 2 decades, artificial intelligence (AI) has emerged as an enabling tool to manage complex datasets and deliver streamlined data-driven patient care. AI algorithms have the ability to extract meaningful signal from complex datasets through an iterative process akin to human learning. Through advancements over the past decade in deep learning, AI-driven innovations have accelerated applications in health care. Herein, the authors explore the development of these emerging AI technologies, focusing on the application of AI to endourology and robotic surgery.
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Affiliation(s)
- Timothy C Chang
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, S-287, Stanford, CA 94305, USA; Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Mail Code 112, Palo Alto, CA 94304, USA.
| | - Caleb Seufert
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, S-287, Stanford, CA 94305, USA
| | - Okyaz Eminaga
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, S-287, Stanford, CA 94305, USA
| | - Eugene Shkolyar
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, S-287, Stanford, CA 94305, USA
| | - Jim C Hu
- Department of Urology, Weill Cornell Medicine-New York Presbyterian Hospital, 525 E 68th Street, Starr Pavilion, Ninth Floor, New York, NY 10065, USA
| | - Joseph C Liao
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, S-287, Stanford, CA 94305, USA; Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Mail Code 112, Palo Alto, CA 94304, USA
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Eminaga O, Loening A, Lu A, Brooks JD, Rubin D. Detection of prostate cancer and determination of its significance using explainable artificial intelligence. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.5555] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5555 Background: The variation of the human perception has limited the potential of multi-parametric magnetic resonance imaging (mpMRI) of the prostate in determining prostate cancer and identifying significant prostate cancer. The current study aims to overcome this limitation and utilizes an explainable artificial intelligence to leverage the diagnostic potential of mpMRI in detecting prostate cancer (PCa) and determining its significance. Methods: A total of 6,020 MR images from 1,498 cases were considered (1,785 T2 images, 2,719 DWI images, and 1,516 ADC maps). The treatment determined the significance of PCa. Cases who received radical prostatectomy were considered significant, whereas cases with active surveillance and followed for at least two years were considered insignificant. The negative biopsy cases have either a single biopsy setting or multiple biopsy settings with the PCa exclusion. The images were randomly divided into development (80%) and test sets (20%) after stratifying according to the case in each image type. The development set was then divided into a training set (90%) and a validation set (10%). We developed deep learning models for PCa detection and the determination of significant PCa based on the PlexusNet architecture that supports explainable deep learning and volumetric input data. The input data for PCa detection was T2-weighted images, whereas the input data for determining significant PCa include all images types. The performance of PCa detection and determination of significant PCa was measured using the area under receiving characteristic operating curve (AUROC) and compared to the maximum PiRAD score (version 2) at the case level. The 10,000 times bootstrapping resampling was applied to measure the 95% confidence interval (CI) of AUROC. Results: The AUROC for the PCa detection was 0.833 (95% CI: 0.788-0.879) compared to the PiRAD score with 0.75 (0.718-0.764). The DL models to detect significant PCa using the ADC map or DWI images achieved the highest AUROC [ADC: 0.945 (95% CI: 0.913-0.982; DWI: 0.912 (95% CI: 0.871-0.954)] compared to a DL model using T2 weighted (0.850; 95% CI: 0.791-0.908) or PiRAD scores (0.604; 95% CI: 0.544-0.663). Finally, the attention map of PlexusNet from mpMRI with PCa correctly showed areas that contain PCa after matching with corresponding prostatectomy slice. Conclusions: We found that explainable deep learning is feasible on mpMRI and achieves high accuracy in determining cases with PCa and identifying cases with significant PCa.
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Affiliation(s)
- Okyaz Eminaga
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | | | | | - James D Brooks
- Department of Urology, Stanford University Hospital, Stanford University, Stanford, CA
| | - Daniel Rubin
- Stanford University, School of Medicine, Stanford, CA
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16
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Eminaga O, Abbas M, Semjonow A, Brooks JD, Rubin D. Determination of biologic and prognostic feature scores from whole slide histology images using deep learning. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e17527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17527 Background: In cancer, histopathology is a reflection of the underlying molecular changes in the cancer cells and provides prognostic information on the risk of disease progression. Therefore, whole slide images may harbor histopathological features that have a biological association and are prognostic. Methods: This study has extracted histopathological feature scores generated from hematoxylin and eosin (HE) histology images based on deep learning models developed for the detection of pathological findings related to prostate cancer (PCa). Correlation analyses between the histopathological feature scores and the most relevant genomic alterations related to PCa were performed based on the original results and diagnostic histology images from TCGA PRAD study (n = 251). We extracted feature scores from tumor lesions after applying tumor segmentation and several data transformation using five models developed for detection of cribriform or ductal morphologies, Gleason patterns 3 and 4, and the presumed tumor precursor. For prognostic evaluation, we performed survival analyses of 371 patients from the TCGA PRAD dataset with biochemical recurrence (BCR) using a Cox regression model, Kaplan Meier (KM) curves. We applied the bootstrapping resampling for the uncertainty evaluation and C-statistics for the randomness measurement. Results: The feature scores were significantly correlated with the androgen receptor protein expression, an androgen-signaling score, mRNA expression, and androgen receptor splice variant 7. In addition, feature scores were associated with SPINK1 overexpression, the heterozygous loss of TP53, and SPOP mutations. Additionally, the mRNA and miRNA clusters identified by the TCGA research team for PCa. These features were independent of Gleason grade and were non-random. The survival analyses revealed that a model, including three of five feature scores, achieved a c-index of 0.706 (95% CI: 0.606-0.779). The KM curve showed that these risk groups based on the Cox regression model are significantly discriminative (Log-rank P-value < 0.0001). The low-risk group (n = 177) achieved a 2-year BCR-free survival rate (BFS) of 97.4% (95% CI: 94.9 - 100.0%) and a 5-year PFS of 88.3% (95% CI: 80.6 - 96.7%). In contrast, the high-risk group (n = 194) showed a 2-year PFS of 86.3% (95% CI: 81.1 - 91.8%) and a 5-year BFS of 66.9% (95% CI: 54.6 - 0.82.1%). Conclusions: Our findings uncover the potential of feature scores from histology images as digital biomarkers in precision medicine and as an expanding utility for digital pathology.
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Affiliation(s)
- Okyaz Eminaga
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | | | - Axel Semjonow
- Prostate Center, University Hospital Muenster, Muenster, Germany
| | - James D Brooks
- Department of Urology, Stanford University Hospital, Stanford University, Stanford, CA
| | - Daniel Rubin
- Stanford University, School of Medicine, Stanford, CA
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Eminaga O, Eminaga N, Semjonow A, Breil B. Diagnostic Classification of Cystoscopic Images Using Deep Convolutional Neural Networks. JCO Clin Cancer Inform 2019; 2:1-8. [PMID: 30652604 DOI: 10.1200/cci.17.00126] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The recognition of cystoscopic findings remains challenging for young colleagues and depends on the examiner's skills. Computer-aided diagnosis tools using feature extraction and deep learning show promise as instruments to perform diagnostic classification. MATERIALS AND METHODS Our study considered 479 patient cases that represented 44 urologic findings. Image color was linearly normalized and was equalized by applying contrast-limited adaptive histogram equalization. Because these findings can be viewed via cystoscopy from every possible angle and side, we ultimately generated images rotated in 10-degree grades and flipped them vertically or horizontally, which resulted in 18,681 images. After image preprocessing, we developed deep convolutional neural network (CNN) models (ResNet50, VGG-19, VGG-16, InceptionV3, and Xception) and evaluated these models using F1 scores. Furthermore, we proposed two CNN concepts: 90%-previous-layer filter size and harmonic-series filter size. A training set (60%), a validation set (10%), and a test set (30%) were randomly generated from the study data set. All models were trained on the training set, validated on the validation set, and evaluated on the test set. RESULTS The Xception-based model achieved the highest F1 score (99.52%), followed by models that were based on ResNet50 (99.48%) and the harmonic-series concept (99.45%). All images with cancer lesions were correctly determined by these models. When the focus was on the images misclassified by the model with the best performance, 7.86% of images that showed bladder stones with indwelling catheter and 1.43% of images that showed bladder diverticulum were falsely classified. CONCLUSION The results of this study show the potential of deep learning for the diagnostic classification of cystoscopic images. Future work will focus on integration of artificial intelligence-aided cystoscopy into clinical routines and possibly expansion to other clinical endoscopy applications.
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Affiliation(s)
- Okyaz Eminaga
- Okyaz Eminaga, Stanford Medical School, Stanford, CA; University Hospital of Cologne, Cologne, France; Nurettin Eminaga, St Mauritius Therapy Clinic, Meerbusch; Axel Semjonow, University Hospital Muenster; and Bernhard Breil, Niederrhein University of Applied Sciences, Krefeld, Germany
| | - Nurettin Eminaga
- Okyaz Eminaga, Stanford Medical School, Stanford, CA; University Hospital of Cologne, Cologne, France; Nurettin Eminaga, St Mauritius Therapy Clinic, Meerbusch; Axel Semjonow, University Hospital Muenster; and Bernhard Breil, Niederrhein University of Applied Sciences, Krefeld, Germany
| | - Axel Semjonow
- Okyaz Eminaga, Stanford Medical School, Stanford, CA; University Hospital of Cologne, Cologne, France; Nurettin Eminaga, St Mauritius Therapy Clinic, Meerbusch; Axel Semjonow, University Hospital Muenster; and Bernhard Breil, Niederrhein University of Applied Sciences, Krefeld, Germany
| | - Bernhard Breil
- Okyaz Eminaga, Stanford Medical School, Stanford, CA; University Hospital of Cologne, Cologne, France; Nurettin Eminaga, St Mauritius Therapy Clinic, Meerbusch; Axel Semjonow, University Hospital Muenster; and Bernhard Breil, Niederrhein University of Applied Sciences, Krefeld, Germany
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Boegemann M, Schlack K, Früchtenicht L, Steinestel J, Schrader AJ, Wennmann Y, Krabbe LM, Eminaga O. A prognostic score for overall survival in patients treated with abiraterone in the pre- and post-chemotherapy setting. Oncotarget 2019; 10:5082-5091. [PMID: 31489117 PMCID: PMC6707939 DOI: 10.18632/oncotarget.27133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/21/2019] [Indexed: 01/07/2023] Open
Abstract
Background: Therapy resistance remains a serious dilemma in metastatic castration-resistant prostate cancer (mCRPC) with primary or secondary resistance frequently occurring against any given therapy. Available prognostic models for Abiraterone Acetate (AA) are specifically designed for either pre- or post-chemotherapy settings and mostly based on trial datasets not necessarily reflecting real-life.
Results: A score of 0–2 (low-risk) is associated with an OS-probability of 80.0% (95%CI: 71.3–90.6) and 50.5% (95%CI: 38.7–66.0) after 1 and 2 years while a score of 3–4 (high risk) is associated with an OS-probability of 35.3% (95%CI: 22.3–55.8) and 5.7% (95%CI: 1.5–21.8), respectively. The bootstrapping survival analysis of the scoring-system revealed a median c-index of 0.80 (IQR: 0.79–0.82).
Material and Methods: We developed a scoring-system using four real-life parameters 117 mCRPC patients treated with AA either pre- or post-chemotherapy. These parameters were evaluated using COX regression analysis. The scoring-system consists of binary-categorized parameters; when any of these exceeds the given cut-off, one point is added up to a final score ranging between 0–4 points. The final score was stratified by a median threshold of 2 into low- and high-risk groups. We evaluated the discriminative ability of our scoring-system using concordance probability (C-index) and Kaplan–Meier-analysis and applied a 100-times bootstrap for survival analysis.
Conclusions: Our study introduces a novel prognostic scoring-system for OS of real-life mCRPC patients receiving AA treatment irrespective of the line of therapy. The scoring-system is simple and can be easily utilized based on PSA and LDH values, neutrophil to lymphocyte ratio, and ECOG performance status.
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Affiliation(s)
- Martin Boegemann
- Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Katrin Schlack
- Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Lena Früchtenicht
- Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Julie Steinestel
- Department of Urology, Augsburg Medical Center, Augburg, Germany
| | - Andres Jan Schrader
- Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Yvonne Wennmann
- Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Laura-Maria Krabbe
- Department of Urology, University of Muenster Medical Center, Muenster, Germany.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Okyaz Eminaga
- Department of Urology, Stanford Medical School, Stanford, CA, USA
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Eminaga O, Al-Hamad O, Boegemann M, Breil B, Semjonow A. Combination possibility and deep learning model as clinical decision-aided approach for prostate cancer. Health Informatics J 2019; 26:945-962. [PMID: 31238766 DOI: 10.1177/1460458219855884] [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] [Indexed: 12/14/2022]
Abstract
This study aims to introduce as proof of concept a combination model for classification of prostate cancer using deep learning approaches. We utilized patients with prostate cancer who underwent surgical treatment representing the various conditions of disease progression. All possible combinations of significant variables from logistic regression and correlation analyses were determined from study data sets. The combination possibility and deep learning model was developed to predict these combinations that represented clinically meaningful patient's subgroups. The observed relative frequencies of different tumor stages and Gleason score Gls changes from biopsy to prostatectomy were available for each group. Deep learning models and seven machine learning approaches were compared for the classification performance of Gleason score changes and pT2 stage. Deep models achieved the highest F1 scores by pT2 tumors (0.849) and Gls change (0.574). Combination possibility and deep learning model is a useful decision-aided tool for prostate cancer and to group patients with prostate cancer into clinically meaningful groups.
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Affiliation(s)
- Okyaz Eminaga
- Stanford University School of Medicine, USA; University Hospital of Cologne, Germany
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20
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Middleton LW, Shen Z, Varma S, Pollack AS, Gong X, Zhu S, Zhu C, Foley JW, Vennam S, Sweeney RT, Tu K, Biscocho J, Eminaga O, Nolley R, Tibshirani R, Brooks JD, West RB, Pollack JR. Genomic analysis of benign prostatic hyperplasia implicates cellular re-landscaping in disease pathogenesis. JCI Insight 2019; 5:129749. [PMID: 31094703 DOI: 10.1172/jci.insight.129749] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is the most common cause of lower urinary tract symptoms in men. Current treatments target prostate physiology rather than BPH pathophysiology and are only partially effective. Here, we applied next-generation sequencing to gain new insight into BPH. By RNAseq, we uncovered transcriptional heterogeneity among BPH cases, where a 65-gene BPH stromal signature correlated with symptom severity. Stromal signaling molecules BMP5 and CXCL13 were enriched in BPH while estrogen regulated pathways were depleted. Notably, BMP5 addition to cultured prostatic myofibroblasts altered their expression profile towards a BPH profile that included the BPH stromal signature. RNAseq also suggested an altered cellular milieu in BPH, which we verified by immunohistochemistry and single-cell RNAseq. In particular, BPH tissues exhibited enrichment of myofibroblast subsets, whilst depletion of neuroendocrine cells and an estrogen receptor (ESR1)-positive fibroblast cell type residing near epithelium. By whole-exome sequencing, we uncovered somatic single-nucleotide variants (SNVs) in BPH, of uncertain pathogenic significance but indicative of clonal cell expansions. Thus, genomic characterization of BPH has identified a clinically-relevant stromal signature and new candidate disease pathways (including a likely role for BMP5 signaling), and reveals BPH to be not merely a hyperplasia, but rather a fundamental re-landscaping of cell types.
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Affiliation(s)
| | | | | | | | - Xue Gong
- Department of Pathology.,Department of Urology
| | | | | | | | | | | | | | | | | | | | - Robert Tibshirani
- Department of Biomedical Data Science, and.,Department of Statistics, Stanford University School of Medicine, Stanford, California, USA
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21
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Eminaga O, Fries J, Neiß S, Heitmann M, Wötzel F, Heidenreich A, Bruns C, Alakus H, Warnecke-Eberz U. The upregulation of hypoxia-related miRNA 210 in primary tumor of lymphogenic metastatic prostate cancer. Epigenomics 2018; 10:1347-1359. [DOI: 10.2217/epi-2017-0114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Aim: To show the association between the expression level of hsa-miR-210 (miR-210) and tumor progression in prostate cancer (PCa). Methods: Quantitative PCR was performed to measure miR-210 on 55 subjects with different tumor stages; our results were then validated using three external datasets. ANOVA and Tukey's post hoc analysis were performed for comparative analyses between different tumor stages. Using the transcriptome data from The Cancer Genome Atlas for CaP, the gene expression analyses were performed on experimentally validated target genes of miR-210 identified in Tarbase and miRWalk datasets. Results & conclusion: miR-210 was significantly higher in N1 PCa compared with nonmetastatic PCa, whereas the metastatic tumor revealed a lower expression level of miR-210 than the primary tumor.
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Affiliation(s)
- Okyaz Eminaga
- Department of Urology, University Hospital of Cologne, Kerpenerstr. 62, D-50937 Cologne, Germany
- Department of Urology, Stanford University, Stanford, CA 94305, USA
| | - Jochen Fries
- Department of Pathology, University Hospital of Cologne, Kerpenerstr. 62, D-50937 Cologne, Germany
| | - Susanne Neiß
- Laboratory for Molecular Oncology, University Hospital of Cologne, Kerpener Strasse 62, D-50937 Cologne, Germany
| | - Michaela Heitmann
- Laboratory for Molecular Oncology, University Hospital of Cologne, Kerpener Strasse 62, D-50937 Cologne, Germany
| | - Fabian Wötzel
- Department of Pathology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, D- 48149 Muenster, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital of Cologne, Kerpenerstr. 62, D-50937 Cologne, Germany
| | - Christiane Bruns
- Laboratory for Molecular Oncology, University Hospital of Cologne, Kerpener Strasse 62, D-50937 Cologne, Germany
| | - Hakan Alakus
- Laboratory for Molecular Oncology, University Hospital of Cologne, Kerpener Strasse 62, D-50937 Cologne, Germany
| | - Ute Warnecke-Eberz
- Laboratory for Molecular Oncology, University Hospital of Cologne, Kerpener Strasse 62, D-50937 Cologne, Germany
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Eminaga O, Semjonow A, Breil B. MP65-02 DIAGNOSTIC CLASSIFICATION OF CYSTOSCOPIC IMAGES USING DEEP CONVOLUTIONAL NEURAL NETWORK. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2068] [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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Eminaga O, Li S, Baker LC, Brooks JD, Eisenberg ML. Male infertility is associated with altered treatment course of men with cancer. Andrology 2018; 6:408-413. [PMID: 29457365 DOI: 10.1111/andr.12472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 12/11/2017] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
This study aims to evaluate whether cancer treatments differ in infertile men compared to men who have undergone vasectomy and age-matched controls. We analyzed subjects from the Truven Health MarketScan Claims database from 2001 to 2009. Infertile men were identified through diagnosis and treatment codes. Comparison groups included vasectomized men and an age-matched cohort who were not infertile and had not undergone vasectomy. We considered cancer types previously associated with infertility that were diagnosed after the diagnosis of infertility. The treatment regimens were determined based on the presence of claims with CPT codes for chemotherapy (CTX), radiation (RTX) or surgical treatment (ST) for each entity in all study groups. Cases with multimodal treatments were also identified. As a result, CTX was similarly distributed among the infertile, vasectomized, and control groups. In contrast, RTX treatment length was shorter in infertile men. The frequency of multimodal treatment (i.e., radiation and chemotherapy) was twofold lower in men with infertility compared to other men. By focusing on treatment patterns for each cancer type among these groups, the duration of RTX and CTX was shorter in infertile men diagnosed with NHL compared to controls. We conclude that Infertile men diagnosed with cancer and specific cancer types experience different treatment courses, with shorter RTX and less combined RTX/CTX compared to fertile and vasectomized men. These differences could reflect differences in stage at presentation, biological behavior, or treatment responses in infertile men.
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Affiliation(s)
- O Eminaga
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - S Li
- Departments of Urology and Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - L C Baker
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - J D Brooks
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - M L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
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Eminaga O, Semjonow A, Oezguer E, Herden J, Akbarov I, Tok A, Engelmann U, Wille S. An Electronic Specimen Collection Protocol Schema (eSCPS). Methods Inf Med 2018; 53:29-38. [PMID: 24317441 DOI: 10.3414/me13-01-0035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 11/04/2013] [Indexed: 11/09/2022]
Abstract
SummaryBackground: The integrity of collection protocols in biobanking is essential for a high-quality sample preparation process. However, there is not currently a well-defined universal method for integrating collection protocols in the biobanking information system (BIMS). Therefore, an electronic schema of the collection protocol that is based on Extensible Markup Language (XML) is required to maintain the integrity and enable the exchange of collection protocols.Materials and Methods: The development and implementation of an electronic specimen collection protocol schema (eSCPS) was performed at two institutions (Muenster and Cologne) in three stages. First, we analyzed the infrastructure that was already established at both the biorepository and the hospital information systems of these institutions and determined the requirements for the sufficient preparation of specimens and documentation. Second, we designed an eSCPS according to these requirements. Fi -nally, a prospective study was conducted to implement and evaluate the novel schema in the current BIMS.Results: We designed an eSCPS that provides all of the relevant information about collection protocols. Ten electronic collection protocols were generated using the supplementary Protocol Editor tool, and these protocols were successfully implemented in the existing BIMS. Moreover, an electronic list of collection protocols for the current studies being performed at each institution was included, new collection protocols were added, and the existing protocols were redesigned to be modifiable. The documentation time was significantly reduced after implementing the eSCPS (5 ± 2 min vs. 7 ± 3 min; p = 0.0002).Conclusion: The eSCPS improves the integrity and facilitates the exchange of specimen collection protocols in the existing open-source BIMS.
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Affiliation(s)
- O Eminaga
- Okyaz Eminaga, M.D., Department of Urology/Prostate Center, University Hospital Cologne, Kerpener Street 62, 50937 Cologne, Germany, E-mail:
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25
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Gong X, Siprashvili Z, Eminaga O, Shen Z, Sato Y, Kume H, Homma Y, Ogawa S, Khavari PA, Pollack JR, Brooks JD. Novel lincRNA SLINKY is a prognostic biomarker in kidney cancer. Oncotarget 2017; 8:18657-18669. [PMID: 28423633 PMCID: PMC5386637 DOI: 10.18632/oncotarget.15703] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/24/2017] [Indexed: 01/01/2023] Open
Abstract
Clear cell renal cell carcinomas (ccRCC) show a broad range of clinical behavior, and prognostic biomarkers are needed to stratify patients for appropriate management. We sought to determine whether long intergenic non-coding RNAs (lincRNAs) might predict patient survival. Candidate prognostic lincRNAs were identified by mining The Cancer Genome Atlas (TCGA) transcriptome (RNA-seq) data on 466 ccRCC cases (randomized into discovery and validation sets) annotated for ~21,000 lncRNAs. A previously uncharacterized lincRNA, SLINKY (Survival-predictive LINcRNA in KidneY cancer), was the top-ranked prognostic lincRNA, and validated in an independent University of Tokyo cohort (P=0.004). In multivariable analysis, SLINKY expression predicted overall survival independent of tumor stage and grade [TCGA HR=3.5 (CI, 2.2-5.7), P < 0.001; Tokyo HR=8.4 (CI, 1.8-40.2), P = 0.007], and by decision tree, ROC and decision curve analysis, added independent prognostic value. In ccRCC cell lines, SLINKY knockdown reduced cancer cell proliferation (with cell-cycle G1 arrest) and induced transcriptome changes enriched for cell proliferation and survival processes. Notably, the genes affected by SLINKY knockdown in cell lines were themselves prognostic and correlated with SLINKY expression in the ccRCC patient samples. From a screen for binding partners, we identified direct binding of SLINKY to Heterogeneous Nuclear Ribonucleoprotein K (HNRNPK), whose knockdown recapitulated SLINKY knockdown phenotypes. Thus, SLINKY is a robust prognostic biomarker in ccRCC, where it functions possibly together with HNRNPK in cancer cell proliferation.
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Affiliation(s)
- Xue Gong
- Department of Urology, School of Medicine, Stanford University, Stanford, California, USA.,Department of Pathology, School of Medicine, Stanford University, Stanford, California, USA
| | - Zurab Siprashvili
- Program in Epithelial Biology, School of Medicine, Stanford University, Stanford, California, USA
| | - Okyaz Eminaga
- Department of Urology, School of Medicine, Stanford University, Stanford, California, USA.,Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Zhewei Shen
- Department of Pathology, School of Medicine, Stanford University, Stanford, California, USA
| | - Yusuke Sato
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Paul A Khavari
- Program in Epithelial Biology, School of Medicine, Stanford University, Stanford, California, USA
| | - Jonathan R Pollack
- Department of Pathology, School of Medicine, Stanford University, Stanford, California, USA
| | - James D Brooks
- Department of Urology, School of Medicine, Stanford University, Stanford, California, USA
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Krabbe LM, Eminaga O, Shariat SF, Hutchinson RC, Lotan Y, Sagalowsky AI, Raman JD, Wood CG, Weizer AZ, Roscigno M, Montorsi F, Bolenz C, Novara G, Kikuchi E, Fajkovic H, Rapoport LM, Glybochko PV, Zigeuner R, Remzi M, Bensalah K, Kassouf W, Margulis V. Postoperative Nomogram for Relapse-Free Survival in Patients with High Grade Upper Tract Urothelial Carcinoma. J Urol 2017; 197:580-589. [DOI: 10.1016/j.juro.2016.09.078] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Laura-Maria Krabbe
- Department of Urology, University of Muenster Medical Center, Muenster, Germany
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | - Okyaz Eminaga
- Department of Urology, University Hospital of Cologne, Cologne, Germany
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Shahrokh F. Shariat
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | | | - Yair Lotan
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | | | - Jay D. Raman
- Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Christopher G. Wood
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alon Z. Weizer
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Marco Roscigno
- Department of Urology, AO Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Montorsi
- Department of Urology, Vita Salute University, San Raffaele, Milan, Italy
| | | | - Giacomo Novara
- Department of Surgery, Oncology and Gastroenterology – Urologic Clinic, University of Padua, Padua, Italy
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Harun Fajkovic
- Department of Urology, General Hospital of St. Poelten, St. Poelten, Austria
| | - Leonid M. Rapoport
- Department of Uronephrology and Reproductive Health, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Peter V. Glybochko
- Department of Uronephrology and Reproductive Health, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Richard Zigeuner
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Mesut Remzi
- Department of Urology, Landesklinikum Korneuburg, Korneuburg, Austria
| | - Karim Bensalah
- Department of Urology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Wassim Kassouf
- Department of Urology, McGill University Health Center, Montreal, Quebec, Canada
| | - Vitaly Margulis
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
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27
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Tolkach Y, Eminaga O, Wötzel F, Huss S, Bettendorf O, Eltze E, Abbas M, Imkamp F, Semjonow A. Blind Biobanking of the Prostatectomy Specimen: Critical Evaluation of the Existing Techniques and Development of the New 4-Level Tissue Extraction Model With High Sampling Efficacy. Prostate 2017; 77:396-405. [PMID: 27862105 DOI: 10.1002/pros.23278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/01/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Fresh tissue is mandatory to perform high-quality translation studies. Several models for tissue extraction from prostatectomy specimens without guidance by frozen sections are already introduced. However, little is known about the sampling efficacy of these models, which should provide representative tissue in adequate volumes, account for multifocality and heterogeneity of tumor, not violate the routine final pathological examination, and perform quickly without frozen section-based histological control. The aim of the study was to evaluate the sampling efficacy of the existing tissue extraction models without guidance by frozen sections ("blind") and to develop an optimized model for tissue extraction. METHODS Five hundred thirty-three electronic maps of the tumor distribution in prostates from a single-center cohort of the patients subjected to radical prostatectomy were used for analysis. Six available models were evaluated in silico for their sampling efficacy. Additionally, a novel model achieving the best sampling efficacy was developed. RESULTS The available models showed high efficacies for sampling "any part" from the tumor (up to 100%), but were uniformly low in efficacy to sample all tumor foci from the specimens (with the best technique sampling only 51.6% of the all tumor foci). The novel 4-level extraction model achieved a sampling efficacy of 93.1% for all tumor foci. CONCLUSIONS The existing "blind" tissue extraction models from prostatectomy specimens without frozen sections control are suitable to target tumor tissues but these tissues do not represent the whole tumor. The novel 4-level model provides the highest sampling efficacy and a promising potential for integration into routine. Prostate 77: 396-405, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Yuri Tolkach
- Institute of Pathology, University Hospital of Bonn, Bonn, Germany
| | - Okyaz Eminaga
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - Fabian Wötzel
- Gerhard-Domagk Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Sebastian Huss
- Gerhard-Domagk Institute of Pathology, University Hospital Münster, Münster, Germany
| | | | - Elke Eltze
- Institute of Pathology, Saarbrücken, Germany
| | - Mahmoud Abbas
- Hannover Medical School, Institute of Pathology, Hannover, Germany
| | - Florian Imkamp
- Hannover Medical School, Institute of Pathology, Hannover, Germany
| | - Axel Semjonow
- Prostate Center, University Hospital Münster, Münster, Germany
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Eminaga O, Fries J, Woetzel F, Alakus H, Warnecke-Eberz U, Heidenreich A. MP66-12 THE EXPRESSION PROFILES OF MIR-210, MIR-375, MIR-378, MIR-345, MIR-143 MIR-183 AND MIR-98 IN THE PROGRESSION OF PROSTATE CANCER FROM HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA TO METASTATIC DISEASES. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1286] [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: 11/16/2022]
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Mikah P, Krabbe LM, Eminaga O, Herrmann E, Papavassilis P, Hinkelammert R, Semjonow A, Schrader AJ, Boegemann M. Dynamic changes of alkaline phosphatase are strongly associated with PSA-decline and predict best clinical benefit earlier than PSA-changes under therapy with abiraterone acetate in bone metastatic castration resistant prostate cancer. BMC Cancer 2016; 16:214. [PMID: 26975660 PMCID: PMC4790058 DOI: 10.1186/s12885-016-2260-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 03/08/2016] [Indexed: 01/23/2023] Open
Abstract
Background Significant progress in treatment of metastatic castration resistant prostate cancer (mCRPC) has been made. Biomarkers to tailor therapy are scarce. To facilitate decision-making we evaluated dynamic changes of alkaline phosphatase (ALP), lactate dehydrogenase (LDH) and prostate specific antigen (PSA) under therapy with Abiraterone. Methods Men with bone mCRPC (bmCRPC) on Abiraterone 12/2009-01/2014 were analyzed. Dynamic ALP-, LDH- and PSA-changes were analyzed as predictors of best clinical benefit and overall survival (OS) with logistic-regression, Cox-regression and Kaplan-Meier-analysis. Results Thirty-nine pre- and 45 post-chemotherapy patients with a median follow up of 14.0 months were analyzed. ALP-Bouncing can be observed very early during therapy with Abiraterone. ALP-Bouncing is defined as rapidly rising ALP-levels independent of baseline ALP during the first 2–4 weeks of Abiraterone-therapy with subsequent equally marked decline to pretreatment levels or better within 8 weeks of therapy, preceding potentially delayed PSA-decline. In univariate analysis failure of PSA-reduction ≥50 % and failure of ALP-Bouncing were the strongest predictors of progressive disease (p = 0.003 and 0.021). Rising ALP at 12 weeks, no PSA-reduction ≥50 % and no ALP-Bouncing were strongest predictors of poor OS, (all p < 0.001). Kaplan-Meier-analysis showed worse OS for rising ALP at 12 weeks, no PSA-reduction ≥50 % and no ALP-Bouncing (p < 0.001). In subgroup-analysis of oligosymptomatic patients all parameters remained significant predictors of poor OS, with no PSA-reduction ≥50 % and rising ALP at 12 weeks being the strongest (p < 0.001). In multivariate analysis PSA-reduction ≥50 % remained an independent predictor of OS for the whole cohort and for the oligosymptomatic subgroup (both p = 0.014). No patient with ALP-Bouncing had PD for best clinical benefit. Patients with rising ALP at 12 weeks had no further benefit of Abiraterone. Conclusions Dynamic changes of ALP, LDH and PSA during Abiraterone-therapy are associated with best clinical benefit and OS in bmCRPC. ALP-Bouncing occurring earlier than PSA-changes as well as prior to equivocal imaging results and rising ALP at 12 weeks under Abiraterone may help to decide whether to discontinue Abiraterone. An external validation of these findings on a prospective cohort is planned. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2260-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Phillip Mikah
- Department of Urology, Muenster University Medical Center, Albert-Schweitzer-Campus 1, GB A1, D-48149, Muenster, Germany
| | - Laura-Maria Krabbe
- Department of Urology, Muenster University Medical Center, Albert-Schweitzer-Campus 1, GB A1, D-48149, Muenster, Germany
| | - Okyaz Eminaga
- Department of Urology, Cologne University Medical Center, Kerpener Strasse 62, GB Nr. 9, D-50937, Cologne, Germany
| | - Edwin Herrmann
- Department of Urology, Muenster University Medical Center, Albert-Schweitzer-Campus 1, GB A1, D-48149, Muenster, Germany
| | - Philipp Papavassilis
- Department of Urology, Muenster University Medical Center, Albert-Schweitzer-Campus 1, GB A1, D-48149, Muenster, Germany
| | - Reemt Hinkelammert
- Department of Urology, Muenster University Medical Center, Albert-Schweitzer-Campus 1, GB A1, D-48149, Muenster, Germany
| | - Axel Semjonow
- Department of Urology, Muenster University Medical Center, Albert-Schweitzer-Campus 1, GB A1, D-48149, Muenster, Germany
| | - Andres-Jan Schrader
- Department of Urology, Muenster University Medical Center, Albert-Schweitzer-Campus 1, GB A1, D-48149, Muenster, Germany
| | - Martin Boegemann
- Department of Urology, Muenster University Medical Center, Albert-Schweitzer-Campus 1, GB A1, D-48149, Muenster, Germany.
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Eminaga O, Alhamad O, Engelmann U, Wille S, Heidenreich A. Inclusion of corrected calcium and creatinine levels in a novel nomogram for prediction of pathologically localized prostate cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
140 Background: The role of routine parameters in the prediction of organ-confined Prostate Cancer (oPCa) remains unclear. Methods: We conducted a retrospective study of 246 patients with PCa diagnosed on biopsy, who underwent radical prostatectomy with extended lymph node dissection. None of these patients received a neoadjuvant therapy. Gleason score (xGLS), percent of positive cores involved by PCa (pCores), results of transrectal evaluation (TRUS, DRE), prostate volume (PVol), albumin-corrected Calcium (Ca), Hemoglobin (Hb), Creatinine (Crea), PSA, and age at RPE were considered. Postoperative variables including Gleason score (pGLS), TNM stages were evaluated. These patients were divided according to disease advancement into pathologically localized (pT2) and advanced PCa (pT3/4 or pN1). A L2 penalized regression model including all preoperative parameters was evaluated to design a nomogram for oPCa prediction. Furthermore, the internal validation of the nomogram was performed using bootstrapping and cross-validations. The precision and accuracy of the novel nomogram were evaluated by using AUC, F-Score, Brier-Score and the classification accuracy (CA). Results: The lowest probability for pathologically localized PCa was found in patients having the following features: PSA > 20 ng/ml, detection of PCa in all cores, high Ca [1.21 fold over upper normal limit (ULN)] and Crea levels (2.27 fold over ULN), xGls > 7 and normal PVol. A nomogram for oPCa was developed including the following parameter: Crea, Ca, PSA, xGls, PVol, TRUS, pCores. The sensitivity and the specificity of the nomogram for prediction of pathologically localized PCa were 92.2% and 35.9%, respectively. AUC of 0.811, CA of 80.1%, F-Score 0.879, a precision of 84.0%. and Brier-Score of 0.2599 were calculated. The predicted probability of the novel nomogram was associated with higher accuracy for prediction of oPCa compared to those of Partin table and Kattan nomogram. Conclusions: Serum creatinine and corrected calcium are indpendent predictors of oPCa. The novel nomogram can predict oPCa with high precision and accuracy. However, an external validation of the novel nomogram is needed.
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Affiliation(s)
- Okyaz Eminaga
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Omran Alhamad
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Udo Engelmann
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Sebastian Wille
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
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Eminaga O, Fries J, Woetzel F, Neiss S, Warnecke-Eberz U, Heitmann M, Heidenreich A. The expression profiles of miRNAs in the progression of prostate cancer from high-grade prostatic intraepithelial neoplasia to metastatic diseases. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
221 Background: The epigenetic regulation by miRNA plays an important role in tumor progression of prostate cancer (PCa). Methods: The expression data of 1054 miRNAs from TCGA were applied to identify relevant miRNAs associated with tumor progression (i.e. miR-210, miR-375, miR-378, miR-345, miR-143 miR-183 and miR-98). miRNA were isolated by miRNeasy FFPE kit (Qiagen, Hilden, Germany) from paraffin-embedded tissues of prostate specimens with PCa, HGPIN and normal tissues. Early-stage PCa was defined as PCa with pT2 tumor stage, Gleason score < = 7a (3+4) and PSA level < 10 ng/ml. PCa with pT3/4 or Gleason > 7a was defined as advanced PCa. PCa with pN1 were considered as metastatic diseases. Additionally, 3 cases with castration-resistant prostate cancer (CRPC) were considered. Quantitative miRNA expression data were acquired and analyzed using a real-time TaqMan-based PCR. ANOVA analyses were performed to evaluate the expression of miRNAs between HGPIN, Normal and PCa tissues. The small nuclear U6 RNA was used as an endogenous control Results: ANOVA analysis revealed a significant variation in expression of all miRNAs among groups. The expression level of miR-183 and miR-375 increased with the tumor progression. miR-143, miR-375-3p were inversely correlated with the tumor progression. miR-210 and miR-183 were significantly overexpressed in metastatic diseases compared to non-metastatic diseases (FDR < 0.01), whereas the expression level of miR-378-3p was lower in metastatic diseases than in organ-confined PCa. The expression of miR-98 was lower in PCa compared to normal tissues. In silico analysis, the down-regulation of miR-98 and miR-345-5p seems to activate the HIF-1 signaling pathway initiating the up-regulation of miR-210 that interact with genes related to cell cycle, RNA transcription, homologous recombination and non-homologous end-joining. Conclusions: Our data reveal epigenetic regulations of miRNA, which are associated with transition from normal tissues to HGIPN, from HGPIN to early-stage PCa, and early-stage PCa to advanced PCa. Advanced PCa represents the first stage of metastatic diseases.
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Affiliation(s)
- Okyaz Eminaga
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Jochen Fries
- Institute of pathology, University Hospital Cologne, Cologne, Germany
| | - Fabian Woetzel
- Gerhard-Domagk Institute for Pathology, University Hospital Muenster, Muenster, Germany
| | - Susanne Neiss
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Ute Warnecke-Eberz
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Michaela Heitmann
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
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Schlack K, Krabbe LM, Eminaga O, Semjonow A, Boegemann M. The role of fPSA, [-2]proPSA and the Prostate Health Index for the early prediction of outcome in patients with metastatic castration resistant prostate cancer on therapy with abirateroneacetate. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
241 Background: Abiraterone acetate (AA) prolongs overall survival (OS) in pre- and post-chemotherapy setting in patients with metastatic castration resistant prostate cancer (mCRPC). Biomarkers to predict response to therapy are limited. Prostate-specific antigen (PSA) and lactate dehydrogenase (LDH) are commonly used as response-indicators but are often misleading during early therapy. Assays for circulating tumor cells, which can be surrogate for poor survival, are not routinely available at most places. In this retrospective study we evaluated the role of the PSA-derivatives free PSA (fPSA), [-2]proPSA (p2PSA) and the prostate health index (PHI) in addition to PSA as indicators of response during early AA-therapy. Methods: Twenty-five men with mCRPC receiving AA between March 2012 and July 2015 at the University Hospital of Muenster were included and analyzed. The PSA response rate (RR) was monitored according to PCWG2-criteria. Dynamic PSA-, fPSA-, p2PSA- and PHI-changes at 8-12 weeks under therapy were analyzed as predictors of progression free survival (PFS) and OS using Kaplan-Meier-analysis (KMA) and uni- and multivariate cox-regression analysis (UVA and MVA). Results: Twenty men were chemotherapy naïve, 5 pretreated with docetaxel. The PSA RR was 44%. In patients with < or ≥ 12 months of PFS the relative change of median PSA and fPSA at 8-12 weeks compared to baseline differed significantly (p = 0.022 and 0.030). For men with ≤ or > 15 months of OS there was a trend for a difference in relative change of median fPSA (p = 0.058). In KMA declining fPSA at 8-12 weeks was associated with a median OS of 32 months compared to 21 months in men with rising fPSA. In UVA rising PSA and fPSA were non-significant predictors of poor OS (Hazard ratio (HR) = 1.3 and 2.5 (p = 0.717 and 0.159)). In MVA PSA and fPSA were independent predictors of poor survival (HR 6.7 and 12.8 (p = 0.050 and 0.012)). Conclusions: fPSA is easily available and cheap. When added to PSA information, change of fPSA at 8-12 weeks of AA therapy may be a promising therapy control marker to help physicians to make decisions weather to stop or to continue AA therapy in men with mCRPC.
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Affiliation(s)
- Katrin Schlack
- University of Muenster Medical Center, Department of Urology, Muenster, Germany
| | | | - Okyaz Eminaga
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Axel Semjonow
- Prostate Center, Department of Urology, University Hospital Muenster, Muenster, Germany
| | - Martin Boegemann
- Department of Urology, University of Muenster, Muenster, Germany
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Eminaga O, Fries J, Woetzel F, Warnecke-Eberz U, Neiss S, Heitmann M, Herden J, Engelmann U, Heidenreich A. Enhanced overexpression of hypoxia-related miRNA-210 in primary tumor of metastatic prostate cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
166 Background: miR-210 is a known transcriptional target of the hypoxia-responsive HIF-1α signaling pathway. However, the association between the expression of miR-210 and the tumor progression in prostate cancer (PCa) remains unclear. Methods: We isolated miRNA by miRNeasy FFPE kit (Qiagen, Hilden, Germany) from paraffin-embedded tissues of 87 prostate specimens with adenocarcinoma of the prostate cancer in different tumor stages, with high-grade prostatic intraepithelial neoplasia (HGPIN) and normal tissues. Organ-confined PCa was defined as PCa with pT2 tumor stage, Gleason score ≤ 7a and PSA level < 10 ng/ml. PCa with pT3/4 or Gleason > 7a was defined as advanced PCa. PCa with pN1 were considered as metastatic diseases. Additionally, 3 cases with castration-resistant prostate cancer (CRPC) were considered. Quantitative miR-210 expression data were acquired and analyzed using a real-time TaqMan-based PCR with the ABI Prism 7900HT (Life Technologies, Darmstadt, Germany). ANOVA and post hoc analysis according to Turkey were performed using SPSS 22 (IBM, Armonk, USA). For silico analysis, Diana tools were applied to determine target genes of miR-210 and related functions and pathways. All the statistical tests were two-sided, and the level of statistical significance was set at P < 0.05. The small nuclear U6 RNA was used as an endogenous control. Results: ANOVA revealed significant differences in expression levels of miR-210 according to the tumor progression. Interestingly, organ-confined PCa showed the lowest expression level of miR-210 in our analysis. No sig. differences in miR-210 expression between normal tissues, HGPIN and organ-confined PCa and between advanced PCa, metastatic diseases and CRPC were observed. However, miR-210 expression was significantly higher in metastatic diseases and CRPC in comparison to organ-confined PCa. The silico analysis showed that genes regulated by miR-210 were associated with homologous recombination, non-homologous end-joining, the cell cycle regulation and synthesis of DNA. Conclusions: We observed an enhanced overexpression of hypoxia-related miRNA-210 in primary tumor of metastatic prostate cancer and CRPC in comparison to organ-confined PCa.
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Affiliation(s)
- Okyaz Eminaga
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Jochen Fries
- Institute of pathology, University Hospital Cologne, Cologne, Germany
| | - Fabian Woetzel
- Gerhard-Domagk Institute for Pathology, University Hospital Muenster, Muenster, Germany
| | - Ute Warnecke-Eberz
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Susanne Neiss
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Michaela Heitmann
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Jan Herden
- Department for Urology, University Hospital Cologne, Cologne, Germany
| | - Udo Engelmann
- Department of Urology, University Hospital Cologne, Cologne, Germany
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Eminaga O, Woetzel F, Fries J, Neiss S, Heitmann M, Engelmann U, Heidenreich A, Warnecke-Eberz U. miRNA expression profiles in high-grade prostatic intraepithelial neoplasia. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
45 Background: High-grade prostatic intraepithelial neoplasia (HGPIN) is widely believed to be a precursor of prostate cancer (PCa). However, little is known about the expression of miRNAs variations in HGPIN compared to normal tissues and PCa. Methods: The expression data of 1054 miRNAs from TCGA were applied to identify relevant miRNAs associated with tumor progression (i.e., miR-98-5p, miR-183-5p, 345-5p, miR-143 miR-210-3p and miR-378-3p). miRNA were isolated by miRNeasy FFPE kit (Qiagen, Hilden, Germany) from paraffin-embedded tissues (FFPE) of prostate specimens with PCa, HGPIN and normal tissues. Early-stage PCa was defined as PCa with pT2 tumor stage, Gleason score <=7a (3+4) and PSA level <10 ng/ml. Quantitative miRNA expression data were acquired and analyzed using a real-time TaqMan-based PCR with the ABI Prism 7900HT (Life Technologies, Darmstadt, Germany). ANOVA analysis were performed to evaluate the expression of miRNAs between HGPIN, Normal and PCa tissues. All statistical analysis was performed using SPSS (IBM, Armonk, USA). P values were adjusted using the false discovery rate for multiple comparisons. The small nuclear U6 RNA was used as an endogenous control. Results: The expression of miR-143-3p, miR-210-3p and miR-345-5p and miR-98-5-p were varied between normal tissue, HGPIN and early-stage PCa. Interestingly, decrease in expression of miR-143.-3p, miR-98-5p and miR-210-3p was associated with tumor development (Normal tissues > HGPIN > early-stage PCa) (FDR<0.001). Furthermore, overexpression of miR-345-5p was observed in normal tissues compared to HGPIN and early-stage PCa, which both showed similar expression level of miR-345-5p. No significant differences in expression of miR-375, miR-183-5p and miR-378-3p were observed between HGPIN and PCa. These miRNAs were interacted with genes related to HIF-1 signaling pathway, p53 signaling pathway, androgen receptor signaling pathway, intrinsic apoptotic signaling pathway, RNA transcription, homologous recombination and non-homologous end-joining. Conclusions: HGPIN shows an altered expression of miRNAs interact with genes related to hypoxia, androgen receptor signaling pathway, cell cycle and epigenetic regulation.
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Affiliation(s)
- Okyaz Eminaga
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Fabian Woetzel
- Gerhard-Domagk Institute for Pathology, University Hospital Muenster, Muenster, Germany
| | - Jochen Fries
- Institute of pathology, University Hospital Cologne, Cologne, Germany
| | - Susanne Neiss
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Michaela Heitmann
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Udo Engelmann
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Ute Warnecke-Eberz
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
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Eminaga O, Semjonow A, Eltze E, Bettendorf O, Schultheis A, Warnecke-Eberz U, Akbarov I, Wille S, Engelmann U. Analysis of topographical distribution of prostate cancer and related pathological findings in prostatectomy specimens using cMDX document architecture. J Biomed Inform 2015; 59:240-7. [PMID: 26707451 DOI: 10.1016/j.jbi.2015.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 12/10/2015] [Accepted: 12/13/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Understanding the topographical distribution of prostate cancer (PCa) foci is necessary to optimize the biopsy strategy. This study was done to develop a technical approach that facilitates the analysis of the topographical distribution of PCa foci and related pathological findings (i.e., Gleason score and foci dimensions) in prostatectomy specimens. MATERIAL & METHODS The topographical distribution of PCa foci and related pathologic evaluations were documented using the cMDX documentation system. The project was performed in three steps. First, we analyzed the document architecture of cMDX, including textual and graphical information. Second, we developed a data model supporting the topographic analysis of PCa foci and related pathologic parameters. Finally, we retrospectively evaluated the analysis model in 168 consecutive prostatectomy specimens of men diagnosed with PCa who underwent total prostate removal. The distribution of PCa foci were analyzed and visualized in a heat map. The color depth of the heat map was reduced to 6 colors representing the PCa foci frequencies, using an image posterization effect. We randomly defined 9 regions in which the frequency of PCa foci and related pathologic findings were estimated. RESULTS Evaluation of the spatial distribution of tumor foci according to Gleason score was enabled by using a filter function for the score, as defined by the user. PCa foci with Gleason score (Gls) 6 were identified in 67.3% of the patients, of which 55 (48.2%) also had PCa foci with Gls between 7 and 10. Of 1173 PCa foci, 557 had Gls 6, whereas 616 PCa foci had Gls>6. PCa foci with Gls 6 were mostly concentrated in the posterior part of the peripheral zone of the prostate, whereas PCa foci with Gls>6 extended toward the basal and anterior parts of the prostate. The mean size of PCa foci with Gls 6 was significantly lower than that of PCa with Gls>6 (P<0.0001). CONCLUSION The cMDX-based technical approach facilitates analysis of the topographical distribution of PCa foci and related pathologic findings in prostatectomy specimens.
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Affiliation(s)
- Okyaz Eminaga
- Dept. of Urology, University Hospital of Cologne, Kerpener Straße 62, D-50937 Cologne, Germany.
| | - Axel Semjonow
- Prostate Center, Dept. of Urology, University Hospital Muenster, Albert-Schweitzer-Campus 1, D-48149 Muenster, Germany
| | - Elke Eltze
- Institute for Pathology Saarbrücken-Rastpfuhl, Rheinstrasse 2, D-66113 Saarbrücken, Germany
| | - Olaf Bettendorf
- Institute of Pathology and Cytology, Technikerstrasse 14, D-48465 Schüttorf, Germany
| | - Anne Schultheis
- Institute for Pathology, University Hospital of Cologne, Kerpener Straße 62, D-50937 Cologne, Germany
| | - Ute Warnecke-Eberz
- Department for Visceral Surgery, University Hospital Cologne, Kerpener Straße 62, D-50937 Cologne, Germany
| | - Ilgar Akbarov
- Dept. of Urology, University Hospital of Cologne, Kerpener Straße 62, D-50937 Cologne, Germany
| | - Sebastian Wille
- Dept. of Urology, University Hospital of Cologne, Kerpener Straße 62, D-50937 Cologne, Germany
| | - Udo Engelmann
- Dept. of Urology, University Hospital of Cologne, Kerpener Straße 62, D-50937 Cologne, Germany
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Tok A, Eminaga O, Burghaus L, Herden J, Akbarov I, Engelmann U, Wille S. Age-stratified cut-off points for the nocturnal penile tumescence measurement using Nocturnal Electrobioimpedance Volumetric Assessment (NEVA(®) ) in sexually active healthy men. Andrologia 2015; 48:631-6. [PMID: 26498135 DOI: 10.1111/and.12492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2015] [Indexed: 11/29/2022] Open
Abstract
The current nocturnal penile tumescence (NPT) measurement is based on standard cut-off levels defined regardless of age. This study was conducted to provide age-stratified cut-off points for NPT measurement. Forty sexually active healthy men between 20 and 60 years old were enrolled and divided equally into four groups defined by age (20-29, 30-39, 40-49 and 50-60 years.). None of the candidates had sexual dysfunction or sleep disturbance or used supportive medication to enhance sexual function. Erectile function was evaluated by using the 5-item version of the international index of erectile function (IIEF-5). NPT was observed using the nocturnal electrobioimpedance volumetric assessment (NEVA(®) ). The NPT values of healthy men aged 20-60 years varied from 268.7% to 202.3%. The NPT differed significantly between age groups (P < 0.0009); however, no significant differences between men aged 30-39 and 40-49 (P = 0.593) were observed. Age was weakly associated with IIEF-5 scores (P = 0.004), whereas a strong and negative correlation between age and NPT (P < 0.0001) was found. IEF-5 scores were not significantly associated with NPT (P = 0.95). Therefore, the standard values for NPT testing should be considered in the evaluation of the nocturnal penile activity of men of all ages.
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Affiliation(s)
- A Tok
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - O Eminaga
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - L Burghaus
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - J Herden
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - I Akbarov
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - U Engelmann
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - S Wille
- Department of Urology, University Hospital of Cologne, Cologne, Germany
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Eminaga O, Akbarov I, Wille S, Engelmann U. Does postoperative radiation therapy impact survival in non-metastatic sarcomatoid renal cell carcinoma? A SEER-based study. Int Urol Nephrol 2015; 47:1653-63. [PMID: 26329746 DOI: 10.1007/s11255-015-1093-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 06/04/2015] [Accepted: 08/17/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The effect of adjuvant radiation therapy on survival in sarcomatoid renal cell carcinoma (sRCC) with no evidence of distant metastasis remains unclear. METHODS Subjects diagnosed with non-metastatic sRCC were identified using the Surveillance Epidemiology and End Results (SEER) (2004-2012) database and divided into groups based on their surgical treatment (ST): no surgery or radiation therapy (NSR); partial nephrectomy (PNE); radical nephrectomy with ureterectomy and bladder cuff resection (RNE + UE + BLAD); and radical nephrectomy (RNE). Certain radical nephrectomy cases also received adjuvant external-beam radiation therapy (RNE + RAD). The Kaplan-Meier method was used to estimate overall survival (OS). A multivariable competing risks regression analysis was used to calculate disease-specific survival (DSS) probability and to determine factors associated with cause-specific mortality (CSM). RESULTS A total of 408 patients were included in this study. The 5-year OS and predicted DSS were significantly higher in the patients who underwent STs (i.e., PNE, RNE + UE + BLAD, RNE, and RNE + RAD) (20.1-54.0 and 20.1-59.9 %, respectively) than in the NSR group (9.0 and 11.6 %, respectively) (P < 0.001). ST was independently associated with a decreased CSM (P < 0.0001). No significant differences in OS or the 1-, 3-, or 5-year DSS probabilities between the RNE and RNE + RAD groups were observed. RNE + RAD was not significantly associated with a decrease in 1-year CSM [subhazard ratio (SHR) 0.95; 95 % CI 0.23-3.96; P = 0.947]. CONCLUSIONS Adjuvant external-beam radiation therapy did not increase OS in non-metastatic sRCC patients.
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Affiliation(s)
- Okyaz Eminaga
- Department of Urology, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Ilgar Akbarov
- Department of Urology, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Sebastian Wille
- Department of Urology, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Udo Engelmann
- Department of Urology, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
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Eminaga O, Hinkelammert R, Abbas M, Wötzel F, Eltze E, Bettendorf O, Boegemann M, Semjonow A. Preoperative Serum Prostate-Specific Antigen Levels Vary According to the Topographical Distribution of Prostate Cancer in Prostatectomy Specimens. Urology 2015; 86:798-804. [PMID: 26255036 DOI: 10.1016/j.urology.2015.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/16/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate whether the spatial distribution of prostate cancer (PCa) influences the concentration of prostate-specific antigen (PSA). METHODS An observational prospective study was performed in 775 consecutive men with preoperative PSA levels ≤20 ng/mL who underwent radical prostatectomy for organ-confined PCa. We evaluated prostate specimens using a cMDX-based map model of the prostate and determined the prostate volume, number of cancer foci, relative tumor volume, Gleason score, zone of origin, localization, and pathologic stage after stratification according to PSA levels categorized into 3 groups: <4 ng/mL, 4-10 ng/mL, and 10.1-20 ng/mL. The distribution of 5254 PCa foci was analyzed after stratification according to PSA levels and visualized on heat maps. A logistic regression analysis was performed to assess the odds ratios of PSA levels for the presence of PCa in 16 regions. RESULTS PCa with PSA <4 ng/mL was predominantly localized to the apical part and the peripheral zone of the prostate. PCa with a PSA level 10.1-20 ng/mL (16.4% of cases) was observed more frequently in the anterior part and the base of the prostate than PCa with a PSA level <4 or 4-10 ng/mL (6% and 10%, respectively). CONCLUSION Preoperative PSA levels vary according to the spatial distribution of PCa in radical prostatectomy specimens. The probability of anterior PCa is increased with higher PSA serum levels. Regions of interest harboring the PCa can be defined according to preoperative PSA and prostate volume. These findings are useful to optimize the focal therapy or to adjust the radiation fields.
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Affiliation(s)
- Okyaz Eminaga
- Department of Urology, University Hospital of Cologne, Cologne, Germany; Prostate Center, Department of Urology, University Hospital Muenster, Muenster, Germany.
| | - Reemt Hinkelammert
- Prostate Center, Department of Urology, University Hospital Muenster, Muenster, Germany
| | - Mahmoud Abbas
- Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Fabian Wötzel
- Prostate Center, Gerhard-Domagk Institute for Pathology, University Hospital Muenster, Muenster, Germany
| | - Elke Eltze
- Institute for Pathology, Saarbrücken-Rastpfuhl, Saarbrücken, Germany
| | | | - Martin Boegemann
- Prostate Center, Department of Urology, University Hospital Muenster, Muenster, Germany
| | - Axel Semjonow
- Prostate Center, Department of Urology, University Hospital Muenster, Muenster, Germany
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Herden J, Eminaga O, Wille S, Weissbach L. Treatment of Incidental Prostate Cancer by Active Surveillance: Results of the HAROW Study. Urol Int 2015; 95:209-15. [DOI: 10.1159/000431024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/29/2015] [Indexed: 11/19/2022]
Abstract
Objective: To report on a cohort of patients with incidental prostate cancer (IPC) that was treated by an active surveillance (AS) protocol in the HAROW study. Materials and Methods: The HAROW study is an observational study on the management of localized prostate cancer in Germany. Treating urologists were reporting clinical parameters, information on therapy and clinical course of disease at 6-month intervals. Results: In total, 3,169 patients were enrolled. In 224 patients were found an IPC and 104 (46%) of them were put on an AS protocol. The mean follow-up was 26.5 months. Tumor progression was noted in 16 patients. In 11 patients, AS was replaced by a definite intervention. In univariate and multivariate analyses, only PSA density correlated with progression. Conclusion: This is the first prospective description of an IPC patient cohort on AS as part of an outcomes research study. AS was selected as a therapeutic strategy in nearly half of the patients (46%). Only a minor proportion (16%) displayed progression. Of the clinical parameters, only PSA density correlated with progression.
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Eminaga O, Hinkelammert R, Abbas M, Titze U, Eltze E, Bettendorf O, Wötzel F, Bögemann M, Semjonow A. Prostate cancers detected on repeat prostate biopsies show spatial distributions that differ from those detected on the initial biopsies. BJU Int 2015; 116:57-64. [DOI: 10.1111/bju.12691] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Okyaz Eminaga
- Department of Urology; University Hospital of Cologne; Cologne Germany
| | - Reemt Hinkelammert
- Prostate Center; Department of Urology; University Hospital Muenster; Muenster Germany
| | - Mahmoud Abbas
- Institute for Pathology; Hannover Medical School; Hannover Germany
| | - Ulf Titze
- Prostate Center; Gerhard-Domagk Institute for Pathology; University Hospital Muenster; Muenster Germany
| | - Elke Eltze
- Institute for Pathology Saarbrücken-Rastpfuhl; Saarbrücken Germany
| | | | - Fabian Wötzel
- Prostate Center; Gerhard-Domagk Institute for Pathology; University Hospital Muenster; Muenster Germany
| | - Martin Bögemann
- Prostate Center; Department of Urology; University Hospital Muenster; Muenster Germany
| | - Axel Semjonow
- Prostate Center; Department of Urology; University Hospital Muenster; Muenster Germany
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Krabbe LM, Eminaga O, Shariat S, Lotan Y, Sagalowsky A, Raman J, Wood C, Weizer A, Roscigno M, Montorsi F, Bolenz C, Remzi M, Bensalah K, Kassouf W, Margulis V. MP2-09 NOMOGRAM FOR PREDICTION OF RECURRENCE-FREE SURVIVAL IN PATIENTS WITH HIGH-GRADE UPPER TRACT UROTHELIAL CARCINOMA AFTER EXTIRPATIVE THERAPY. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.132] [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: 10/23/2022]
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Eminaga O, Hinkelammert R, Semjonow A. The impact of spatial distribution patterns of tumor foci on biochemical recurrence in prostate cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.7_suppl.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
130 Background: The influence of spatial distribution patterns of organ-confined Prostate Cancer (PCa) on the biochemical recurrence (BCR) remains unclear. Therefore, we conducted a study investigating the association between distribution patterns and BCR-free rate in organ-confined PCa. Methods: The anatomical distribution of PCa in 743 men with pT1-pT3N0 and without neoadjuvant therapy was analyzed to determine 20 groups with similar distribution patterns of PCa. Then, 245 men with pT2N0R0 were considered for prognostic evaluation. Spatial distribution patterns of PCa were evaluated using a cMDX-based map model of the prostate. A comparison analysis including 552,049 compare operations was performed to assist the similarity levels of the distribution patterns. K-mean cluster analysis was applied to determine 20 groups with similar distribution patterns. A decision tree-Analysis was performed to divide these groups according to BCR. BCR-free survival was compared. Predictors of progression were investigated using a Cox proportional hazards model. Results: BCR was occurred in 8.2% men with pT2N0R0 PCa. In decision tree analysis, certain PCa distribution patterns revealed no BCR at a median follow-up of 60 mo. (IQR: 42.3-77.0) In univariate and multivariate analysis, the prostate volume, the distribution patterns were an independent predictor for BCR in univariate and multivariate, whereas tumor stage, Gleason score, PSA, relative tumor volume were not. When patients with pT2R0 were stratified according to PCa distribution patterns, the presence of BCR-negative PCa distribution patterns was significantly associated with no risk of BCR by comparison to BCR-associated PCa distribution patterns (P=0.001). Conclusions: PCa distribution patterns provide a prognostic value for BCR. Distribution patterns of PCa can be applied to create more meaningfully predictive pathological T2 sub-divisions than current pT2 prostate cancer sub-stages.
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Affiliation(s)
- Okyaz Eminaga
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Reemt Hinkelammert
- Prostate Center, Department of Urology, University Hospital Muenster, Muenster, Germany
| | - Axel Semjonow
- Prostate Center, Department of Urology, University Hospital Muenster, Muenster, Germany
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Boegemann M, Mikah P, Eminaga O, Herrmann E, Papavassilis PM, Hinkelammert R, Semjonow A, Schrader AJ, Krabbe LM. Dynamic changes of alkaline phosphatase as surrogate for best clinical benefit and overall survival during very early abiraterone therapy compared to PSA-changes in bone metastatic castration resistant prostate cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.7_suppl.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
260 Background: Significant progress in treatment of metastatic castration resistant prostate cancer (mCRPC) has been made. Biomarkers to tailor therapy are scarce. To facilitate decision-making we evaluated dynamic changes of alkaline phosphatase (ALP), lactate dehydrogenase (LDH) and prostate specific antigen (PSA) under Abiraterone acetate (AA). ALP-Bouncing can be observed during very early AA-therapy. Methods: Men with bone mCRPC (bmCRPC) on AA 12/2009-01/2014 were analyzed. Dynamic ALP-, LDH- and PSA-changes were analyzed as predictors of best clinical benefit (BCB) and overall survival (OS) with logistic-regression, Cox-regression and Kaplan-Meier-analysis. Results: 39 pre- and 45 post-chemotherapy patients with median follow up of 14.0 months were analyzed. In univariate analysis failure of PSA-reduction ≥50% (PSA-red≥50%) and failure of ALP-Bouncing were the strongest predictors of progressive disease (p=0.003 and 0.021). Rising ALP at 12 weeks (ALP12), no PSA-red≥50% and no ALP-Bouncing were strongest predictors of poor OS, (all p<0.001). Kaplan-Meier-analysis showed worse OS for ALP12, no PSA-red≥50% and no ALP-Bouncing (p<0.001). In subgroup-analysis of oligosymptomatic patients all parameters remained significant predictors of poor OS, no PSA-red≥50% and ALP12 being the strongest (p<0.001). In multivariate analysis PSA-red≥50% remained independent predictor of OS for the whole cohort and for the oligosymptomatic subgroup (p=0.014). No patient with ALP-Bouncing had PD for BCB. Patients with ALP12 had no further benefit of AA. Conclusions: Dynamic changes of ALP, LDH and PSA during AA-therapy are associated with BCB and OS in bmCRPC. ALP-Bouncing occurring earlier than PSA-changes and rising ALP12 under AA may help to decide whether to discontinue AA.
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Affiliation(s)
- Martin Boegemann
- Department of Urology, University of Muenster, Muenster, Germany
| | - Phillip Mikah
- Department of Urology, University of Muenster, Muenster, Germany
| | - Okyaz Eminaga
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | | | | | - Reemt Hinkelammert
- Prostate Center, Department of Urology, University Hospital Muenster, Muenster, Germany
| | - Axel Semjonow
- Prostate Center, Department of Urology, University Hospital Muenster, Muenster, Germany
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Wille S, Tenholte D, Cornely OA, Muthen N, Engelmann UH, Mehner J, Eminaga O, Herden J, Schumacher P, Paas J. [Prediction of overactive bladder treatment outcome by using long-term urodynamics]. Urologe A 2014; 53:1812-4. [PMID: 25406371 DOI: 10.1007/s00120-014-3629-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In Germany, overactive bladder (OAB) syndrome affects around 6.5 million people over the age of 40. The primary treatment consists of anticholinergics or beta-3-receptor agonists. After an anticholinergic treatment period of around 4 months, compliance is around 40%, which is probably due a larger proportion of nonresponders. One condition of an efficient medication treatment is the presence of detrusor overactivity (DO). However, the detection rate of DO during standard urodynamics is very low. The primary goal in the future is to target OAB treatment by detection of DO. Using the Wille Capsule (WiCa) in an in vitro model, DO could be detected over a time period of 72 h, which would ensure a higher compliance to the OAB treatment in a positive way.
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Affiliation(s)
- S Wille
- Klinik und Poliklinik für Urologie, Uniklinik Köln, Kerpenerstr., 50931, Köln, Deutschland,
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Eminaga O, Bögemann M, Breil B, Titze U, Wötzel F, Eltze E, Bettendorf O, Semjonow A. Preoperative prostate-specific antigen isoform p2PSA ≤ 22.5 pg/ml predicts advanced prostate cancer in patients undergoing radical prostatectomy. Urol Oncol 2014; 32:1317-26. [PMID: 24893699 DOI: 10.1016/j.urolonc.2014.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 12/09/2013] [Revised: 04/18/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The prediction value of prostate-specific antigen (PSA) isoform [-2]proPSA (p2PSA) for detecting advanced prostate cancer (PCa) remains unclear. Our objective was to evaluate the additional clinical utility of p2PSA compared with total PSA (tPSA), free PSA (fPSA), and preoperative Gleason score (Gls) in predicting locally advanced PCa (pT3/T4) with high-accuracy discrimination. The aim was to develop a novel classification based on p2PSA and preoperative Gls for predicting advanced PCa. MATERIALS AND METHODS In 208 consecutive men diagnosed with clinically localized PCa who underwent radical prostatectomy, we determined the predictive and discriminatory accuracy of serum tPSA, fPSA, percentage of fPSA to tPSA, p2PSA, p2PSA density, percentage of p2PSA to fPSA, and the Prostate Health Index. The cutoff level of p2PSA with best accuracy was estimated. The novel classification was developed by analyzing the interaction between p2PSA and Gls in predicting pathologic outcomes using a chi-square automatic interaction detection analysis. Decision curve analysis was applied to test the clinical consequences of using the novel classification. RESULTS On univariate analyses, p2PSA, p2PSA density, percentage of p2PSA to fPSA, and Prostate Health Index were accurate but were not independent predictors by multivariate analysis. The p2PSA cutoff level of 22.5 pg/ml showed the best accuracy level for predicting and discriminating advanced diseases (area under the curve [AUC] = 0.725, sensitivity = 51.4%, specificity = 81.8%). By chi-square automatic interaction detection, univariate and multivariate analysis, a p2PSA level > 22.5 pg/ml was significantly associated with an increased frequency and risk of advanced disease. In patients with a p2PSA level ≤ 22.5 pg/ml, 91.8% of Gleason sum 6 PCa was organ confined. The combination of p2PSA and Gls enhanced slightly but significantly the predictive and discriminatory accuracy for advanced disease (0.6%-3.6%). CONCLUSIONS The p2PSA cutoff level of 22.5 pg/ml can accurately discriminate between organ-confined and advanced PCa. The additional use of p2PSA enhanced slightly the predictive accuracy for advanced PCa (pT3/pT4) and has limited additional predictive value in identifying aggressive PCa (Gls > 7a).
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Affiliation(s)
- Okyaz Eminaga
- Department of Urology, University Hospital of Cologne, Cologne, Germany.
| | - Martin Bögemann
- Prostate Center, Department of Urology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster, Germany
| | - Bernhard Breil
- Department of Medical Informatics, University Muenster, Muenster, Germany
| | - Ulf Titze
- Prostate Center, Gerhard-Domagk Institute for Pathology, University Hospital Muenster, Muenster, Germany
| | - Fabian Wötzel
- Prostate Center, Gerhard-Domagk Institute for Pathology, University Hospital Muenster, Muenster, Germany
| | - Elke Eltze
- Institute of Pathology, Saarbrücken-Rastpfuhl, Saarbrücken, Germany
| | | | - Axel Semjonow
- Prostate Center, Department of Urology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster, Germany
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Boegemann M, Mikah P, Eminaga O, Herrmann E, Papavassilis PM, Semjonow A, Krabbe LM. Indicators of clinical response to abiraterone acetate (AA) in men with metastatic castration-resistant-prostate-cancer (mCRPC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e16066] [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: 11/20/2022] Open
Affiliation(s)
- Martin Boegemann
- Department of Urology, University of Muenster, Muenster, Germany
| | - Phillip Mikah
- Department of Urology, University of Muenster, Muenster, Germany
| | - Okyaz Eminaga
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | | | | | - Axel Semjonow
- Prostate Center, Department of Urology, University Hospital Muenster, Muenster, Germany
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Wille S, Schumacher P, Paas J, Tenholte D, Eminaga O, Müller U, Muthen N, Mehner J, Cornely O, Engelmann U. Catheterless long-term ambulatory urodynamic measurement using a novel three-device system. PLoS One 2014; 9:e96280. [PMID: 24840482 PMCID: PMC4026131 DOI: 10.1371/journal.pone.0096280] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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] [Received: 09/17/2013] [Accepted: 04/04/2014] [Indexed: 11/25/2022] Open
Abstract
Aims Long-term urodynamics are required because bladder-emptying disorders are often not clearly revealed by conventional urodynamics. Patients with severe clinical overactive bladder symptoms, for instance, often show normal results. This may be due to the short evaluation time and psychological factors that complicate conventional urodynamics. This study aimed to develop an ambulatory three-component urodynamic measurement system that is easy to operate, registers urodynamic parameters for several days, and has no negative impact on the patient. Methods We developed an intravesical capsule combined with a hand-held device to register voiding desire and micturition, and an alarm pad device that detects urine loss. Recently, the intravesical capsule and its proven function were detailed in the literature. Here, we present detailed in vitro results using a female bladder model. The flexible capsule was C-shaped to minimize the risk of expulsion from the bladder during micturition. Results of biocompatibility evaluation of the intravesical capsule, which is called Wille Capsule (WiCa) are described. Results The WiCa with an oval nose and a maximum outer diameter of 5.5 mm was easily inserted through a 25-French cystoscope. Removing the WiCa by grasping the nose using the female model with bladder was easily conducted. Expulsion of the WiCa during voiding was avoided through a novel C-shaped device design. Based on in vitro cytotoxicity studies, the capsule is a promising and safe device. Conclusion Our novel system is an innovative minimally-invasive tool for accurate long-term urodynamic measurement, and does not require inserting a transurethral catheter.
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Affiliation(s)
- Sebastian Wille
- Department of Urology, University of Cologne, Cologne, Germany
- * E-mail:
| | | | - Jenny Paas
- Department of Urology, University of Cologne, Cologne, Germany
| | - Dirk Tenholte
- Chemnitz University of Technology, Faculty of Electrical Engineering and Information Technology, Chemnitz, Germany
| | - Okyaz Eminaga
- Department of Urology, University of Cologne, Cologne, Germany
| | - Ute Müller
- BMP Labor für medizinische Materialprüfung GmbH, Aachen, Germany
| | - Noemi Muthen
- ZKS Köln-Zentrum für Klinische Studien, Cologne, Germany
| | - Jan Mehner
- Chemnitz University of Technology, Faculty of Electrical Engineering and Information Technology, Chemnitz, Germany
| | - Oliver Cornely
- ZKS Köln-Zentrum für Klinische Studien, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Medical Faculty, University of Cologne, Cologne, Germany
| | - Udo Engelmann
- Department of Urology, University of Cologne, Cologne, Germany
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Eminaga O, Hinkelammert R, Titze U, Wötzel F, Bögemann M, Semjonow A. PD15-02 SPATIAL DISTRIBUTIONS OF PROSTATE CANCERS DETECTED ON REPEAT PROSTATE BIOPSIES. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1291] [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: 11/29/2022]
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Eminaga O, Hinkelammert R, Eltze E, Bettendorf O, Semjonow A. PI-03 LATE-BREAKING ABSTRACT: PREOPERATIVE SERUM PROSTATE SPECIFIC ANTIGEN LEVELS VARY ACCORDING TO TOPOGRAPHICAL DISTRIBUTION OF PROSTATE CANCER IN PROSTATECTOMY SPECIMENS. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2575] [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: 10/25/2022]
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Wille S, Katarzyna K, Ahrens U, Eminaga O, Engelmann U, Jenny P. Is there an urban-rural-gradient in patients with urinary incontinence? Can Urol Assoc J 2014; 8:E126-31. [PMID: 24678350 DOI: 10.5489/cuaj.1488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The objective of this study was to determine whether the responses to the same questionnaire differ between women living in a large city and women living in a rural area. METHODS We evaluated the medical records of 88 patients living in the large city of Cologne and of 86 patients living in Brühl and its surrounding rural regions. The responses on the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) of 88 patients who suffer from urinary incontinence and live in a large city were compared to the responses 86 patients who live the rural region of Brühl. In addition, ages, frequency of micturition, use of pads, prior and desired treatment were compared. Limitations of this study include its retrospective study design and the absence of sociodemographic data. Furthermore, the use of a pad test could objectify the extent of incontinence. RESULTS On average, patients from Cologne used of 6.2 pads and patients from Brühl used 3 pads. Patients from the large city scored 14 out of 21 points on the ICIQ-SF, and women from Brühl scored 11 out of 21 points. This difference was significant. Patients from Cologne had received medicinal treatment or physical therapy significantly more often. CONCLUSION The results suggest that urinary incontinence is perceived as a greater impairment by patients residing in (large) cities compared to patients residing in rural areas. An urban-rural gradient in patients with urinary incontinence can be described.
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Affiliation(s)
- Sebastian Wille
- Department of Urology, University Hospital of Cologne, Kerpener Straße. Cologne, Germany
| | - Kawa Katarzyna
- Department of Urology, University Hospital of Cologne, Kerpener Straße. Cologne, Germany
| | - Ulrike Ahrens
- Department of Urology, University Hospital of Cologne, Kerpener Straße. Cologne, Germany
| | - Okyaz Eminaga
- Department of Urology, University Hospital of Cologne, Kerpener Straße. Cologne, Germany
| | - Udo Engelmann
- Department of Urology, University Hospital of Cologne, Kerpener Straße. Cologne, Germany
| | - Paas Jenny
- Department of Urology, University Hospital of Cologne, Kerpener Straße. Cologne, Germany
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