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Uleri A, Baboudjian M, Gallioli A, Territo A, Gaya JM, Sanz I, Robalino J, Casadevall M, Diana P, Verri P, Basile G, Rodriguez-Faba O, Rosales A, Palou J, Breda A. A new machine-learning model to predict long-term renal function impairment after minimally invasive partial nephrectomy: the Fundació Puigvert predictive model. World J Urol 2023; 41:2985-2990. [PMID: 37714966 DOI: 10.1007/s00345-023-04593-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/22/2023] [Indexed: 09/17/2023] Open
Abstract
PURPOSE To provide a new model to predict long-term renal function impairment after partial nephrectomy (PN). METHODS Data of consecutive patients who underwent minimally invasive PN from 2005 to 2022 were analyzed. A minimum of 12 months of follow-up was required. We relied on a machine-learning algorithm, namely classification and regression tree (CART), to identify the predictors and associated clusters of chronic kidney disease (CKD) stage migration during follow-up. RESULTS 568 patients underwent minimally invasive PN at our center. A total of 381 patients met our inclusion criteria. The median follow-up was 69 (IQR 38-99) months. A total of 103 (27%) patients experienced CKD stage migration at last follow-up. Progression of CKD stage after surgery, ACCI and baseline CKD stage were selected as the most informative risk factors to predict CKD progression, leading to the creation of four clusters. The progression of CKD stage rates for cluster #1 (no progression of CKD stage after surgery, baseline CKD stage 1-2, ACCI 1-4), #2 (no progression of CKD stage after surgery, baseline CKD stage 1-2, ACCI ≥ 5), #3 (no progression of CKD stage after surgery and baseline CKD stage 3-4-5) and #4 (progression of CKD stage after surgery) were 6.9%, 28.2%, 37.1%, and 69.6%, respectively. The c-index of the model was 0.75. CONCLUSION We developed a new model to predict long-term renal function impairment after PN where the perioperative loss of renal function plays a pivotal role to predict lack of functional recovery. This model could help identify patients in whom functional follow-up should be intensified to minimize possible worsening factors of renal function.
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Affiliation(s)
- Alessandro Uleri
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain.
| | - Michael Baboudjian
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Josep Maria Gaya
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Isabel Sanz
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Jorge Robalino
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Marta Casadevall
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Pietro Diana
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Paolo Verri
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Giuseppe Basile
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Oscar Rodriguez-Faba
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Antonio Rosales
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
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Zakri RH, Hevia V, Bossier R, Rodriguez-Faba O, Garcia EL, Budde K, Breda A, Olsburgh J, Figueiredo A. Benefits and Harms of Benign Prostatic Obstruction Treatments in Renal Transplanted Patients. Eur Urol Focus 2023; 9:913-919. [PMID: 37596113 DOI: 10.1016/j.euf.2023.05.001] [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: 11/14/2022] [Revised: 03/07/2023] [Accepted: 05/09/2023] [Indexed: 08/20/2023]
Abstract
CONTEXT In an increasingly ageing transplant population, timely management of benign prostatic obstruction (BPO) is key to preventing complications that result in graft dysfunction or compromise survival. OBJECTIVE To evaluate benefits/harms of BPO treatments in transplant patients by reviewing current literature. EVIDENCE ACQUISITION A computerised bibliographic search of Medline, Embase, and Cochrane databases was performed for studies reporting outcomes on BPO treatments in transplanted patients. EVIDENCE SYNTHESIS A total of 5021 renal transplants (RTs) performed between 1990 and 2016 were evaluated. BPO incidence was 1.61 per 1000 population per year. Overall, 264 men underwent intervention. The mean age was 58.4 yr (27-73 yr). In all, 169 patients underwent surgery (n = 114 transurethral resection of the prostate [TURP]/n = 55 transurethral incision of the prostate [TUIP]) and 95 were treated with an un-named alpha-blocker (n = 46) or doxazosin (n = 49). There was no correlation between prostate volume and treatment modality (mean prostate size = 26 cc in the surgical group where reported and 48 cc in the medical group). The mean follow-up was 31.2 mo (2-192 mo). The time from RT to BPO treatment was reported in six studies (mean: 15.4 mo, range: 0-156 mo). The time on dialysis before RT was recorded in only three studies (mean: 47.3 mo, range: 0-288 mo). There was a mean improvement in creatinine after intervention from 2.17 to 1.77 mg/dl. A total of 157 men showed an improvement in the International Prostate Symptom Score (from 18.26 to 6.89), and there was a significant reduction in postvoid residual volume in 199 (mean fall 90.6 ml). Flow improved by a mean of 10 ml/s following intervention in 199 patients. Complications included acute urinary retention (4.1%), urinary tract infections (8.4%), bladder neck contracture (2.2%), and urethral strictures (6.9%). The mean reoperation rate was 1.4%. CONCLUSIONS Current literature is heterogeneous and of low-level evidence. Despite this, alpha-blockers, TUIP, and TURP showed a beneficial increase in the peak urinary flow and reduced symptoms in transplants patients with BPO. Improvement in the mean graft creatinine was noted after intervention. Complications were under-reported. A multicentre comparative cohort study is needed to draw firm conclusions about the ideal treatment for BPO in RT patients. PATIENT SUMMARY In this report, we looked at the outcomes for transplant patients undergoing medical or surgical management of benign prostatic obstruction. Although the literature was very heterogeneous, we found that medical management and surgery with transurethral resection/incision of the prostate are beneficial for improving urinary flow and bothersome symptoms. We conclude that further prospective studies are required for better clarity about timing and modality of intervention in transplant patients.
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Affiliation(s)
- Rhana Hassan Zakri
- Department of Transplantation, Renal & Urology, Guy's and St Thomas' Hospital, London, UK.
| | - Vital Hevia
- Urology Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain
| | - Romain Bossier
- Aix-Marseille University, Marseille, France; Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance-Publique, Marseille, France
| | - Oscar Rodriguez-Faba
- Department of Urology, Fundacion Puigvert, University Autonoma of Barcelona, Barcelona, Spain
| | - Enrique Lledo Garcia
- Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Klemens Budde
- Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Alberto Breda
- Department of Urology, Fundacion Puigvert, University Autonoma of Barcelona, Barcelona, Spain
| | - Jonathon Olsburgh
- Department of Transplantation, Renal & Urology, Guy's and St Thomas' Hospital, London, UK
| | - Arnaldo Figueiredo
- Department of Urology and Renal Transplantation, Coimbra University Hospital, Coimbra, Portugal
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Baboudjian M, Territo A, Gallioli A, Verri P, Aumatell J, Izquierdo P, Uleri A, Tedde A, Basile G, Gaya JM, Huguet J, Rodriguez-Faba O, Sanguedolce F, Algaba F, Palou J, Breda A. Long-Term Oncologic Outcomes of Endoscopic Management of High-Risk Upper Tract Urothelial Carcinoma: The Fundació Puigvert's Experience. J Endourol 2023; 37:973-977. [PMID: 37310884 DOI: 10.1089/end.2023.0092] [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] [Indexed: 06/15/2023] Open
Abstract
Objectives: Many patients with upper tract urothelial carcinoma (UTUC) outside of the low-risk criteria may possess low absolute risks of distant progression. Herein, we hypothesized that careful selection of high-risk patients undergoing an endoscopic approach could result in acceptable oncologic outcomes. Materials and Methods: Patients with high-risk UTUC managed endoscopically between 2015 and 2021 were retrospectively identified from a prospectively maintained single academic institution database. Elective and imperative indications for endoscopic treatment were considered. Regarding elective indications, the decision to perform endoscopic treatment was systematically proposed to high-risk patients in whom macroscopically complete ablation was deemed feasible, excluding invasive appearance on CT scan, and without histologic variant. Results: A total of 60 patients with high-risk UTUC met our inclusion criteria (29 imperative and 31 elective indications). The median follow-up in patients without any event was 36 months. At 5 years, the estimated overall survival, cancer-specific survival, metastasis-free survival, UTUC recurrence-free survival, radical nephroureterectomy-free survival, and bladder recurrence-free survival were 57% (41-79), 75% (57-99), 86% (71-100), 56% (40-76), 81% (70-93), and 69% (54-88), respectively. All oncologic outcomes were similar between patients with elective and imperative indications (all log-rank p > 0.05). Conclusions: In conclusion, we report the first large series of endoscopic treatment in patients with high-risk UTUC, arguing that promising oncologic outcomes can be achieved in properly selected candidates. We encourage multi-institutional collaborative work as a large cohort of high-risk patients treated endoscopically may allow subgroup analyses to define the best candidates.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
- Department of Urology, APHM, North Academic Hospital, Marseille, France
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Paolo Verri
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Julia Aumatell
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Paula Izquierdo
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Alessandro Uleri
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Alessandro Tedde
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Giuseppe Basile
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
- Department of Urology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Josep Maria Gaya
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Jorge Huguet
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Oscar Rodriguez-Faba
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Francesco Sanguedolce
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Ferran Algaba
- Department of Pathology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
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Basile G, Gallioli A, Verri P, Martini A, Territo A, Sanguedolce F, Fontanet S, Aumatell J, Uleri A, Rodriguez-Faba O, Palou J, Breda A. Follow-up intensity scheme for upper tract urothelial carcinoma after nephron-sparing surgery. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00966-1] [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: 02/12/2023]
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Territo A, Baboudjian M, Diana P, Gallioli A, Verri P, Uleri A, Basile G, Tedde A, Gaya JM, Huguet J, Rodriguez-Faba O, Sanguedolce F, Sanz Gomez I, Sanchez Molina R, Palou J, Breda A. To drain or not to drain in uro-oncological robotic surgery? A systematic review and meta-analysis. Minerva Urol Nephrol 2023; 75:144-153. [PMID: 36722161 DOI: 10.23736/s2724-6051.22.05160-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to compare the perioperative outcomes of routine drainage insertion vs. no drainage in patients undergoing robot-assisted radical prostatectomy (RARP), robot-assisted partial nephrectomy (RAPN), and robot-assisted radical cystectomy (RARC). EVIDENCE ACQUISITION A literature search was conducted through April 2022 using PubMed/Medline, Embase, and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. EVIDENCE SYNTHESIS Eleven studies comprising 8447 RARPs and 1890 RAPNs met our inclusion criteria. Our search strategy did not identify any studies within the RARC framework. In RARP, patients without postoperative drainage had lower rate of postoperative ileus (OR 0.53, 95% CI: 0.38 to 0.74; P<0.001) and similar low-grade (Clavien 1-2, P=0.41) and high-grade (Clavien ≥3; P=0.85) complications, urinary leakage (P=0.07), pelvic hematoma (P=0.35), symptomatic lymphocele (P=0.13), fever (P=0.25), incisional hernia (P=0.31), reintervention (P=0.57), length of hospital stay (P=0.22), and readmission (P=0.74) compared with routinely drained patients. In RAPN, patients without postoperative drainage had shorter length of hospital stay (mean difference: -0.84 days, 95% CI: -1.06 to -0.63; P<0.001) and similar low-grade (P=0.94) and high-grade (P=0.31) complications, urinary leakage (P=0.49), hemorrhage (P=0.39), reintervention (P=0.69), and readmission (P=0.20) compared with routinely drained patients. CONCLUSIONS In our study, patients without drainage had similar perioperative course to patients with prophylactic drain insertion after RARP and RAPN. Omission of drain insertion was associated with a lower rate of postoperative ileus for RARP and a shorter hospital stay for RAPN. In the era of robotic surgery, routine drain placement is no longer indicated in unselected patients.
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Affiliation(s)
- Angelo Territo
- Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain -
| | - Michael Baboudjian
- Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Department of Urology, North Academic Hospital, Marseille, France.,Department of Urology, La Conception Hospital, Marseille, France.,Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Pietro Diana
- Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Department of Urology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Andrea Gallioli
- Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Paolo Verri
- Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Alessandro Uleri
- Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Giuseppe Basile
- Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Alessandro Tedde
- Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Josep M Gaya
- Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Jordi Huguet
- Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Oscar Rodriguez-Faba
- Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Francesco Sanguedolce
- Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Isabel Sanz Gomez
- Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Raul Sanchez Molina
- Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Joan Palou
- Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Alberto Breda
- Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Gaya JM, Territo A, Basile G, Gallioli A, Martínez C, Turco M, Baboudjian M, Verri P, Tedde A, Uleri A, Meneghetti I, Huguet J, Rosales A, Sanguedolce F, Rodriguez-Faba O, Palou J, Breda A. Optimizing decision-making process of benign uretero-enteric anastomotic stricture treatment after radical cystectomy. World J Urol 2023; 41:733-738. [PMID: 36725730 DOI: 10.1007/s00345-023-04298-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/14/2023] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To identify preoperative predictors of endo-urological treatment (EUT) failure while promoting a new diagnostic and therapeutic pathway for benign uretero-enteric anastomosis stricture (UES) management after radical cystectomy (RC). MATERIALS AND METHODS We relied on a prospectively maintained database including 96 individuals (122 renal units) who developed a benign UES at our institution between 1990 and 2018. UES was classified into two different types according to morphology: FP1 (i.e., sharp or duckbill) and FP2 (i.e., flat or concave). EUT feasibility, success rate, as well as intra and postoperative complications were recorded. Uni- and multivariable logistic regression analysis (MVA) assessed for predictors of EUT failure. RESULTS Overall, 78 (63.9%) and 32 (26.3%) cases were defined as FP1 and FP2, respectively. EUT was not feasible in 33 (27.1%) cases. After a median follow-up of 50 (IQR 5-240) months, successful treatment was reached only in 15/122 (12.3%) cases. EUT success rates raised when considering short (< 1 cm) (16.8%), FP1 morphology (16.7%) strictures, or the combination of these characteristics (22.4%). Overall, 5 (5.2%) cases had CD ≥ III complications. FP2 (OR: 1.91, 95%CI 1.21-5.31, p = 0.03) and stricture length ≥ 1 cm (OR: 9.08, 95%CI 2.09-65.71, p = 0.009) were associated with treatment failure at MVA. CONCLUSIONS Endoscopic treatment for benign UES after RC is feasible but harbors a low success rate. Stricture length and radiological morphology of the stricture are related to endoscopic treatment failure. Surgeons should be aware of the stricture features during the preoperative decision-making process to choose the optimal candidate for endoscopic treatment.
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Affiliation(s)
- Josep M Gaya
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Giuseppe Basile
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain.
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Christian Martínez
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Morena Turco
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Michael Baboudjian
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Paolo Verri
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Alessandro Tedde
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Alessandro Uleri
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Iacopo Meneghetti
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Jordi Huguet
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Antonio Rosales
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Francesco Sanguedolce
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Oscar Rodriguez-Faba
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
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Marra G, Soria F, Peretti F, Oderda M, Dariane C, Timsit MO, Branchereau J, Hedli O, Mesnard B, Tilki D, Olsburgh J, Kulkarni M, Kasivisvanathan V, Lebacle C, Rodriguez-Faba O, Breda A, Soeterik T, Gandaglia G, Todeschini P, Biancone L, Gontero P. Prostate Cancer in Renal Transplant Recipients: Results from a Large Contemporary Cohort. Cancers (Basel) 2022; 15:cancers15010189. [PMID: 36612184 PMCID: PMC9818510 DOI: 10.3390/cancers15010189] [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: 09/19/2022] [Revised: 10/18/2022] [Accepted: 11/18/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives: The aim of this study was to assess the natural history of prostate cancer (PCa) in renal transplant recipients (RTRs) and to clarify the controversy over whether RTRs have a higher risk of PCa and poorer outcomes than non-RTRs, due to factors such as immunosuppression. Patients and Methods: We performed a retrospective multicenter study of RTRs diagnosed with cM0 PCa between 2001 and 2019. Primary outcomes were overall (OS) and cancer-specific survival (CSS). Secondary outcomes included biochemical recurrence and/or progression after active surveillance (AS) and evaluation of variables possibly influencing PCa aggressiveness and outcomes. Management modalities included surgery, radiation, cryotherapy, HIFU, AS, and watchful waiting. Results: We included 166 men from nine institutions. Median age and eGFR at diagnosis were 67 (IQR 60−73) and 45.9 mL/min (IQR 31.5−63.4). ASA score was >2 in 58.4% of cases. Median time from transplant to PCa diagnosis was 117 months (IQR 48−191.5), and median PSA at diagnosis was 6.5 ng/mL (IQR 5.02−10). The biopsy Gleason score was ≥8 in 12.8%; 11.6% and 6.1% patients had suspicion of ≥cT3 > cT2 and cN+ disease. The most frequent management method was radical prostatectomy (65.6%), followed by radiation therapy (16.9%) and AS (10.2%). At a median follow-up of 60.5 months (IQR 31−106) 22.9% of men (n = 38) died, with only n = 4 (2.4%) deaths due to PCa. Local and systemic progression rates were 4.2% and 3.0%. On univariable analysis, no major influence of immunosuppression type was noted, with the exception of a protective effect of antiproliferative agents (HR 0.39, 95% CI 0.16−0.97, p = 0.04) associated with a decreased risk of biochemical recurrence (BCR) or progression after AS. Conclusion: PCa diagnosed in RTRs is mainly of low to intermediate risk and organ-confined at diagnosis, with good cancer control and low PCa death at intermediate follow-up. RTRs have a non-negligible risk of death from causes other than PCa. Aggressive upfront management of the majority of RTRs with PCa may, therefore, be avoided.
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Affiliation(s)
- Giancarlo Marra
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, 10126 Turin, Italy
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, 75014 Paris, France
- Department of Urology, Hôpital Tenon, 75020 Paris, France
- Correspondence: ; Tel./Fax: +39-0116337591
| | - Francesco Soria
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, 10126 Turin, Italy
| | - Federica Peretti
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, 10126 Turin, Italy
| | - Marco Oderda
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, 10126 Turin, Italy
| | - Charles Dariane
- Department of Urology, Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Marc-Olivier Timsit
- Department of Urology, Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Julien Branchereau
- Institut de Transplantation Urologie Nèphrologie (ITUN), CHU Nantes, 44093 Nantes, France
- Nuffield Department of Surgical Sciences, Oxford University, Oxford OX1 2JD, UK
| | - Oussama Hedli
- Institut de Transplantation Urologie Nèphrologie (ITUN), CHU Nantes, 44093 Nantes, France
| | - Benoit Mesnard
- Institut de Transplantation Urologie Nèphrologie (ITUN), CHU Nantes, 44093 Nantes, France
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
| | | | | | | | - Cedric Lebacle
- Department of Urology, Kremlin-Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France
| | | | - Alberto Breda
- Department of Urology, Fundacio Puigvert, 08025 Barcelona, Spain
| | - Timo Soeterik
- Department of Urology, Saint Antonius Hospital, 3543 AZ Utrecht, The Netherlands
| | | | - Paola Todeschini
- Department of Nephrology, Sant’Orsola Malpighi Hospital, 40138 Bologna, Italy
| | - Luigi Biancone
- Department of Nephrology, Sant’Orsola Malpighi Hospital, 40138 Bologna, Italy
- Department of Nephrology, University of Turin and Città della Salute e della Scienza, 10126 Turin, Italy
| | - Paolo Gontero
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, 10126 Turin, Italy
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Boissier R, Rodriguez-Faba O, Zakri RH, Hevia V, Budde K, Figueiredo A, García EL, Olsburgh J, Regele H, Yuan CY, Breda A. Evaluation of the Effectiveness of Interventions on Nephrolithiasis in Transplanted Kidney. Eur Urol Focus 2022:S2405-4569(22)00278-4. [PMID: 36567234 DOI: 10.1016/j.euf.2022.11.019] [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: 06/18/2022] [Revised: 08/08/2022] [Accepted: 11/16/2022] [Indexed: 12/25/2022]
Abstract
CONTEXT De Novo nephrolithiasis in renal transplant can have severe consequences since renal transplantation involves a single functioning kidney with medical and anatomical specificities (heterotopic transplantation on iliac vessels, immunosuppressive treatments, and comorbidities). OBJECTIVE To systematically review all available evidence on the prevalence of de novo nephrolithiasis in renal transplant, presentation, and stone characteristics, and to report in a meta-analysis the efficacy of stone treatments (extracorporeal shock wave lithotripsy [ESWL], medical treatment, percutaneous nephrolithotomy [PCNL], open surgery, and ureteroscopy). EVIDENCE ACQUISITION Medline, Embase, and the Cochrane Library were searched up to November 2021 for all relevant publications reporting the management of de novo nephrolithiasis in renal allografts. The primary outcome was stone-free rate (SFR) at 3 mo. Secondary outcomes included prevalence, stone characteristics (size, density, and composition), symptoms on presentation, need for drainage, complications, and recurrence. Data were narratively synthesized in light of methodological and clinical heterogeneity, and a meta-analysis was performed for SFR. The risk of bias of each included study was assessed. EVIDENCE SYNTHESIS We included 37 retrospective studies with 553 patients and 612 procedures; of the 612 procedures 20 were antegrade ureteroscopy, 154 retrograde ureteroscopy, 118 PCNL, 25 open surgery, 155 ESWL, and 140 surveillance/medical treatment. The prevalence of nephrolithiasis in renal transplant was 1.0%. The mean stone size on diagnosis was 11 mm (2-50). The overall SFR at 3 mo was 82%: 96% with open surgery, 95% with antegrade ureteroscopy, 86% with PCNL, 81% with retrograde ureteroscopy, and 75% with ESWL. CONCLUSIONS De novo nephrolithiasis in renal transplant is an infrequent condition. A high SFR were obtained with an antegrade approach (ureteroscopy, PCNL, and open approach) that should be considered in renal transplant patients owing to the heterotopic position of the renal graft. The choice of technique was correlated with stone size: generally ureteroscopy and ESWL for stones 11-12 mm (mean stone size) versus PCNL and open surgery for 17-25 mm stones. PATIENT SUMMARY De novo nephrolithiasis in renal transplants is an infrequent situation that can have severe consequences on the function of the renal graft. We evaluated the efficacy of each treatment and noted that antegrade approaches (open surgery, percutaneous nephrolithotomy, and antegrade ureteroscopy) were associated with the highest stone-free rate. As opposed to the management of nephrolithiasis in native kidney, an antegrade approach should be considered more in renal transplant patients.
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Affiliation(s)
- Romain Boissier
- Aix-Marseille University, Marseille, France; Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance-Publique Marseille, France
| | - Oscar Rodriguez-Faba
- Department of Urology, Fundacion Puigvert, University Autonoma of Barcelona, Barcelona, Spain
| | - Rhana Hassan Zakri
- Department of Urology & Renal Transplantation Guy's and St Thomas' Hospital, London, UK
| | - Vital Hevia
- Urology Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain
| | - Klemens Budde
- Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Arnaldo Figueiredo
- Department of Urology and Renal Transplantation, Coimbra University Hospital, Coimbra, Portugal
| | - Enrique Lledó García
- Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jonathon Olsburgh
- Department of Urology & Renal Transplantation Guy's and St Thomas' Hospital, London, UK
| | - Heinz Regele
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Cathy Yuhong Yuan
- Department of Medicine, Health Science Centre, McMaster University, Hamilton, Ontario, Canada
| | - Alberto Breda
- Department of Urology, Fundacion Puigvert, University Autonoma of Barcelona, Barcelona, Spain.
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9
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Verri P, Uleri A, Diana P, Baboudjian M, Gaya J, Rodriguez-Faba O, Gallioli A, Huguet J, Bravo A, Aumatell J, Breda A, Palou J. Challenging robotic-assisted radical cystectomy in patient with history of radical prostatectomy and radiotherapy. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02225-x] [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: 11/07/2022] Open
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10
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Verri P, Baboudjian M, Diana P, Gallioli A, Territo A, Gaya J, Huguet J, Rodriguez-Faba O, Palou J, Breda A. Reduced- vs full-dose BCG in bladder cancer: a systematic review and meta-analysis. Actas Urológicas Españolas (English Edition) 2022; 47:4-14. [PMID: 37078844 DOI: 10.1016/j.acuroe.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To assess the oncologic outcomes and the safety profile of a reduced-dose versus full-dose BCG regimen in patients with non-muscle-invasive bladder cancer (NMIBC). MATERIAL AND METHODS We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PubMed, Embase, and Web of Science databases were searched in January 2022 for studies that analyzed oncological outcomes and compared between reduced- and full-dose BCG regimens. RESULTS Seventeen studies including 3757 patients met our inclusion criteria. Patients who received reduced-dose BCG had significantly higher recurrence rates (OR 1.19; 95%CI, 1.03-1.36; p = 0.02). The risks of progression to muscle-invasive BC (OR 1.04; 95%CI, 0.83-1.32; p = 0.71), metastasis (OR 0.82; 95%CI, 0.55-1.22; p = 0.32), death from BC (OR 0.80; 95%CI, 0.57-1.14; p = 0.22), and all-cause death (OR 0.82; 95%CI, 0.53-1.27; p = 0.37) were not statistically different. When restricting the analyses to randomized controlled trials, we found similar results. In subgroup analysis, reduced dose was associated with a higher rate of BC recurrence in studies that used only an induction regimen (OR 1.70; 95%CI, 1.19-2.42; p = 0.004), but not when a maintenance regimen was used (OR 1.07; 95%CI, 0.96-1.29; p = 0.17). Regarding side effects, the reduced-dose BCG regimen was associated with fewer episodes of fever (p = 0.003), and therapy discontinuation (p = 0.03). CONCLUSION This review found no association between BCG dose and BC progression, metastasis, and mortality. There was an association between reduced dose and BC recurrence, which was no longer significant when a maintenance regimen was used. In times of BCG shortage, reduced-dose regimens could be offered to BC patients.
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11
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Campi R, Grosso AA, Lane BR, DE Cobelli O, Sanguedolce F, Hatzichristodoulou G, Antonelli A, Noyes S, DI Maida F, Mari A, Rodriguez-Faba O, Keeley FX, Langenhuijsen J, Musi G, Klatte T, Roscigno M, Akdogan B, Furlan M, Karakoyunlu N, Marszalek M, Capitanio U, Volpe A, Brookman-May S, Gschwend JE, Smaldone MC, Uzzo RG, Kutikov A, Minervini A. Impact of Trifecta definition on rates and predictors of "successful" robotic partial nephrectomy for localized renal masses: results from the Surface-Intermediate-Base Margin Score International Consortium. Minerva Urol Nephrol 2022; 74:186-193. [PMID: 35345387 DOI: 10.23736/s2724-6051.21.04601-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Over the years, five different Trifecta score definitions have been proposed to optimize the framing of "success" in partial nephrectomy (PN) field. However, such classifications rely on different metrics. The aim of the present study was to explore how the success rate of robotic PN, as well as its drivers, vary according to the currently available definitions of Trifecta. METHODS Data from consecutive patients with cT1-2N0M0 renal masses treated with robotic PN at 16 referral centers from September 2014 to March 2015 were prospectively collected. Trifecta rate was defined for each of the currently available definitions. Multivariable logistic regression analysis was used to evaluate possible predictors of "Trifecta failure" according to the different adopted formulation. RESULTS Overall, 289 patients met the inclusion criteria. Among the definitions, Trifecta rates ranged between 66.4% and 85.9%. Multivariable analysis showed that predictors for "Trifecta failure" were mainly tumor-related (i.e. tumor's nephrometry) for those Trifecta scores relying on WIT as a surrogate metric for postoperative renal function deterioration (definitions 1,2), while mainly surgery-related (i.e. ischemia time and excision strategy) for those including the percentage change in postoperative eGFR as the functional cornerstone of Trifecta (definitions 3-5). CONCLUSIONS There was large variability in rates and predictors of "unsuccessful PN" when using different Trifecta scores. Further research is needed to improve the value of the Trifecta metrics, integrating them into routine patient counseling and standardized assessment of surgical quality across institutions.
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Affiliation(s)
- Riccardo Campi
- Department of Urology, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Antonio A Grosso
- Department of Urology, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Brian R Lane
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - Ottavio DE Cobelli
- Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy
| | - Francesco Sanguedolce
- Bristol Urological Institute, Southmead Hospital, Bristol, UK.,Unit of Uro-Oncology, Puigvert Foundation, Barcelona, Spain
| | - Georgios Hatzichristodoulou
- Department of Urology, Technical University of Munich, University Hospital Klinikum Rechts Der Isar, Munich, Germany.,Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | | | - Sabrina Noyes
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - Fabrizio DI Maida
- Department of Urology, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Mari
- Department of Urology, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Frank X Keeley
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Johan Langenhuijsen
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK.,Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Marco Roscigno
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Bulent Akdogan
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Maria Furlan
- Department of Urology, University of Brescia, Brescia, Italy
| | - Nihat Karakoyunlu
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Martin Marszalek
- Department of Urology and Andrology, Donauspital, Austria.,Department of Urology, Graz Medical University, Graz, Austria
| | - Umberto Capitanio
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Sabine Brookman-May
- Department of Urology, Campus Grosshadern, Ludwig-Maximilians University (LMU) Munich, Germany.,Janssen Pharma Research and Development, Los Angeles, CA, USA
| | - Jürgen E Gschwend
- Department of Urology, Technical University of Munich, University Hospital Klinikum Rechts Der Isar, Munich, Germany
| | - Marc C Smaldone
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Robert G Uzzo
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Andrea Minervini
- Department of Urology, University of Florence, Florence, Italy - .,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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12
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Di Maida F, Campi R, Lane BR, De Cobelli O, Sanguedolce F, Hatzichristodoulou G, Antonelli A, Grosso AA, Noyes S, Rodriguez-Faba O, Keeley FX, Langenhuijsen J, Musi G, Klatte T, Roscigno M, Akdogan B, Furlan M, Simeone C, Karakoyunlu N, Marszalek M, Capitanio U, Volpe A, Brookman-May S, Gschwend JE, Smaldone MC, Uzzo RG, Kutikov A, Minervini A. Predictors of Positive Surgical Margins after Robot-Assisted Partial Nephrectomy for Localized Renal Tumors: Insights from a Large Multicenter International Prospective Observational Project (The Surface-Intermediate-Base Margin Score Consortium). J Clin Med 2022; 11:jcm11071765. [PMID: 35407375 PMCID: PMC8999836 DOI: 10.3390/jcm11071765] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/12/2022] [Accepted: 03/19/2022] [Indexed: 12/30/2022] Open
Abstract
Background: To explore predictors of positive surgical margins (PSM) after robotic partial nephrectomy (PN) in a large multicenter international observational project, harnessing the Surface-Intermediate-Base (SIB) margin score to report the resection technique after PN in a standardized way. Methods: Data from consecutive patients with cT1-2N0M0 renal masses treated with PN from September 2014 to March 2015 at 16 tertiary referral centers and included in the SIB margin score International Consortium were prospectively collected. For the present study, only patients treated with robotic PN were included. Uni- and multivariable analysis were fitted to explore clinical and surgical predictors of PSMs after PN. Results: Overall, 289 patients were enrolled. Median (IQR) preoperative tumor size was 3.0 (2.3−4.2) cm and median (IQR) PADUA score was 8 (7−9). SIB scores of 0−2 (enucleation), 3−4 (enucleoresection) and 5 (resection) were reported in 53.3%, 27.3% and 19.4% of cases, respectively. A PSM was recorded in 18 (6.2%) patients. PSM rate was 4.5%, 11.4% and 3.6% in case of enucleation, enucleoresection and resection, respectively. Patients with PSMs had tumors with a higher rate of contact with the urinary collecting system (55.6% vs. 27.3%; p < 0.001) and a longer median warm ischemia time (22 vs. 16 min; p = 0.02) compared with patients with negative surgical margins, while no differences emerged between the two groups in terms of other tumor features (i.e., pathological diameter, PADUA score). In multivariable analysis, only enucleoresection (SIB score 3−4) versus enucleation (SIB score 0−2) was found to be an independent predictor of PSM at final pathology (HR: 2.68; 95% CI: 1.25−7.63; p = 0.04), while resection (SIB score 5) was not. Conclusions: In our experience, enucleoresection led to a higher risk of PSMs as compared to enucleation. Further studies are needed to assess the differential impacts of resection technique and surgeon’s experience on margin status after robotic PN.
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Affiliation(s)
- Fabrizio Di Maida
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, 50134 Florence, Italy; (F.D.M.); (A.A.G.)
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, 50134 Florence, Italy;
| | - Brian R. Lane
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI 49508, USA; (B.R.L.); (S.N.)
| | - Ottavio De Cobelli
- Department of Urology, European Institute of Oncology (IEO), University of Milan, 20141 Milan, Italy; (O.D.C.); (G.M.)
| | - Francesco Sanguedolce
- Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB, UK; (F.S.); (F.X.K.)
- Uro-Oncology Unit, Fundacio Puigvert, 08025 Barcelona, Spain;
| | - Georgios Hatzichristodoulou
- Department of Urology, Rechts der Isar University Hospital, Technical University of Munich, 81675 Munich, Germany; (G.H.); (J.E.G.)
- Department of Urology, Martha-Maria Hospital Nuremberg, 90491 Nurnberg, Germany
| | - Alessandro Antonelli
- Department of Urology, University of Brescia, 25121 Brescia, Italy; (A.A.); (M.F.); (C.S.)
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy
| | - Antonio Andrea Grosso
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, 50134 Florence, Italy; (F.D.M.); (A.A.G.)
| | - Sabrina Noyes
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI 49508, USA; (B.R.L.); (S.N.)
| | | | - Frank X. Keeley
- Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB, UK; (F.S.); (F.X.K.)
| | - Johan Langenhuijsen
- Department of Urology, Radboud University Nijmegen Medical Centre, 6525 GA Nijmegen, The Netherlands;
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology (IEO), University of Milan, 20141 Milan, Italy; (O.D.C.); (G.M.)
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Bournemouth BH7 7DW, UK;
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
| | - Marco Roscigno
- Department of Urology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Bulent Akdogan
- Department of Urology, School of Medicine, Hacettepe University, Ankara 06800, Turkey;
| | - Maria Furlan
- Department of Urology, University of Brescia, 25121 Brescia, Italy; (A.A.); (M.F.); (C.S.)
| | - Claudio Simeone
- Department of Urology, University of Brescia, 25121 Brescia, Italy; (A.A.); (M.F.); (C.S.)
| | - Nihat Karakoyunlu
- Department of Urology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara 06145, Turkey;
| | - Martin Marszalek
- Department of Urology and Andrology, Sozialmedizinishes Zentrum Ost-Donauspital, 1220 Vienna, Austria;
- Department of Urology, Graz Medical University, 8036 Graz, Austria
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, 20132 Milan, Italy;
| | - Alessandro Volpe
- Department of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, 28100 Novara, Italy;
| | - Sabine Brookman-May
- Department of Urology, Campus Grosshadern, Ludwig-Maximilians University (LMU), 80539 Munich, Germany;
- Janssen Pharma Research and Development, San Diego, CA 92121, USA
| | - Jürgen E. Gschwend
- Department of Urology, Rechts der Isar University Hospital, Technical University of Munich, 81675 Munich, Germany; (G.H.); (J.E.G.)
| | - Marc C. Smaldone
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (M.C.S.); (R.G.U.); (A.K.)
| | - Robert G. Uzzo
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (M.C.S.); (R.G.U.); (A.K.)
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (M.C.S.); (R.G.U.); (A.K.)
| | - Andrea Minervini
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, 50134 Florence, Italy; (F.D.M.); (A.A.G.)
- Correspondence:
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Soeterik T, Van Den Bergh R, Van Melick H, Soria F, Peretti F, Oderda M, Dariane C, Timsit M, Brancherau J, Hedli O, Mesnard B, Tilki D, Kulkarni M, Kasivisvanathan V, Lebacle C, Rodriguez-Faba O, Breda A, Gandaglia G, Todeschini P, Biancone L, Gontero P, Marra G. The outcomes of active surveillance of prostate cancer in renal transplant patients: A propensity score matched comparison with a non-renal transplant cohort with prostate cancer. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)03119-0] [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: 11/30/2022] Open
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14
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Marra G, Soria F, Oderda M, Peretti F, Giorgio C, Lamanna G, Todeschini P, Secchi A, Dariane C, Timsit O, Brancherau J, Hedli O, Mesnard B, Tilki D, Olsburgh J, Kulkarni M, Kasivisvanathan V, Lebacle C, Irani J, Breda A, Rodriguez-Faba O, Gaya J, Biancone L, Gontero P. Prostate cancer in kidney transplant recipients: large contemporary multicenter cohort study. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00833-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Boissier R, Hidalgo R, Rodriguez-Faba O, Territo A, Subiela J, Huguet J, Sanchez-Puy A, Galliolia A, Vanacore D, Mercade A, Martinez C, Palou J, Guirado L, Breda A. History of urological malignancies before kidney transplantation, oncological outcome on the long term. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00732-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Marra G, Peretti F, Calleris G, Oderda M, Biancone L, Lamanna G, Todeschini P, Secchi A, Dariane C, Timsit O, Brancherau J, Hedli O, Mesnard B, Tilki D, Olsburgh J, Kulkarni M, Kasivisvanathan V, Lebacle C, Irani J, Breda A, Rodriguez-Faba O, Gaya J, Gandaglia G, Gontero P. Prostate cancer in renal transplant recipients: Results from a large multicentre contemporary cohort. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00730-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Boissier R, Sanguedolce F, Territo A, Gaya JM, Huguet J, Rodriguez-Faba O, Regis F, Gallioli A, Vedovo F, Martinez C, Palou J, Breda A. Partial salvage cryoablation of the prostate for local recurrent prostate cancer after primary radiotherapy: Step-by-step technique and outcomes. Urology Video Journal 2020. [DOI: 10.1016/j.urolvj.2020.100040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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González J, Gaynor JJ, Martínez-Salamanca JI, Capitanio U, Tilki D, Carballido JA, Chantada V, Daneshmand S, Evans CP, Gasch C, Gontero P, Haferkamp A, Huang WC, Espinós EL, Master VA, McKiernan JM, Montorsi F, Pahernik S, Palou J, Pruthi RS, Rodriguez-Faba O, Russo P, Scherr DS, Shariat SF, Spahn M, Terrone C, Vera-Donoso C, Zigeuner R, Hohenfellner M, Libertino JA, Ciancio G. Association of an organ transplant-based approach with a dramatic reduction in postoperative complications following radical nephrectomy and tumor thrombectomy in renal cell carcinoma. Eur J Surg Oncol 2019; 45:1983-1992. [PMID: 31155470 DOI: 10.1016/j.ejso.2019.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/06/2019] [Accepted: 05/08/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Our aim was to determine whether using an organ transplant-based(TB) approach reduces postoperative complications(PCs) following radical nephrectomy(RN) and tumor thrombectomy(TT) in renal cell carcinoma(RCC) patients with level II-IV thrombi. METHODS A total of 390(292 non-TB/98 TB) IRCC-VT Consortium patients who received no preoperative embolization/IVC filter were included. Stepwise linear/logistic regression analyses were performed to determine significant multivariable predictors of intraoperative estimated blood loss(IEBL), number blood transfusions received, and overall/major PC development within 30days following surgery. Propensity to receive the TB approach was controlled. RESULTS The TB approach was clearly superior in limiting IEBL, blood transfusions, and PC development, even after controlling for other significant prognosticators/propensity score(P < .000001 in each case). Median IEBL for non-TB/TB approaches was 1000 cc/300 cc and 1500 cc/500 cc for tumor thrombus Level II-III patients, respectively, with no notable differences for Level IV patients(2000 cc each). In comparing PC outcomes between non-TB/TB patients with a non-Right-Atrium Cranial Limit, the observed percentage developing a: i) PC was 65.8%(133/202) vs. 4.3%(3/69) for ECOG Performance Status(ECOG-PS) 0-1, and 84.8%(28/33) vs. 25.0%(4/16) for ECOG-PS 2-4, and ii) major PC was 16.8%(34/202) vs. 1.4%(1/69) for ECOG-PS 0-1, and 27.3%(9/33) vs. 12.5%(2/16) for ECOG-PS 2-4. Major study limitation was the fact that all TB patients were treated by a single, experienced, high volume surgeon from one center (non-TB patients were treated by various surgeons at 13 other centers). CONCLUSIONS Despite this major study limitation, the observed dramatic differences in PC outcomes suggest that the TB approach offers a major breakthrough in limiting operative morbidity in RCC patients receiving RN and TT.
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Affiliation(s)
- Javier González
- Department of Urolorgy, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Jeffrey J Gaynor
- The Lillian Jean Kaplan Renal Transplant Center and the Miami Transplant Institute, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | | | - Umberto Capitanio
- Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy.
| | - Derya Tilki
- Department of Urology, University of California, Davis, School of Medicine, Sacramento, CA, USA.
| | - Joaquín A Carballido
- Servicio de Urología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain.
| | - Venancio Chantada
- Servicio de Urología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | | | - Christopher P Evans
- Department of Urology, University of California, Davis, School of Medicine, Sacramento, CA, USA.
| | - Claudia Gasch
- Department of Urology, University of Heidelberg, Heidelberg, Germany.
| | - Paolo Gontero
- Department of Urology, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy.
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, Mainz University Medical Center, Mainz, Germany.
| | - William C Huang
- Department of Urology, New York University Langone School of Medicine, New York, USA.
| | | | - Viraj A Master
- Department of Urology, Emory University, Atlanta, GA, USA.
| | - James M McKiernan
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, USA.
| | - Francesco Montorsi
- Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy.
| | - Sascha Pahernik
- Department of Urology, Paracelsus University Hospital (PMU), Nürnberg, Germany.
| | - Juan Palou
- Department of Urology, Fundació Puigvert, Barcelona, Spain.
| | - Raj S Pruthi
- Department of Urology, UNC at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Paul Russo
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical Center, New York, USA.
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
| | - Martin Spahn
- Department of Urology, Center of Urology/Prostate Cancer Center Hirslanden, Zürich, Switzerland.
| | - Carlo Terrone
- Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy.
| | | | - Richard Zigeuner
- Department of Urology, Medical University of Graz, Graz, Austria.
| | | | - John A Libertino
- Department of Urology, Emerson Hospital-MGH Cancer Center, Boston, MA, USA.
| | - Gaetano Ciancio
- The Lillian Jean Kaplan Renal Transplant Center and the Miami Transplant Institute, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
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Maia A, Martin-Fernandez J, Gaya J, Rodriguez-Faba O, Palou J, Castillo-Martin M. PO-488 AGR2 is a progression marker and a potential therapeutic target in non-muscle invasive bladder cancer. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.990] [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: 11/04/2022] Open
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Campi R, Brookman-May SD, Subiela Henríquez JD, Akdoğan B, Brausi M, Klatte T, Langenhuijsen JF, Linares-Espinos E, Marszalek M, Roupret M, Stief CG, Volpe A, Minervini A, Rodriguez-Faba O. Impact of Metabolic Diseases, Drugs, and Dietary Factors on Prostate Cancer Risk, Recurrence, and Survival: A Systematic Review by the European Association of Urology Section of Oncological Urology. Eur Urol Focus 2018; 5:1029-1057. [PMID: 29661588 DOI: 10.1016/j.euf.2018.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/23/2018] [Accepted: 04/01/2018] [Indexed: 12/20/2022]
Abstract
CONTEXT To date, established risk factors for prostate cancer (PCa) are limited to age, race, family history, and certain genetic polymorphisms. Despite great research efforts, available evidence on potentially modifiable risk factors is conflicting. Moreover, most studies on PCa risk factors did not consider the impact of prostate-specific antigen (PSA) testing on PCa diagnosis. OBJECTIVE To provide a detailed overview of the latest evidence on the role of metabolic diseases, drugs, and dietary factors for risk of PCa incidence, recurrence, and survival in men exposed to PSA testing. EVIDENCE ACQUISITION A systematic review of the English-language literature was performed using the MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses recommendations. Randomized, case-control, or cohort studies published during the periods 2008-2017 (on drugs and metabolic diseases) and 2003-2017 (on dietary factors), with extensive follow-up (≥8-10yr for studies on PCa risk; ≥2-5yr for studies on PCa recurrence, progression, and survival, depending on the review subtopic) and adjusting of the analyses, beyond established risk factors, for either rate of PSA testing (for risk analyses) or PCa stage and primary treatment (for survival analyses), were eligible for inclusion. EVIDENCE SYNTHESIS Overall, 39 reports from 22 observational studies were included. Studies were heterogeneous regarding definitions of exposure or outcomes, length of follow-up, risk of bias, and confounding. For some risk factors, evidence was insufficient to assess potential effects, while for others there was no evidence of an effect. For selected risk factors, namely metformin, aspirin and statin use, diabetes, obesity, and specific dietary intakes, there was low-quality evidence of modest effects on PCa risk. CONCLUSIONS Current evidence from long-term observational studies evaluating the effect of drugs, metabolic diseases, and dietary factors for PCa risk considering the impact of PSA testing is still not conclusive. Future research is needed to confirm the associations suggested by our review, exploring their potential biological explanations and selecting those risk factors most likely to trigger effective public health interventions. PATIENT SUMMARY We reviewed the available studies published in the recent literature on the potential role of drugs, metabolic diseases, and food and dietary factors for the risk of prostate cancer, considering the impact of prostate-specific antigen testing on prostate cancer diagnosis. We found that for some factors data are currently insufficient to make definitive conclusions, while for others available studies seem to indicate an effect on the risk of prostate cancer.
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Affiliation(s)
- Riccardo Campi
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
| | | | | | - Bülent Akdoğan
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey.
| | - Maurizio Brausi
- Department of Urology, B. Ramazzini Hospital, Carpi-Modena, Italy.
| | - Tobias Klatte
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK.
| | - Johan F Langenhuijsen
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | | | - Martin Marszalek
- Department of Urology and Andrology, Donauspital, Vienna, Austria.
| | - Morgan Roupret
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Department of Urology, Pitié-Salpétrière Hospital, F-75013, Paris, France.
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians University (LMU) Munich, Munich, Germany.
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
| | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
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Brookman-May SD, Campi R, Henríquez JDS, Klatte T, Langenhuijsen JF, Brausi M, Linares-Espinós E, Volpe A, Marszalek M, Akdogan B, Roll C, Stief CG, Rodriguez-Faba O, Minervini A. Latest Evidence on the Impact of Smoking, Sports, and Sexual Activity as Modifiable Lifestyle Risk Factors for Prostate Cancer Incidence, Recurrence, and Progression: A Systematic Review of the Literature by the European Association of Urology Section of Oncological Urology (ESOU). Eur Urol Focus 2018; 5:756-787. [PMID: 29576530 DOI: 10.1016/j.euf.2018.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 01/14/2018] [Revised: 02/05/2018] [Accepted: 02/19/2018] [Indexed: 12/19/2022]
Abstract
CONTEXT Smoking, sexual activity, and physical activity (PA) are discussed as modifiable lifestyle factors associated with prostate cancer (PCa) development and progression. OBJECTIVE To evaluate the available evidence concerning the association of smoking, sexual activity, and sports and exercise on PCa risk, treatment outcome, progression, and cancer-specific mortality. EVIDENCE ACQUISITION A systematic review of studies published between 2007 and 2017 using MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials, and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement criteria was conducted. EVIDENCE SYNTHESIS While data concerning the impact of smoking on PCa development remain conflicting, there is robust evidence that smoking is associated with aggressive tumor features and worse cancer-related outcome, which seems to be maintained for 10 yr after smoking cessation. Less convincing and limited evidence exists for the association of sexual activity with PCa risk. The findings related to PA and PCa support the inference that exercise might be a useful factor in the prevention of PCa and tumor progression, while it is not finally proved under which specific conditions PA might be protective against disease development. CONCLUSIONS Smoking is associated with aggressive tumor features and worse cancer-related prognosis; as this negative impact seems to be maintained for 10yr after smoking cessation, urologists should advise men to quit smoking latest at PCa diagnosis to improve their prognosis. As several studies indicate a positive impact of exercise on tumor development, progression, and treatment outcome, it is certainly reasonable to advocate an active lifestyle. Least convincing evidence is available for the interaction of sexual activity and PCa, and well-conducted and longitudinal studies are clearly necessary to evaluate whether the suggested associations between PCa risk and sexual behavior are real or spurious. PATIENT SUMMARY In this systematic review, we looked at the impact of smoking, sexual activity, and sports and exercise on prostate cancer risk and outcome after treatment. While the evidence for sexual activity is not overall clear, we found that smoking might lead to more aggressive cancers and result in worse treatment outcome. Physical activity might prevent prostate cancer and improve cancer-related outcomes as well. Hence, it is certainly reasonable to advocate an active lifestyle and advise men to quit smoking.
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Affiliation(s)
| | - Riccardo Campi
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Jose D S Henríquez
- Unidad de Uro-Oncología, Servicio de Urología, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tobias Klatte
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Maurizio Brausi
- Department of Urology, B. Ramazzini Hospital, Carpi-Modena, Italy
| | | | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Martin Marszalek
- Department of Urology and Andrology, Donauspital, Vienna, Austria
| | - Bulent Akdogan
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Christina Roll
- Department of Trauma and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians University (LMU) Munich, Munich, Germany
| | - Oscar Rodriguez-Faba
- Unidad de Uro-Oncología, Servicio de Urología, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
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Subiela JD, Balla A, Bollo J, Dilme JF, Soto Carricas B, Targarona EM, Rodriguez-Faba O, Breda A, Palou J. Endovascular Management of Ureteroarterial Fistula: Single Institution Experience and Systematic Literature Review. Vasc Endovascular Surg 2018; 52:275-286. [DOI: 10.1177/1538574418761721] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Ureteroarterial fistula (UAF) represents an uncommon complication after urological surgery; however, this is a well-documented condition in patients with predisposing risk factors. The aim of the present study is to report and analyze the endovascular management of a series of patients with UAF, treated in authors’ hospital, and to report and analyze the same data concerning patients retrieved from a systematic literature review. Methods: Authors conducted a retrospective analysis of prospectively collected data and a systematic literature review. The research was carried out through PubMed database searching the following keywords: “uretero arterial fistula” and “uretero iliac fistula.” It includes only articles reporting the endovascular management. Results: Forty-six articles were included in the present study for a total of 94 patients. Risk factors were as follows: chronic indwelling ureteral stents, pelvic surgery, radiotherapy, iliac artery pseudo-aneurysm, and chemotherapy. All patients had gross hematuria at presentation. Stent graft placement was performed in 89 patients, embolization in 5 patients, and iliac internal artery embolization combined with stent graft placement was performed in 24 patients. Four postprocedural complications were observed (4.2%). During a median follow-up of 8 months, 10 complications related to UAF were observed (10.6%): rebleeding (7 cases) and stent thrombosis (3 cases). Two patients died for causes related to UAF (2.1%): rebleeding (1) and retroperitoneal abscess (1). Conclusion: Based on the present data, endovascular treatment is feasible and safe with low postprocedural complications and mortality rate. Considering the increase in surgery and radiotherapy performed, UAF should be always debated in patients with massive hematuria.
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Affiliation(s)
- José D. Subiela
- Department of Urology, Fundació Puigvert, Universidad Aurtónoma de Barcelona, Barcelona, Spain
| | - Andrea Balla
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
- Department of General Surgery and Surgical Specialties “Paride Stefanini,” Sapienza, University of Rome, Rome, Italy
| | - Jesús Bollo
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jaume F. Dilme
- Departament of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Begoña Soto Carricas
- Departament of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Eduard M. Targarona
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Oscar Rodriguez-Faba
- Department of Urology, Fundació Puigvert, Universidad Aurtónoma de Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Universidad Aurtónoma de Barcelona, Barcelona, Spain
| | - Juan Palou
- Department of Urology, Fundació Puigvert, Universidad Aurtónoma de Barcelona, Barcelona, Spain
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Tilki D, Chandrasekar T, Capitanio U, Ciancio G, Daneshmand S, Gontero P, Gonzalez J, Haferkamp A, Hohenfellner M, Huang WC, Linares Espinós E, Lorentz A, Martinez-Salamanca JI, Master VA, McKiernan JM, Montorsi F, Novara G, Pahernik S, Palou J, Pruthi RS, Rodriguez-Faba O, Russo P, Scherr DS, Shariat SF, Spahn M, Terrone C, Vera-Donoso C, Zigeuner R, Libertino JA, Evans CP. Impact of lymph node dissection at the time of radical nephrectomy with tumor thrombectomy on oncological outcomes: Results from the International Renal Cell Carcinoma-Venous Thrombus Consortium (IRCC-VTC). Urol Oncol 2017; 36:79.e11-79.e17. [PMID: 29129353 DOI: 10.1016/j.urolonc.2017.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 04/10/2017] [Revised: 09/11/2017] [Accepted: 10/09/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To study the effect of lymph node dissection (LND) at the time of nephrectomy and tumor thrombectomy on oncological outcomes in patients with renal cell carcinoma (RCC) and tumor thrombus. PATIENTS AND METHODS The records of 1,978 patients with RCC and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1985 to 2014 at 24 centers were analyzed. None of the patients had distant metastases. Extent and pathologic results of LND were compared with respect to cancer-specific survival (CSS). Multivariable Cox regression models were used to quantify the effect of multiple covariates. RESULTS LND was performed in 1,026 patients. In multivariable analysis, the presence of LN metastasis, the number of positive LNs, and LN density were independently associated with cancer-specific mortality (CSM). Clinical node-negative (cN-) disease was documented in 573 patients, 447 of them underwent LND with 43 cN- patients (9.6%) revealing positive LNs at pathology. LN positive cN- patients showed significantly better CSS when compared to LN positive cN+ patients. In multivariable analysis, positive cN status in LN positive patients was a significant predictor of CSM (HR, 2.923; P = 0.015). CONCLUSIONS The number of positive nodes harvested during LND and LN density was strong prognostic indicators of CSS, while number of removed LNs did not have a significant effect on CSS. The rate of pN1 patients among clinically node-negative patients was relatively high, and LND in these patients suggested a survival benefit. However, only a randomized trial can determine the absolute benefit of LND in this setting.
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Affiliation(s)
- Derya Tilki
- Department of Urology, University of California, Davis School of Medicine, Sacramento, CA
| | - Thenappan Chandrasekar
- Department of Urology, University of California, Davis School of Medicine, Sacramento, CA
| | - Umberto Capitanio
- Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy
| | - Gaetano Ciancio
- Department of Urology, Miami Transplant Institute, University of Miami, Miami, FL
| | - Siamak Daneshmand
- Department of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Paolo Gontero
- Department of Urology, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy
| | - Javier Gonzalez
- Department of Urology, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain
| | - Axel Haferkamp
- Department of Urology, University of Frankfurt, Frankfurt, Germany
| | | | - William C Huang
- Department of Urology, New York University School of Medicine, New York City, NY
| | | | - Adam Lorentz
- Department of Urology, Emory University, Atlanta, GA
| | - Juan I Martinez-Salamanca
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - James M McKiernan
- Department of Urology, Columbia University College of Physicians and Surgeons, New York City, NY
| | - Francesco Montorsi
- Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy
| | - Giacomo Novara
- Department of Urology, University of Padua, Padua, Italy
| | - Sascha Pahernik
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - Juan Palou
- Department of Urology, Fundació Puigvert, Barcelona, Spain
| | - Raj S Pruthi
- Department of Urology, UNC at Chappel Hill, Chapel Hill, NC
| | | | - Paul Russo
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical Center, New York City, NY
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Martin Spahn
- Department of Urology, University of Würzburg, Würzburg, Germany; Department of Urology, University Hospital Bern, Bern, Switzerland
| | - Carlo Terrone
- Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy
| | - Cesar Vera-Donoso
- Department of Urology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Richard Zigeuner
- Department of Urology, Medical University of Graz, Graz, Austria
| | | | - Christopher P Evans
- Department of Urology, University of California, Davis School of Medicine, Sacramento, CA.
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Tilki D, Chandrasekar T, Ciancio G, Daneshmand S, Martinez-Salamanca J, Montorsi F, Rodriguez-Faba O, Terrone C, Zigeuner R, Libertino J, Evans C. PD41-12 IMPACT OF LYMPH NODE DISSECTION AT THE TIME OF RADICAL NEPHRECTOMY AND TUMOR THROMBECTOMY ON ONCOLOGICAL OUTCOMES OF PATIENTS WITH RENAL CELL CARCINOMA AND TUMOR THROMBUS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1558] [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: 12/01/2022]
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Mengual L, Ribal MJ, Lozano JJ, Ingelmo-Torres M, Liang J, Han CT, Palou J, Rodriguez-Faba O, Witjes F, Van der Heijden AG, Medina R, Conde JM, Marberger M, Schmidbauer J, Ye D, Ye X, Meng X, Alcaraz A. S&T-65 PROSPECTIVE, BLINDED, INTERNATIONAL AND MULTICENTER VALIDATION OF A GENE EXPRESSION TEST FOR THE NON-INVASIVE DIAGNOSIS OF BLADDER CANCER. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | | | | | | | - CT. Han
- Shanghai, China, People's Republic of
| | | | | | | | | | | | | | | | | | | | - Xun Ye
- Shanghai, China, People's Republic of
| | - Xia Meng
- Shanghai, China, People's Republic of
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Nguyen HG, Tilki D, Dall'Era MA, Durbin-Johnson B, Carballido JA, Chandrasekar T, Chromecki T, Ciancio G, Daneshmand S, Gontero P, Gonzalez J, Haferkamp A, Hohenfellner M, Huang WC, Espinós EL, Mandel P, Martinez-Salamanca JI, Master VA, McKiernan JM, Montorsi F, Novara G, Pahernik S, Palou J, Pruthi RS, Rodriguez-Faba O, Russo P, Scherr DS, Shariat SF, Spahn M, Terrone C, Vergho D, Wallen EM, Xylinas E, Zigeuner R, Libertino JA, Evans CP. Cardiopulmonary Bypass has No Significant Impact on Survival in Patients Undergoing Nephrectomy and Level III-IV Inferior Vena Cava Thrombectomy: Multi-Institutional Analysis. J Urol 2015; 194:304-308. [PMID: 25797392 DOI: 10.1016/j.juro.2015.02.2948] [Citation(s) in RCA: 19] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The impact of cardiopulmonary bypass in level III-IV tumor thrombectomy on surgical and oncologic outcomes is unknown. We determine the impact of cardiopulmonary bypass on overall and cancer specific survival, as well as surgical complication rates and immediate outcomes in patients undergoing nephrectomy and level III-IV tumor thrombectomy with or without cardiopulmonary bypass. MATERIALS AND METHODS We retrospectively analyzed 362 patients with renal cell cancer and with level III or IV tumor thrombus from 1992 to 2012 at 22 U.S. and European centers. Cox proportional hazards models were used to compare overall and cancer specific survival between patients with and without cardiopulmonary bypass. Perioperative mortality and complication rates were assessed using logistic regression analyses. RESULTS Median overall survival was 24.6 months in noncardiopulmonary bypass cases and 26.6 months in cardiopulmonary bypass cases. Overall survival and cancer specific survival did not differ significantly in both groups on univariate analysis or when adjusting for known risk factors. On multivariate analysis no significant differences were seen in hospital length of stay, Clavien 1-4 complication rate, intraoperative or 30-day mortality and cancer specific survival. Limitations include the retrospective nature of the study. CONCLUSIONS In our multi-institutional analysis the use of cardiopulmonary bypass did not significantly impact cancer specific survival or overall survival in patients undergoing nephrectomy and level III or IV tumor thrombectomy. Neither approach was independently associated with increased mortality on multivariate analysis. Greater surgical complications were not independently associated with the use of cardiopulmonary bypass.
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Affiliation(s)
- Hao G Nguyen
- Department of Urology, UC Davis Medical Center, Sacramento, California, USA
| | - Derya Tilki
- Department of Urology, UC Davis Medical Center, Sacramento, California, USA
| | - Marc A Dall'Era
- Department of Urology, UC Davis Medical Center, Sacramento, California, USA
| | | | - Joaquín A Carballido
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Thomas Chromecki
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Gaetano Ciancio
- Miami Transplant Institute, University of Miami, Miami, FL, USA
| | - Siamak Daneshmand
- USC/Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Paolo Gontero
- Department of Urology, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy
| | - Javier Gonzalez
- Department of Urology, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain
| | - Axel Haferkamp
- Department of Urology, University of Frankfurt, Frankfurt, Germany
| | | | - William C Huang
- Department of Urology, New York University School of Medicine, New York, USA
| | - Estefania Linares Espinós
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - Philipp Mandel
- Institute of of Empirical Economic Research, University of Leipzig, Leipzig, Germany
| | - Juan I Martinez-Salamanca
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - Viraj A Master
- Department of Urology, Emory University, Atlanta, Georgia, USA
| | - James M McKiernan
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, USA
| | - Francesco Montorsi
- Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy
| | | | - Sascha Pahernik
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - Juan Palou
- Department of Urology, Fundació Puigvert, Barcelona, Spain
| | - Raj S Pruthi
- Department of Urology, UNC at Chappel Hill, Chapel Hill, North Carolina, USA
| | | | - Paul Russo
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical Center, New York, USA
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | | | - Carlo Terrone
- Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy
| | | | - Eric M Wallen
- Department of Urology, UNC at Chappel Hill, Chapel Hill, North Carolina, USA
| | - Evanguelos Xylinas
- Department of Urology, Weill Cornell Medical Center, New York, USA.,Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - Richard Zigeuner
- Department of Urology, Medical University of Graz, Graz, Austria
| | - John A Libertino
- Department of Urology, Lahey Clinic, Burlington, Massachusetts, USA
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Breda A, Schwartzmann I, Emiliani E, Rodriguez-Faba O, Gausa L, Caffaratti J, de León XP, Villavicencio H. Mini-laparoscopic live donor nephrectomy with the use of 3-mm instruments and laparoscope. World J Urol 2014; 33:707-12. [PMID: 25182807 DOI: 10.1007/s00345-014-1360-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/01/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To analyze our preliminary outcomes on the use of 3 mm instruments for laparoscopic live donor nephrectomy (LLDN). METHODS Our series includes thirteen patients, who underwent LLDN using 3-mm instruments and laparoscope and 5-mm transumbilical trocar. The patients were followed at 7 and 14 days from discharge and were specifically asked about their cosmetic satisfaction. At follow-up, the recipient graft function was controlled, as well as the donor's cosmetic results. Eight months after surgery, all thirteen patients were asked to fill out the Patient Scar Assessment Questionnaire and Scoring System (PSAQ). RESULTS All patients presented good recovery after surgery. Regarding cosmetic outcomes, the donors expressed their satisfaction toward the minimal incision size and optimal esthetic results at 7 and 14 days from discharge home. The low scores on each section of the PSAQ confirmed the favorable outcomes. Early graft function was satisfactory at 1 and 3 months after the kidney transplantation. Furthermore, there were no major complications in the recipients. CONCLUSIONS Our persistent positive results with the use of 3-mm instruments during LLDN support this technique as a good alternative to the standard laparoscopic approach for minimizing the incision site, while maintaining safety and excellent clinical outcomes. The fact that the general laparoscopic standards are maintained could make this approach a very attractive alternative to the other minimally invasive approaches for live donor nephrectomy. The hope is in that the higher degree of satisfaction in the donor population demonstrated in this study may likely enhance living kidney donation.
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Affiliation(s)
- Alberto Breda
- Urology Department, Fundació Puigvert, Barcelona, Spain,
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28
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Breda A, Lucarelli G, Luccarelli G, Rodriguez-Faba O, Guirado L, Facundo C, Bettocchi C, Gesualdo L, Castellano G, Grandaliano G, Battaglia M, Palou J, Ditonno P, Villavicencio H. Clinical and pathological outcomes of renal cell carcinoma (RCC) in native kidneys of patients with end-stage renal disease: a long-term comparative retrospective study with RCC diagnosed in the general population. World J Urol 2014; 33:1-7. [PMID: 24504760 DOI: 10.1007/s00345-014-1248-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/21/2014] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Patients with end-stage renal disease (ESRD) have an increased risk of developing renal cell carcinoma (RCC). This retrospective study compared clinical and pathological outcomes of RCC occurring in native kidneys of patients with ESRD (whether they underwent kidney transplantation or not) with those of renal tumors diagnosed in the general population. METHODS The study included a total of 533 patients with RCC. The ESRD cohort included 92 patients with RCC in native kidneys. Of these, 58 and 34 cases were identified before (pre-Tx group) and after kidney transplantation (post-Tx group), respectively. The control group was composed of 441 RCCs diagnosed in the general population. Variables were compared by chi-square and Student's t tests. Cancer-specific survival was assessed by Kaplan-Meier and Cox methods. RESULTS The ESRD groups had smaller (P = 0.001), lower-grade, and lower-stage tumors than the non-ESRD group (P = 0.001). The papillary RCC rate was higher in the ESRD groups (P = 0.01). Ten-year cancer-specific survivals were 94.5, 87.9, and 74.6 % in pre-Tx, post-Tx, and non-ESRD patients, respectively (P = 0.003). Mean follow-up was 90.2 months. At multivariate analysis, tumor size (HR = 1.10), pathological stage (HR = 1.46), presence of nodal (HR = 2.22) and visceral metastases (HR = 3.49), and Fuhrman grade (HR = 1.48) were independent adverse prognostic factors for cancer-specific survival. CONCLUSIONS Native kidney RCCs arising in ESRD patients are lower stage and lower grade as compared to RCCs diagnosed in the general population, and these tumors exhibit favorable clinical and outcome features.
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Affiliation(s)
- Alberto Breda
- Department of Urology, Fundació Puigvert, Universitat Autonòma de Barcelona, c/Cartagena 340-350, 08025, Barcelona, Spain,
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Brookman-May S, Langenhuijsen JF, Volpe A, Minervini A, Joniau S, Salagierski M, Roscigno M, Akdogan B, Vandromme A, Rodriguez-Faba O, Marszalek M. Management of localized and locally advanced renal tumors. A contemporary review of current treatment options. Minerva Med 2013; 104:237-259. [PMID: 23748279] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
About 70% of patients with renal cell carcinoma present with localized or locally advanced disease at primary diagnosis. Whereas these patients are potentially curable by surgical treatment alone, a further 20% to 30% of patients are diagnosed with primary metastatic disease. Although over the past years medical treatment for metastatic patients has nearly completely changed from immunotherapy to effective treatment with targeted agents, metastatic disease still represents a disease status which is not curable. Also in patients with metastatic disease, surgical treatment of the primary tumor plays an important role, since local tumor related complications can be avoided or minimized by surgery. Furthermore, also improvement of overall survival has been proven for surgery in metastatic patients when combined with cytokine treatment. Hence, surgical combined with systemic treatment as a multi-modal, adjuvant, and neo-adjuvant treatment is also required in patients with advanced or metastatic disease. A growing number of elderly and comorbid patients are currently diagnosed with small renal masses, which has led to increased attention paid to alternative ablative treatment modalities as well as active surveillance strategies, which are applied in order to avoid unnecessary overtreatment in these patients. Since surgical treatment also might enhance the risk of chronic kidney disease with consecutive cardiac disorders as well as reduced overall survival, ablative techniques and active surveillance are increasingly applied. In this review article we focus on current surgical and none-surgical treatment options for the management of patients with localized, locally advanced, and metastatic renal cell carcinoma.
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Affiliation(s)
- S Brookman-May
- Department of Urology Ludwig‑Maximilians‑University CampusGrosshadern, Munich, Germany.
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Brookman-May S, Marszalek M, Joniau S, Minervini A, Langenhujisen JF, Ficarra V, Salagierski M, Roscigno M, Akdogan B, Vandromme A, Rodriguez-Faba O, Volpe A. Role of carbonic anhydrase IX (CAIX) in patients with renal cell carcinoma: can we currently assess its definitive value in prognosis, prediction to treatment response and diagnosis, and as a therapeutic approach? BJU Int 2013. [DOI: 10.1111/bju.12188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sabine Brookman-May
- Department of Urology; Ludwig-Maximilians-University; Campus Grosshadern; Munich Germany
| | - Martin Marszalek
- Department of Urology and Andrology; Donauspital; Vienna Austria
- Department of Urology; Graz Medical University; Graz Austria
| | - Steven Joniau
- Department of Urology; University Hospitals Leuven; Belgium
| | | | - Johan F. Langenhujisen
- Department of Urology; Radboud University Nijmegen Medical Center; Nijmegen The Netherlands
| | - Vincenzo Ficarra
- Department of Oncological and Surgical Sciences; Urologic Unit; University of Padua; Italy
| | | | - Marco Roscigno
- Department of Urology; AO Papa Giovanni XXIII; Bergamo Italy
| | - Bülent Akdogan
- Department of Urology; Hacettepe University; School of Medicine; Ankara Turkey
| | - Alkuin Vandromme
- Department of Urology; Klinikum Braunschweig; Brauanschweig Germany
| | | | - Alessandro Volpe
- Department of Urology; University of Eastern Piedmont; Maggiore della Carità Hospital; Novara Italy
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Brookman-May S, Minervini A, Volpe A, Ficarra V, Salagierski M, Marszalek M, Roscigno M, Akdogan B, Vandromme A, Langenhuijsen JF, Langenhuijsen H, Rodriguez-Faba O, Joniau S. Robot-assisted partial nephrectomy in patients with recurrent disease: fiction or fact? BJU Int 2013; 111:692-4. [PMID: 23578230 DOI: 10.1111/bju.12076] [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]
Affiliation(s)
- Sabine Brookman-May
- Department of Urology, Ludwig-Maximilians-University, Campus Grosshadern, Munich, Germany
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Breda A, Lucarelli G, Rodriguez-Faba O, Ditonno P, Battaglia M, Selvaggi FP, Impedovo S, Luis G, Palou J, Villavicencio H. 638 CLINICAL AND PATHOLOGICAL OUTCOMES OF RENAL CELL CARCINOMA IN NATIVE KIDNEYS PRE- AND POST- KIDNEY TRANSPLANTATION. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.190] [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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Salagierski M, Akdogan B, Brookman-May S, Dobrowolska-Glazar B, Ficarra V, Langenhuijsen JF, Marszalek M, Minervini A, Rodriguez-Faba O, Roscigno M, Vandromme A, Volpe A, Joniau S. What Is the Contemporary Role of Radiofrequency Ablation in the Management of Small Renal Masses? Are Small Lesions the Radiologist's Tumors? Eur Urol 2013; 63:493-5. [DOI: 10.1016/j.eururo.2012.09.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 09/26/2012] [Indexed: 01/20/2023]
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Cosentino M, Palou J, Gaya JM, Breda A, Rodriguez-Faba O, Villavicencio-Mavrich H. Upper urinary tract urothelial cell carcinoma: location as a predictive factor for concomitant bladder carcinoma. World J Urol 2012; 31:141-5. [PMID: 22552732 DOI: 10.1007/s00345-012-0877-2] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 04/16/2012] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE To investigate the existence of predictive factors for concomitant, primary UUT-UCC and BC. Upper urinary tract urothelial cell carcinoma (UUT-UCC) is a pan-urothelial disease of the transitional epithelial cells. Although several studies have shown the association of bladder recurrence following UUT-UCC, little is known on the incidence of concomitant UUT-UCC and bladder cancer (BC) without previous BC. MATERIALS AND METHODS A retrospective review of 673 patients diagnosed and treated for UUT-UCC was performed. Patients with history of BC were excluded. We investigated age, sex, location of the upper tract tumor (calyx, renal pelvis, upper ureter, mid-ureter, lower ureter), multifocality, clinical symptoms, tumor grade and pathological stage. Contingency tables and chi-square test were used for categorical variables and analysis of variance (ANOVA) for quantitative variables. RESULTS 450 patients eligible for inclusion were identified. Of these, 76 (17 %) presented concomitant primary UUT-UCC and BC. Location of primary UUT-UCC was in calyx and/or renal pelvis in 25 patients (34 %), upper ureter 8 (11 %) and lower ureter 37 (49 %). In 6 patients (8 %), data were missing. Concomitant BC was found in 10, 18, and 33 % of patients with primary caliceal/renal pelvis, upper ureter and lower ureter UUT-UCC, respectively. On multivariate analysis, location of UUT-UCC was the only predictive factor for concomitant bladder tumor (OR: 1.7; 95 % CI, 1.007-2.906 p = 0.047). CONCLUSIONS Our findings suggest that the possibility of concomitant BC in primary diagnosed patient with UUT-UCC is as high as 33 % and mainly depends on upper tract tumor location.
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Affiliation(s)
- Marco Cosentino
- Urology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, c/Cartagena 340, 08025, Barcelona, Spain.
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Huguet J, Monllau V, Sabaté S, Rodriguez-Faba O, Algaba F, Palou J, Villavicencio H. Diagnosis, Risk Factors, and Outcome of Urethral Recurrences Following Radical Cystectomy for Bladder Cancer in 729 Male Patients. Eur Urol 2008; 53:785-92 discussion 792-3. [DOI: 10.1016/j.eururo.2007.06.045] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 06/27/2007] [Indexed: 11/27/2022]
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Fernandez-Gomez J, Escaf Barmadah S, Gosalbez D, Rodriguez-Faba O, Jalon A, Gonzalez R, Garcia Miralles T, Calas A. Telomere length on bladder washing samples from patients with bladder cancer correlates with tumor characteristics flow cytometry method for quantitative fluorescence in situ hybridization (flow-FISH technique). Eur Urol 2005; 48:432-7. [PMID: 15963630 DOI: 10.1016/j.eururo.2005.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Accepted: 04/26/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of the present study was to evaluate the length of telomeres in patients with bladder cancer using a quantitative flow cytometry (flow-FISH) technique. METHODS Bladder washing samples from 51 patients with bladder cancer were obtained immediately before transurethral resection. The average length of telomere repeats was measured by flow-FISH, as previously reported. Results were expressed in molecular equivalents of soluble fluorochrome (MESF) units. RESULTS Bladder washing specimens provided adequate cell numbers for flow-FISH in 49 cases. The TEL means were 1014.71, 2343.36, 5567 and 18267.57 for Ta, T1, T2 and T3/4 tumors, respectively. Regarding grade it was obtained a mean MESF value of 1379.46, 3391.29 and 15925.11 for G1, G2 and G3, respectively. ANOVA demonstrated statistically significant differences in stage (p: 0.014) and tumor grades (p: 0.012). In relation to ploidy, we found a mean MESF value of 2701.37 and 16085.44 MESF units for diploid and aneuploid cells, respectively. Significant difference (p: 0.003) was observed between both groups. CONCLUSION To date, this is the first report wherein telomere length was measured using flow-FISH method in exfoliated cells in urine from patients with bladder cancer. Further investigations are required to demonstrate whether flow-FISH technique might be considered as a tumor marker of bladder cancer.
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Affiliation(s)
- Jesus Fernandez-Gomez
- Department of Urology, Hospital Central of Asturias, University of Oviedo, Asturias, Spain.
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