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Deivasigamani S, Kotamarti S, Rastinehad AR, Salas RS, de la Rosette JJMCH, Lepor H, Pinto P, Ahmed HU, Gill I, Klotz L, Taneja SS, Emberton M, Lawrentschuk N, Wysock J, Feller JF, Crouzet S, Kumar M P, Seguier D, Adams ES, Michael Z, Abreu A, Jack Tay K, Ward JF, Shinohara K, Katz AE, Villers A, Chin JL, Stricker PD, Baco E, Macek P, Ahmad AE, Chiu PKF, Crawford ED, Rogers CG, Futterer JJ, Rais-Bahrami S, Robertson CN, Hadaschik B, Marra G, Valerio M, Chong KT, Kasivisvanathan V, Tan WP, Lomas D, Walz J, Guimaraes GC, Mertziotis NI, Becher E, Finelli A, Kasraeian A, Lebastchi AH, Vora A, Rosen MA, Bakir B, Arcot R, Yee S, Netsch C, Meng X, de Reijke TM, Tan YG, Regusci S, Benjamin TGR, Olivares R, Noureldin M, Bianco FJ, Sivaraman A, Kim FJ, Given RW, Dason S, Sheetz TJ, Shoji S, Schulman A, Royce P, Shah TT, Scionti S, Salomon G, Laguna P, Tourinho-Barbosa R, Aminsharifi A, Cathelineau X, Gontero P, Stabile A, Grummet J, Ledbetter L, Graton M, Stephen Jones J, Polascik TJ. Primary Whole-gland Ablation for the Treatment of Clinically Localized Prostate Cancer: A Focal Therapy Society Best Practice Statement. Eur Urol 2023; 84:547-560. [PMID: 37419773 DOI: 10.1016/j.eururo.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/25/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023]
Abstract
CONTEXT Whole-gland ablation is a feasible and effective minimally invasive treatment for localized prostate cancer (PCa). Previous systematic reviews supported evidence for favorable functional outcomes, but oncological outcomes were inconclusive owing to limited follow-up. OBJECTIVE To evaluate the real-world data on the mid- to long-term oncological and functional outcomes of whole-gland cryoablation and high-intensity focused ultrasound (HIFU) in patients with clinically localized PCa, and to provide expert recommendations and commentary on these findings. EVIDENCE ACQUISITION We performed a systematic review of PubMed, Embase, and Cochrane Library publications through February 2022 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. As endpoints, baseline clinical characteristics, and oncological and functional outcomes were assessed. To estimate the pooled prevalence of oncological, functional, and toxicity outcomes, and to quantify and explain the heterogeneity, random-effect meta-analyses and meta-regression analyses were performed. EVIDENCE SYNTHESIS Twenty-nine studies were identified, including 14 on cryoablation and 15 on HIFU with a median follow-up of 72 mo. Most of the studies were retrospective (n = 23), with IDEAL (idea, development, exploration, assessment, and long-term study) stage 2b (n = 20) being most common. Biochemical recurrence-free survival, cancer-specific survival, overall survival, recurrence-free survival, and metastasis-free survival rates at 10 yr were 58%, 96%, 63%, 71-79%, and 84%, respectively. Erectile function was preserved in 37% of cases, and overall pad-free continence was achieved in 96% of cases, with a 1-yr rate of 97.4-98.8%. The rates of stricture, urinary retention, urinary tract infection, rectourethral fistula, and sepsis were observed to be 11%, 9.5%, 8%, 0.7%, and 0.8%, respectively. CONCLUSIONS The mid- to long-term real-world data, and the safety profiles of cryoablation and HIFU are sound to support and be offered as primary treatment for appropriate patients with localized PCa. When compared with other existing treatment modalities for PCa, these ablative therapies provide nearly equivalent intermediate- to long-term oncological and toxicity outcomes, as well as excellent pad-free continence rates in the primary setting. This real-world clinical evidence provides long-term oncological and functional outcomes that enhance shared decision-making when balancing risks and expected outcomes that reflect patient preferences and values. PATIENT SUMMARY Cryoablation and high-intensity focused ultrasound are minimally invasive treatments available to selectively treat localized prostate cancer, considering their nearly comparable intermediate- to long term cancer control and preservation of urinary continence to other radical treatments in the primary setting. However, a well-informed decision should be made based on one's values and preferences.
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Affiliation(s)
| | - Srinath Kotamarti
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | | | | | | | - Herbert Lepor
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Peter Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Hashim U Ahmed
- Division of Urology, Imperial College London & Imperial College Healthcare NHS Trust, London, UK
| | - Inderbir Gill
- Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Laurence Klotz
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Samir S Taneja
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Mark Emberton
- Division of Surgery, University College London, London, UK
| | - Nathan Lawrentschuk
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - James Wysock
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | | | | | | | - Denis Seguier
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA; Department of Urology, University Lille Nord de France, Lille, France
| | - Eric S Adams
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Zoe Michael
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Andre Abreu
- Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore
| | - John F Ward
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Katsuto Shinohara
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Aaron E Katz
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Arnauld Villers
- Department of Urology, University Lille Nord de France, Lille, France
| | - Joseph L Chin
- Department of Urology, University of Western Ontario, London, Ontario, Canada
| | | | - Eduard Baco
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Petr Macek
- Department of Urology, Institute Mutualiste Montsouris, Paris, France
| | - Ardalan E Ahmad
- Department of Urology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter K F Chiu
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | - E David Crawford
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
| | - Jurgen J Futterer
- Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | - Cary N Robertson
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Giancarlo Marra
- Department of Urology, The University Hospital of Turin, Turin, Italy
| | - Massimo Valerio
- Service of Urology, University Hospital of Lausanne, Lausanne, Switzerland
| | | | | | - Wei Phin Tan
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Derek Lomas
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Jochen Walz
- Department of Urology, Paoli-Calmettes Institute Cancer Center, Marseille, France
| | | | | | | | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | | | - Amir H Lebastchi
- Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Anup Vora
- Chesapeake Urology, Silver Spring, MD, USA
| | - Mark A Rosen
- Department of Urology, Sutter Health, Sacramento, CA, USA
| | - Baris Bakir
- Department of Radiology, Istanbul University, Istanbul, Turkey
| | - Rohit Arcot
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA; Department of Urology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Samuel Yee
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | | | - Xiaosong Meng
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Theo M de Reijke
- Department of Urology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Yu Guang Tan
- Department of Urology, Singapore General Hospital, Singapore
| | - Stefano Regusci
- Department of Interventional Oncology, Swiss International Prostate Centelenor, Geneva, Switzerland
| | | | - Ruben Olivares
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Fernando J Bianco
- Urological Research Network, Urologist Specialist Group, Miami Lakes, FL, USA
| | - Arjun Sivaraman
- Division of Urology, Washington University School of Medicine, St Louis, MO, USA
| | - Fernando J Kim
- Division of Urology, Denver Health Medical Center and University of Colorado Hospital, Denver, CO, USA
| | | | - Shawn Dason
- Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Tyler J Sheetz
- Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Sunao Shoji
- Department of Urology, Tokai University School of Medicine, Tokyo, Japan
| | - Ariel Schulman
- Department of Urology, Maimonides Health Medical Center, New York, NY, USA
| | - Peter Royce
- Division of Urology, Monash University, Melbourne, Australia
| | - Taimur T Shah
- Division of Urology, Imperial College London & Imperial College Healthcare NHS Trust, London, UK
| | | | - Georg Salomon
- Martini-Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Pilar Laguna
- Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
| | | | - Alireza Aminsharifi
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Paolo Gontero
- Department of Urology, The University Hospital of Turin, Turin, Italy
| | - Armando Stabile
- Unit of Urology/Division of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jeremy Grummet
- Division of Urology, Monash University, Melbourne, Australia
| | - Leila Ledbetter
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Margaret Graton
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | | | - Thomas J Polascik
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA.
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Dell'Oglio P, Tappero S, Panunzio A, Antonelli A, Salvador D, Xylinas E, Alvarez-Maestro M, Hurle R, Salas RS, Colomer A, Simone G, Hendricksen K, Peroni A, Lonati C, Olivero A, Rouprêt M, Roumiguié M, Soria F, Umari P, D'Andrea D, Terrone C, Galfano A, Moschini M, Trapani ED. Age represents the main driver of surgical decision making in patients candidate to radical cystectomy. J Surg Oncol 2023. [PMID: 37126407 DOI: 10.1002/jso.27255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/10/2023] [Accepted: 03/13/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Age might influence the choice of surgical approach, type of urinary diversion (UD) and lymph node dissection (LND) in patients candidate to radical cystectomy (RC) for urothelial bladder cancer (UBC). Similarly, age may enhance surgical morbidity and worsen perioperative outcomes. We tested the impact of age (octogenarian vs. younger patients) on surgical decision making and peri- and postoperative outcomes of RC. METHODS Non-metastatic muscle-invasive UBC patients treated with RC at 18 high-volume European institutions between 2006 and 2021 were identified and stratified according to age (≥80 vs. <80 years). Intraoperative Complications Assessment and Reporting with Universal Standards and European Association of Urology guidelines recommendations were accomplished in collection and reporting of, respectively, intraoperative and postoperative complications. Multivariable logistic regression models (MVA) tested the impact of age on outcomes of interest. Sensitivity analyses after 1:3 propensity score matching were performed. RESULTS Of 1955 overall patients, 251 (13%) were ≥80-year-old. Minimally invasive RC was performed in 18% and 40% of octogenarian and younger patients, respectively (p < 0.001). UD without bowel manipulation (ureterocutaneostomy, UCS) was performed in 31% and 7% of octogenarian and younger patients (p < 0.001). LND was delivered to 81% and 93% of octogenarian and younger patients (p < 0.001). At MVA, age ≥80 years independently predicted open approach (odds ratio [OR]: 1.55), UCS (OR: 3.70), and omission of LND (OR: 0.41; all p ≤ 0.02). Compared to their younger counterparts, octogenarian patients experienced higher rates of intraoperative (8% vs. 4%, p = 0.04) but not of postoperative complications (64% vs. 61%, p = 0.07). At MVA, age ≥80 years was not an independent predictor of length of stay, intraoperative or postoperative transfusions and complications, and readmissions (all p values >0.1). These results were replicated in sensitivity analyses. CONCLUSIONS Age ≥80 years does not independently portend worse surgical outcomes for RC. However, octogenarians are unreasonably more likely to receive open approach and UCS diversion, and less likely to undergo LND.
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Affiliation(s)
- Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
| | - Stefano Tappero
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Andrea Panunzio
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Daniel Salvador
- Department of Urology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Evanguelos Xylinas
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | | | - Rodolfo Hurle
- Department of Urology, Istituto Clinico Humanitas Istituto di Ricovero e Cura a Carattere Scientifico-Clinical and Research Hospital, Milan, Italy
| | | | - Anna Colomer
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Kees Hendricksen
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Angelo Peroni
- Department of Urology, ASST Spedali Civili, Brescia, Italy
| | - Chiara Lonati
- Department of Urology, ASST Spedali Civili, Brescia, Italy
| | - Alberto Olivero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Morgan Rouprêt
- Department of Urology, Pierre and Marie Curie Medical School, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Sorbonne, Paris, France
| | - Mathieu Roumiguié
- Department of Urology, Institut Universitaire du Cancer, Oncopole, Toulouse, France
| | - Francesco Soria
- Department of Surgical Sciences, Division of Urology, Torino School of Medicine, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paolo Umari
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Carlo Terrone
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Moschini
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ettore Di Trapani
- Division of Urology, IEO-European Institute of Oncology, IRCCS, Milan, Italy
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3
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Tappero S, Dell'Oglio P, Cerruto MA, Sanchez Salas R, Buisan Rueda O, Simone G, Hendricksen K, Soria F, Umari P, Antonelli A, Briganti A, Montorsi F, de Cobelli O, Terrone C, Galfano A, Moschini M, Di Trapani E. Ileal Conduit Versus Orthotopic Neobladder Urinary Diversion in Robot-assisted Radical Cystectomy: Results from a Multi-institutional Series. EUR UROL SUPPL 2023; 50:47-56. [PMID: 37101775 PMCID: PMC10123439 DOI: 10.1016/j.euros.2023.01.009] [Citation(s) in RCA: 4] [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] [Accepted: 01/19/2023] [Indexed: 02/22/2023] Open
Abstract
Background Head-to-head comparisons between ileal conduit (IC) and orthotopic neobladder (ONB) in terms of peri- and postoperative outcomes and complications, in the specific setting of robot-assisted radical cystectomy (RARC), are not available. Objective To address the impact of the type of urinary diversion (UD, IC vs ONB) on RARC morbidity, as well as operative time (OT), length of stay (LOS), and readmissions. Design setting and participants Urothelial bladder cancer patients treated with RARC at nine high-volume European institutions between 2008 and 2020 were identified. Intervention RARC with either IC or ONB. Outcome measurements and statistical analysis Intra- and postoperative complications were collected and reported according to the Intraoperative Complications Assessment and Reporting with Universal Standards recommendations and European Association of Urology guidelines, respectively. Multivariable logistic regression models tested the impact of UD on outcomes, after adjustment for clustering at single hospital level. Results and limitations Overall, 555 nonmetastatic RARC patients were identified. In 280 (51%) and 275 (49%) patients, an IC and an ONB were performed, respectively. Eighteen intraoperative complications were recorded. The rates of intraoperative complications were 4% in IC patients and 3% in ONB patients (p = 0.4). The median LOS and readmission rates were 10 versus 12 d (p < 0.001) and 20% versus 21% (p = 0.8) in IC versus ONB patients, respectively. At a multivariable logistic regression analyses, the type of UD (IC vs ONB) reached the independent predictor status for prolonged OT (odds ratio [OR]: 0.61, p = 0.03) and prolonged LOS (OR: 0.34, p < 0.001), but not for readmission (OR: 0.92, p = 0.7). Overall, 513 postoperative complications were experienced by 324 patients (58%). At least one postoperative complication was experienced by 160 (57%) IC patients versus 164 (60%) ONB patients (p = 0.6). The type of UD reached the status of an independent predictor of UD-related complications (OR: 0.64, p = 0.03). Conclusions Compared with RARC with ONB, RARC with IC is less prone to UD-related postoperative complications, prolonged OT, and prolonged LOS. Patient summary To date, the impact of the type of urinary diversion, namely, ileal conduit versus orthotopic neobladder, on peri- and postoperative outcomes of robot-assisted radical cystectomy is unknown. Based on a rigorous data accrual, which relied on established complication reporting systems (Intraoperative Complications Assessment and Reporting with Universal Standards and European Association of Urology recommended systems), we reported intra- and postoperative complications according to urinary diversion type. Moreover, we found that ileal conduit was associated with lower operative time and length of stay, and yielded a protective effect in terms of urinary diversion-related complications.
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Affiliation(s)
- Stefano Tappero
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
- Corresponding author. Department of Urology, IRCCS Policlinico San Martino, Largo R. Benzi 10, 16132 Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. Tel. +39 3287132369, +39 0105553935.
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Kees Hendricksen
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, Torino School of Medicine, Torino, Italy
| | - Paolo Umari
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - Ottavio de Cobelli
- Department of Urology, European Institute of Oncology IRCCS, Milan, Italy
| | - Carlo Terrone
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Ettore Di Trapani
- Department of Urology, European Institute of Oncology IRCCS, Milan, Italy
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Chys B, Devos G, Everaerts W, Albersen M, Moris L, Claessens F, De Meerleer G, Haustermans K, Briganti A, Chlosta P, Gontero P, Graefen M, Gratzke C, Karnes RJ, Kneitz B, Marchioro G, Salas RS, Spahn M, Tombal B, Van Der Poel H, Walz J, Van Poppel H, Joniau S. Preoperative Risk-Stratification of High-Risk Prostate Cancer: A Multicenter Analysis. Front Oncol 2020; 10:246. [PMID: 32211317 PMCID: PMC7068909 DOI: 10.3389/fonc.2020.00246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 02/13/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Cancer-specific survival (CSS) within high-risk non-metastatic prostate cancer varies dramatically. It is likely that within this heterogenous population there are subgroup(s) at extraordinary risk, burdened with an exaptational poor prognosis. Establishing the characteristics of these group(s) would have significant clinical implications since high quality preoperative risk stratification remains the cornerstone of therapeutic decision making to date. Objective: To stratify high-risk prostate cancer based on preoperative characteristics and evaluate cancer specific survival after radical prostatectomy. Method: The EMPaCT multi-center database offers an international population of non-metastatic high-risk prostate cancer. Preoperative characteristics such as age, biopsy Gleason score, PSA and clinical stage were subcategorized. A multivariate analysis was performed using predictors showing significant survival heterogeneity after stratification, as observed by a univariate analysis. Based upon the hazard ratios of this multivariate analysis, a proportional score system was created. The most ideal group distribution was evaluated trough different score cut-off's. The predictive value was tested by the herald C index. Results: An overall 5-years CSS of 94% was noted within the entire high-risk cohort (n = 4,879). Except for age, all preoperative risk factors showed a significantly differing CSS. Multivariate analysis indicated, T4 stage as being the strongest predictor of CSS (HR: 3.31), followed by ISUP grade 5 group (HR 3,05). A score system was created by doubling the hazard ratios of this multivariate analysis and rounding off to the nearest complete number. Multivariate analysis suggested 0, 4, 8, and 12 pts as being the most optimal group distribution (p-value: 0.0015). Five-years CSS of these groups were 97, 93, 87, and 70%, respectively. The calculated Herald C-index of the model was 0.77. Conclusion: An easy-to-use pre-operative model for risk stratification of newly diagnosed high-risk prostate cancer is presented. The heterogeneous CSS of high-risk non-metastatic prostate cancer after radical prostatectomy is illustrated. The model is clinically accessible through an online calculator, presenting cancer specific survival based on individualized patient characteristics.
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Affiliation(s)
- Brecht Chys
- Urology, Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
| | - Gaëtan Devos
- Urology, Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
| | - Wouter Everaerts
- Urology, Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Albersen
- Urology, Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
| | - Lisa Moris
- Urology, Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | - Frank Claessens
- Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Alberto Briganti
- Department of Urology, San Raffaele Hospital, University Vita Salute, Milan, Italy
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University Medical College, Kraków, Poland
| | - Paolo Gontero
- Department of Urology, University of Turin, Turin, Italy
| | - Markus Graefen
- Department of Urology, Martini Klinik am UKE GmbH, Hamburg, Germany
| | - Christian Gratzke
- Urologische Klinik Und Poliklinik, Ludwig Maximilians Universität, Munich, Germany
| | - R Jeffrey Karnes
- Department of Urology, Mayo Clinic, Rochester, NY, United States
| | - Burkhard Kneitz
- Department of Urology and Pediatric Urology, University Hospital Würzburg, Würzburg, Germany
| | | | - Rafael Sanchez Salas
- Department of Urology, Institut Mutualiste Montsouris and Paris Descartes University, Paris, France
| | - Martin Spahn
- Department of Urology, University Hospital Bern, Inselspital, Switzerland
| | - Bertrand Tombal
- Department of Urology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Henk Van Der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Jochen Walz
- Department of Urology, Institut Paoli Calmettes Cancer Centre, Marseille, France
| | - Hendrik Van Poppel
- Urology, Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
| | - Steven Joniau
- Urology, Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
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Martini A, Gandaglia G, Karnes RJ, Zaffuto E, Bianchi M, Gontero P, Chlosta P, Gratzke C, Graefen M, Tilki D, Cucchiara V, Mirone V, Kneitz B, Sanchez Salas R, Van Der Poel H, Tombal B, Spahn M, Joniau TS, Montorsi F, Briganti A. Defining the Most Informative Intermediate Clinical Endpoints for Predicting Overall Survival in Patients Treated with Radical Prostatectomy for High-risk Prostate Cancer. Eur Urol Oncol 2019; 2:456-463. [DOI: 10.1016/j.euo.2018.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 11/13/2018] [Accepted: 12/04/2018] [Indexed: 01/07/2023]
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Tosco L, Laenen A, Briganti A, Gontero P, Karnes RJ, Bastian PJ, Chlosta P, Claessens F, Chun FK, Everaerts W, Gratzke C, Albersen M, Graefen M, Kneitz B, Marchioro G, Salas RS, Tombal B, Van den Broeck T, Van Der Poel H, Walz J, De Meerleer G, Bossi A, Haustermans K, Van Poppel H, Spahn M, Joniau S. The EMPaCT Classifier: A Validated Tool to Predict Postoperative Prostate Cancer-related Death Using Competing-risk Analysis. Eur Urol Focus 2018; 4:369-375. [DOI: 10.1016/j.euf.2016.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 12/21/2016] [Indexed: 11/15/2022]
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Tosco L, Laenen A, Briganti A, Gontero P, Karnes RJ, Albersen M, Bastian PJ, Chlosta P, Claessens F, Chun FK, Everaerts W, Gratzke C, Graefen M, Kneitz B, Marchioro G, Salas RS, Tombal B, Van den Broeck T, Moris L, Battaglia A, van der Poel H, Walz J, Bossi A, De Meerleer G, Haustermans K, Van Poppel H, Spahn M, Joniau S. The survival impact of neoadjuvant hormonal therapy before radical prostatectomy for treatment of high-risk prostate cancer. Prostate Cancer Prostatic Dis 2017; 20:407-412. [PMID: 28485390 DOI: 10.1038/pcan.2017.29] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 04/07/2017] [Accepted: 04/08/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Several randomized controlled trials assessed the outcomes of patients treated with neoadjuvant hormonal therapy (NHT) before radical prostatectomy (RP). The majority of them included mainly low and intermediate risk prostate cancer (PCa) without specifically assessing PCa-related death (PCRD). Thus, there is a lack of knowledge regarding a possible effect of NHT on PCRD in the high-risk PCa population. We aimed to analyze the effect of NHT on PCRD in a multicenter high-risk PCa population treated with RP, using a propensity-score adjustment. METHODS This is a retrospective multi-institutional study including patients with high-risk PCa defined as: clinical stage T3-4, PSA >20 ng ml-1 or biopsy Gleason score 8-10. We compared PCRD between RP and NHT+RP using competing risks analysis. Correction for group differences was performed by propensity-score adjustment. RESULTS After application of the inclusion/exclusion criteria, 1573 patients remained for analysis; 1170 patients received RP and 403 NHT+RP. Median follow-up was 56 months (interquartile range 29-88). Eighty-six patients died of PCa and 106 of other causes. NHT decreased the risk of PCRD (hazard ratio (HR) 0.5; 95% confidence interval (CI) 0.32-0.80; P=0.0014). An interaction effect between NHT and radiotherapy (RT) was observed (HR 0.3; 95% CI 0.21-0.43; P<0.0008). More specifically, of patients who received adjuvant RT, those who underwent NHT+RP had decreased PCRD rates (2.3% at 5 year) compared to RP (7.5% at 5 year). The retrospective design and lack of specific information about NHT are possible limitations. CONCLUSIONS In this propensity-score adjusted analysis from a large high-risk PCa population, NHT before surgery significantly decreased PCRD. This effect appeared to be mainly driven by the early addition of RT post-surgery. The specific sequence of NHT+RP and adjuvant RT merits further study in the high-risk PCa population.
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Affiliation(s)
- L Tosco
- Department of Development and Regeneration, University Hospitals Leuven, Urology, Leuven, Belgium.,Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium
| | - A Laenen
- Department of Public Health and Primary Care, Leuven Biostatistics and Statistical Bioinformatics Center, KU Leuven, Leuven, Belgium
| | - A Briganti
- Department of Urology, San Raffaele Hospital, University VitaSalute, Milan, Italy
| | - P Gontero
- Department of University Urology, Urologia U, Città della Salue e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - R J Karnes
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - M Albersen
- Department of Development and Regeneration, University Hospitals Leuven, Urology, Leuven, Belgium
| | - P J Bastian
- Department of Urology, Urologische Klinik Und Poliklinik, Klinikum Der Universität München Campus Großhadern, Munich, Germany
| | - P Chlosta
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - F Claessens
- Department of Cellular and Molecular Medicine, Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | - F K Chun
- Department of Urology, University of Hamburg, Hamburg, Germany
| | - W Everaerts
- Department of Development and Regeneration, University Hospitals Leuven, Urology, Leuven, Belgium
| | - C Gratzke
- Department of Urology, Urologische Klinik Und Poliklinik, Klinikum Der Universität München Campus Großhadern, Munich, Germany
| | - M Graefen
- Department of Urology, Martini Klinik am UKE GmbH, Hamburg, Germany
| | - B Kneitz
- Department of Urology and Pediatric Urology, University Hospital Wurzburg, Wurzburg, Germany
| | - G Marchioro
- Department of Urology, University of Piemonte Orientale, Novara, Italy
| | - R S Salas
- Department of Urology, Institut Mutualiste Montsouris and Paris Descartes University, Paris, France
| | - B Tombal
- Department of Urology, Cliniques Universitaires SaintLuc, Brussels, Belgium
| | - T Van den Broeck
- Department of Cellular and Molecular Medicine, Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | - L Moris
- Department of Cellular and Molecular Medicine, Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | - A Battaglia
- Department of University Urology, Urologia U, Città della Salue e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - H van der Poel
- Department Of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Walz
- Department of Urology, Institut Paoli Calmettes Cancer Centre, Marseille, France
| | - A Bossi
- Department of Radiation Oncology, Gustave Roussy Cancer Institute, Villejuif, France
| | - G De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - K Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - H Van Poppel
- Department of Development and Regeneration, University Hospitals Leuven, Urology, Leuven, Belgium
| | - M Spahn
- Department of Urology, University Hospital Bern, Inselspital, Berne, Switzerland
| | - S Joniau
- Department of Development and Regeneration, University Hospitals Leuven, Urology, Leuven, Belgium
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Moris L, Van den Broeck T, Tosco L, Van Baelen A, Gontero P, Karnes RJ, Everaerts W, Albersen M, Bastian PJ, Chlosta P, Claessens F, Chun FK, Graefen M, Gratzke C, Kneitz B, Marchioro G, Salas RS, Tombal B, Van Der Poel H, Walz JC, De Meerleer G, Bossi A, Haustermans K, Montorsi F, Van Poppel H, Spahn M, Briganti A, Joniau S. Impact of Lymph Node Burden on Survival of High-risk Prostate Cancer Patients Following Radical Prostatectomy and Pelvic Lymph Node Dissection. Front Surg 2016; 3:65. [PMID: 28018903 PMCID: PMC5159485 DOI: 10.3389/fsurg.2016.00065] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 11/29/2016] [Indexed: 11/13/2022] Open
Abstract
AIM To determine the impact of the extent of lymph node invasion (LNI) on long-term oncological outcomes after radical prostatectomy (RP). MATERIAL AND METHODS In this retrospective study, we examined the data of 1,249 high-risk, non-metastatic PCa patients treated with RP and pelvic lymph node dissection (PLND) between 1989 and 2011 at eight different tertiary institutions. We fitted univariate and multivariate Cox models to assess independent predictors of cancer-specific survival (CSS) and overall survival (OS). The number of positive lymph node (LN) was dichotomized according to the most informative cutoff predicting CSS. Kaplan-Meier curves assessed CSS and OS rates. Only patients with at least 10 LNs removed at PLND were included. This cutoff was chosen as a surrogate for a well performed PNLD. RESULTS Mean age was 65 years (median: 66, IQR 60-70). Positive surgical margins were present in 53.7% (n = 671). Final Gleason score (GS) was 2-6 in 12.7% (n = 158), 7 in 52% (n = 649), and 8-10 in 35.4% (n = 442). The median number of LNs removed during PLND was 15 (IQR 12-17). Of all patients, 1,128 (90.3%) had 0-3 positive LNs, while 126 (9.7%) had ≥4 positive LNs. Patients with 0-3 positive LNs had significantly better CSS outcome at 10-year follow-up compared to patients with ≥4 positive LNs (87 vs. 50%; p < 0.0001). Similar results were obtained for OS, with a 72 vs. 37% (p < 0.0001) survival at 10 years for patients with 0-3 vs. ≥4 positive LNs, respectively. At multivariate analysis, final GS of 8-10, salvage ADT therapy, and ≥4 (vs. <4) positive LNs were predictors of worse CSS and OS. Pathological stage pT4 was an additional predictor of worse CSS. CONCLUSION Four or more positive LNs, pathological stage pT4, and final GS of 8-10 represent independent predictors for worse CSS in patients with high-risk PCa. Primary tumor biology remains a strong driver of tumor progression and patients having ≥4 positive LNs could be considered an enriched patient group in which novel treatment strategies should be studied.
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Affiliation(s)
- Lisa Moris
- Department of Development and Regeneration, Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KULeuven, Leuven, Belgium
| | - Thomas Van den Broeck
- Department of Development and Regeneration, Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KULeuven, Leuven, Belgium
| | - Lorenzo Tosco
- Department of Development and Regeneration, Urology, University Hospitals Leuven, Leuven, Belgium; Nuclear Medicine and Molecular Imaging, KULeuven, Leuven, Belgium
| | | | - Paolo Gontero
- A.O.U. San Giovanni Battista-le Molinette, Department of Urology, University of Turin , Turin , Italy
| | | | - Wouter Everaerts
- Department of Development and Regeneration, Urology, University Hospitals Leuven , Leuven , Belgium
| | - Maarten Albersen
- Department of Development and Regeneration, Urology, University Hospitals Leuven , Leuven , Belgium
| | - Patrick J Bastian
- Urologische Klinik Und Poliklinik, Klinikum Der Universität München Campus Großhadern, Ludwig Maximilians Universität , Munich , Germany
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University Medical College , Krakow , Poland
| | - Frank Claessens
- Laboratory of Molecular Endocrinology, KULeuven , Hamburg , Germany
| | - Felix K Chun
- Department of Urology, University of Hamburg , Hamburg , Germany
| | | | - Christian Gratzke
- Urologische Klinik Und Poliklinik, Klinikum Der Universität München Campus Großhadern, Ludwig Maximilians Universität , Munich , Germany
| | - Burkhard Kneitz
- Department of Urology and Pediatric Urology, University Hospital Wurzburg , Wurzburg , Germany
| | | | - Rafael Sanchez Salas
- Department of Urology, Institut Mutualiste Montsouris and Paris Descartes University , Paris , France
| | - Bertrand Tombal
- Department of Urology, Cliniques Universitaires SaintLuc , Brussels , Belgium
| | - Henk Van Der Poel
- Department of Urology, Netherlands Cancer Institute , Amsterdam , Netherlands
| | | | - Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven , Leuven , Belgium
| | - Alberto Bossi
- Department of Radiation Oncology, Gustave Roussy Cancer Institute , Villejuif , France
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven , Leuven , Belgium
| | - Francesco Montorsi
- San Raffaele Hospital, Department of Urology, University VitaSalute , Milan , Italy
| | - Hendrik Van Poppel
- Department of Development and Regeneration, Urology, University Hospitals Leuven , Leuven , Belgium
| | - Martin Spahn
- University Hospital Bern, Inselspital, Department of Urology , Berne , Switzerland
| | - Alberto Briganti
- San Raffaele Hospital, Department of Urology, University VitaSalute , Milan , Italy
| | - Steven Joniau
- Department of Development and Regeneration, Urology, University Hospitals Leuven , Leuven , Belgium
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La Croce G, Moschini M, Capogrosso P, Ventimiglia E, Luzzago S, Shariat SF, Sanchez Salas R, Chatelineau X, Salonia A, Briganti A, Montorsi F, Colombo R, Gallina A. MP63-11 PREOPERATIVE PLATELET TO LYMPHOCYTE RATIO AS A PREDICTOR OF SURVIVAL AFTER RADICAL CYSTECTOMY DUE TO BLADDER CANCER. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.940] [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: 11/26/2022]
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Veneziano D, Minervini A, Beatty J, Fornara P, Gozen A, Greco F, Langenhuijsen JF, Lunelli L, Overgaauw D, Rassweiler J, Rocco B, Salas RS, Shariat S, Sweet RM, Simone G, Springer C, Tuccio A, Van Cleynenbreugel B, Weibl P, Cozzupoli P. Construct, content and face validity of the camera handling trainer (CHT): a new E-BLUS training task for 30° laparoscope navigation skills. World J Urol 2015; 34:479-84. [DOI: 10.1007/s00345-015-1657-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022] Open
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Autran-Gomez AM, Secin FP, Sivaraman A, Sanchez Salas R, Monzo JI, Prapotnich D, Barret E, Rozet F, Galiano M, Mombet A, Cathala N, Cathelineau X. MP42-17 PREDICTORS OF PATHOLOGICAL UPGRADING AND UPSTAGING IN PATIENTS ELIGIBLE FOR ACTIVE SURVEILLANCE SUBMITTED TO RADICAL PROSTATECTOMY. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bianchi M, Karnes RJ, Joniau S, Gandaglia G, Spahn M, Gontero P, Sanchez Salas R, Cathelineau X, Kneitz B, Chun FK, Karakiewicz P, Graefen M, Marchioro G, Frohneberg D, Van Poppel H, Montorsi F, Briganti A. MP82-01 LONG-TERM OUTCOMES OF VERY HIGH RISK PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY WITH OR WITHOUT ADJUVANT TREATMENTS. RESULTS OF A COMPETING RISKS, MULTI INSTITUTIONAL ANALYSIS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bianchi M, Karnes RJ, Joniau S, Gandaglia G, Spahn M, Gontero P, Tosco L, Sanchez Salas R, Cathelineau X, Kneitz B, Chun FK, Karakiewicz P, Graefen M, Chlosta P, Marchioro G, Frohneberg D, Van Poppel H, Montorsi F, Briganti A. MP56-10 LONG-TERM SURVIVAL PATTERNS OF YOUNG PATIENTS WITH HIGH RISK PROSTATE CANCER TREATED WITH RADICAL PROSTATECTOMY. RESULTS OF A MULTI INSTITUTIONAL, CONDITIONAL SURVIVAL ANALYSIS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Joniau S, Tosco L, Briganti A, Gontero P, Bastian P, Chun FK, Hsu CY, Marchioro G, Salas RS, Tombal B, Van Der Poel H, Karnes RJ, Spahn M. MP78-05 CHANGING TRENDS IN THE CLINICAL PRESENTATION OF HIGH-RISK PROSTATE CANCER OVER THE LAST 22 YEARS. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ouzzane A, Rozet F, Salas RS, Galiano M, Barret E, Prapotnich D, Cathelineau X. Positive surgical margins after minimally invasive radical prostatectomy in patients with pT2 and pT3a disease could be considered pathological upstaging. BJU Int 2013; 113:586-91. [PMID: 23889763 DOI: 10.1111/bju.12249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the prognostic significance of positive surgical margins (PSMs) after minimally invasive radical prostatectomy (MIRP) in interaction with other established prognosis factors. PATIENTS AND METHODS We retrospectively analysed data prospectively collected between 1998 and 2010 for 4628 consecutive patients who underwent MIRP for clinically localized prostate cancer. The impact of PSM on biochemical recurrence (BCR), defined as prostate-specific antigen (PSA) >0.2 ng/mL, was evaluated using multivariable Cox proportional hazards regression. Estimates of BCR-free survival were generated using the Kaplan-Meier method and compared among groups using the log-rank test. RESULTS The median follow-up was 55 months. On multivariable analysis, PSM was an independent prognostic factor for BCR (adjusted hazard ratio: 2.14 for PSMs vs negative surgical margins (NSMs); 95% confidence interval [CI]: 1.86-2.45; P < 0.001). Other independent predictors for BCR were preoperative PSA, date of surgery, pT stage, Gleason score and lymph node involvement (all P < 0.001). The 5-year BCR-free probability was 80.6% (95% CI: 79-82.2) for NSMs vs 51% (95% CI: 47-55) for PSMs (log-rank P < 0.001). Patients with pT2 and pT3a PSMs had a similar prognosis to those with pT3a and pT3b NSMs, respectively (log-rank P ≥ 0.05). CONCLUSION A PSM after MIRP is associated with 2.14-fold increased risk of BCR. In patients with pT2 and pT3a disease, a PSM could be considered a pathological upstaging.
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Valero R, Barret E, Salas RS, Miranda N, Encinas MS, Rozet F, Ouzzane A, Saad M, Galiano M, Cathelineau X. V1883 ROBOTIC RADICAL CYSTECTOMY WITH NEOADJUVANT CHEMOTHERAPY. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.2038] [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: 11/25/2022]
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Touijer K, Otero JR, Secin FP, Salas RS, Stasi J, Eastham JA, Scardino PT, Guillonneau B. 553: Comprehensive Prospective Comparative Analysis of Outcomes between Open and Laparoscopic Radical Prostatectomy. J Urol 2007. [DOI: 10.1016/s0022-5347(18)30793-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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