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White RE, Linscott JA, Hayn MT, Ryan ST, Howard JM, James E, Hansen MH, Sammon JD. Distance to Treatment With Radical Cystectomy in a Rural State: Long Car Rides, Equivalent Outcomes. Urol Pract 2023; 10:588-594. [PMID: 37647141 DOI: 10.1097/upj.0000000000000449] [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: 04/13/2023] [Accepted: 08/04/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Radical cystectomy is a complex surgery with better outcomes reported when performed at high-volume centers. This may lead to patients traveling farther for care. We examined the impact of travel distance on clinical outcomes. METHODS A total of 220 patients undergoing radical cystectomy from 2015-2021 were retrospectively reviewed. Distance traveled to the treatment center by patient zip codes was classified as <12.5 miles, 12.5-49.9 miles, and ≥50 miles. Multivariable logistic regression was used to assess complications, readmissions, 90-day mortality, and length of stay by distance traveled. Time to treatment based on distance traveled was compared. RESULTS A total of 220 patients underwent radical cystectomy with complete 90-day follow-up. Of the patients 38.6% (85/220) were readmitted; 62.5% (53/85) presented to the treatment center or were transferred. All patients readmitted to an outside hospital traveled ≥12.5 miles (P < .001). Patients with high-grade complications were likely to be transferred to the treatment center with only 23.7% (9/38) definitively managed by outside hospital. Patients traveling >12.5 miles with low-grade complications were more likely to be managed at an outside hospital (57.5%, P = .01). There was no difference in time to initiation of neoadjuvant chemotherapy (P = .99) or time to radical cystectomy following neoadjuvant chemotherapy (P = .23) by distance traveled. For 49 muscle-invasive bladder cancer patients proceeding directly to surgery without neoadjuvant chemotherapy, time from diagnosis to radical cystectomy was increased if traveling >12.5 miles (P = .04). CONCLUSIONS Increased travel distance did not impact early postoperative outcomes. Distance traveled may impact access to care, such as time to surgery or location of readmission to the treatment center postoperatively.
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Pagadala MS, Linscott JA, Talwar JV, Seibert TM, Rose B, Lynch J, Panizzon M, Hauger R, Hansen MH, Sammon JD, Hayn MH, Kader K, Carter H, Ryan ST. PRState: Incorporating genetic ancestry in prostate cancer risk scores for men of African ancestry. BMC Cancer 2022; 22:1289. [PMID: 36494783 PMCID: PMC9733391 DOI: 10.1186/s12885-022-10258-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Prostate cancer (PrCa) is one of the most genetically driven solid cancers with heritability estimates as high as 57%. Men of African ancestry are at an increased risk of PrCa; however, current polygenic risk score (PRS) models are based on European ancestry groups and may not be broadly applicable. The objective of this study was to construct an African ancestry-specific PrCa PRS (PRState) and evaluate its performance. METHODS African ancestry group of 4,533 individuals in ELLIPSE consortium was used for discovery of African ancestry-specific PrCa SNPs. PRState was constructed as weighted sum of genotypes and effect sizes from genome-wide association study (GWAS) of PrCa in African ancestry group. Performance was evaluated using ROC-AUC analysis. RESULTS We identified African ancestry-specific PrCa risk loci on chromosomes 3, 8, and 11 and constructed a polygenic risk score (PRS) from 10 African ancestry-specific PrCa risk SNPs, achieving an AUC of 0.61 [0.60-0.63] and 0.65 [0.64-0.67], when combined with age and family history. Performance dropped significantly when using ancestry-mismatched PRS models but remained comparable when using trans-ancestry models. Importantly, we validated the PRState score in the Million Veteran Program (MVP), demonstrating improved prediction of PrCa and metastatic PrCa in individuals of African ancestry. CONCLUSIONS African ancestry-specific PRState improves PrCa prediction in African ancestry groups in ELLIPSE consortium and MVP. This study underscores the need for inclusion of individuals of African ancestry in gene variant discovery to optimize PRSs and identifies African ancestry-specific variants for use in future studies.
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Affiliation(s)
- Meghana S Pagadala
- Department of Medicine, Division of Medical Genetics, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
- Medical Scientist Training Program, University of California San Diego, La Jolla, CA, USA.
- Biomedical Science Program, University of California, San Diego, La Jolla, CA, USA.
| | | | - James V Talwar
- Bioinformatics and Systems Biology Program, University of California, San Diego, La Jolla, CA, USA
| | - Tyler M Seibert
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, La Jolla, CA, USA
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Brent Rose
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, La Jolla, CA, USA
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Julie Lynch
- VA Salt Lake City Healthcare System, Salt Lake City, UT, USA
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Matthew Panizzon
- VA San Diego Healthcare System, La Jolla, CA, USA
- Center for Behavioral Genetics of Aging, University of California San Diego, La Jolla, CA, USA
| | - Richard Hauger
- VA San Diego Healthcare System, La Jolla, CA, USA
- Center for Behavioral Genetics of Aging, University of California San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health (CESAMH), San Diego Healthcare System, San Diego, CA, USA
| | - Moritz H Hansen
- Division of Urology, Maine Medical Center, Portland, ME, USA
| | - Jesse D Sammon
- Division of Urology, Maine Medical Center, Portland, ME, USA
| | - Matthew H Hayn
- Division of Urology, Maine Medical Center, Portland, ME, USA
| | - Karim Kader
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Hannah Carter
- Department of Medicine, Division of Medical Genetics, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Stephen T Ryan
- Division of Urology, Maine Medical Center, Portland, ME, USA
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Brassetti A, Cacciamani GE, Mari A, Garisto JD, Bertolo R, Sundaram CP, Derweesh I, Bindayi A, Dasgupta P, Porter J, Mottrie A, Schips L, Rah KH, Chen DYT, Zhang C, Jacobsohn K, Anceschi U, Bove AM, Costantini M, Ferriero M, Mastroianni R, Misuraca L, Tuderti G, Kutikov A, White WM, Ryan ST, Porpiglia F, Kaouk J, Minervini A, Gill I, Autorino R, Simone G. On-Clamp vs. Off-Clamp Robot-Assisted Partial Nephrectomy for cT2 Renal Tumors: Retrospective Propensity-Score-Matched Multicenter Outcome Analysis. Cancers (Basel) 2022; 14:cancers14184431. [PMID: 36139591 PMCID: PMC9496892 DOI: 10.3390/cancers14184431] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 07/20/2022] [Revised: 08/30/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022] Open
Abstract
We compared perioperative outcomes after on-clamp versus off-clamp robot-assisted partial nephrectomy (RAPN) for >7 cm renal masses. A multicenter dataset was queried for patients who had undergone RAPN for a cT2cN0cM0 kidney tumor from July 2007 to February 2022. The Trifecta achievement (negative surgical margins, no severe complications, and ≤ 30% postoperative estimated glomerular filtration rate (eGFR) reduction) was considered a surrogate of surgical quality. Overall, 316 cases were included in the analysis, and 58% achieved the Trifecta. A propensity-score-matched analysis generated two cohorts of 89 patients homogeneous for age, ASA score, preoperative eGFR, and RENAL score (all p > 0.21). Compared to the on-clamp approach, OT was significantly shorter in the off-clamp group (80 vs. 190 min; p < 0.001), the incidence of sRFD was lower (22% vs. 40%; p = 0.01), and the Trifecta rate higher (66% vs. 46%; p = 0.01). In a crude analysis, >20 min of hilar clamping was associated with a significantly higher risk of sRFD (OR: 2.30; 95%CI: 1.13−4.64; p = 0.02) and with reduced probabilities of achieving the Trifecta (OR: 0.46; 95%CI: 0.27−0.79; p = 0.004). Purely off-clamp RAPN seems to be a safe and viable option to treat cT2 renal masses and may outperform the on-clamp approach regarding perioperative surgical outcomes.
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Affiliation(s)
- Aldo Brassetti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
- Correspondence: ; Tel.: +39-065-266-6772
| | - Giovanni E. Cacciamani
- USC Institute of Urology and Catherine, Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, CA 90033, USA
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, Oncologic Minimally Invasive Urology and Andrology Unit, Careggi Hospital, University of Florence, 50134 Florence, Italy
| | - Juan D. Garisto
- Department of Urology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Riccardo Bertolo
- Division of Urology, San Carlo di Nancy Hospital, 00165 Rome, Italy
| | | | - Ithaar Derweesh
- Department of Urology, UCSD Health System, La Jolla, CA 92103, USA
| | - Ahmet Bindayi
- Department of Urology, UCSD Health System, La Jolla, CA 92103, USA
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy’s Hospital, King’s College, London WC2R 2LS, UK
| | | | | | - Luigi Schips
- Department of Urology, Annunziata Hospital, G. D’Annunzio University, 66100 Chieti, Italy
| | - Koon Ho Rah
- Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea
| | - David Y. T. Chen
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Chao Zhang
- Department of Urology, Changhai Hospital, Shanghai 200433, China
| | - Kenneth Jacobsohn
- Department of Urology, Medical College Wisconsin, Milwaukee, WA 53226, USA
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Alfredo M. Bove
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Manuela Costantini
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | | | - Riccardo Mastroianni
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Wesley M. White
- Department of Urology, University of Tennessee Medical Center, Knoxville, TN 37920, USA
| | - Stephen T. Ryan
- Department of Urology, UCSD Health System, La Jolla, CA 92103, USA
| | - Francesco Porpiglia
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, 10124 Orbassano, Italy
| | - Jihad Kaouk
- Department of Urology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, Oncologic Minimally Invasive Urology and Andrology Unit, Careggi Hospital, University of Florence, 50134 Florence, Italy
| | - Inderbir Gill
- USC Institute of Urology and Catherine, Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, CA 90033, USA
| | - Riccardo Autorino
- Division of Urology, Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA 23298, USA
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
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Hendrix N, Gulati R, Jiao B, Kader AK, Ryan ST, Etzioni R. Clarifying the Trade-Offs of Risk-Stratified Screening for Prostate Cancer: A Cost-Effectiveness Study. Am J Epidemiol 2021; 190:2064-2074. [PMID: 34023874 DOI: 10.1093/aje/kwab155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/13/2021] [Accepted: 05/18/2021] [Indexed: 12/18/2022] Open
Abstract
Cancer risk prediction is necessary for precision early detection, which matches screening intensity to risk. However, practical steps for translating risk predictions to risk-stratified screening policies are not well established. We used a validated population prostate-cancer model to simulate the outcomes of strategies that increase intensity for men at high risk and reduce intensity for men at low risk. We defined risk by the Prompt Prostate Genetic Score (PGS) (Stratify Genomics, San Diego, California), a germline genetic test. We first recalibrated the model to reflect the disease incidence observed within risk strata using data from a large prevention trial where some participants were tested with Prompt PGS. We then simulated risk-stratified strategies in a population with the same risk distribution as the trial and evaluated the cost-effectiveness of risk-stratified screening versus universal (risk-agnostic) screening. Prompt PGS risk-adapted screening was more cost-effective when universal screening was conservative. Risk-stratified strategies improved outcomes at a cost of less than $100,000 per quality-adjusted life year compared with biennial screening starting at age 55 years, but risk stratification was not cost-effective compared with biennial screening starting at age 45. Heterogeneity of risk and fraction of the population within each stratum were also important determinants of cost-effectiveness.
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Daly WC, Han PKJ, Hayn M, Ryan ST, Hansen MH, Linscott JP, Trinh QD, Sammon JD. Meditative and mind-body practice among patients with genitourinary malignancy. Urol Oncol 2021; 39:192.e15-192.e20. [PMID: 33431327 DOI: 10.1016/j.urolonc.2020.09.011] [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: 04/22/2020] [Revised: 08/23/2020] [Accepted: 09/05/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND OBJECTIVE Research on the utility of meditative and mind-body (MB) practices has increased dramatically in the last two decades and both have been suggested as useful adjuncts in coping with stressors associated with cancer survivorship. There exists little data on use among genitourinary (GU) cancer survivors. This study seeks to describe meditative and MB utilization among GU cancer survivors. METHODS Analysis of data from the 2012 and 2017 National Health Interview Survey was conducted. Patients aged 40 and older reporting a history of any cancer diagnosis (including 3 GU cancers) were included in the analysis. We explored questions about meditative and MB practices in the past 12 months. Complex Samples Logistic regression was performed to compare the relationship between cancer status and use of these practices. RESULTS Self-reported meditative practices were more prevalent in 2017 (17%) than in 2012 (5%). Patients who self-reported a cancer diagnosis of any kind were significantly more likely to utilize meditative practices. Patients with kidney cancer were significantly more likely to meditate and trended towards higher MB utilization. In contrast, bladder cancer patients were less likely to meditate and use MB practices. Increases in meditation were greater than those seen for MB in all groups. CONCLUSIONS Meditative and MB practices increased in prevalence between 2012 and 2017 with notable heterogeneity between cancer types. Given the potential benefit, more broad incorporation into survivorship programs may be warranted. Future work should explore the significance of this heterogeneity and the utility of these practices to patients with urologic malignancy.
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Affiliation(s)
- William C Daly
- Division of Urology Surgery, Maine Medical Center, Portland, ME; Tufts University School of Medicine, Boston, MA
| | - Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME; Tufts University School of Medicine, Boston, MA
| | - Matthew Hayn
- Division of Urology Surgery, Maine Medical Center, Portland, ME; Tufts University School of Medicine, Boston, MA
| | - Stephen T Ryan
- Division of Urology Surgery, Maine Medical Center, Portland, ME; Tufts University School of Medicine, Boston, MA
| | - Moritz H Hansen
- Division of Urology Surgery, Maine Medical Center, Portland, ME; Tufts University School of Medicine, Boston, MA
| | - Joshua P Linscott
- Division of Urology Surgery, Maine Medical Center, Portland, ME; Tufts University School of Medicine, Boston, MA
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jesse D Sammon
- Division of Urology Surgery, Maine Medical Center, Portland, ME; Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME; Tufts University School of Medicine, Boston, MA.
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Ghali F, Daly WC, Hansen M, Hayn M, Sammon J, Beaule LT, Sarkar R, Murphy J, Kader AK, Derweesh I, Rose B, Ryan ST. Pathologic nodal downstaging in men with clinically involved lymph nodes undergoing radical prostatectomy: Implications for definitive locoregional therapy. Urol Oncol 2020; 39:130.e1-130.e7. [PMID: 33121914 DOI: 10.1016/j.urolonc.2020.08.035] [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: 03/28/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 11/26/2022]
Abstract
A prostate cancer (CaP) patient with nonmetastatic but clinical positive lymph nodes (cN+) represents a difficult clinical scenario. We compare overall survival (OS) between cN+ men that underwent radical prostatectomy (RP) and were found to have negative node status (pN) with those found to have positive nodal status (pN+), and assess predictors of discordant nodal status. We queried the National Cancer Data Base between 2004 and 2015 for patients that were cT1-3 cN+ cM0 CaP treated with RP. Patients with 0 nodes, cT4, or cM1 disease were excluded. We compared groups based on pathologic nodal status: Discordant (cN+ -> pN) & Concordant (cN+ -> pN+). Kaplan Meier estimations were used to compare OS. Logistic regression was used to determine possible predictors of nodal status. We find that of 6470 cN+ patients, 1,367 (21.1%) underwent RP, 866 (13.4%) had confirmed nodal status. Discordant status was found in 159 (18.4%) and concordant staging in 707 (81.6%). Differences exist in PSA at diagnosis (7.3 vs. 11.2), biopsy group, # of nodes examined (7 vs. 10), race, and Charlson index. Discordant staging had longer OS compared to Concordant staging (P = 0.007) and similar OS to a 3:1 matched cohort of high risk localized CaP patients used as reference (P = 0.46). Lower Gleason Score (GG1-3) was associated with an increased likelihood of discordant staging. Clinical nodal staging is associated with a substantial false positive rate. Discordant status had better OS than Concordant status and similar OS to matched patients with localized CaP. Clinical nodal staging may inappropriately lead to noncurative therapy in a substantial number of men with potentially curable disease.
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Affiliation(s)
- Fady Ghali
- Department of Urology, University of California, San Diego, CA.
| | | | - Moritz Hansen
- Division of Urology, Maine Medical Center, Portland, ME
| | - Matthew Hayn
- Division of Urology, Maine Medical Center, Portland, ME
| | - Jesse Sammon
- Division of Urology, Maine Medical Center, Portland, ME
| | - Lisa T Beaule
- Division of Urology, Maine Medical Center, Portland, ME
| | - Reith Sarkar
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA
| | - James Murphy
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA
| | - A Karim Kader
- Department of Urology, University of California, San Diego, CA
| | - Ithaar Derweesh
- Department of Urology, University of California, San Diego, CA
| | - Brent Rose
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA
| | - Stephen T Ryan
- Department of Urology, University of California, San Diego, CA
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Ryan ST, Patel DN, Ghali F, Patel SH, Sarkar R, Yim K, Eldefrawy A, Cotta BH, Bradshaw AW, Meagher MF, Hamilton ZA, Murphy JD, Derweesh IH. Impact of positive surgical margins on survival after partial nephrectomy in localized kidney cancer: analysis of the National Cancer Database. Minerva Urol Nephrol 2020; 73:233-244. [PMID: 32748614 DOI: 10.23736/s2724-6051.20.03728-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The impact of positive surgical margins (PSM) on outcomes in partial nephrectomy (PN) is controversial. We investigated impact of PSM for patients undergoing PN on overall survival (OS) in different stages of renal cell carcinoma (RCC). METHODS Retrospective analysis of patients from the US National Cancer Database who underwent PN for cT1a-cT2b N0M0 RCC between 2004-13. Patients were stratified by pathological stage (pT1a, pT1b, pT2a, pT2b, and pT3a [upstaged]) and analyzed by margin status. Cox Regression multivariable analysis (MVA) was performed to investigate associations of PSM and covariates on all-cause mortality (ACM). Kaplan-Meier analysis (KMA) of OS was performed for PSM versus negative margin (NSM) by pathological stage. Sub-analysis of Charlson Comorbidity Index 0 (CCI=0) subgroup was conducted to reduce bias from comorbidities. RESULTS We analyzed 42,113 PN (pT1a: 33,341 [79.2%]; pT1a, pT1b: 6689 [15.9%]; pT2a: 757 [1.8%]; pT2b: 165 [0.4%]; and pT3a: upstaged 1161 [2.8%]). PSM occurred in 6.7% (2823) (pT1a: 6.5%, pT1b: 6.3%, pT2a: 5.9%, pT2b: 6.1%, pT3a: 14.1%, P<0.001). On MVA, PSM was associated with 31% increase in ACM (HR 1.31, P<0.001), which persisted in CCI=0 sub-analysis (HR: 1.25, P<0.001). KMA revealed negative impact of PSM vs. NSM on 5-year OS: pT1 (87.3% vs. 90.9%, P<0.001), pT2 (86.7% vs. 82.5%, P=0.48), and upstaged pT3a (69% vs. 84.2%, P<0.001). CONCLUSIONS PSM after PN was independently associated with across-the-board decrement in OS, which worsened in pT3a disease and persisted in sub-analysis of patients with CCI=0. PSM should prompt more aggressive surveillance or definitive resection strategies.
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Affiliation(s)
- Stephen T Ryan
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Devin N Patel
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Fady Ghali
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Sunil H Patel
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Reith Sarkar
- Department of Radiation Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Kendrick Yim
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Ahmed Eldefrawy
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Brittney H Cotta
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Aaron W Bradshaw
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Margaret F Meagher
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Zachary A Hamilton
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - James D Murphy
- Department of Radiation Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Ithaar H Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA -
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Ryan ST, Patel DN, Ghali F, Patel SH, Sarkar R, Yim K, Eldefrawy A, Cotta BH, Bradshaw AW, Meagher MF, Hamilton ZA, Murphy JD, Derweesh IH. Impact of positive surgical margins on survival after partial nephrectomy in localized kidney cancer: analysis of the National Cancer Database. Minerva Urol Nephrol 2020. [PMID: 32748614 DOI: 10.23736/s0393-2249.20.03728-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The impact of positive surgical margins (PSM) on outcomes in partial nephrectomy (PN) is controversial. We investigated impact of PSM for patients undergoing PN on overall survival (OS) in different stages of renal cell carcinoma (RCC). METHODS Retrospective analysis of patients from the US National Cancer Database who underwent PN for cT1a-cT2b N0M0 RCC between 2004-13. Patients were stratified by pathological stage (pT1a, pT1b, pT2a, pT2b, and pT3a [upstaged]) and analyzed by margin status. Cox Regression multivariable analysis (MVA) was performed to investigate associations of PSM and covariates on all-cause mortality (ACM). Kaplan-Meier analysis (KMA) of OS was performed for PSM versus negative margin (NSM) by pathological stage. Sub-analysis of Charlson Comorbidity Index 0 (CCI=0) subgroup was conducted to reduce bias from comorbidities. RESULTS We analyzed 42,113 PN (pT1a: 33,341 [79.2%]; pT1a, pT1b: 6689 [15.9%]; pT2a: 757 [1.8%]; pT2b: 165 [0.4%]; and pT3a: upstaged 1161 [2.8%]). PSM occurred in 6.7% (2823) (pT1a: 6.5%, pT1b: 6.3%, pT2a: 5.9%, pT2b: 6.1%, pT3a: 14.1%, P<0.001). On MVA, PSM was associated with 31% increase in ACM (HR 1.31, P<0.001), which persisted in CCI=0 sub-analysis (HR: 1.25, P<0.001). KMA revealed negative impact of PSM vs. NSM on 5-year OS: pT1 (87.3% vs. 90.9%, P<0.001), pT2 (86.7% vs. 82.5%, P=0.48), and upstaged pT3a (69% vs. 84.2%, P<0.001). CONCLUSIONS PSM after PN was independently associated with across-the-board decrement in OS, which worsened in pT3a disease and persisted in sub-analysis of patients with CCI=0. PSM should prompt more aggressive surveillance or definitive resection strategies.
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Affiliation(s)
- Stephen T Ryan
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Devin N Patel
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Fady Ghali
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Sunil H Patel
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Reith Sarkar
- Department of Radiation Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Kendrick Yim
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Ahmed Eldefrawy
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Brittney H Cotta
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Aaron W Bradshaw
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Margaret F Meagher
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Zachary A Hamilton
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - James D Murphy
- Department of Radiation Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Ithaar H Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA -
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9
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Ryan ST, Zhang J, Burner DN, Liss M, Pittman E, Muldong M, Shabaik A, Woo J, Basler N, Cunha J, Shalapour S, Estrada MV, Karin M, Messer K, Howell S, Kane CJ, Jamieson CAM. Neoadjuvant rituximab modulates the tumor immune environment in patients with high risk prostate cancer. J Transl Med 2020; 18:214. [PMID: 32466781 PMCID: PMC7257145 DOI: 10.1186/s12967-020-02370-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Immunotherapeutic regulation of the tumor microenvironment in prostate cancer patients is not understood. Most antibody immunotherapies have not succeeded in prostate cancer. We showed previously that high-risk PCa patients have a higher density of tumor infiltrating B-cells in prostatectomy specimens. In mouse models, anti-CD20 antibody ablation of B-cells delayed PCa regrowth post-treatment. We sought to determine whether neoadjuvant anti-CD20 immunotherapy with rituximab could reduce CD20+ B cell infiltration of prostate tumors in patients. METHODS An open label, single arm clinical trial enrolled eight high-risk PCa patients to receive one cycle of neoadjuvant rituximab prior to prostatectomy. Eleven clinical specimens with similar characteristics were selected as controls. Treated and control samples were concurrently stained for CD20 and digitally scanned in a blinded fashion. A new method of digital image quantification of lymphocytes was applied to prostatectomy sections of treated and control cases. CD20 density was quantified by a deconvolution algorithm in pathologist-marked tumor and adjacent regions. Statistical significance was assessed by one sided Welch's t-test, at 0.05 level using a gatekeeper strategy. Secondary outcomes included CD3+ T-cell and PD-L1 densities. RESULTS Mean CD20 density in the tumor regions of the treated group was significantly lower than the control group (p = 0.02). Mean CD3 density in the tumors was significantly decreased in the treated group (p = 0.01). CD20, CD3 and PD-L1 staining primarily occurred in tertiary lymphoid structures (TLS). Neoadjuvant rituximab was well-tolerated and decreased B-cell and T-cell density within high-risk PCa tumors compared to controls. CONCLUSIONS This is the first study to treat patients prior to surgical prostate removal with an immunotherapy that targets B-cells. Rituximab treatment reduced tumor infiltrating B and T-cell density especially in TLSs, thus, demonstrating inter-dependence between B- and T-cells in prostate cancer and that Rituximab can modify the immune environment in prostate tumors. Future studies will determine who may benefit from using rituximab to improve their immune response against prostate cancer. Trial registration NCT01804712, March 5th, 2013 https://clinicaltrials.gov/ct2/show/NCT01804712?cond=NCT01804712&draw=2&rank=1.
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Affiliation(s)
- Stephen T Ryan
- Department of Urology, UCSD Moores Cancer Center, University of California San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code: 0987, La Jolla, CA, 92093-0987, USA
| | - Jing Zhang
- Department of Pharmacology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Danielle N Burner
- Department of Urology, UCSD Moores Cancer Center, University of California San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code: 0987, La Jolla, CA, 92093-0987, USA
| | - Michael Liss
- Department of Urology, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Emily Pittman
- Department of Pharmacology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Michelle Muldong
- Department of Urology, UCSD Moores Cancer Center, University of California San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code: 0987, La Jolla, CA, 92093-0987, USA
| | - Ahmed Shabaik
- Department of Pathology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Jason Woo
- Department of Urology, UCSD Moores Cancer Center, University of California San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code: 0987, La Jolla, CA, 92093-0987, USA
| | - Nicole Basler
- Department of Urology, UCSD Moores Cancer Center, University of California San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code: 0987, La Jolla, CA, 92093-0987, USA
| | - Jonathan Cunha
- Department of Urology, UCSD Moores Cancer Center, University of California San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code: 0987, La Jolla, CA, 92093-0987, USA
| | - Shabnam Shalapour
- Department of Pharmacology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Monica V Estrada
- Biorepository and Tissue Technology Shared Resource at the University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Michael Karin
- Department of Pharmacology, University of California San Diego School of Medicine, La Jolla, CA, USA.,Department of Pharmacology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Karen Messer
- Department of Pharmacology, University of California San Diego School of Medicine, La Jolla, CA, USA.,Division of Biostatistics, Department of Family and Preventive Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Stephen Howell
- Department of Pharmacology, University of California San Diego School of Medicine, La Jolla, CA, USA.,Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Christopher J Kane
- Department of Urology, UCSD Moores Cancer Center, University of California San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code: 0987, La Jolla, CA, 92093-0987, USA.,Department of Pharmacology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Christina A M Jamieson
- Department of Urology, UCSD Moores Cancer Center, University of California San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code: 0987, La Jolla, CA, 92093-0987, USA. .,Department of Pharmacology, University of California San Diego School of Medicine, La Jolla, CA, USA.
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10
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Ghali F, Elbakry AA, Hamilton Z, Nasseri R, Eldefrawy A, Ryan ST, Yim K, Patel S, Bradshaw A, Meagher M, Reddy M, Lee HJ, Derweesh I. Association of robotic partial nephrectomy for clinical T2a renal mass with improved trifecta outcome compared to open partial nephrectomy: A single surgeon comparative analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
653 Background: We compared surgical quality and functional outcomes of robotic partial nephrectomy (RPN) and open PN (OPN) for cT2a renal masses (cT2aRM). Methods: Retrospective analysis of 150 consecutive patients [RPN 59/OPN 91] from 6/2008 to 6/2016. Main outcome was achievement of Trifecta [negative surgical margin, no major urologic complications, and ≥90% preservation of estimated glomerular filtration rate (eGFR)]. Multivariable analysis was performed to identify factors of Trifecta attainment. Results: Mean tumor size (RPN 7.9 vs. OPN 8.4 cm, p=0.139) and median RENAL score (p=0.361) were similar. No difference was noted for positive margins (RPN 3.4% vs. OPN 1.1%, p=0.561), DeGFR (RPN -6.2 vs. OPN -7.8, p=0.543), and ≥90% eGFR recovery (RPN 54.1% vs. OPN 47.2%, p=0.504). RPN had lower blood loss (p=0.015), hospital stay (p=0.013), and Clavien ≥3 complications (RPN 5.1% vs. OPN 16.5%, p=0.041). Trifecta rate was significantly higher in RPN (47.5% vs. 34.0%, p=0.041). Multivariable analysis demonstrated decreasing RENAL score (OR 1.11, p<0.001), RPN (OR 1.2, p=0.013), and decreasing EBL (OR 1.02, p=0.016) to be associated with Trifecta attainment. Conclusions: RPN provided similar functional and oncologic precision to OPN, while being associated with improvements in major complications, the latter of which was reflected in a higher rate of Trifecta achievement for RPN. RPN may be considered to be a first-line option for select patients with cT2aRM when feasible and safe.
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Affiliation(s)
- Fady Ghali
- UC San Diego, Department of Urology, San Diego, CA
| | | | - Zachary Hamilton
- Saint Louis University Department of Surgery-Urology Division, St Louis, MO
| | | | | | | | - Kendrick Yim
- University of California San Diego, San Diego, CA
| | - Sunil Patel
- University of California San Diego, San Diego, CA
| | | | | | | | - Hak J. Lee
- Department of Urology, University of California San Diego, San Diego, CA
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11
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Parsons JK, Cotta B, Rose B, Murphy JD, Ryan ST. Association of salvage cryoablation with decreased utilization of androgen deprivation therapy for recurrent prostate cancer after radiotherapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
358 Background: Cryoablation is an established treatment for recurrent prostate cancer after primary radiotherapy, but outcomes data are mostly limited to uncontrolled case series. We assessed salvage cryoablation efficacy with a comparative analysis in a large national cohort. Methods: Patients with clinically localized prostate cancer treated with primary radiotherapy from 2000 to 2015 were identified in the Veterans Affairs Informatics and Computing Infrastructure (VINCI) dataset. Prostate-specific antigen (PSA) recurrence was defined as nadir + 2 ng/mL. Inclusion criteria included availability of serial PSA measures for ≥ 3 years after completion of radiotherapy and PSA < 10 ng/mL at recurrence. Salvage cryotherapy was identified with procedure- and fee-based billing codes. Chi square and Wilcoxon analysis was utilized for descriptive statistics; and Kaplan Meier analyses for time to androgen deprivation therapy (ADT). Results: Among 35,502 patients who underwent primary radiotherapy, 4,391 (12.3%) developed biochemical recurrence a median (IQR) of 4.5 (2.7, 6.9) years after treatment. Of these, 3889 (88.9%) had PSA < 10 ng/mL at time of recurrence, of whom 95 (2.4%) underwent salvage cryoablation. Cryoablation patients were younger at initial diagnosis (60 years versus 65 years, p < 0.01); had a lower pre-treatment PSA (6.6 ng/mL versus 7.8 ng/mL, p < 0.01); and had a lower PSA nadir (0.04 ng/mL versus 0.19 ng/mL, p<0.01). There were no between-group differences for clinical stage at initial diagnosis (p = 0.22) or African American prevalence (34.7% versus 29%, p =0.27). After recurrence, median (IQR) follow-up for those who did and did not receive cryoablation was 9.1 (7.2, 9.11) and 8.1 (5.4, 10.9) years, respectively. Cryoablation patients were less likely to receive ADT (40% versus 55%, p < 0.01); and, among those who did, time to ADT from recurrence was significantly longer compared to those who did not receive cryoablation (15.5 months versus 5.8 months, p<0.01). Conclusions: Salvage cryoablation is associated with decreased utilization of ADT in patients with biochemical recurrence after radiation.
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Affiliation(s)
| | | | | | - James Don Murphy
- University of California, San Diego School of Medicine, La Jolla, CA
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12
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Sarkar RR, Bryant AK, Parsons JK, Ryan ST, Karim Kader A, Kane CJ, McKay RR, Sandhu A, Murphy JD, Rose BS. Association between Radical Prostatectomy and Survival in Men with Clinically Node-positive Prostate Cancer. Eur Urol Oncol 2019; 2:584-588. [PMID: 31411995 PMCID: PMC6697241 DOI: 10.1016/j.euo.2018.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/02/2018] [Revised: 09/15/2018] [Accepted: 09/27/2018] [Indexed: 11/24/2022]
Abstract
Evidence supporting radical prostatectomy (RP) for men with clinically node-positive (cN+) prostate cancer (PC) is limited. In a US national database, we identified 741 men with cN+ nonmetastatic PC diagnosed during 2000-2015 who underwent definitive local therapy with RP (n=78), radiotherapy (RT) with neoadjuvant androgen deprivation therapy (ADT) (n=193), or nondefinitive therapy with ADT alone (n=445) or observation (n=25). We compared PC-specific mortality (PCSM) and all-cause mortality (ACM) using multivariable Fine-Gray competing risk regression and Cox regression, respectively. Compared to nondefinitive therapy, RP was associated with significantly better PCSM (subdistribution hazard ratio [SHR] 0.32, 95% confidence interval [CI] 0.16-0.66; p=0.002) and ACM (HR 0.36, 95% CI 0.21-0.61; p<0.001). Compared to RT, RP was not associated with a significant difference in PCSM (SHR 0.47, 95% CI 0.19-1.17; p=0.1) or ACM (HR 0.88, 95% CI 0.46-1.70; p=0.71). These data suggest that RP is associated with favorable survival outcomes that appear to be superior to those for patients who did not receive definitive therapy and comparable to those for patients receiving definitive ADT/RT. Randomized trials of surgery with multimodal therapy are needed. PATIENT SUMMARY: We found that in clinically node-positive prostate cancer, radical prostatectomy was associated with a cancer-specific and overall survival benefit compared to nondefinitive therapy. Randomized clinical trials are required to determine the best treatment approach in this patient population.
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Affiliation(s)
- Reith R Sarkar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Alex K Bryant
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - J Kellogg Parsons
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Stephen T Ryan
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - A Karim Kader
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Christopher J Kane
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Rana R McKay
- Division of Hematology-Oncology, Department of Internal Medicine, University of California San Diego, La Jolla, CA, USA
| | - Ajay Sandhu
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Brent S Rose
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA.
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13
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Sarkar RR, Parsons JK, Bryant AK, Ryan ST, Kader AK, McKay RR, D'Amico AV, Nguyen PL, Hulley BJ, Einck JP, Mundt AJ, Kane CJ, Murphy JD, Rose BS. Association of Treatment With 5α-Reductase Inhibitors With Time to Diagnosis and Mortality in Prostate Cancer. JAMA Intern Med 2019; 179:812-819. [PMID: 31058923 PMCID: PMC6503564 DOI: 10.1001/jamainternmed.2019.0280] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE 5α-Reductase inhibitors (5-ARIs), commonly used to treat benign prostatic hyperplasia, reduce serum prostate-specific antigen (PSA) concentrations by 50%. The association of 5-ARIs with detection of prostate cancer in a PSA-screened population remains unclear. OBJECTIVE To test the hypothesis that prediagnostic 5-ARI use is associated with a delayed diagnosis, more advanced disease at diagnosis, and higher risk of prostate cancer-specific mortality and all-cause mortality than use of other or no PSA-decreasing drugs. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study linked the Veterans Affairs Informatics and Computing Infrastructure with the National Death Index to obtain patient records for 80 875 men with American Joint Committee on Cancer stage I-IV prostate cancer diagnosed from January 1, 2001, to December 31, 2015. Patients were followed up until death or December 31, 2017. Data analysis was performed from March 2018 to May 2018. EXPOSURES Prediagnostic 5-ARI use. MAIN OUTCOMES AND MEASURES The primary outcome was prostate cancer-specific mortality (PCSM). Secondary outcomes included time from first elevated PSA (defined as PSA≥4 ng/mL) to diagnostic prostate biopsy, cancer grade and stage at time of diagnosis, and all-cause mortality (ACM). Prostate-specific antigen levels for 5-ARI users were adjusted by doubling the value, consistent with previous clinical trials. RESULTS Median (interquartile range [IQR]) age at diagnosis was 66 (61-72) years; median [IQR] follow-up was 5.90 (3.50-8.80) years. Median time from first adjusted elevated PSA to diagnosis was significantly greater for 5-ARI users than 5-ARI nonusers (3.60 [95% CI, 1.79-6.09] years vs 1.40 [95% CI, 0.38-3.27] years; P < .001) among patients with known prostate biopsy date. Median adjusted PSA at time of biopsy was significantly higher for 5-ARI users than 5-ARI non-users (13.5 ng/mL vs 6.4 ng/mL; P < .001). Patients treated with 5-ARI were more likely to have Gleason grade 8 or higher (25.2% vs 17.0%; P < .001), clinical stage T3 or higher (4.7% vs 2.9%; P < .001), node-positive (3.0% vs 1.7%; P < .001), and metastatic (6.7% vs 2.9%; P < .001) disease than 5-ARI nonusers. In a multivariable regression, patients who took 5-ARI had higher prostate cancer-specific (subdistribution hazard ratio [SHR], 1.39; 95% CI, 1.27-1.52; P < .001) and all-cause (HR, 1.10; 95% CI, 1.05-1.15; P < .001) mortality. CONCLUSIONS AND RELEVANCE Results of this study demonstrate that prediagnostic use of 5-ARIs was associated with delayed diagnosis and worse cancer-specific outcomes in men with prostate cancer. These data highlight a continued need to raise awareness of 5-ARI-induced PSA suppression, establish clear guidelines for early prostate cancer detection, and motivate systems-based practices to facilitate optimal care for men who use 5-ARIs.
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Affiliation(s)
- Reith R Sarkar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla
| | - J Kellog Parsons
- Department of Urology, University of California San Diego, La Jolla
| | - Alex K Bryant
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla
| | - Stephen T Ryan
- Department of Urology, University of California San Diego, La Jolla
| | - Andrew K Kader
- Department of Urology, University of California San Diego, La Jolla
| | - Rana R McKay
- Department of Internal Medicine, Division of Hematology-Oncology, University of California San Diego, La Jolla
| | - Anthony V D'Amico
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin J Hulley
- Department of Medicine, Veterans Affairs San Diego Health System, La Jolla.,Department of Internal Medicine, University of California San Diego, La Jolla
| | - John P Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla
| | - Arno J Mundt
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla
| | | | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla
| | - Brent S Rose
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla
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14
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Berquist SW, Yim K, Ryan ST, Patel SH, Eldefrawy A, Cotta BH, Bradshaw AW, Meagher MF, Bindayi A, McKay RR, Autorino R, Staehler M, Derweesh IH. Systemic therapy in the management of localized and locally advanced renal cell carcinoma: Current state and future perspectives. Int J Urol 2019; 26:532-542. [DOI: 10.1111/iju.13943] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/17/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Sean W Berquist
- Department of Urology UC San Diego School of Medicine La Jolla California USA
| | - Kendrick Yim
- Department of Urology UC San Diego School of Medicine La Jolla California USA
| | - Stephen T Ryan
- Department of Urology UC San Diego School of Medicine La Jolla California USA
| | - Sunil H Patel
- Department of Urology UC San Diego School of Medicine La Jolla California USA
| | - Ahmed Eldefrawy
- Department of Urology UC San Diego School of Medicine La Jolla California USA
| | - Brittney H Cotta
- Department of Urology UC San Diego School of Medicine La Jolla California USA
| | - Aaron W Bradshaw
- Department of Urology UC San Diego School of Medicine La Jolla California USA
| | - Margaret F Meagher
- Department of Urology UC San Diego School of Medicine La Jolla California USA
| | - Ahmet Bindayi
- Department of Urology UC San Diego School of Medicine La Jolla California USA
| | - Rana R McKay
- Division of Medical Oncology UC San Diego School of Medicine La Jolla California USA
| | - Riccardo Autorino
- Division of Urology Virginia Commonwealth University School of Medicine Richmond Virginia USA
| | - Michael Staehler
- Department of Urology Ludwig‐Maximilian University Munich Germany
| | - Ithaar H Derweesh
- Department of Urology UC San Diego School of Medicine La Jolla California USA
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15
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Cotta BH, Meagher MF, Bradshaw A, Ryan ST, Rivera-Sanfeliz G, Derweesh IH. Percutaneous renal mass biopsy: historical perspective, current status, and future considerations. Expert Rev Anticancer Ther 2019; 19:301-308. [DOI: 10.1080/14737140.2019.1571915] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Brittney H. Cotta
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Margaret F. Meagher
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Aaron Bradshaw
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Stephen T. Ryan
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Gerant Rivera-Sanfeliz
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Ithaar H. Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA, USA
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16
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Mohler JL, Halabi S, Ryan ST, Al-Daghmin A, Sokoloff MH, Steinberg GD, Sanford BL, Eastham JA, Walther PJ, Morris MJ, Small EJ. Management of recurrent prostate cancer after radiotherapy: long-term results from CALGB 9687 (Alliance), a prospective multi-institutional salvage prostatectomy series. Prostate Cancer Prostatic Dis 2018; 22:309-316. [PMID: 30385835 DOI: 10.1038/s41391-018-0106-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/09/2018] [Accepted: 09/29/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND To evaluate efficacy and morbidity prospectively in a contemporary multi-institutional salvage radical prostatectomy (SRP) series. METHODS Forty-one men were enrolled between 1997 and 2006, who suffered biopsy-proven recurrent prostate cancer (CaP) after receiving ≥ 60c Gy radiation as primary treatment for cT1-2NXM0 disease. Surgical morbidity, quality of life, biochemical progression-free survival (BPFS) and overall survival (OS) were evaluated. RESULTS Twenty-four men had undergone external beam radiotherapy, 11 brachytherapy, and six both. Median time between radiation and SRP was 64 months. Median age at SRP was 64 years. Pathologic staging revealed 44% pT2, 54% pT3, and 3% pT4. Surgical margins were positive in 17 and 88% were pN0. Twenty-two percent required intraoperative blood transfusion. Three rectal and one obturator nerve injuries occurred. Seventeen of 38 evaluable patients (45%) had urinary incontinence ( ≥ 3 pads/day) prior to SRP; 88% reported urinary incontinence at 6 months, 85% at 12 months, 63% at 24 months after SRP. Furthermore, 37% of men reported impotence prior to SRP; 78% reported impotence at 6 months, 82% at 12 months, and 44% at 24 months after SRP. The 2-, 5- and 10-year BPFS rates were 51, 39, and 33% respectively; the 2-, 5- and 10-year OS rates were 100, 89, and 52%, respectively, at median follow-up 91 months. CONCLUSIONS Modern surgical techniques continue to be associated with significant peri-operative complication rates. Nevertheless, SRP may benefit carefully selected patients through durable oncologic control.
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Affiliation(s)
- James L Mohler
- Roswell Park Cancer Institute, Buffalo, NY, CA59518, United States.
| | - Susan Halabi
- Department of Biostatistics and Bioinformatics and Alliance Statistics and Data Center, Duke University, Durham, NC, CA33601, United States
| | - Stephen T Ryan
- University of California San Diego, La Jolla, CA, United States
| | - Ali Al-Daghmin
- Roswell Park Cancer Institute, Buffalo, NY, CA59518, United States
| | | | | | - Ben L Sanford
- Alliance Statistics and Data Center, Duke University, Durham, NC, CA33601, United States
| | - James A Eastham
- Memorial Sloan Kettering Cancer Center, New York, NY, CA77651, United States
| | - Philip J Walther
- Duke University Medical Center, Durham, NC, CA47577, United States
| | - Michael J Morris
- Memorial Sloan Kettering Cancer Center, New York, NY, CA77651, United States
| | - Eric J Small
- University of California at San Francisco, San Francisco, CA, CA60138, United States
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17
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Derweesh IH, Ryan ST, Hamilton ZA. Partial nephrectomy for T1b and T2 renal masses: A subtle paradigm shift and a new synthesis. Cancer 2018; 124:3798-3801. [DOI: 10.1002/cncr.31579] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 04/23/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Ithaar H. Derweesh
- Department of Urology, UC San Diego Moores Cancer Center; University of California San Diego School of Medicine; Louisiana Jolla, California Maryland
| | - Stephen T. Ryan
- Department of Urology, UC San Diego Moores Cancer Center; University of California San Diego School of Medicine; Louisiana Jolla, California Maryland
| | - Zachary A. Hamilton
- Department of Urology, UC San Diego Moores Cancer Center; University of California San Diego School of Medicine; Louisiana Jolla, California Maryland
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18
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Abstract
Lower urinary tract dysfunction is an umbrella diagnosis that covers difficulty evacuating urine from the bladder. In its most simple form, it is either an inability to store urine or an inability to empty the bladder of urine appropriately. The normal and the abnormal bladder, the role of urodynamics in evaluation of lower urinary tract dysfunction, and the medical and behavioral management of some of these disorders are reviewed.
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Affiliation(s)
- Robert C McDonough
- Division of Urology, Maine Medical Center, Tufts University School of Medicine, Portland, ME 04105, USA.
| | - Stephen T Ryan
- Division of Urology, Maine Medical Center, Portland, ME 04105, USA
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Abstract
Inguinal herniation of the bladder is relatively common, reported in as many as 4% of inguinal hernias. In the majority of those cases, it is a sliding hernia that is noted at time of herniorrhaphy. Complete herniation of the bladder or “scrotal cystocele” is very rare and normally managed with herniorrhaphy. This case report presents a case of massive inguinal scrotal herniation of the urinary bladder successfully managed with trans-scrotal drainage via neocystostomy tube.
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Affiliation(s)
- Stephen T Ryan
- Maine Medical Center, Urology, 22 Bramhall St, Portland, ME 04102, USA
| | - Brian Jumper
- Maine Medical Center, Urology, 22 Bramhall St, Portland, ME 04102, USA
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Sampson NS, Ryan ST, Enke DA, Cosgrove D, Koteliansky V, Gotwals P. Global gene expression analysis reveals a role for the alpha 1 integrin in renal pathogenesis. J Biol Chem 2001; 276:34182-8. [PMID: 11447218 DOI: 10.1074/jbc.m102859200] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Kidney fibrosis is the hallmark of most types of progressive kidney disease, including the genetic disorder Alport's syndrome. We undertook gene expression analysis in Alport's syndrome mouse kidneys using microchip arrays to characterize the development of fibrosis. In addition to matrix and matrix-remodeling genes, consistent with interstitial fibrosis, macrophage-related genes show elevated expression levels in Alport's syndrome kidneys. Immunohistochemical analysis of kidney sections illustrated that macrophages as well as myofibroblasts accumulate in the tubular interstitium. Deletion of alpha(1) integrin results in decreased accumulation of both myofibroblasts and macrophages in the tubular interstitium in Alport's syndrome mice and delays disease progression. Transforming growth factor beta antagonism, although reducing interstitial fibrosis, does not limit macrophage accumulation in the tubular interstitium and disease progression. In this study, we identified previously overlooked inflammatory events that occur in the tubulointerstitial region. We propose that in addition to the previously suggested role for the alpha(1)beta(1) integrin in mesangial expansion and abnormal laminin deposition, this integrin may be critical for monocyte accumulation that, in turn, may lead directly to renal failure. Our gene expression and immunohistochemical data indicate that macrophage accumulation is dependent on alpha(1) integrin expression on the macrophage cell surface and that anti-alpha(1) integrin strategies may be employed as therapeutics in the treatment of chronic inflammatory and fibrotic diseases.
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Affiliation(s)
- N S Sampson
- Biogen, Inc., Cambridge, Massachusetts 02142, USA
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22
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Wang Q, Wang Y, Hyde DM, Gotwals PJ, Lobb RR, Ryan ST, Giri SN. Effect of antibody against integrin alpha4 on bleomycin-induced pulmonary fibrosis in mice. Biochem Pharmacol 2000; 60:1949-58. [PMID: 11108812 DOI: 10.1016/s0006-2952(00)00491-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Integrins are a family of transmembrane glycoproteins that can interact with components of the extracellular matrix. The alpha4beta1 and alpha4beta7 integrins are heterodimeric leukocyte cell surface molecules critical to their cell and matrix adhesive interactions. Evidence for a central role for the alpha4 integrins in leukocyte pathophysiology in the lung is well documented. In this study, we tested the hypothesis that neutralizing antibody for integrin alpha4 (PS2) may reduce bleomycin (BL)-induced lung fibrosis in vivo. Male C57BL/6 mice were injected intratracheally with saline (SA) or BL (0.08 U/mouse) followed by intraperitoneal injection of SA, isotype control antibody (1E6), or PS2 (100 microg) three times a week. Twenty-one days after the intratracheal instillation, mice were killed for bronchoalveolar lavage (BAL), biochemical, histopathological, and immunohistological analyses. Treatment with PS2 significantly reduced BL-induced increases in lung lipid peroxidation and hydroxyproline content. Lung histopathology also showed reduced fibrotic lesions in the BL-treated lungs by treatment with PS2. BL-treated mouse lungs also showed induction of cells with the myofibroblast phenotype, as indicated by the increased expression of alpha-smooth muscle actin (alphaSMA), whereas treatment with PS2 minimized the BL-induced alphaSMA expression. Furthermore, treatment with PS2 reduced the BL-induced increase in the BAL total cell number, and attenuated the BL-induced increase in the BAL protein level. It is concluded that integrin alpha4 may play an important role in BL-induced pulmonary fibrosis, and the use of anti-alpha4 antibody offers therapeutic antifibrotic potential in vivo.
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Affiliation(s)
- Q Wang
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, CA 95616, USA.
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Wang Q, Wang Y, Hyde DM, Gotwals PJ, Koteliansky VE, Ryan ST, Giri SN. Reduction of bleomycin induced lung fibrosis by transforming growth factor beta soluble receptor in hamsters. Thorax 1999; 54:805-12. [PMID: 10456973 PMCID: PMC1745567 DOI: 10.1136/thx.54.9.805] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Transforming growth factor beta (TGF-beta) is a key mediator of collagen synthesis in the development of lung fibrosis. It has previously been shown that the administration of TGF-beta antibody and TGF-beta binding proteoglycan, decorin, reduced bleomycin (BL) induced lung fibrosis in animals. The present study was carried out to investigate whether intratracheal instillation of TGF-beta soluble receptor (TR) would minimise the BL induced lung fibrosis in hamsters. METHODS The effect of a recombinant TR (TGFbetaRII) on the lung collagen accumulation was evaluated in a BL hamster model of pulmonary fibrosis. Animals were divided into four groups and intratracheally injected with saline or BL at 6.5 U/4 ml/kg followed by intratracheal instillation of phosphate buffered saline (PBS) or 4 nmol TR in 0.3 ml twice a week. Twenty days after the first intratracheal instillation the hamsters were killed for bronchoalveolar lavage (BAL) fluid, biochemical, and histopathological analyses. RESULTS Treatment of hamsters with TR after intratracheal instillation of BL significantly reduced BL induced lung fibrosis as shown by decreases in the lung hydroxyproline level and prolyl hydroxylase activity, although they were still significantly higher than those of the saline control. Histopathological examination showed a considerable decrease in BL induced fibrotic lesions by TR treatment. However, TR did not prevent the BL induced increases in total cells and protein in the BAL fluid. CONCLUSIONS These results suggest that TR has antifibrotic potential in vivo and may be useful in the treatment of fibrotic diseases where increased TGF-beta is associated with excess collagen accumulation.
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Affiliation(s)
- Q Wang
- Department of Molecular Biosciences, University of California, Davis, California 95616, USA Biogen Inc, Cambridge, Massachusetts 02142, USA
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Gotwals PJ, Chi-Rosso G, Ryan ST, Sizing I, Zafari M, Benjamin C, Singh J, Venyaminov SY, Pepinsky RB, Koteliansky V. Divalent cations stabilize the alpha 1 beta 1 integrin I domain. Biochemistry 1999; 38:8280-8. [PMID: 10387073 DOI: 10.1021/bi982860m] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recent structural and functional analyses of alpha integrin subunit I domains implicate a region in cation and ligand binding referred to as the metal ion-dependent adhesion site (MIDAS). Although the molecular interactions between Mn2+ and Mg2+ and the MIDAS region have been defined by crystallographic analyses, the role of cation in I domain function is not well understood. Recombinant alpha 1 beta 1 integrin I domain (alpha1-I domain) binds collagen in a cation-dependent manner. We have generated and characterized a panel of antibodies directed against the alpha1-I domain, and selected one (AJH10) that blocks alpha 1 beta 1 integrin function for further study. The epitope of AJH10 was localized within the loop between the alpha 3 and alpha 4 helices which contributes one of the metal coordination sites of the MIDAS structure. Kinetic analyses of antibody binding to the I domain demonstrate that divalent cation is required to stabilize the epitope. Denaturation experiments demonstrate that cation has a dramatic effect on the stabilization of the I domain structure. Mn2+ shifts the point at which the I domain denatures from 3.4 to 6.3 M urea in the presence of the denaturant, and from 49.5 to 58.6 degrees C following thermal denaturation. The structural stability provided to the alpha1-I domain by divalent cations may contribute to augmented ligand binding that occurs in the presence of these cations.
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Affiliation(s)
- P J Gotwals
- Biogen, Inc., Cambridge, Massachusetts 02142, USA.
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Taylor FR, Bixler SA, Budman JI, Wen D, Karpusas M, Ryan ST, Jaworski GJ, Safari-Fard A, Pollard S, Whitty A. Induced fit activation mechanism of the exceptionally specific serine protease, complement factor D. Biochemistry 1999; 38:2849-59. [PMID: 10052957 DOI: 10.1021/bi982140f] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We have investigated the mechanism by which the complement protease, Factor D, achieves its high specificity for the cleavage of Factor B in complex with C3(H2O). Kinetic experiments showed that Factor B and C3(H2O) associate with a KD of >/=2.5 microM and that Factor D acts on this complex with a second-order rate constant of kcat/KM >/= 2 x 10(6) M-1 s-1, close to the rate of a diffusion-controlled reaction for proteins of this size. In contrast, Factor D, which is a member of the trypsin family of serine proteases, was 10(3)-10(4)-fold less active than trypsin toward both thioester and p-nitroanilide substrates containing an arginine at P1. Furthermore, peptides spanning the Factor B cleavage site were not detectably cleaved by Factor D (kcat/KM </= 0.5 M-1 s-1). These results imply that contacts between Factor D and the C3(H2O)B complex, outside the vicinity of the cleavage site in Factor B, generate >/=9 kcal/mol of binding energy to stabilize the transition state for reaction. In support of this, we demonstrate that chemical modification of Factor D at a single lysine residue that is distant from the active site abolishes the activity of the enzyme toward Factor B while not affecting activity toward small synthetic substrates. We propose that Factor D may exemplify a special case of the induced fit mechanism in which the requirement for conformational activation of the enzyme results in a substantial increase in substrate specificity.
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Affiliation(s)
- F R Taylor
- Department of Protein Engineering, Biogen, Inc., Cambridge, Massachusetts 02142, USA
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Ryan ST, Chi-Rosso G, Bonnycastle LL, Scott JK, Koteliansky V, Pollard S, Gotwals PJ. Epitope mapping of a function-blocking beta 1 integrin antibody by phage display. Cell Adhes Commun 1998; 5:75-82. [PMID: 9638343 DOI: 10.3109/15419069809005600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Integrins are a major class of cell surface receptors involved in cell-cell and cell-matrix adhesion and communication. Ha2/11 is a function-blocking anti-rat beta 1 integrin hamster IgM that should be a useful reagent for understanding beta 1 integrin function. We demonstrate that Ha2/11 cross reacts with human, Xenopus, and Drosophila beta 1 integrins, and use phage display to map the epitope for Ha2/11 to residues within the sequence LRSGEPQTF which lies 18 amino acids proximal to the putative I domain in beta 1 integrins. Monoclonal antibody mapping experiments, mutational analyses, and direct binding assays have implicated integrin I domains in both cation and ligand binding. Our data therefore suggest that Ha2/11 blocks beta 1 integrin function by interfering with I domain-mediated ligand binding.
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Affiliation(s)
- S T Ryan
- Biogen, Inc., Cambridge, MA 02142, USA
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