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Vlachostergios PJ, Karathanasis A, Dimitropoulos K, Zachos I, Tzortzis V. High PSMA expression is associated with immunosuppressive tumor microenvironment in clear cell renal cell carcinoma. Precis Clin Med 2024; 7:pbae010. [PMID: 38726361 PMCID: PMC11079668 DOI: 10.1093/pcmedi/pbae010] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Affiliation(s)
- Panagiotis J Vlachostergios
- Department of Medical Oncology, IASO Thessalias Hospital, Larissa 41110, Greece
- Department of Urology, University of Thessaly, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, Larissa 41110, Greece
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Athanasios Karathanasis
- Department of Urology, University of Thessaly, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, Larissa 41110, Greece
| | | | - Ioannis Zachos
- Department of Urology, University of Thessaly, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, Larissa 41110, Greece
| | - Vassilios Tzortzis
- Department of Urology, University of Thessaly, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, Larissa 41110, Greece
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Gatsos S, Kalogeras N, Dimakopoulos G, Samarinas M, Papakonstantinou A, Petinaki E, Tzortzis V, Gravas S. Infectious complications of transrectal prostate biopsy in patients receiving targeted antibiotic prophylaxis after urethral and rectal swab versus standard prophylaxis: A prospective comparative study. Prostate Int 2024; 12:35-39. [PMID: 38523904 PMCID: PMC10960084 DOI: 10.1016/j.prnil.2023.11.002] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 03/26/2024] Open
Abstract
Background To evaluate the role of targeted antibiotic prophylaxis (TAP) after rectal and urethral swab cultures compared to empiric antibiotic prophylaxis (EAP) for the prevention of infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-Bx). Methods We conducted a prospective comparative study on 141 patients who underwent TRUS-Bx and were allocated in two groups. The first group (n = 71) received EAP with ciprofloxacin and the second (n = 70) received TAP according to rectal and urethral cultures. Post-biopsy infectious complications rates were compared between the two groups. Fluoroquinolone resistance (FQ-R) in the urethral and rectal swabs was recorded. Baseline characteristics were analyzed to assess their relationship with infectious complications and antibiotic resistance. Results A total of 8 infectious complications were observed, 7 of them in the EAP group (9.85%) and 1 in the TAP group (1.4%). There was a statistically significant difference in febrile UTIs between the two groups (6 vs 0, P = 0.028). FQ-R rate was 4.3% and 12.9% for rectal and urethral samples, respectively. Recent antibiotic exposure was associated with higher post-biopsy infection rates for EAP group and FQ-R rates for TAP group. Conclusion Combination of rectal and urethral swab cultures for TAP was able to detect FQ-R bacteria carriers and was associated with fewer infectious complications compared to EAP.
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Affiliation(s)
- Sotirios Gatsos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Nikolaos Kalogeras
- Department of Urology, Agios Dimitrios General Hospital, Thessaloniki, Greece
| | - Georgios Dimakopoulos
- BIOSTATS, Epirus Science and Technology Park, Campus of the University of Ioannina, Ioannina, Greece
| | | | | | - Efi Petinaki
- Department of Microbiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Vassilios Tzortzis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Evmorfopoulos K, Marsitopoulos K, Karachalios R, Karathanasis A, Dimitropoulos K, Tzortzis V, Zachos I, Vlachostergios PJ. The Immune Landscape and Immunotherapeutic Strategies in Platinum-Refractory Testicular Germ Cell Tumors. Cancers (Basel) 2024; 16:428. [PMID: 38275869 PMCID: PMC10814346 DOI: 10.3390/cancers16020428] [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: 12/27/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Testicular germ cell tumors (TGCTs) are cancers with very good prognosis, even in the metastatic setting, with high curative potential mainly attributed to the introduction of cisplatin-based chemotherapy. However, approximately 15% of the patients develop platinum-refractory disease and suffer multiple relapses. Therefore, there is an unmet need for novel therapeutic agents with improved efficacy and minimal long-term side effects. Recent advances in the development of immunotherapeutic agents, particularly immune checkpoint inhibitors (ICIs), have offered an opportunity to test their activity in various tumor types, including GCTs. This review aims to analyze the immune microenvironment of these tumors and present the most recently available data from studies that have tested immunotherapeutic agents against GCTs. The majority of the available knowledge derives from case reports or small cohort studies, particularly those involving ICIs of the PD-1/PD-L1 axis alone or in combination with anti-CTLA-4 monoclonal antibodies. Other immunotherapeutic targeted approaches, including antibody-drug conjugates, antibody prodrugs, vaccines, tyrosine kinase inhibitors, chimeric antigen receptor (CAR) T-cell therapy, have biological rationales and have shown preliminary activity or are currently being tested. Growing evidence on these and other approaches will assist in broadening the currently limited treatment armamentarium against platinum-refractory TGCTs.
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Affiliation(s)
- Konstantinos Evmorfopoulos
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece (V.T.)
| | - Konstantinos Marsitopoulos
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece (V.T.)
| | - Raphael Karachalios
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece (V.T.)
| | - Athanasios Karathanasis
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece (V.T.)
| | | | - Vassilios Tzortzis
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece (V.T.)
| | - Ioannis Zachos
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece (V.T.)
| | - Panagiotis J. Vlachostergios
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece (V.T.)
- Department of Medical Oncology, IASO Thessalias Hospital, 41500 Larissa, Greece
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
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Tsiakoulias E, Gravas S, Hadjichristodoulou C, Oikonomou KG, Kyritsi M, Dadouli K, Matziri A, Kola K, Vacthsioli E, Tsiakoulia M, Gianniou M, Tzortzis V. Randomized, placebo-controlled, double-blinded study of prophylactic cranberries use in women with recurrent uncomplicated cystitis. World J Urol 2024; 42:27. [PMID: 38214795 DOI: 10.1007/s00345-023-04741-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/17/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Τhe adherence of p-fimbriated Escherichia coli (E. coli) to urothelial cells leading to recurrent urinary tract infections (rUTIs) may be prevented by proanthocyanidins (PACs) contained in American cranberries. PURPOSE The purpose of this clinical trial was to assess the clinical utility of prophylactic use of high-dose PACs daily in women with a history of rUTIs. MATERIALS AND METHODS 172 adult women with a history of rUTIs, defined as ≥ 2 within a 6-month period or ≥ 3 within a 12-month period were enrolled and randomized in two groups to receive either Cysticlean™ 240 mg or placebo for a 12-month period. Urine samples, vaginal and rectal swabs were collected at initial and quarterly study visits. The primary study endpoints were the number of urinary tract infections (UTIs) and changes in Quality of Life (QoL), assessed by the 36-Item Short Form Survey (SF-36) questionnaire. RESULTS 160 adult women of median age 40 years old (range 19-82) were finally analyzed in this randomized, placebo-controlled, double-blinded clinical trial. In response to intervention, the number of UTIs was significantly lower (Incidence rate ratio IRR 0.49, p < 0.001) and QoL was slightly improved. The numbers of E. coli isolates detected in vaginal (IRR 0.71, p value < 0.001) and in rectal swabs (IRR 0.87, p value < 0.001) were also significantly decreased. No adverse events were reported. CONCLUSION The daily use of Cysticlean™ 240 mg was associated with a reduction of UTIs and a prolongation of UTI-free survival compared to placebo treatment, supporting its use as prophylaxis in this patient population. TRIAL REGISTRATION Clinicaltrials.gov, identifier NCT03032003.
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Affiliation(s)
- Eleftherios Tsiakoulias
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110, Larissa, Greece.
| | - Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
| | | | - Katerina G Oikonomou
- Intensive Care Unit, General Hospital of Larissa, 41221, Larissa, Thessaly, Greece
| | - Maria Kyritsi
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41222, Larissa, Greece
| | - Katerina Dadouli
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41222, Larissa, Greece
| | - Alexia Matziri
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41222, Larissa, Greece
| | - Konstantina Kola
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41222, Larissa, Greece
| | - Evangelia Vacthsioli
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41222, Larissa, Greece
| | - Marianna Tsiakoulia
- Department of Occupational Therapy, Melathron Agoniston EOKA, 4549, Limassol, Cyprus
| | - Michaela Gianniou
- Department of Immunology and Histocompatibility, Faculty of Medicine, University of Thessaly, 41500, Larissa, Greece
| | - Vassilios Tzortzis
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110, Larissa, Greece
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Samara M, Vlachostergios PJ, Thodou E, Zachos I, Mitrakas L, Evmorfopoulos K, Tzortzis V, Giakountis A. Characterization of a miRNA Signature with Enhanced Diagnostic and Prognostic Power for Patients with Bladder Carcinoma. Int J Mol Sci 2023; 24:16243. [PMID: 38003433 PMCID: PMC10671612 DOI: 10.3390/ijms242216243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/04/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Bladder carcinoma is globally among the most prevalent cancers and is associated with a high mortality rate at advanced stages. Its detection relies on invasive diagnostic methods that are unpleasant for the patient. Non-invasive molecular biomarkers, such as miRNAs, could serve as alternatives for early detection and prognosis of this malignancy. We designed a computational approach that combines transcriptome profiling, survival analyses, and calculation of diagnostic power in order to isolate miRNA signatures with high diagnostic and prognostic utility. Our analysis of TCGA-BLCA data from 429 patients yielded one miRNA signature, consisting of five upregulated and three downregulated miRNAs with cumulative diagnostic power that outperforms current diagnostic methods. The same miRNAs have a strong prognostic significance since their expression is associated with the overall survival of bladder cancer patients. We evaluated the expression of this signature in 19 solid cancer types, supporting its unique diagnostic utility for bladder carcinoma. We provide computational evidence regarding the functional implications of this miRNA signature in cell cycle regulation, demonstrating its abundance in body fluids, including peripheral blood and urine. Our study characterized a novel miRNA signature with the potential to serve as a non-invasive method for bladder cancer diagnosis and prognosis.
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Affiliation(s)
- Maria Samara
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41335 Larissa, Greece
| | - Panagiotis J. Vlachostergios
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Eleni Thodou
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41335 Larissa, Greece
| | - Ioannis Zachos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41335 Larissa, Greece
| | - Lampros Mitrakas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41335 Larissa, Greece
| | - Konstantinos Evmorfopoulos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41335 Larissa, Greece
| | - Vassilios Tzortzis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41335 Larissa, Greece
| | - Antonis Giakountis
- Department of Biochemistry and Biotechnology, University of Thessaly, 41335 Larissa, Greece
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Evmorfopoulos K, Mitrakas L, Karathanasis A, Zachos I, Tzortzis V, Vlachostergios PJ. Upper Tract Urothelial Carcinoma: A Rare Malignancy with Distinct Immuno-Genomic Features in the Era of Precision-Based Therapies. Biomedicines 2023; 11:1775. [PMID: 37509415 PMCID: PMC10376290 DOI: 10.3390/biomedicines11071775] [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: 04/19/2023] [Revised: 06/11/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
Upper tract urothelial carcinoma (UTUC) is a rare malignancy, occurring in 5-10% of patients diagnosed with UC, and involves the renal pelvis, calyces, or ureters. UTUC can be sporadic or hereditary as a clinical manifestation of Lynch syndrome. Therapeutic management of these patients is challenging. Following risk stratification of localized disease, patients with low-grade UTUC may undergo kidney-sparing surgery or radical nephroureterectomy (RNU) and/or chemoablation with mitomycin-c instillation to reduce recurrence. In high-grade disease, RNU followed by adjuvant chemotherapy remains the standard of care. For decades, platinum-based chemotherapy has been the cornerstone of treatment for locally advanced and metastatic disease. The aim of the present review is to summarize recent advances in UTUC's therapeutic management through the lens of its genomic and immune landscape. Accumulating knowledge on the genetic and immune aspects of UTUC tumors has increased our understanding of their underlying biology, supporting a luminal papillary, T-cell depleted contexture and enrichment in fibroblast growth factor receptor (FGFR) expression. These advances have fueled successful clinical testing of several precision-based therapeutic approaches, including immune checkpoint inhibitors (ICIs), the antibody-drug conjugates (ADCs) enfortumab vedotin and sacituzumab govitecan, and agents targeting the FGFR axis such as erdafitinib and other kinase inhibitors, allowing their entry into the therapeutic armamentarium and improving the prognosis of these patients. Not all patients respond to these precision-based targeted therapies; thus, validating and expanding the toolkit of potential biomarkers of response or resistance, including molecular subtypes, FGFR pathway gene alterations, DNA repair gene defects, tumor mutational burden (TMB), circulating tumor DNA (ctDNA), nectin-4, TROP2, and programmed death ligand-1 (PD-L1), are key to maximizing the benefit to these particular subgroups of patients.
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Affiliation(s)
- Konstantinos Evmorfopoulos
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Lampros Mitrakas
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Athanasios Karathanasis
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Ioannis Zachos
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Vassilios Tzortzis
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Panagiotis J. Vlachostergios
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
- Department of Medical Oncology, IASO Thessalias Hospital, 41500 Larissa, Greece
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
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Evmorfopoulos K, Chasiotis G, Barbatis A, Zachos I, Kouvelos G, Bareka M, Vlachostergios PJ, Arnaoutoglou E, Tzortzis V, Matsagkas M. Complete Vascular Replacement of the Infrarenal Inferior Vena Cava and Abdominal Aorta during Post-Chemotherapy Retroperitoneal Lymph Node Dissection for a Non-Seminomatous Germ Cell Tumor. Curr Oncol 2023; 30:5448-5455. [PMID: 37366895 DOI: 10.3390/curroncol30060412] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/04/2023] [Revised: 05/27/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
Testicular germ cell tumors (TGCTs) are the leading cause of cancer-related death in males between the ages of 20 and 40. In the advanced stages, the combination of cisplatin-based chemotherapy and surgical excision of the remaining tumor can cure many of these patients. Vascular procedures may be required during retroperitoneal lymph node dissection (RPLND) in order to achieve the complete excision of all residual retroperitoneal masses. Careful assessment of pre-operative imaging and the identification of patients who could benefit from additional procedures are important for minimizing peri- and postoperative complications. We report on a case of a 27-year-old patient with non-seminomatous TGCT, who successfully underwent post-chemotherapy RPLND with additional infrarenal inferior vena cava (IVC) and complete abdominal aorta replacement using synthetic grafts.
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Affiliation(s)
- Konstantinos Evmorfopoulos
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
| | - Georgios Chasiotis
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
| | - Alexandros Barbatis
- Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
| | - Ioannis Zachos
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
| | - George Kouvelos
- Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
| | - Metaxia Bareka
- Department of Anesthesiology, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
| | - Panagiotis J Vlachostergios
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
- Department of Medical Oncology, IASO Thessalias Hospital, 41500 Larissa, Greece
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Eleni Arnaoutoglou
- Department of Anesthesiology, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
| | - Vassilios Tzortzis
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
| | - Miltiadis Matsagkas
- Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
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Evmorfopoulos K, Tzortzis V, Vlachostergios PJ. Granular cell tumors of the urethra. Cancer Treat Res Commun 2023; 35:100695. [PMID: 36940531 DOI: 10.1016/j.ctarc.2023.100695] [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: 05/28/2022] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 05/15/2023]
Abstract
Granular cell tumors (GCTs) are a rare type of mesenchymal tumors that are histologically derived by Schwann cells and rise within soft tissues such as skin and mucosal surfaces. Differentiation between benign and malignant GCTs is often difficult and relies on their biological behavior and metastatic potential. While there are no standard guidelines for management, upfront surgical resection, whenever feasible, is key as a definitive measure. Systemic therapy is often limited by poor chemosensitivity of these tumors; however, accumulating knowledge of their underlying genomic landscape has opened some opportunities for targeted approaches, for example, the vascular endothelial growth factor tyrosine kinase inhibitor pazopanib, which is already in clinical use for the treatment of many types of advanced soft tissue sarcomas.
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Affiliation(s)
- Konstantinos Evmorfopoulos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece
| | - Vassilios Tzortzis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece
| | - Panagiotis J Vlachostergios
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece; Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY 10065, USA.
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Dimitropoulos K, Pisters LL, Papandreou CN, Daliani D, Karatzas A, Petsiti A, Tassoudis V, Arnaoutoglou E, Vlachostergios PJ, Tzortzis V. The Impact of Enhanced Recovery after Surgery Protocol Implementation on Postoperative Pain Management in the Era of Opioid Crisis: The Postchemotherapy Open RPLND Experience. Curr Cancer Drug Targets 2023; 23:910-916. [PMID: 37170984 DOI: 10.2174/1568009623666230426093255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 02/03/2023] [Accepted: 02/16/2023] [Indexed: 05/13/2023]
Abstract
AIM Enhanced Recovery After Surgery (ERAS) protocols have been proven to optimize postoperative outcomes; however, misuse of opioid analgesics can still hinder postoperative recovery due to related side effects and potential complications. INTRODUCTION To determine if the implementation of ERAS protocol in post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) patients could help with reducing postoperative pain and opioid use. METHODS A case-control study of consecutive testicular cancer patients with indications for PCRLPND, who were offered Conventional Post-operative Management (CPM) or ERAS protocol. Outcomes of interest included Visual Analogue Scale (VAS)-assessed pain level at postoperative days 3, 7, and 30, and Morphine-Equivalent Doses (MEDs)/postoperative day. Intraoperative parameters and postoperative complications were recorded. Parametric and non-parametric tests were used for statistical analysis. RESULTS In total, 100 opioid-naïve PC-RPLND patients were studied. CPM and ERAS groups (36 and 64 patients, respectively) had similar demographic and baseline clinical characteristics). ERAS group patients had significantly lower blood loss (p = 0.005), blood transfusion rate (p < 0.001), and duration of the procedure (p < 0.001). Post-operative complications were comparable between groups. Nausea and bowel disorders were numerically but not statistically more frequent in the CPM group. ERAS patients had shorter mean hospital stay (5.3 ± 1.4 vs. 7.4 ± 1.6 days, p < 0.001), lower daily MEDs (4.73 ± 2.63 vs. 7.04 ± 2.29, p < 0.001), and lower VAS scores on post-operative day 7 (3.89 ± 1.07 vs. 4.67 ± 1.17, p = 0.001). Post-operative pain was similar between groups on post-operative days 3 and 30. CONCLUSION Systematic implementation of ERAS protocol after PC-RPLND improves pain management, optimizes patient recovery, and prevents over-prescription of opioid analgesics.
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Affiliation(s)
- Konstantinos Dimitropoulos
- Department of Urology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, Scotland, United Kingdom
- Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Louis L Pisters
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christos N Papandreou
- Department of Medical Oncology, Faculty of Medicine, School of Health Sciences, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Danai Daliani
- Department of Medical Oncology, Euroclinic, Athens, Greece
| | - Anastasios Karatzas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Argiro Petsiti
- Department of Anaesthesiology, University Hospital of Larissa, Larissa, Greece
| | - Vassilios Tassoudis
- Department of Anaesthesiology, University Hospital of Larissa, Larissa, Greece
| | - Eleni Arnaoutoglou
- Department of Anaesthesiology, University Hospital of Larissa, Larissa, Greece
| | - Panagiotis J Vlachostergios
- Department of Urology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
- Department of Medical Oncology, IASO Thessalias Hospital, Larissa, Greece
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Vassilios Tzortzis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
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Evmorfopoulos K, Vlachostergios PJ, Sountoulides P, Tzortzis V. Εmerging Biomarkers in the Diagnosis and Treatment of Testicular Tumors. Curr Cancer Drug Targets 2023; 23:858-867. [PMID: 36967458 DOI: 10.2174/1568009623666230324114236] [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: 08/25/2022] [Revised: 12/13/2022] [Accepted: 01/20/2023] [Indexed: 03/29/2023]
Abstract
Testicular germ cell tumors (TGCT) are the leading cause of cancer-related death in young males between the ages of 20-40. Surgical resection and cisplatin-based chemotherapy can achieve a cure for the majority of patients with TGCTs, with survival rates of up to 97% for patients diagnosed at an early stage. The use of serum biomarkers, such as AFP β-HCG, and LDH, plays a significant role in both diagnosis and evaluation of response to treatment, and despite their low sensitivity and specificity levels, they are an integral part of the current tumor staging system and daily practice. Molecular biomarkers, including micro-RNAs and gene-expression profiles, are currently being developed in TGCTs and could potentially hold a prominent place in the future diagnosis, treatment selection, surveillance, and prognostication of these tumors. This review discusses how current advances in our understanding of the underlying biology of TGCTs have helped biomarker discovery, with a focus on the recognition of key molecular alterations that could serve as potential indicators of disease onset, response to systemic or/and surgical therapies, and overall clinical course.
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Affiliation(s)
- Konstantinos Evmorfopoulos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, 41100, Greece
| | - Panagiotis J Vlachostergios
- Department of Urology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, 41100, Greece
- Department of Medical Oncology, IASO Thessalias Hospital, Larissa, 41500, Greece
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Petros Sountoulides
- 1st Department of Urology, School of Medicine, "G Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, 54635, Greece
| | - Vassilios Tzortzis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, 41100, Greece
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Papathanassiou M, Tamposis I, Exarchou-Kouveli KK, Kontou PI, de Paz AT, Mitrakas L, Samara M, Bagos PG, Tzortzis V, Vlachostergios PJ. Immune-based treatment re-challenge in renal cell carcinoma: A systematic review and meta-analysis. Front Oncol 2022; 12:996553. [DOI: 10.3389/fonc.2022.996553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022] Open
Abstract
IntroductionThe use of immune checkpoint inhibitors (ICIs) as a front-line treatment for metastatic renal cell carcinoma (RCC) has significantly improved patient’ outcome. However, little is known about the efficacy or lack thereof of immunotherapy after prior use of anti-PD1/PD-L1 or/and anti-CTLA monoclonal antibodies.MethodsElectronic databases, including PubMed, EMBASE, Medline, Web of Science, and Cochrane Library, were comprehensively searched from inception to July 2022. Objective response rates (ORR), progression-free survival (PFS), and ≥ grade 3 adverse events (AEs) were assessed in the meta-analysis, along with corresponding 95% confidence intervals (CIs) and publication bias.ResultsTen studies which contained a total of 500 patients were included. The pooled ORR was 19% (95% CI: 10, 31), and PFS was 5.6 months (95% CI: 4.1, 7.8). There were ≥ grade 3 AEs noted in 25% of patients (95% CI: 14, 37).ConclusionThis meta-analysis on different second-line ICI-containing therapies in ICI-pretreated mRCC patients supports a modest efficacy and tolerable toxicity.
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Tsougos I, Michaliou M, Vassiou K, Tsivaka D, Vamvakas A, Tzortzis V, Theodorou K, Vlychou M. ULTRA-HIGH (B1,600), MULTI-B-VALUE (B500, B800, B1,000) AND SYNTHETIC B-VALUE DIFFUSION WEIGHTED IMAGING COMPARISON, IN MULTI-PARAMETRIC PROSTATE CANCER MRI. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03111-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Vlachostergios P, Apostolopoulou C, Mitrakas L, Tzortzis V, Anagnostou M, Papathanasiou M, Ioannou M, Samara M, Thodou E. Evaluation of a cytology-molecular co-test in urine of patients with non-muscle invasive urothelial cancer. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02572-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Zachos I, Mitrakas L, Karasavvidou F, Karatzas A, Tzortzis V. Clear-cell renal cell carcinoma single urinary bladder metastasis: a case report and review of the literature. J Surg Case Rep 2022; 2022:rjac475. [PMID: 36299912 PMCID: PMC9586710 DOI: 10.1093/jscr/rjac475] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/21/2022] [Indexed: 11/25/2022] Open
Abstract
Renal cell carcinoma (RCC) is the most frequent solid lesion accounting for ~90% of all kidney malignancies. Clear-cell RCC (ccRCC) represents the most frequent subtype. Urinary bladder is a rare metastatic site either synchronous or metachronous. Hereby, we report the case of an 85-year-old male patient with a single urinary bladder metastasis due to ccRCC and we present a review of the literature.
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Affiliation(s)
- Ioannis Zachos
- Correspondence addres. Department of Urology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece. Tel: (+30)-2413-502986, Mobile: (+30)-6948057871; E-mail:
| | - Lampros Mitrakas
- Department of Urology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Foteini Karasavvidou
- Department of Pathology and Cytology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Anastasios Karatzas
- Department of Urology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Vassilios Tzortzis
- Department of Urology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa, Larissa, Greece
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15
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Karasavvidou F, Mitrakas L, Tzika S, Zachos I, Anagnostou A, Tzortzis V. Mixed epithelial and stromal tumor—adult cystic nephroma of the kidney: a case report with immunohistochemical analysis. J Surg Case Rep 2022; 2022:rjac387. [PMID: 36105648 PMCID: PMC9467513 DOI: 10.1093/jscr/rjac387] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/06/2022] [Indexed: 11/23/2022] Open
Abstract
The mixed epithelial and stromal tumor family of kidney contain neoplasms with biphasic epithelial and stromal component. According to the 2016 World Health Organization Classification, they encompasses a spectrum of tumors ranging from predominantly cystic tumors (adult cystic nephroma) to tumors that are variably solid (Mixed epithelial and stromal tumor-MESTs). We present the case of a 20-year-old woman with an adult cystic nephroma which was verified by immunohistochemical examination.
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Affiliation(s)
- Foteini Karasavvidou
- Department of Pathology and Cytology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa , Larissa , Greece
| | - Lampros Mitrakas
- Department of Urology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa , Larissa , Greece
| | - Styliani Tzika
- Department of Pathology and Cytology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa , Larissa , Greece
| | - Ioannis Zachos
- Department of Urology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa , Larissa , Greece
| | - Athanasios Anagnostou
- Department of Urology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa , Larissa , Greece
| | - Vassilios Tzortzis
- Department of Urology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa , Larissa , Greece
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Mitsogiannis IC, Mitsogianni M, Bakalis V, Tzortzi de Paz A, Vlachostergios PJ, Tzortzis V. Health-Related Quality of Life Assessment in Daily Urologic Practice: A Survey of Greek Urologists. Res Rep Urol 2022; 14:71-78. [PMID: 35321536 PMCID: PMC8937306 DOI: 10.2147/rru.s354925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/08/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose Health-related quality of life (HRQoL) assessment has become an integral part of clinical research across different disciplines. However, the degree of incorporation of QoL standardized questionnaires in daily routine is variable. This survey study examined how HRQoL is perceived and utilized among urologists from the Hellenic Urological Association (HUA) in their daily practice. Methods A nationwide survey of Greek urologists registered with the HUA was conducted. Participants were asked to complete a questionnaire sent via email. The survey questionnaire consisted of demographic data including sex, age, working position and working environment and 11 Likert-scale questions regarding perception and use of HRQoL in clinical practice. Results A total of 1000 Greek urologists were contacted, of whom 400 (40%) responded. Participants were predominantly male (94.8%) with a mean age of 43.7 years and a mean working experience of 12.5 years. Most participants considered HRQoL assessment to be important in their clinical practice (95.3%) and valuable in both patient consultation (95.8%) and treatment follow-up (91.8%). Half of urologists (51%) agreed with the statement that there is limited time for HRQoL assessment in daily practice. Validated questionnaires were rated as useful by 75.5% of participants. Overall, only 26.7% of participants stated they have incorporated HRQoL questionnaires in their daily practice. A subgroup analysis of participants showed that experienced physicians (>10 years) were less likely to utilize HRQoL (OR 0.38, p=0.008, 95% CI 0.19–0.77) and experienced difficulty in distinguishing between HRQoL assessment and symptom-rating (OR 0.32, p<0.001, 95% CI 0.17–0.61). Lack of time for HRQoL assessment was a main concern for urologists in-training (OR 0.7, p<0.001, 95% CI 0.57–0.85). Conclusion HRQoL assessment is well-perceived by Greek urologists, although it has yet to achieve a substantial degree of integration in their daily practice.
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Affiliation(s)
- Iraklis C Mitsogiannis
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanoglio General Hospital, Athens, Greece
| | - Maria Mitsogianni
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanoglio General Hospital, Athens, Greece
| | - Vissarion Bakalis
- Department of Nursing, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Anna Tzortzi de Paz
- Department of Urology, University of Thessaly, Faculty of Medicine, University Hospital of Larissa, Larissa, Greece
| | - Panagiotis J Vlachostergios
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Correspondence: Panagiotis J Vlachostergios, Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA, Tel +1 646-962-2072, Email
| | - Vassilios Tzortzis
- Department of Urology, University of Thessaly, Faculty of Medicine, University Hospital of Larissa, Larissa, Greece
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Vlachostergios PJ, Karathanasis A, Papandreou CN, Tzortzis V. Early mRNA Expression of Neuroendocrine Differentiation Signals Predicts Recurrence After Radical Prostatectomy: A Transcriptomic Analysis. World J Oncol 2022; 12:232-239. [PMID: 35059083 PMCID: PMC8734499 DOI: 10.14740/wjon1423] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/30/2021] [Indexed: 12/04/2022] Open
Abstract
Background Neuroendocrine differentiation (NED) of prostate cancer (PC) is a process that often occurs under evolutionary pressure from pharmacologic blockade of androgen receptor signaling at advanced stages of the disease. Identifying a subset of early PC that has a higher likelihood to evolve into this entity is key for developing therapeutic strategies that could more effectively target this phenotype. This study aimed to assess the prognostic relevance of mRNA expression of major players involved in NED of primary prostate tumors. Methods RNA sequencing data from 122 patients with localized PC were analyzed. Transcript levels of key genes involved in NED, with a focus on endothelin axis and nuclear factor kappa B (NF-κB), were assessed and were correlated with time to prostate specific antigen (PSA) recurrence. Copy number alteration of tumor suppressor genes and gene expression of additional signals hallmarking NED was compared between altered and unaltered groups, including lineage determining transcription factors, transcriptional repressors, cell cycle and epigenetic regulators. Results The presence of altered mRNA expression using a z-score threshold of 2 in NFKB1, RELA, EDN1, EDNRA, and EDNRB genes was associated with a higher Gleason score (P < 0.001) and a shorter time to biochemical recurrence (BCR) (P = 0.029). There was a significant direct correlation between NFKB1 and RELA (P < 0.001), NFKB1 and EDNRA (P < 0.001), NFKB1 and EDNRB (P < 0.001), EDNRA and EDNRB expression (P < 0.001). ASCL1 (q < 0.001), ONECUT2 (q < 0.001), DLL3 (q = 0.019), AURKA (q = 0.013), AURKB (q = 0.014), PLK1 (q < 0.001), and EZH2 (q < 0.001) were enriched in patients with tumors harboring alterations in endothelin axis and NF-κB subunit genes whereas REST was downregulated (q < 0.001). Conclusions This analysis suggests that altered mRNA expression of NF-κB and endothelin axis genes in early PC is not only a harbinger of a more aggressive clinical course but is also associated with aberrant gene expression of several transcription factors, transcriptional repressors, cell cycle and epigenetic regulators that are directly involved in NED, in line with their biological roles. This may have implications for closer follow-up and potential use of targeted therapeutic approaches postoperatively in the adjuvant setting to improve outcomes of these patients.
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Affiliation(s)
- Panagiotis J Vlachostergios
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Athanasios Karathanasis
- Department of Urology, University of Thessaly School of Health Sciences Faculty of Medicine, University Hospital of Larissa, Larissa 41100, Greece
| | - Christos N Papandreou
- Department of Medical Oncology, Faculty of Medicine Papageorgiou Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Thessaloniki 54124, Greece
| | - Vassilios Tzortzis
- Department of Urology, University of Thessaly School of Health Sciences Faculty of Medicine, University Hospital of Larissa, Larissa 41100, Greece
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Vlachostergios PJ, Karathanasis A, Tzortzis V. Expression of Fibroblast Activation Protein Is Enriched in Neuroendocrine Prostate Cancer and Predicts Worse Survival. Genes (Basel) 2022; 13:genes13010135. [PMID: 35052475 PMCID: PMC8774973 DOI: 10.3390/genes13010135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Advanced prostate cancer (PC) may accumulate genomic alterations that hallmark lineage plasticity and transdifferentiation to a neuroendocrine (NE) phenotype. Fibroblast activation protein (FAP) is a key player in epithelial-to-mesenchymal transition (EMT). However, its clinical value and role in NE differentiation in advanced PC has not been fully investigated. Methods: Two hundred and eight patients from a multicenter, prospective cohort of patients with metastatic castration-resistant prostate cancer (CRPC) with available RNA sequencing data were analyzed for tumor FAP mRNA expression, and its association with overall survival (OS) and NE tumor features was investigated. Results: Twenty-one patients (10%) were found to have high FAP mRNA expression. Compared to the rest, this subset had a proportionally higher exposure to taxanes and AR signaling inhibitors (abiraterone or enzalutamide) and was characterized by active NE signaling, evidenced by high NEPC- and low AR-gene expression scores. These patients with high tumor mRNA FAP expression had a more aggressive clinical course and significantly shorter survival (12 months) compared to those without altered FAP expression (28 months, log-rank p = 0.016). Conclusions: FAP expression may serve as a valuable NE marker indicating a worse prognosis in patients with metastatic CRPC.
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MESH Headings
- Androgen Antagonists/therapeutic use
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Carcinoma, Neuroendocrine/drug therapy
- Carcinoma, Neuroendocrine/metabolism
- Carcinoma, Neuroendocrine/mortality
- Carcinoma, Neuroendocrine/pathology
- Endopeptidases/genetics
- Endopeptidases/metabolism
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Male
- Membrane Proteins/genetics
- Membrane Proteins/metabolism
- Middle Aged
- Prognosis
- Prospective Studies
- Prostatic Neoplasms, Castration-Resistant/drug therapy
- Prostatic Neoplasms, Castration-Resistant/metabolism
- Prostatic Neoplasms, Castration-Resistant/mortality
- Prostatic Neoplasms, Castration-Resistant/pathology
- Survival Rate
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Affiliation(s)
- Panagiotis J. Vlachostergios
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
- Correspondence: (P.J.V.); (V.T.)
| | - Athanasios Karathanasis
- Department of Urology, University of Thessaly School of Health Sciences Faculty of Medicine, University Hospital of Larissa, 41100 Larissa, Greece;
| | - Vassilios Tzortzis
- Department of Urology, University of Thessaly School of Health Sciences Faculty of Medicine, University Hospital of Larissa, 41100 Larissa, Greece;
- Correspondence: (P.J.V.); (V.T.)
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Karasavvidou F, Mitrakas L, Strataki M, Anastasiou D, Koukoulis G, Tzortzis V. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac046. [PMID: 35422996 PMCID: PMC9004407 DOI: 10.1093/jscr/rjac046] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/06/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Foteini Karasavvidou
- Department of Pathology and Cytology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Lampros Mitrakas
- Correspondence address: Department of Urology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa, Larissa 41110, Greece. Tel: (+30) 2413 502811; E-mail:
| | - Maria Strataki
- Department of Pathology and Cytology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Dimitrios Anastasiou
- Department of Urology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Georgios Koukoulis
- Department of Pathology and Cytology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Vassilios Tzortzis
- Department of Urology, Faculty of Medicine-School of Health Sciences-University of Thessaly, University Hospital of Larissa, Larissa, Greece
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Samara M, Papathanassiou M, Farmakioti I, Anagnostou M, Satra M, Mitrakas L, Anastasiou D, Chasiotis G, Christopoulos A, Anagnostou A, Christodoulou A, Daponte A, Ioannou M, Koukoulis G, Tzortzis V, Vlachostergios PJ. Renin-Angiotensin System Single Nucleotide Polymorphisms Are Associated with Bladder Cancer Risk. Curr Oncol 2021; 28:4702-4708. [PMID: 34898568 PMCID: PMC8628720 DOI: 10.3390/curroncol28060396] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/16/2021] [Accepted: 11/09/2021] [Indexed: 01/02/2023] Open
Abstract
The renin-angiotensin system (RAS), besides being a major regulator of blood pressure, is also involved in tumor angiogenesis. Emerging evidence suggests a correlation between the use of pharmacologic RAS inhibitors and a delay in urothelial bladder cancer (BC) progression. However, it is unknown whether RAS gene variants may predispose to the development of BC. This study examined the association of RAS single nucleotide polymorphisms (SNPs) including AT1R rs5186, AT2R rs11091046, REN rs12750834, ANG rs4762, and ANG rs699 with the risk of developing non-invasive BC. Peripheral blood samples from 73 patients with T1 urothelial BC (66 men, seven women) and an equal number of healthy subjects (control group) were collected. The TT genotype of the REN rs12750834 SNP (OR: 2.8 [1.3–6.05], p = 0.008) and to a lesser extent the presence of the T allele (OR: 2.3 [1.2–4.48], p = 0.01) conferred a higher risk of BC. The highest risk for BC within SNP carriers of the RAS system was associated with the presence of the CC genotype (OR: 17.6 [7.5–41.35], p < 0.001) and C allele (OR: 17.7 [8.8–35.9], p < 0.001) of the ANG rs699 SNP. The presence of the AT2R rs11091046 SNP, particularly the AA genotype, was associated with a protective effect against developing BC (OR: 0.268 [0.126–057], p < 0.001). In conclusion, these results support the clinical utility of RAS gene SNPs AT2R rs11091046, REN rs12750834, and ANG rs699 in the genetic cancer risk assessment of patients and families with BC.
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Affiliation(s)
- Maria Samara
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece; (M.S.); (M.P.); (I.F.); (M.A.); (M.I.); (G.K.)
| | - Maria Papathanassiou
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece; (M.S.); (M.P.); (I.F.); (M.A.); (M.I.); (G.K.)
| | - Ioanna Farmakioti
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece; (M.S.); (M.P.); (I.F.); (M.A.); (M.I.); (G.K.)
| | - Maria Anagnostou
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece; (M.S.); (M.P.); (I.F.); (M.A.); (M.I.); (G.K.)
| | - Maria Satra
- Department of Biology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece;
| | - Lampros Mitrakas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece; (L.M.); (D.A.); (G.C.); (A.C.); (A.A.); (A.C.)
| | - Dimitrios Anastasiou
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece; (L.M.); (D.A.); (G.C.); (A.C.); (A.A.); (A.C.)
| | - Georgios Chasiotis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece; (L.M.); (D.A.); (G.C.); (A.C.); (A.A.); (A.C.)
| | - Agamemnon Christopoulos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece; (L.M.); (D.A.); (G.C.); (A.C.); (A.A.); (A.C.)
| | - Athanasios Anagnostou
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece; (L.M.); (D.A.); (G.C.); (A.C.); (A.A.); (A.C.)
| | - Anastasios Christodoulou
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece; (L.M.); (D.A.); (G.C.); (A.C.); (A.A.); (A.C.)
| | - Alexandros Daponte
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Thessaly, 41100 Larissa, Greece;
| | - Maria Ioannou
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece; (M.S.); (M.P.); (I.F.); (M.A.); (M.I.); (G.K.)
| | - George Koukoulis
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece; (M.S.); (M.P.); (I.F.); (M.A.); (M.I.); (G.K.)
| | - Vassilios Tzortzis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece; (L.M.); (D.A.); (G.C.); (A.C.); (A.A.); (A.C.)
- Correspondence: (V.T.); (P.J.V.)
| | - Panagiotis J. Vlachostergios
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY 10065, USA
- Correspondence: (V.T.); (P.J.V.)
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Samara M, Papathanassiou M, Mitrakas L, Koukoulis G, Vlachostergios PJ, Tzortzis V. DNA Repair Gene Polymorphisms and Susceptibility to Urothelial Carcinoma in a Southeastern European Population. ACTA ACUST UNITED AC 2021; 28:1879-1885. [PMID: 34068981 PMCID: PMC8161783 DOI: 10.3390/curroncol28030174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/03/2021] [Accepted: 05/12/2021] [Indexed: 12/24/2022]
Abstract
Single nucleotide polymorphisms (SNPs) in DNA repair genes may predispose to urothelial carcinoma of the bladder (UCB). This study focused on three specific SNPs in a population with high exposure to environmental carcinogens including tobacco and alcohol. A case-control study design was used to assess for presence of XPC PAT +/-, XRCC3 Thr241Met, and ERCC2 Lys751Gln DNA repair gene SNPs in peripheral blood from patients with UCB and healthy individuals. One hundred patients and equal number of healthy subjects were enrolled. The XPC PAT +/+ genotype was associated with a 2-fold increased risk of UCB (OR = 2.16; 95%CI: 1.14-4; p = 0.01). The -/+ and +/+ XPC PAT genotypes were more frequently present in patients with multiple versus single tumors (p = 0.01). No association was detected between ERCC2 Lys751Gln genotypes/alleles, and risk for developing UCB. Presence of the XRCC3 TT genotype (OR = 0.14; 95%CI:0.07-0.25; p < 0.01) and of the T allele overall (OR = 0.26; 95%CI:0.16-0.41; p < 0.01) conferred a protective effect against developing UCB. The XPC PAT -/+ and XRCC3 Thr241Met SNPs are associated with predisposition to UCB. The XPC PAT -/+ SNP is also an indicator of bladder tumor multiplicity, which might require a more individualized surveillance and treatment.
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Affiliation(s)
- Maria Samara
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece; (M.S.); (M.P.); (G.K.)
| | - Maria Papathanassiou
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece; (M.S.); (M.P.); (G.K.)
| | - Lampros Mitrakas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece;
| | - George Koukoulis
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece; (M.S.); (M.P.); (G.K.)
| | - Panagiotis J. Vlachostergios
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY 10065, USA
- Correspondence: (P.J.V.); (V.T.)
| | - Vassilios Tzortzis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece;
- Correspondence: (P.J.V.); (V.T.)
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Bargiota A, Oeconomou A, Zachos I, Samarinas M, L Pisters L, Tzortzis V. Adverse effects of androgen deprivation therapy in patients with prostate cancer: Focus on muscle and bone health. J BUON 2020; 25:1286-1294. [PMID: 32862568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Androgen deprivation therapy (ADT) is the most effective systemic treatment for prostate cancer and can be succeeded either surgically or pharmaceutically. Both approaches lead to hypogonadism with a large variety of adverse events, including obesity, metabolic syndrome, osteoporosis, sarcopenia, diabetes mellitus, cardiovascular disease, gynecomastia and sexual dysfunction. In addition, undesirable effects on muscle and bone health may have a significant impact not only on the quality of life but also on life expectancy. Currently, supervised exercise seems to be the only intervention that could prevent the adverse effects of the ADT and improve quality of life. Lifestyle modification, supplementation of calcium, vitamin D and when indicated antiosteoporotic treatments improve bone health. However, patients receiving ADT must be well informed about the potential benefits as well as the risks of the treatment.
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Affiliation(s)
- Alexandra Bargiota
- Department of Endocrinology and Metabolic Diseases, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Abstract
Bladder cancer is extremely rare in children. We report a case series of two children with transitional cell bladder cancer who presented with lower urinary tract symptoms. Pathology revealed a low risk for recurrence and progression tumor. In such a case, early diagnosis is crucial and surgical treatment is usually the only treatment needed.
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Affiliation(s)
- Anastasios Karatzas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Volos, Greece
| | - Vassilios Tzortzis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Volos, Greece
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Georgiadis G, Mavridis C, Belantis C, Zisis IE, Skamagkas I, Fragkiadoulaki I, Heretis I, Tzortzis V, Psathakis K, Tsatsakis A, Mamoulakis C. Nephrotoxicity issues of organophosphates. Toxicology 2018; 406-407:129-136. [PMID: 30063941 DOI: 10.1016/j.tox.2018.07.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 06/09/2018] [Revised: 07/15/2018] [Accepted: 07/25/2018] [Indexed: 12/12/2022]
Abstract
Organophosphates are a large class of chemicals, initially invented in 1850 and since then they have been applied in numerous aspects of science to serve our purposes. Their mechanism of action in living organisms involves the irreversible inhibition of acetylcholinesterase, therefore they interfere with neuromuscular signal transmission. Due to the systematic and exaggerated use of these chemicals, there is massive exposure to them, hence there is great concern regarding the ramifications to all mammalian organisms. It has been widely accepted that over-exposure to organophosphates, has a deleterious impact on the renal tissue and subsequently on the renal function. Despite the significance of this global issue, limited knowledge exists, regarding the effect of these substances on our health. Therefore, new and extensive research is required to expand our knowledge and ensure proper guidance regarding the use of organophosphates as well the protection against their detrimental consequences. The aim of this review is to negotiate the effect of organophosphate exposure on renal tissue and kidney function.
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Affiliation(s)
- G Georgiadis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - C Mavridis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - C Belantis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - I E Zisis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - I Skamagkas
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - I Fragkiadoulaki
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece; Department of Forensic Sciences and Toxicology, University of Crete, Medical School, Heraklion, Crete, Greece
| | - I Heretis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - V Tzortzis
- Department of Urology, University of Thessaly, Larissa, Greece
| | - K Psathakis
- Department of Forensic Sciences and Toxicology, University of Crete, Medical School, Heraklion, Crete, Greece
| | - A Tsatsakis
- Department of Forensic Sciences and Toxicology, University of Crete, Medical School, Heraklion, Crete, Greece.
| | - C Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
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Perdikakis E, Fezoulidis I, Tzortzis V, Rountas C. Varicocele embolization: Anatomical variations of the left internal spermatic vein and endovascular treatment with different types of coils. Diagn Interv Imaging 2018; 99:599-607. [PMID: 29910172 DOI: 10.1016/j.diii.2018.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 05/28/2018] [Accepted: 05/28/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE To present anatomical variations of left internal spermatic vein and a comparison between treatments with hydrogel-coated and non-coated platinum coils in patients with varicocele. MATERIALS AND METHODS A total of 153 men (mean age, 27.5±6.7 [SD] years; range: 18-45 years) with left sided varicocele underwent coil embolization. Anatomic variants of gonadal vein were categorized into five subtypes (I-V). Additional venous collaterals were also recorded. Three types of coils were used (hydrogel coated platinum coils, fibered coils and non-coated platinum coils). Technical success, tolerance, efficacy and safety of hydrogel coated platinum coils were recorded. Comparison between different types of coils used was made. Fisher's exact test was used for statistical analysis. RESULTS Varicoceles were classified as type I (26.1%), type II (13.7%), type III (32.1%), type IV (18.3%) and type V (9.8%). The internal spermatic vein - renal vein angle ranged from 32°-128° (mean angle, 93.5°). Technical success was achieved in 145 patients (94.8%) without complications. The mean number of coils used was 3 (range: 1-6 coils). A total of 260 hydrogel coated platinum coils in 95 patients and 135 non-coated coils in 50 patients were deployed with no complications. No differences were noted between the different types of coils used regarding embolic efficacy and safety. A 6.2% (9/145) recurrence rate and a 33.3% (14/42) fertility rate were observed. Clinical success regarding symptom relief after painful varicocele embolization was 100% (36/36) for technically successful cases. CONCLUSION Varicocele embolization with the use of hydrogel coated or non-coated platinum coils is technically feasible and safe without complications. No superiority of one type of coil over the other was found.
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Affiliation(s)
- E Perdikakis
- Department of Radiology, 424 GMTH Military Hospital of Thessaloniki, Thessaloniki, Greece.
| | - I Fezoulidis
- Department of Radiology, University of Thessaly, Larisa, Greece
| | - V Tzortzis
- Department of Urology, University of Thessaly, Larisa, Greece
| | - C Rountas
- Department of Radiology, University of Thessaly, Larisa, Greece
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Dimitropoulos K, Tzortzis V. Could there be a relationship between type of anesthesia and oncological parameters after transurethral resection of bladder cancer? Transl Androl Urol 2018; 7:287-288. [PMID: 29733085 PMCID: PMC5911533 DOI: 10.21037/tau.2018.03.12] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
Malignant transformation of teratoma develops in a small subset of testis cancer patients. Primitive neuroectodermal tumor represents a highly malignant component of testicular germ cell tumors. It is a rare clinical entity which is characterized by a high risk of disease progression and death. Surgical resection plus chemotherapy appears to be the therapy of choice.
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Affiliation(s)
- Anastasios Karatzas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Vasileios Papadopoulos
- Department of Medical Oncology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Vagianna Katsiouli
- Department of Medical Oncology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Louis Pisters
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christos Papandreou
- Department of Medical Oncology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Vassilios Tzortzis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Karatzas A, Paridis D, Kozyrakis D, Tzortzis V, Samarinas M, Dailiana Z, Karachalios T. Fanconi syndrome in the adulthood. The role of early diagnosis and treatment. J Musculoskelet Neuronal Interact 2017; 17:303-306. [PMID: 29199190 PMCID: PMC5749037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Anastasios Karatzas
- Department of Urology, Faculty of Medicine, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece,Corresponding author: Anastasios D. Karatzas, M.D., Ph.D., F.E.B.U., F.E.A.P.U., Urology Department, Faculty of Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa 41110, Greece E-mail:
| | - Dionyssios Paridis
- Department of Orthopedic Surgery, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Diomidis Kozyrakis
- Department of Urology, General Hospital of Volos “Achillopoulio”, Volos, Magnesia, Greece
| | - Vassilios Tzortzis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Michael Samarinas
- Department of Urology, Faculty of Medicine, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Zoe Dailiana
- Department of Orthopedic Surgery, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Theofilos Karachalios
- Department of Orthopedic Surgery, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larisa, Greece
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Zachos I, Dimitropoulos K, Karatzas A, Samarinas M, Petsiti A, Tassoudis V, Tzortzis V. Ultrasound-guided radiofrequency ablation for cT1a renal masses in poor surgical candidates: mid-term, single-center outcomes. Ther Adv Med Oncol 2016; 8:331-8. [PMID: 27583025 DOI: 10.1177/1758834016654694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Surgical management of small renal masses can be challenging in frail patients and thus modalities such as radiofrequency ablation (RFA) have emerged as valid alternative options. The aim of the current study was to present mid-term oncological and functional results on a series of patients with cT1a renal cell carcinomas (RCCs) who were unfit for surgery and underwent RFA using ultrasound guidance under local anesthesia. METHODS Data from patients fulfilling the study selection criteria were retrospectively collected. RENAL nephrometry score was used for tumor description. Parametric tests were used for data analysis and survival curves were estimated using the Kaplan-Meier method. RESULTS Overall, 32 patients (mean±standard deviation age, 72.4 ± 7.6 years) with biopsy-proven RCCs (tumor size, 23.75 ± 10.44 mm and RENAL score, 5.28 ± 1.33) underwent 32 RFA sessions. Twenty-seven patients (84.4%) had low complexity masses and five patients had masses of intermediate complexity (15.6%) according to RENAL score categorization. Over a follow-up period of 22.1 ± 13.7 months, one case of primary treatment failure was recognized (primary technical success 97.0%), and overall, three patients were diagnosed with residual disease (primary technique effectiveness 90.6%). No major complications occurred during the postprocedure 90-day follow up, while no difference was found in serum creatinine and estimated glomerular filtration rate pre and post procedure. Patients with intermediate-complexity renal lesions had shorter time to recurrence in comparison to low-complexity masses (p = 0.002). All patients were alive at the time of study data analysis without diagnosed metastases. CONCLUSIONS Percutaneous RFA of small RCCs using ultrasound-based guidance under local anesthesia can be an effective alternative method for managing patients who are unfit for surgery.
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Affiliation(s)
- Ioannis Zachos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Greece
| | - Konstantinos Dimitropoulos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, GR-41100 Larissa, Greece
| | - Anastasios Karatzas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Greece
| | - Michael Samarinas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Greece
| | - Argiro Petsiti
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Greece
| | - Vassilios Tassoudis
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Greece
| | - Vassilios Tzortzis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Greece
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Dimitropoulos K, Skriapas K, Karvounis G, Tzortzis V. Intrauterine device migration to the urinary bladder causing sexual dysfunction: a case report. Hippokratia 2016; 20:70-72. [PMID: 27895447 PMCID: PMC5074402] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Intravesical migration represents an uncommon complication of intrauterine device (IUD) insertion. We present the case of an IUD that migrated to the urinary bladder, causing significant sexual complaints. CASE REPORT A 38-year-old woman presented with complaints of gradually evolving dyspareunia and recurrent urinary tract infections during the past 12 months. She reported an IUD insertion 18 months before. Further detailed evaluation revealed disorders in all sexual domains. Imaging and cystoscopy detected the presence of IUD in the urinary bladder. Under anesthesia, the IUD was removed out of the bladder without any complications. In her follow-up evaluation after six months, her sexual function was significantly improved and she had no urinary symptoms. CONCLUSION Sexual difficulties in a woman with an IUD should raise the suspicion of device dislodgement or dislocation. Hippokratia 2016, 20(1): 70-72.
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Affiliation(s)
- K Dimitropoulos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - K Skriapas
- Department of Urology, General Hospital of Larissa, Larissa, Greece
| | - G Karvounis
- Department of Urology, General Hospital of Larissa, Larissa, Greece
| | - V Tzortzis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Tzortzis V, Dimitropoulos K, Karatzas A, Zachos I, Stamoulis K, Melekos M, Gravas S. Feasibility and safety of radical cystectomy under combined spinal and epidural anesthesia in octogenarian patients with ASA score ≥3: A case series. Can Urol Assoc J 2015; 9:E500-4. [PMID: 26279724 DOI: 10.5489/cuaj.2063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION This study evaluated the feasibility and safety of open radical cystectomy (RC) under combined regional anesthesia (CRA) in high-risk octogenarian patients. METHODS We retrospectively evaluated the medical records of high-risk, octogenarian bladder cancer patients submitted to open RC with CRA. Demographic and clinical data, intraoperative parameters and perioperative and postoperative complications were recorded using the Clavien-Dindo classification. RESULTS In total, 14 male and 4 female patients, with a median age of 82.5 years were enrolled. Ureterocutaneostomy was performed in 15 patients and Bricker ileal conduit in the remaining 3. Operative time ranged from 97 to 184 minutes. Five patients were transfused and no major intraoperative complications occurred. Postoperative complications 30 days later included ileus (Grade II) in 3 patients, surgical trauma infection in 1 patient (Grade II), respiratory infection in 2 patients (Grade III), and hydronephrosis with concurrent urinary tract infection in 3 patients (Grade III). No deaths occurred. CONCLUSIONS Our study showed that octogenarian, high-risk bladder cancer patients with indications for RC can safely undergo the surgical procedure under CRA, without apparent increase in major complications.
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Affiliation(s)
- Vassilios Tzortzis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Thessaly, Greece
| | - Konstantinos Dimitropoulos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Thessaly, Greece
| | - Anastasios Karatzas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Thessaly, Greece
| | - Ioannis Zachos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Thessaly, Greece
| | - Konstantinos Stamoulis
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Thessaly, Greece
| | - Michael Melekos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Thessaly, Greece
| | - Stavros Gravas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Thessaly, Greece
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Dimitropoulos K, Karatzas A, Papandreou C, Daliani D, Zachos I, Pisters LL, Tzortzis V. Sexual dysfunction in testicular cancer patients subjected to post-chemotherapy retroperitoneal lymph node dissection: a focus beyond ejaculation disorders. Andrologia 2015; 48:425-30. [DOI: 10.1111/and.12462] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 01/01/2023] Open
Affiliation(s)
- K. Dimitropoulos
- Department of Urology; Faculty of Medicine; School of Health Sciences; University of Thessaly; Larissa Greece
| | - A. Karatzas
- Department of Urology; Faculty of Medicine; School of Health Sciences; University of Thessaly; Larissa Greece
| | - C. Papandreou
- Department of Medical Oncology; Faculty of Medicine; School of Health Sciences; University of Thessaly; Larissa Greece
| | - D. Daliani
- Department of Medical Oncology; Euroclinic; Athens Greece
| | - I. Zachos
- Department of Urology; Faculty of Medicine; School of Health Sciences; University of Thessaly; Larissa Greece
| | - L. L. Pisters
- Department of Urology; Division of Surgery; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - V. Tzortzis
- Department of Urology; Faculty of Medicine; School of Health Sciences; University of Thessaly; Larissa Greece
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Dimitropoulos K, Bargiota A, Mouzas O, Melekos M, Koukoulis G, Tzortzis V. Dissatisfaction with male sexual performance and female sexual dysfunction in women with type 1 diabetes. Int J Impot Res 2014; 27:25-8. [DOI: 10.1038/ijir.2014.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 10/17/2013] [Accepted: 06/06/2014] [Indexed: 11/09/2022]
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Tzortzis V, Dimitropoulos K, Gravas S, Karatzas A, Zachos I, Gkialas I, Papadopoulos G, Melekos M. The impact of stapling devices use on patients with increased body mass index treated with radical cystectomy. Can J Urol 2014; 21:7114-7119. [PMID: 24529011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The aim of this retrospective study was to evaluate the impact of stapling devices use on overweight and obese bladder cancer patients treated with radical cystectomy (RC). MATERIALS AND METHODS Fifty-two overweight and 24 obese patients underwent open RC for muscle invasive bladder cancer. Bladder removal was performed using standard suture technique (SST) or multifire autosuture articulated vascular Endo-GIA (eG). Twenty-three overweight and 11 obese patients formed the SST arms and the remaining 29 overweight and 13 obese patients formed the eG arms. Intra and postoperative parameters and early postoperative complications (30 days) using the Clavien-Dindo classification were recorded. RESULTS SST and eG arms of overweight and obese patients were comparable in intra and postoperative parameters. Both overweight and obese eG arms had significantly lower estimated blood loss, lower number of transfused packed red blood cells units (PRBC) and lower cystectomy intraoperative time compared with the SST ones (p < 0.05). In obese patients, staplers use led to significantly lower total length of stay compared with SST (p = 0.041). Complications rate was significantly higher in the obese group compared with the overweight group (58.33% versus 30.77%, p = 0.042). No difference in complications was found between the SST and eG arms of the overweight and obese patients. No deaths occurred. CONCLUSIONS Staplers use in RC in overweight/obese patients is accompanied by significantly shorter intraoperative time, lower blood loss and lower number of transfused PRBC units, compared with SST. In obese patients, eG use led to shorter length of stay.
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Affiliation(s)
- Vassilios Tzortzis
- University of Thessaly, School of Health Sciences, Faculty of Medicine, Larissa, Greece
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Karatzas A, Tzortzis V, Giannatou E, Gravas S, Zachos I, Oeconomou A, Melekos M, Tsezou A. Lack of association between the UDP-glucuronosyltransferase 1A1 (UGT1A1) gene polymorphism and the risk of benign prostatic hyperplasia in Caucasian men. Mol Biol Rep 2013; 40:6665-9. [PMID: 24057187 DOI: 10.1007/s11033-013-2781-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 09/14/2013] [Indexed: 10/26/2022]
Abstract
Glucuronidation, mediated by the UDP-glucuronosyltransferase 1A1 (UGT1A1) enzyme, is an important metabolic process during which steroids are converted to more easily excreted compounds in steroid target tissues, such as the prostate. The aim of our study was to investigate the possible correlation between UGT1A1 promoter gene polymorphism and benign prostatic hyperplasia. 421 blood samples were obtained from 138 consecutive patients diagnosed with benign prostatic hypeplasia (BPH group) and 283 healthy volunteers (control group). A(TA)6TAA promoter polymorphism of UGT1A1 gene was studied using the Fragment Analysis Software of an automated DNA sequencer and three genotypes (homozygous 7/7, heterozygous 6/7 and normal homozygous 6/6) were identified. No significant differences were observed between the BPH group and controls regarding the genotyping distribution of the three UGT1A1 promoter genotypes (P = 0.39). Also, no association was found between overall disease risk and the presence of the polymorphic homozygous genotype (TA(7)/TA)7) vs. TA(6)/TA(7) + TA(6)/TA(6)) (P = 0.31). Our data suggest that the TA repeat polymorphism of UGT1A1 is not associated with increased BPH risk susceptibility in Caucasian men.
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Affiliation(s)
- Anastasios Karatzas
- Department of Urology, University of Thessaly School of Medicine, Mezourlo, 41110, Larissa, Greece,
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Rountas C, Sioka E, Karagounis A, Golphinopoulos S, Kourti P, Stefanidis I, Zacharoulis D, Tzortzis V. Spontaneous perirenal hemorrhage in end-stage renal disease treated with selective embolization. Ren Fail 2013; 34:1037-9. [PMID: 22880810 DOI: 10.3109/0886022x.2012.706887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Spontaneous nontraumatic rupture of the kidney (Wunderlich syndrome) is an extremely uncommon condition on hemodialysis. We report a case of 44-year-old hemodialysis patient presented with hemorrhagic shock and a right quadrant abdominal pain to the emergency department. There was no history of trauma. A kidney rupture was revealed by abdominal computed tomography, and active bleeding was successfully managed with arterial embolization. This case illustrates the safe and successful application of interventional radiology in the management of nontraumatic renal hemorrhage in the specific group of hemodialyzed patients even in the emergency setting.
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Affiliation(s)
- Christos Rountas
- Department of Interventional Radiology, University Hospital of Larissa, Larissa, Greece
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Bargiota A, Dimitropoulos K, Mouzas O, Melekos M, Tzortzis V, Koukoulis G. The Impact of Parental Bonding on Sexual Distress in Women with Type 1 Diabetes Mellitus. J Sex Med 2013; 10:378-85. [DOI: 10.1111/j.1743-6109.2012.02969.x] [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: 11/28/2022]
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Gravas S, Efstathiou K, Zachos I, Melekos MD, Tzortzis V. Is there a learning curve for photodynamic diagnosis of bladder cancer with hexaminolevulinate hydrochloride? Can J Urol 2012; 19:6269-6273. [PMID: 22704312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION To assess the learning curve for fluorescence cystoscopy using hexaminolevulinate hydrochloride (HAL) in patients with bladder cancer. MATERIAL AND METHODS Fifty patients underwent bladder instillation with HAL. Two senior residents inspected separately the bladder using white light cystoscopy, followed by fluorescence cystoscopy and mapped the lesions. An experienced with photodynamic diagnosis (PDD) urologist also performed both cystoscopies, mapped, resected or cold biopsied suspect lesions under the supervision of another experienced urologist. To evaluate the learning curve, patients were divided into five subgroups, including group 1 (patients 1-10), group 2 (11-20), group 3 (21-30), group 4 (31-40) and group 5 (41-50). The kappa statistics was calculated to assess interobserver agreement between the physicians and the false positive rates of urologists and residents were also compared. RESULTS Histologically verified tumors were diagnosed in 103 of 142 lesions identified by PDD. The interobserver agreement between urologists and residents was moderate, moderate, good, excellent, and excellent for group 1, 2, 3, 4, and 5, respectively. Both residents had increased false positive rates compared to urologists in all subgroups of patients but this difference did not reach statistical significance. In addition, false positive rate of residents was declining as the number of procedures was increasing. CONCLUSIONS Our data suggest that 20 cases of HAL PDD are required to achieve a good interobserver agreement between inexperienced and experienced operator, and excellent agreement is achieved after 30 cases. The false positive rate of inexperienced operators was comparable to the experts and showed a gradual decrease.
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Affiliation(s)
- Stavros Gravas
- Department of Urology, University of Thessaly, Larissa, Greece
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Dimitropoulos K, Bargiota A, Mouzas O, Melekos M, Tzortzis V, Koukoulis G. Sexual Functioning and Distress among Premenopausal Women with Uncomplicated Type 1 Diabetes. J Sex Med 2012; 9:1374-81. [DOI: 10.1111/j.1743-6109.2012.02664.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Panteliou SD, Tzortzis V, Anagnostopoulos GT, Sunaric M, Sarris J, Hatzimouratidis K, Hatzichristou D. Development of a New Optical Device and Its Feasibility in Prostate Cancer Detection. Urol Int 2012; 89:290-5. [DOI: 10.1159/000339966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 06/07/2012] [Indexed: 11/19/2022]
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Gravas S, Tzortzis V, de la Riva SIM, Laguna P, de la Rosette J. Focal therapy for prostate cancer: patient selection and evaluation. Expert Rev Anticancer Ther 2011; 12:77-86. [PMID: 22149434 DOI: 10.1586/era.11.144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Recent stage migration toward low-risk prostate cancer, overtreatment of biologically insignificant tumors with radical prostatectomy at the additional expense of a non-negligible morbidity and undertreatment of patients improperly selected for active surveillance are the main reasons that have fueled the concept of focal therapy. Optimal selection of patients is the key for the successful implementation of focal therapy. Selection criteria for focal therapy vary widely and depend on clinical, histological and imaging characteristics of the patients that are highlighted in this article. In addition, the rationales, merits and limitations of the available methods for the assessment of potential candidates, the evaluation of treatment efficacy and follow-up of these patients are discussed.
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Affiliation(s)
- Stavros Gravas
- Department of Urology, University of Thessaly, Larissa, Greece.
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Karatzas A, Zachos I, Tzortzis V, Melekos M. Use of haemostatic glue for fistula prevention after iatrogenic combined rupture of anterior vaginal wall, bladder and urethra, during vaginal delivery. J OBSTET GYNAECOL 2011; 31:670-1. [PMID: 21973153 DOI: 10.3109/01443615.2011.601360] [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: 11/13/2022]
Affiliation(s)
- A Karatzas
- Department of Urology, University of Thessaly School of Medicine, Larissa, Greece.
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Zachos I, Tzortzis V, Konstantinopoulos PA, Karatzas A, Gravas S, Melekos M, Papavassiliou AG. Molecular pathogenesis of non muscle-invasive bladder cancer: implications for novel targeted therapies. Curr Mol Med 2011; 11:623-32. [PMID: 21902654 DOI: 10.2174/156652411797536697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 06/03/2011] [Accepted: 07/09/2011] [Indexed: 11/22/2022]
Abstract
Approximately 70% to 80% of patients with urothelial carcinomas of the bladder are initially diagnosed with non-muscle invasive disease. Superficial, non-muscle invasive bladder cancers (NMIBCs) are managed with cystoscopic transurethral resection of all visible lesions followed by intravesical chemotherapy and/or immunotherapy. Despite this treatment, up to 70% of these tumors will recur within five years and 15% will ultimately progress to muscle-invasive disease, suggesting that novel therapeutic strategies are necessary. Recent studies have greatly advanced our understanding of urothelial carcinogenesis and have highlighted the distinct molecular pathogenesis of NMIBCs versus muscle-invasive bladder tumors. It is now clear that diverse genetic and epigenetic events are driving the oncogenesis of NMIBCs, thereby attesting to their potential as therapeutic targets for these tumors. This article reviews the molecular pathogenesis of NMIBCs, discusses recently completed and ongoing clinical trials and anticipates the future direction of molecular targeted agents in this disease.
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Affiliation(s)
- I Zachos
- Department of Urology, University of Thessalia, Larissa, Greece
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Nomikos M, Kardakos I, Kalikaki A, Karyotis I, Serafetinides E, Tzortzis V, Stefanidis I, Delakas D, Melekos M. MP-10.16 Cystatin-C, Interleukin-18 and N-GAL Levels as Biomarkers of Inflammatory Response After Extracorporeal Shock Wave Lithotripsy. Urology 2011. [DOI: 10.1016/j.urology.2011.07.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Affiliation(s)
- Alexandra Bargiota
- Department of Endocrinology and Metabolic Diseases, Larissa University Hospital, Medical School, University of Thessaly, Larissa Greece.
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Zachos I, Konstantinopoulos PA, Tzortzis V, Gravas S, Karatzas A, Karamouzis MV, Melekos M, Papavassiliou AG. Systemic therapy of metastatic bladder cancer in the molecular era: current status and future promise. Expert Opin Investig Drugs 2010; 19:875-87. [PMID: 20528482 DOI: 10.1517/13543784.2010.496450] [Citation(s) in RCA: 21] [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] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Platinum-based chemotherapy is considered the standard-of-care first-line therapy for metastatic bladder cancer. Despite the initial high response rate, the vast majority of patients eventually progress and succumb to their disease, urging the need for development of novel therapies. AREAS COVERED IN THIS REVIEW This article discusses the main signaling pathways implicated in the pathogenesis of bladder carcinomas, reviews recently completed and ongoing clinical trials, and anticipates the future direction of molecularly targeted agents. WHAT THE READER WILL GAIN This manuscript presents the current status of conventional chemotherapy in advanced bladder cancer, and provides a comprehensive review of molecular targeted agents currently in clinical development for this disease. TAKE HOME MESSAGE Improved understanding of the biology of urothelial carcinogenesis has paved the way for the development of novel molecularly targeted therapies, several of which are currently tested in clinical trials. In this regard, VEGF and EGFR pathways are emerging as important therapeutic targets for metastatic bladder cancer, either alone or in combination with conventional chemotherapeutics. Other therapies, including aurora kinase inhibitors, endothelin receptor antagonists, RAS/MAPK pathway inhibitors and novel immunologic strategies, may also prove helpful in the treatment of this disease.
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Affiliation(s)
- Ioannis Zachos
- University of Thessalia, Department of Urology, Larissa, Greece
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Karatzas A, Giannatou E, Tzortzis V, Gravas S, Aravantinos E, Moutzouris G, Melekos M, Tsezou A. Genetic polymorphisms in the UDP-glucuronosyltransferase 1A1 (UGT1A1) gene and prostate cancer risk in Caucasian men. Cancer Epidemiol 2010; 34:345-9. [DOI: 10.1016/j.canep.2010.02.009] [Citation(s) in RCA: 14] [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: 10/07/2009] [Revised: 02/14/2010] [Accepted: 02/23/2010] [Indexed: 10/19/2022]
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Rioja J, Tzortzis V, Mamoulakis C, Laguna MP. [Cryotherapy for renal tumors: current status and contemporary developments]. Actas Urol Esp 2010; 34:309-317. [PMID: 20470692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The proportion of renal tumors found incidentally dramatically increased in the past decade. More than half of them were diagnosed in patients over 70 years of age, a population with high associated comorbidity. Nephron-sparing minimally invasive surgical procedures are aimed at treating patients with small renal tumors and multiple comorbidities. Cryotherapy stands out among all other ablative procedures because of its better mid-term oncological outcome. A non-systematic review of the literature on cryotherapy as a treatment for renal tumors was made, analyzing its indications, actual and future application techniques, results, and complications.
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Affiliation(s)
- J Rioja
- Department of Urology, AMC University Hospital, University of Amsterdam, Holanda.
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