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Sandberg M, Namugosa M, Ritts R, Costa CM, Temple D, Hayes M, Whitman W, Ye E, Refugia J, Ben-David R, Alerasool P, Eilender B, Zanotti RR, Mourão TC, Kim JK, Marchiñena PG, Byun SS, Abreu D, Mehrazin R, Spiess P, de Cassio Zequi S, Rodriguez A. The role of preoperative immune cell metrics in renal cell carcinoma with a tumor thrombus. Urologia 2024:3915603241248020. [PMID: 38661082 DOI: 10.1177/03915603241248020] [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] [Indexed: 04/26/2024]
Abstract
INTRODUCTION The objective of this study was to stratify preoperative immune cell counts by cancer specific outcomes in patients with renal cell carcinoma (RCC) and a tumor thrombus after radical nephrectomy with tumor thrombectomy. METHODS Patients with a diagnosis of RCC with tumor thrombus that underwent radical nephrectomy with thrombectomy across an international consortium of seven institutions were included. Patients who were metastatic at diagnosis and those who received preoperative medical treatment were also included. Retrospective chart review was performed to collect demographic information, past medical history, preoperative lab work, surgical pathology, and follow up data. Neutrophil counts, lymphocyte counts, monocyte counts, neutrophil to lymphocyte ratios (NLR), lymphocyte to monocyte ratios (LMR), and neutrophil to monocyte ratios (NMR) were compared against cancer-specific outcomes using independent samples t-test, Pearson's bivariate correlation, and analysis of variance. RESULTS One hundred forty-four patients were included in the study, including nine patients who were metastatic at the time of surgery. Absolute lymphocyte count preoperatively was greater in patients who died from RCC compared to those who did not (2 vs 1.4; p < 0.001). Patients with tumor pathology showing perirenal fat invasion had a greater neutrophil count compared to those who did not (7.5 vs 5.5; p = 0.010). Patients with metastatic RCC had a lower LMR compared to those without metastases after surgery (2.5 vs 3.2; p = 0.041). Tumor size, both preoperatively and on gross specimen, had an interaction with multiple immune cell metrics (p < 0.05). CONCLUSIONS Preoperative immune metrics have clinical utility in predicting cancer-specific outcomes for patients with RCC and a tumor thrombus. Additional study is needed to determine the added value of preoperative serum immune cell data to established prognostic risk calculators for this patient population.
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Affiliation(s)
- Maxwell Sandberg
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Mary Namugosa
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Rory Ritts
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | | | - Davis Temple
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Mitchell Hayes
- Department of Urology, Moffitt Cancer Center, Tampa Bay, FL, USA
| | - Wyatt Whitman
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Emily Ye
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Justin Refugia
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Reuben Ben-David
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parissa Alerasool
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin Eilender
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Jung Kwon Kim
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | | | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Diego Abreu
- Urology Service, Pasteur Hospital, Montevideo, Uruguay
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Philippe Spiess
- Department of Urology, Moffitt Cancer Center, Tampa Bay, FL, USA
| | | | - Alejandro Rodriguez
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC, USA
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Palese MA, Chin CP, Garden EB, Eilender B, Levy M, Ravivarapu KT, Wang D, Freid H, Al-Alao O, Araya JS, LaPointe-Rudow D, Herron D, Chin E, Arvelakis A, Shapiro R, Larenas F, Florman SS. Comparison of Single-Port Robotic Donor Nephrectomy and Laparoscopic Donor Nephrectomy. J Endourol 2024; 38:136-141. [PMID: 38185847 DOI: 10.1089/end.2023.0364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Purpose: To compare the intra- and postoperative outcomes of single-port robotic donor nephrectomies (SP RDNs) and laparoscopic donor nephrectomies (LDNs). Materials and Methods: We retrospectively reviewed our institutional database for patients who received LDN or SP RDN between September 2020 and December 2022. Donor baseline characteristics, intraoperative outcomes, postoperative outcomes, and recipient renal function were extracted and compared between LDN and SP RDN. SP RDN learning curve analysis based on operative time and graft extraction time was performed using cumulative sum analysis. Results: One hundred forty-four patients underwent LDN and 32 patients underwent SP RDN. LDN and SP RDN had similar operative times (LDN: 190.3 ± 28.0 minutes, SP RDN: 194.5 ± 35.1 minutes, p = 0.3253). SP RDN patients had significantly greater extraction times (LDN: 83.2 ± 40.3 seconds, SP RDN: 204.1 ± 52.2 seconds, p < 0.0001) and warm ischemia times (LDN: 145.1 ± 61.7 seconds, SP RDN: 275.4 ± 65.6 seconds, p < 0.0001). There were no differences in patient subjective pain scores, inpatient opioid usage, or Clavien-Dindo II+ complications. Short- and medium-term postoperative donor and recipient renal function were also similar between the groups. SP RDN graft extraction time and total operative time learning curves were achieved at case 27 and 13, respectively. Conclusion: SP RDN is a safe and feasible alternative to LDN that minimizes postoperative abdominal incisional scars and has a short learning curve. Future randomized prospective clinical trials are needed to confirm the findings of this study and to identify other potential benefits and drawbacks of SP RDNs.
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Affiliation(s)
- Michael A Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Chih Peng Chin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Evan B Garden
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin Eilender
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Micah Levy
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Krishna T Ravivarapu
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Wang
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hannah Freid
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Osama Al-Alao
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph Sewell Araya
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dianne LaPointe-Rudow
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Herron
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Edward Chin
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Antonios Arvelakis
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ron Shapiro
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Francisca Larenas
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sander S Florman
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Izadmehr S, Lundon DJ, Mohamed N, Katims A, Patel V, Eilender B, Mehrazin R, Badani KK, Sfakianos JP, Tsao CK, Wiklund P, Oh WK, Cordon-Cardo C, Tewari AK, Galsky MD, Kyprianou N. The Evolving Clinical Management of Genitourinary Cancers Amid the COVID-19 Pandemic. Front Oncol 2021; 11:734963. [PMID: 34646777 PMCID: PMC8504458 DOI: 10.3389/fonc.2021.734963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/31/2021] [Indexed: 12/24/2022] Open
Abstract
Coronavirus disease-2019 (COVID-19), a disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, has become an unprecedented global health emergency, with fatal outcomes among adults of all ages throughout the world. There is a high incidence of infection and mortality among cancer patients with evidence to support that patients diagnosed with cancer and SARS-CoV-2 have an increased likelihood of a poor outcome. Clinically relevant changes imposed as a result of the pandemic, are either primary, due to changes in timing or therapeutic modality; or secondary, due to altered cooperative effects on disease progression or therapeutic outcomes. However, studies on the clinical management of patients with genitourinary cancers during the COVID-19 pandemic are limited and do little to differentiate primary or secondary impacts of COVID-19. Here, we provide a review of the epidemiology and biological consequences of SARS-CoV-2 infection in GU cancer patients as well as the impact of COVID-19 on the diagnosis and management of these patients, and the use and development of novel and innovative diagnostic tests, therapies, and technology. This article also discusses the biomedical advances to control the virus and evolving challenges in the management of prostate, bladder, kidney, testicular, and penile cancers at all stages of the patient journey during the first year of the COVID-19 pandemic.
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Affiliation(s)
- Sudeh Izadmehr
- Department of Medicine, Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Dara J. Lundon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nihal Mohamed
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andrew Katims
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Vaibhav Patel
- Department of Medicine, Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Benjamin Eilender
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Reza Mehrazin
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ketan K. Badani
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - John P. Sfakianos
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Che-Kai Tsao
- Department of Medicine, Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - William K. Oh
- Department of Medicine, Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Carlos Cordon-Cardo
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ashutosh K. Tewari
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Matthew D. Galsky
- Department of Medicine, Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Natasha Kyprianou
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Zahalka A, Fram E, Howard L, Garden E, Mohn L, Annam J, Reagan A, Eilender B, Dehoedt A, Wiggins E, Agalliu I, Freedland S, Tewari A, Watts K. MP62-18 ATENOLOL IS ASSOCIATED WITH REDUCED RISK OF PROSTATE CANCER UPGRADING: A MULTICENTER RETROSPECTIVE STUDY. J Urol 2021. [DOI: 10.1097/ju.0000000000002102.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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