1
|
Yu CC, Chang CH, Fang JK, Huang SK, Tseng WH, Lee HY, Yeh HC, Chen IHA, Lin JT, Chen PC, Cheong IS, Hsueh TY, Jiang YH, Lee YK, Chen WC, Lo SH, Lin PH, Wang SS, Huang CY, Wu CC, Tseng JS, Wu SY, Tsai YC. Impact of pathological response on oncological outcomes in patients with upper tract urothelial cancer receiving neo-adjuvant chemotherapy. J Formos Med Assoc 2023; 122:1274-1281. [PMID: 37400294 DOI: 10.1016/j.jfma.2023.06.003] [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: 12/14/2022] [Revised: 03/24/2023] [Accepted: 06/05/2023] [Indexed: 07/05/2023] Open
Abstract
PURPOSE The purpose of this study is to evaluate the rates of pathological complete response (ypT0N0/X) and pathological response (ypT1N0/X or less) in patients with upper tract urothelial cancer who were treated with neo-adjuvant chemotherapy and to examine their impact on oncological outcomes. METHODS This study is a multi-institutional retrospective analysis of patients with high-risk upper tract urothelial cancer who underwent neoadjuvant chemotherapy and radical nephroureterectomy between 2002 and 2021. Logistic regression analyses were used to investigate all clinical parameters for response after neoadjuvant chemotherapy. Cox proportional hazard models were performed to assess the effect of the response on the oncological outcomes. RESULTS A total of 84 patients with UTUC who received neo-adjuvant chemotherapy were identified. Among them, 44 (52.4%) patients received cisplatin-based chemotherapy, and 22 (26.2%) patients had a carboplatin-based regimen. The pathological complete response rate was 11.6% (n = 10), and the pathological response rate was 42.9% (n = 36). Multifocal tumors or tumors larger than 3 cm significantly reduced the odds of pathological response. In the multivariable Cox proportional hazard model, pathological response was independently associated with better overall survival (HR 0.38, p = 0.024), cancer-specific survival (HR 0.24, p = 0.033), and recurrence-free survival (HR 0.17, p = 0.001), but it was not associated with bladder recurrence-free survival (HR 0.84, p = 0.69). CONCLUSION Pathological response after neo-adjuvant chemotherapy and radical nephroureterectomy is strongly associated with patient survival and recurrence, and it might be a good surrogate for evaluating the efficacy of neo-adjuvant chemotherapy in the future.
Collapse
Affiliation(s)
- Chih-Chin Yu
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Jen-Kai Fang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan
| | - Steven K Huang
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Taiwan; Department of Medical Science Industries, College of Health Sciences, Chang Jung Christian University, Tainan City, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan
| | - Wen-Hsin Tseng
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Taiwan
| | - Hsiang-Ying Lee
- School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan; Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Chih Yeh
- School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan; Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Hsuan Alan Chen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Taiwan
| | - Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Taiwan
| | - Pi-Che Chen
- Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Ian-Seng Cheong
- Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Thomas Y Hsueh
- Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taiwan; Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yu-Khun Lee
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Wei-Chieh Chen
- Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shih-Hsiu Lo
- Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Po-Hung Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shian-Shiang Wang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Chang Wu
- Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Jen-Shu Tseng
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan; Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shu-Yu Wu
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Yao-Chou Tsai
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
| |
Collapse
|
2
|
Huang HP, Chen CH, Chang KH, Lee MS, Lee CF, Chao YH, Lu SY, Wu TF, Liang ST, Lin CY, Lin YC, Liu SP, Lu YC, Shun CT, Huang WJ, Lin TP, Ku MH, Chung HJ, Chang YH, Liao CH, Yu CC, Chung SD, Tsai YC, Wu CC, Chen KC, Ho CH, Hsiao PW, Pu YS. Prediction of clinically significant prostate cancer through urine metabolomic signatures: A large-scale validated study. J Transl Med 2023; 21:714. [PMID: 37821919 PMCID: PMC10566053 DOI: 10.1186/s12967-023-04424-9] [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: 04/27/2023] [Accepted: 08/07/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE Currently, there are no accurate markers for predicting potentially lethal prostate cancer (PC) before biopsy. This study aimed to develop urine tests to predict clinically significant PC (sPC) in men at risk. METHODS Urine samples from 928 men, namely, 660 PC patients and 268 benign subjects, were analyzed by gas chromatography/quadrupole time-of-flight mass spectrophotometry (GC/Q-TOF MS) metabolomic profiling to construct four predictive models. Model I discriminated between PC and benign cases. Models II, III, and GS, respectively, predicted sPC in those classified as having favorable intermediate risk or higher, unfavorable intermediate risk or higher (according to the National Comprehensive Cancer Network risk groupings), and a Gleason sum (GS) of ≥ 7. Multivariable logistic regression was used to evaluate the area under the receiver operating characteristic curves (AUC). RESULTS In Models I, II, III, and GS, the best AUCs (0.94, 0.85, 0.82, and 0.80, respectively; training cohort, N = 603) involved 26, 24, 26, and 22 metabolites, respectively. The addition of five clinical risk factors (serum prostate-specific antigen, patient age, previous negative biopsy, digital rectal examination, and family history) significantly improved the AUCs of the models (0.95, 0.92, 0.92, and 0.87, respectively). At 90% sensitivity, 48%, 47%, 50%, and 36% of unnecessary biopsies could be avoided. These models were successfully validated against an independent validation cohort (N = 325). Decision curve analysis showed a significant clinical net benefit with each combined model at low threshold probabilities. Models II and III were more robust and clinically relevant than Model GS. CONCLUSION This urine test, which combines urine metabolic markers and clinical factors, may be used to predict sPC and thereby inform the necessity of biopsy in men with an elevated PC risk.
Collapse
Affiliation(s)
- Hsiang-Po Huang
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Hsin Chen
- Department of Urology, National Taiwan University College of Medicine and Hospital, 7 Zhongshan South Road, Taipei, 100225, Taiwan, Republic of China
| | - Kai-Hsiung Chang
- Institute of Cellular and System Medicine, National Health Research Institutes, Miaoli, Taiwan
| | - Ming-Shyue Lee
- Department of Biochemistry and Molecular Biology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Fan Lee
- Department of Biochemistry and Molecular Biology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Hsiang Chao
- Department of Urology, National Taiwan University College of Medicine and Hospital, 7 Zhongshan South Road, Taipei, 100225, Taiwan, Republic of China
| | - Shih-Yu Lu
- Department of Urology, National Taiwan University College of Medicine and Hospital, 7 Zhongshan South Road, Taipei, 100225, Taiwan, Republic of China
| | - Tzu-Fan Wu
- Department of Urology, National Taiwan University College of Medicine and Hospital, 7 Zhongshan South Road, Taipei, 100225, Taiwan, Republic of China
| | - Sung-Tzu Liang
- Department of Urology, National Taiwan University College of Medicine and Hospital, 7 Zhongshan South Road, Taipei, 100225, Taiwan, Republic of China
| | - Chih-Yu Lin
- Agricultural Biotechnology Research Center, Academia Sinica, No. 128, Sec. 2, Academia Road, Nankang, Taipei, 11529, Taiwan
| | - Yuan Chi Lin
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shih-Ping Liu
- Department of Urology, National Taiwan University College of Medicine and Hospital, 7 Zhongshan South Road, Taipei, 100225, Taiwan, Republic of China
| | - Yu-Chuan Lu
- Department of Urology, National Taiwan University College of Medicine and Hospital, 7 Zhongshan South Road, Taipei, 100225, Taiwan, Republic of China
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Chia-Tung Shun
- Department of Pathology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - William J Huang
- Department of Urology, Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzu-Ping Lin
- Department of Urology, Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Hsuan Ku
- Department of Urology, Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiao-Jen Chung
- Department of Urology, Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Hwa Chang
- Department of Urology, Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Hou Liao
- Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan
- School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chih-Chin Yu
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, and the Buddhist Tzu Chi Medical Foundation, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Shiu-Dong Chung
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, and Department of Nursing, College of Healthcare & Management, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
| | - Yao-Chou Tsai
- Department of Medicine & Division of Urology, Taipei Tzu Chi Hospital, New Taipei City, Taiwan
| | - Chia-Chang Wu
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Urology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Chou Chen
- Department of Urology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chen-Hsun Ho
- School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Division of Urology, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Pei-Wen Hsiao
- Agricultural Biotechnology Research Center, Academia Sinica, No. 128, Sec. 2, Academia Road, Nankang, Taipei, 11529, Taiwan.
| | - Yeong-Shiau Pu
- Department of Urology, National Taiwan University College of Medicine and Hospital, 7 Zhongshan South Road, Taipei, 100225, Taiwan, Republic of China.
| |
Collapse
|
3
|
Chen YT, Yeh HC, Lee HY, Hsieh PF, Chou ECL, Tsai YC, Hong JH, Huang CY, Jiang YH, Lee YK, Tseng JS, Yu CC, Chiang BJ, Hsueh TY, Wu CC, Tsai CY. Endoscopic management of upper tract urothelial cancer in a highly endemic area: A Taiwan nationwide collaborative study. Asian J Surg 2023; 46:3058-3065. [PMID: 37525448 DOI: 10.1016/j.asjsur.2022.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/25/2022] [Accepted: 10/13/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Endoscopic management of upper tract urothelial cancer (UTUC) is an important treatment option for low risk UTUC. Although Taiwan is an endemic area for UTUC, endoscopic treatment outcomes in Taiwan are frequently under- reported. METHODS This study retrospectively reviewed the treatment outcomes of endoscopic management for clinically localized UTUC. Patients with biopsy or washing cytology confirmed UTUC who underwent endoscopic or percutaneous management with a curative intent were retrospectively reviewed for eligibility of analysis. Those cases without pre-intervention confirmed UTUC, and metastatic or nodal disease at diagnosis were excluded. RESULTS In total, 307 patients who underwent endoscopic management were reviewed and 279 cases were eligible for final analysis. With a median follow-up of 44.3 months (inter-quartile range (IQR): 23.4-76.4 months), 117 cases (46.4%) were endoscopic cured after median one session (range:1-8; IQR:1-2) of endoscopic treatment. Those endoscopic cured UTUC was associated with more small-sized tumor, more low-grade biopsied-histology, less concomitant bladder UC and less pre-operative hydronephrosis. In addition, 201(79.7%) cases among 252 cases with confirmed oncological outcome were free of UTUC at the end of follow-up and only 43 (17%) patients had a UTUC related mortality. Salvage RNU offered a better tumor free survival rate (92% vs. 77.5%) than those without salvage RNU in those UTUC refractory to endoscopic management. In multivariable analyses, pre-operative hydronephrosis was the independent risk factor for OS. Multiplicity and concomitant bladder UC were independent risk factors for DFS. CONCLUSIONS We confirmed the consistent safety and efficacy of endoscopic management of clinical localized UTUC in a highly UTUC endemic area like Taiwan. Early salvage RNU is mandatory in those UTUC refractory to endoscopic management in prevention of UTUC related death.
Collapse
Affiliation(s)
- Yung Tai Chen
- Department of Urology, Postal Hospital, Taipei, Taiwan; Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Hsin-Chih Yeh
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Po-Fan Hsieh
- Department of Urology, China Medical University Hospital, Taichung, 40447, Taiwan; School of Medicine, China Medical University, Taichung, 40402, Taiwan; Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung, 40402, Taiwan
| | - Eric Chieh-Lung Chou
- Department of Urology, China Medical University Hospital, Taichung, 40447, Taiwan; School of Medicine, China Medical University, Taichung, 40402, Taiwan; Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung, 40402, Taiwan
| | - Yao-Chou Tsai
- Division of Urology, Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
| | - Jian-Hua Hong
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yu-Khun Lee
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Jen-Shu Tseng
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 252, Taiwan; Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan No.155, Sec.2, Linong Street, Taipei, 112, Taiwan
| | - Chih-Chin Yu
- Division of Urology, Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Bing-Juin Chiang
- College of Medicine, Fu-Jen Catholic University, New Taipei City, 24205, Taiwan; Department of Urology, Cardinal Tien Hospital, New Taipei City, 23148, Taiwan; Department of Life Science, College of Science, National Taiwan Normal University, Taipei, 11677, Taiwan
| | - Thomas Y Hsueh
- Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taiwan; Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Chang Wu
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chung-You Tsai
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Taiwan; Department of Healthcare Information&Management, Ming Chuan University, Taiwan
| |
Collapse
|
4
|
Kuo KL, Chiang CW, Chen YMA, Yu CC, Lee TS. Folic Acid Ameliorates Renal Injury in Experimental Obstructive Nephropathy: Role of Glycine N-Methyltransferase. Int J Mol Sci 2023; 24:ijms24076859. [PMID: 37047834 PMCID: PMC10095475 DOI: 10.3390/ijms24076859] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
Folic acid exerts both anti-inflammatory and antifibrotic effects. Glycine N-methyltransferase (GNMT), the major folic acid-binding protein in the liver, is a crucial enzyme that regulates the cellular methylation process by maintaining S-adenosylmethionine levels. However, as yet neither the therapeutic effects of folic acid in renal fibrosis nor whether GNMT is involved in these folic acid-associated mechanisms has been investigated. First, the expression of GNMT was examined in human kidneys with or without obstructive nephropathy. Later, wild-type and GNMT knockout (GNMT-/-) mice were subjected to unilateral ureteral obstruction (UUO) and then treated with either folic acid or vehicle for 14 days. Renal tubular injury, inflammation, fibrosis, and autophagy were evaluated by histological analysis and Western blotting. We observed increased expression of GNMT in humans with obstructive nephropathy. Furthermore, UUO significantly increased the expression of GNMT in mice; in addition, it caused renal injury as well as the development of both hydronephrosis and tubular injury. These were all alleviated by folic acid treatment. In contrast, GNMT-/- mice exhibited exacerbated UUO-induced renal injury, but the protective effect of folic acid was not observed in GNMT-/- mice. We propose a novel role for folic acid in the treatment of renal fibrosis, which indicates that GNMT may be a therapeutic target.
Collapse
Affiliation(s)
- Ko-Lin Kuo
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231405, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien 97004, Taiwan
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Chin-Wei Chiang
- Department of Physiology, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Yi-Ming Arthur Chen
- Graduate Institute of Biomedical and Pharmaceutical Science, Fu Jen Catholic University, New Taipei 24205, Taiwan
| | - Chih-Chin Yu
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231405, Taiwan
- College of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Tzong-Shyuan Lee
- Graduate Institute, Department of Physiology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| |
Collapse
|
5
|
Cheng PY, Lee HY, Li WM, Huang SK, Liu CL, Chen IHA, Lin JT, Lo CW, Yu CC, Wang SS, Chen CS, Tseng JS, Lin WR, Yeong-Chin J, Cheong IS, Jiang YH, Lee YK, Chen YT, Chen SH, Chiang BJ, Hsueh TY, Huang CY, Wu CC, Lin WY, Tsai YC, Yu KJ, Huang CP, Huang YY, Tsai CY. Preoperative hydronephrosis is an independent protective factor of renal function decline after nephroureterectomy for upper tract urothelial carcinoma. Front Oncol 2023; 13:944321. [PMID: 36910617 PMCID: PMC9998910 DOI: 10.3389/fonc.2023.944321] [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: 05/15/2022] [Accepted: 02/03/2023] [Indexed: 02/26/2023] Open
Abstract
Objectives To evaluate the predictive role of pre-nephroureterectomy (NU) hydronephrosis on post-NU renal function (RF) change and preserved eligibility rate for adjuvant therapy in patients with upper tract urothelial carcinoma (UTUC). Patients and methods This retrospective study collected data of 1018 patients from the Taiwan UTUC Collaboration Group registry of 26 institutions. The patients were divided into two groups based on the absence or presence of pre-NU hydronephrosis. Estimated glomerular filtration rate (eGFR) was calculated pre- and post-NU respectively. The one month post-NU RF change, chronic kidney disease (CKD) progression, and the preserved eligibility rate for adjuvant therapy were compared for each CKD stage. Results 404 (39.2%) patients without and 614 (60.8%) patients with pre-NU hydronephrosis were enrolled. The median post-NU change in the eGFR was significantly lower in the hydronephrosis group (-3.84 versus -12.88, p<0.001). Pre-NU hydronephrosis was associated with a lower post-NU CKD progression rate (33.1% versus 50.7%, p< 0.001) and was an independent protective factor for RF decline after covariate adjustment (OR=0.46, p<0.001). Patients with pre-NU hydronephrosis had a higher preserved eligibility rate for either adjuvant cisplatin-based chemotherapy (OR=3.09, 95%CI 1.95-4.69) or immune-oncology therapy (OR=2.31, 95%CI 1.23-4.34). Conclusion Pre-NU hydronephrosis is an independent protective predictor for post-NU RF decline, CKD progression, and eligibility for adjuvant therapy. With cautious selection for those unfavorably prognostic, non-metastatic UTUC patients with preoperative hydronephrosis, adjuvant rather than neoadjuvant therapy could be considered due to higher chance of preserving eligibility.
Collapse
Affiliation(s)
- Pai-Yu Cheng
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Ming Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan.,Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Steven K Huang
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.,Department of Medical Science Industries, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Chien-Liang Liu
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - I-Hsuan Alan Chen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chi-Wen Lo
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan
| | - Chih-Chin Yu
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Shian-Shiang Wang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan
| | - Chuan-Shu Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Jen-Shu Tseng
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan.,Mackay Medical College, Taipei, Taiwan.,Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wun-Rong Lin
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan.,Mackay Medical College, Taipei, Taiwan
| | - Jou Yeong-Chin
- Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.,Department of Health and Nutrition Biotechnology, Asian University, Taichung, Taiwan
| | - Ian-Seng Cheong
- Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yu Khun Lee
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yung-Tai Chen
- Department of Urology Taiwan Adventist Hospital, Taipei, Taiwan
| | - Shin-Hong Chen
- Department of Urology Taiwan Adventist Hospital, Taipei, Taiwan
| | - Bing-Juin Chiang
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.,Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan.,Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
| | - Thomas Y Hsueh
- Division of Urology, Department of Surgery, Taipei City Hospital renai branch, Taipei, Taiwan.,Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Chang Wu
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Wei Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan.,Chang Gung University of Science and Technology, Chia-Yi, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Chou Tsai
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.,Department of Surgery, Taipei Tzu chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kai-Jie Yu
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Chemical Engineering and Biotechnology and Graduate Institute of Biochemical and Biomedical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Yi-You Huang
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chung-You Tsai
- Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| |
Collapse
|
6
|
Wu KH, Chang CH, Wu HC, Huang SK, Liu CL, Yang CK, Li JR, Tseng JS, Lin WR, Yu CC, Lo CW, Huang CY, Chen CH, Tsai CY, Cheng PY, Jiang YH, Lee YK, Chen YT, Yeh TC, Lin JT, Tsai YC, Hsueh TY, Chiang BJ, Chiang YD, Lin WY, Jou YC, Pang ST, Ke HL. Oncologic impact of delay between diagnosis and radical nephroureterectomy. Front Oncol 2022; 12:1025668. [PMID: 36591462 PMCID: PMC9795168 DOI: 10.3389/fonc.2022.1025668] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/28/2022] [Indexed: 01/03/2023] Open
Abstract
Purpose This study aimed to evaluate the oncological outcome of delayed surgical wait time from the diagnosis of upper tract urothelial carcinoma (UTUC) to radical nephroureterectomy (RNU). Methods In this multicenter retrospective study, medical records were collected between 1988 and 2021 from 18 participating Taiwanese hospitals under the Taiwan UTUC Collaboration Group. Patients were dichotomized into the early (≤90 days) and late (>90 days) surgical wait-time groups. Overall survival, disease-free survival, and bladder recurrence-free survival were calculated using the Kaplan-Meier method and multivariate Cox regression analysis. Multivariate analysis was performed using stepwise linear regression. Results Of the 1251 patients, 1181 (94.4%) were classifed into the early surgical wait-time group and 70 (5.6%) into the late surgical wait-time group. The median surgical wait time was 21 days, and the median follow-up was 59.5 months. Our study showed delay-time more than 90 days appeared to be associated with worse overall survival (hazard ratio [HR] 1.974, 95% confidence interval [CI] 1.166-3.343, p = 0.011), and disease-free survival (HR 1.997, 95% CI 1.137-3.507, p = 0.016). This remained as an independent prognostic factor after other confounding factors were adjusted. Age, ECOG performance status, Charlson Comorbidity Index (CCI), surgical margin, tumor location and adjuvant systemic therapy were independent prognostic factors for overall survival. Tumor location and adjuvant systemic therapy were also independent prognostic factors for disease-free survival. Conclusions For patients with UTUC undergoing RNU, the surgical wait time should be minimized to less than 90 days. Prolonged delay times may be associated with poor overall and disease-free survival.
Collapse
Affiliation(s)
- Kuan-Hsien Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan,School of Medicine, China Medical University, Taichung, Taiwan
| | - Hsi-Chin Wu
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan,School of Medicine, China Medical University, Taichung, Taiwan,Department of Urology, China Medical University Beigang Hospital, Yunlin, Taiwan
| | - Steven K. Huang
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan,Department of Medical Science Industries, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan,School of medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Liang Liu
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jian-Ri Li
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Jen-Shu Tseng
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan,Department of Medicine, Mackay Medical College, Taipei, Taiwan,Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wun-Rong Lin
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan,Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Chih-Chin Yu
- Division of Urology, Department of surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chi-Wen Lo
- Division of Urology, Department of surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Hsin Chen
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-You Tsai
- Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Pai-Yu Cheng
- Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan,Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yu-Khun Lee
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yung-Tai Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Ting-Chun Yeh
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yao-Chou Tsai
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan,Department of surgery, Taipei Tzu chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan,Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Thomas Y. Hsueh
- Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan,Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Bing-Juin Chiang
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan,Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan,Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
| | - Yi-De Chiang
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan,Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Wei-Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan,Chang Gung University of Science and Technology, Chiayi, Taiwan,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yeong-Chin Jou
- Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan,Department of Health and Nutrition Biotechnology, Asian University, Taichung, Taiwan
| | - See-Tong Pang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Hung-Lung Ke
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan,*Correspondence: Hung-Lung Ke,
| |
Collapse
|
7
|
Kuo CC, Chen GH, Chang CH, Huang CY, Chen CH, Li CC, Wu WJ, Yu CC, Lo CW, Chen YT, Chen SH, Cheng PY, Hsueh T, Chiu AW, Lin PH, Tseng JS, Lin JT, Jiang YH, Wu CC, Lin WY, Huang HC, Chiang HS, Chiang BJ. Surgical outcome predictor analysis following hand-assisted or pure laparoscopic transperitoneal nephroureterectomy using the Taiwan upper urinary tract urothelial carcinoma database. Front Surg 2022; 9:934355. [PMID: 36117820 PMCID: PMC9475171 DOI: 10.3389/fsurg.2022.934355] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTaiwan has a high incidence of upper tract urothelial carcinoma (UTUC). This study aimed to compare the surgical outcomes following transperitoneal hand-assisted laparoscopic nephroureterectomy (TP-HALNU) and transperitoneal pure laparoscopic nephroureterectomy (TP-LNU) from the Taiwan nationwide UTUC collaboration database using different parameters, including surgical volumes.Materials and methodsThe nationwide UTUC collaboration database includes 14 hospitals in Taiwan from the Taiwan Cancer Registry. We retrospectively reviewed the records of 622 patients who underwent laparoscopic nephroureterectomy between July 1988 and September 2020. In total, 322 patients who received TP-LNU or TP-HALNU were included in the final analysis. Clinical and pathological data and oncological outcomes were compared.ResultsOf the 322 patients, 181 and 141 received TP-LNU and TP-HALNU, respectively. There were no differences in clinical and histopathological data between the two groups. No differences were observed in perioperative and postoperative complications. There were no significant differences in oncological outcomes between the two surgical approaches. In the multivariate analysis, the cohort showed that age ≥70 years, positive pathological lymph node metastasis, tumors located in the upper ureter, and male sex were predictive factors associated with an increased risk of adverse oncological outcomes. A surgical volume of ≥20 cases showed a trend toward favorable outcomes on cancer-specific survival [hazard ratio (HR) 0.154, p = 0.052] and marginal benefit for overall survival (HR 0.326, p = 0.019) in the multivariate analysis.ConclusionAlthough different approaches to transperitoneal laparoscopic nephroureterectomy showed no significant differences in surgical outcomes, age, sex, lymph node metastasis, and tumor in the upper ureter in the following period were predictive factors for oncological outcomes. Higher surgical volume did not impact disease-free survival and bladder recurrence-free survival but was associated with improved overall survival and cancer-specific survival. Exploration of unknown influencing factors is warranted.
Collapse
Affiliation(s)
- Chih-Chun Kuo
- Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Guang-Heng Chen
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan
- Department of Urology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Hsin Chen
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Chin Yu
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chi-Wen Lo
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Yung-Tai Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Shin-Hong Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Pai-Yu Cheng
- Division of Urology, Department of Surgery, Far-Eastern Memorial Hospital, New Taipei, Taiwan
| | - Thomas Y. Hsueh
- Division of Urology, Department of Surgery, Taipei City Hospital Ren-Ai Branch, Taipei, Taiwan
- Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Allen W. Chiu
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Han Lin
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Jen-Shu Tseng
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
- Mackay Medical College, Taipei, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Chia-Chang Wu
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Wei-Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
- Chang Gung University of Science and Technology, Chia-Yi, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsu-Che Huang
- Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
| | - Han-Sun Chiang
- Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Urology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
- Correspondence: Bing-Juin Chiang ; Han-Sun Chiang
| | - Bing-Juin Chiang
- Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Correspondence: Bing-Juin Chiang ; Han-Sun Chiang
| |
Collapse
|
8
|
Yeh HC, Chang CH, Fang JK, Chen IHA, Lin JT, Hong JH, Huang CY, Wang SS, Chen CS, Lo CW, Yu CC, Tseng JS, Lin WR, Jou YC, Cheong IS, Jiang YH, Tsai CY, Hsueh TY, Chen YT, Huang HC, Tsai YC, Lin WY, Wu CC, Lin PH, Lin TW, Wu WJ. The Value of Preoperative Local Symptoms in Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Retrospective, Multicenter Cohort Study. Front Oncol 2022; 12:872849. [PMID: 35719933 PMCID: PMC9201473 DOI: 10.3389/fonc.2022.872849] [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: 02/10/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose We aimed to evaluate the impact of preoperative local symptoms on prognosis after radical nephroureterectomy in patients with upper tract urothelial carcinoma (UTUC). Methods This retrospective study consisted of 2,662 UTUC patients treated at 15 institutions in Taiwan from 1988 to 2019. Clinicopathological data were retrospectively collected for analysis by the Taiwan UTUC Collaboration Group. The Kaplan-Meier method was used to calculate overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS). The prognostic value of preoperative local symptoms in OS, CSS, DFS, and BRFS was investigated using Cox proportional hazards models. Results The median follow-up was 36.6 months. Among 2,662 patients, 2,130 (80.0%) presented with hematuria and 398 (15.0%) had symptomatic hydronephrosis at diagnosis. Hematuria was associated with less symptomatic hydronephrosis (p <0.001), more dialysis status (p = 0.027), renal pelvic tumors (p <0.001), and early pathological tumor stage (p = 0.001). Symptomatic hydronephrosis was associated with female patients (p <0.001), less dialysis status (p = 0.001), less bladder cancer history (p <0.001), ureteral tumors (p <0.001), open surgery (p = 0.006), advanced pathological tumor stage (p <0.001), and postoperative chemotherapy (p = 0.029). Kaplan-Meier analysis showed that patients with hematuria or without symptomatic hydronephrosis had significantly higher rates of OS, CSS, and DFS (all p <0.001). Multivariate analysis confirmed that presence of hematuria was independently associated with better OS (HR 0.789, 95% CI 0.661-0.942) and CSS (HR 0.772, 95% CI 0.607-0.980), while symptomatic hydronephrosis was a significant prognostic factor for poorer OS (HR 1.387, 95% CI 1.142-1.683), CSS (HR 1.587, 95% CI 1.229-2.050), and DFS (HR 1.378, 95% CI 1.122-1.693). Conclusions Preoperative local symptoms were significantly associated with oncological outcomes, whereas symptomatic hydronephrosis and hematuria had opposite prognostic effects. Preoperative symptoms may provide additional information on risk stratification and perioperative treatment selection for patients with UTUC.
Collapse
Affiliation(s)
- Hsin-Chih Yeh
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan.,Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Jen-Kai Fang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - I-Hsuan Alan Chen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jian-Hua Hong
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shian-Shiang Wang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan
| | - Chuan-Shu Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Chi-Wen Lo
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan
| | - Chih-Chin Yu
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Jen-Shu Tseng
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan.,Mackay Medical College, New Taipei City, Taiwan.,Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wun-Rong Lin
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan.,Mackay Medical College, New Taipei City, Taiwan
| | - Yeong-Chin Jou
- Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.,Department of Health and Nutrition Biotechnology, Asian University, Taichung, Taiwan
| | - Ian-Seng Cheong
- Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Chung-You Tsai
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Healthcare Information & Management, Ming Chuan University, Taoyuan, Taiwan
| | - Thomas Y Hsueh
- Division of Urology, Department of Surgery, Taipei City Hospital renai branch, Taipei, Taiwan.,Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Tai Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Hsu-Che Huang
- Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan.,Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
| | - Yao-Chou Tsai
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wei-Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Chang Gung University of Science and Technology, Chiayi, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Chang Wu
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Taipei Medical University Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Po-Hung Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Te-Wei Lin
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
9
|
Yu CC, Chen CH, Hong JH, Ke HL, Li WM, Chung SD, Wu WC, Chen YT, Jiang YH, Lin YH, Lin WY, Wu CC, Tsai YC. Comparison of oncological outcomes for hand-assisted and pure laparoscopic radical nephroureterectomy: results from the Taiwan Upper Tract Urothelial Cancer Collaboration Group. Surg Endosc 2022; 36:4342-4348. [PMID: 34716480 DOI: 10.1007/s00464-021-08779-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/13/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE Laparoscopic radical nephroureterectomy (LNU) has gradually become the new standard treatment for localized upper tract urothelial cancer (UTUC). With more blunt dissection and tactile sensation, hand-assisted LNU might shorten the operative time compared with the pure laparoscopic approach. However, whether the use of the hand-assisted or the pure laparoscopic approach has an effect on oncological outcomes remains unclear. METHODS We retrospectively identified 629 patients with non-metastatic UTUC who underwent hand-assisted (n = 515) or pure LNU (n = 114) at 9 hospitals in Taiwan between 2004 and 2019. Overall survival, cancer-specific survival, recurrence-free survival, and bladder recurrence-free survival were compared between these two groups using inverse-probability of treatment weighting (IPTW) derived from the propensity scores for baseline covariate adjustment. RESULTS The median follow-up period was 32.9 and 28.7 months in the hand-assisted and the pure groups, respectively. IPTW-adjusted Cox proportional hazards models showed that the laparoscopic approach (pure vs. hand-assisted) was not significantly associated with all-cause mortality (HR 0.79, 95% CI 0.49-1.24, p = 0.304), cancer-specific mortality (HR 0.88, 95% CI 0.51-1.51, p = 0.634), or extra-vesical recurrence (HR 0.65, 95% CI 0.41-1.04, p = 0.071). However, the pure laparoscopic approach was significantly associated with lower intra-vescial recurrence (HR 0.64, 95% CI 0.43-0.96, p = 0.029) for patients who underwent LNU. Kaplan-Meier curves also revealed that the pure laparoscopic approach was associated with better bladder recurrence-free survival compared with the hand-assisted laparoscopic approach in both the original cohort and the IPTW-adjusted cohort (log-rank p = 0.042 and 0.027, respectively). CONCLUSIONS The performance of hand-assisted or pure LNU does not significantly affect the all-cause mortality, cancer-specific mortality, or extra-vesical recurrence for patients with non-metastatic UTUC. However, the hand-assisted laparoscopic approach could increase the risk of intra-vesical recurrence for patients who undergo LNU.
Collapse
Affiliation(s)
- Chih-Chin Yu
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian, New Taipei City, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chung-Hsin Chen
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jian-Hua Hong
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Hung-Lung Ke
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Ming Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan
| | - Shiu-Dong Chung
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Program in Biomedical Informatics, College of Informatics, Yuan-Ze University, Chung-Li, Taiwan
| | - Wei-Che Wu
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yung-Tai Chen
- Department of Urology, Postal Hospital, Taipei, Taiwan
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yu-Hua Lin
- Department of Surgery, Division of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Chemistry, Fu Jen Catholic University, New Taipei City, Taiwan
- Graduate Institute of Biochemical and Pharmaceutical Science, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Wei-Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
- Chang Gung University of Science and Technology, Chia-Yi, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Chang Wu
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yao-Chou Tsai
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian, New Taipei City, Taiwan.
- Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
- TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
10
|
Lee HY, Chang CH, Huang CP, Yu CC, Lo CW, Chung SD, Wu WC, Chen IHA, Lin JT, Jiang YH, Lee YK, Hsueh TY, Chiu AW, Chen YT, Lin CM, Tsai YC, Chen WC, Chiang BJ, Huang HC, Chen CH, Huang CY, Wu CC, Lin WY, Tseng JS, Ke HL, Yeh HC. Is Lymph Node Dissection Necessary During Radical Nephroureterectomy for Clinically Node-Negative Upper Tract Urothelial Carcinoma? A Multi-Institutional Study. Front Oncol 2022; 12:791620. [PMID: 35574295 PMCID: PMC9099435 DOI: 10.3389/fonc.2022.791620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/08/2021] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThis study aimed to compare the oncological outcomes of patients with upper tract urothelial carcinoma (UTUC) without clinical lymph node metastasis (cN0) undergoing lymph node dissection (LND) during radical nephroureterectomy (NU).MethodsFrom the updated data of the Taiwan UTUC Collaboration Group, a total of 2726 UTUC patients were identified. We only include patients with ≥ pT2 stage and enrolled 658 patients. The Kaplan–Meier estimator and Cox proportional hazards model were used to analyze overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS) in LND (+) and LND (−) groups.ResultsA total of 658 patients were included and 463 patients without receiving LND and 195 patients receiving LND. From both univariate and multivariate survival analysis, there are no significant difference between LND (+) and LND (-) group in survival rate. In LND (+) group, 18.5% patients have pathological LN metastasis. After analyzing pN+ subgroup, it revealed worse CSS (p = 0.010) and DFS (p < 0.001) compared with pN0 patients.ConclusionsWe found no significant survival benefit related to LND in cN0 stage, ≥ pT2 stage UTUC, irrespective of the number of LNs removed, although pN+ affected cancer prognosis. However, from the result of pN (+) subgroup of LND (+) cohort analysis, it may be reasonable to not perform LND in patients with cT2N0 stage due to low positive predictive value of pN (+). In addition, performing LND may be considered for ureter cancer, which tends to cause lymphatic and hematogenous tumor spreading. Further large prospective studies are needed to validate our findings.
Collapse
Affiliation(s)
- Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Chin Yu
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chi-Wen Lo
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan
| | - Shiu-Dong Chung
- Graduate Program in Biomedical Informatics, College of Informatics, Yuan-Ze University, Chung-Li, Taiwan
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wei-Che Wu
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - I-Hsuan Alan Chen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yu-Khun Lee
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Thomas Y. Hsueh
- Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan
- Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Allen W. Chiu
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Tai Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Chang-Min Lin
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Yao-Chou Tsai
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Wei-Chieh Chen
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Bing-Juin Chiang
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
| | - Hsu-Che Huang
- Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
| | - Chung-Hsin Chen
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Chang Wu
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Wei Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jen-Shu Tseng
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Urology, Mackay Medical College, New Taipei City, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hung-Lung Ke
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Chih Yeh
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- *Correspondence: Hsin-Chih Yeh,
| |
Collapse
|
11
|
Lo CW, Li WM, Ke HL, Chang YH, Wu HC, Chen IHA, Lin JT, Huang CY, Chen CH, Tseng JS, Lin WR, Jiang YH, Lee YK, Tsai CY, Chung SD, Hsueh TY, Chiu AW, Jou YC, Cheong IS, Chen YT, Chen JS, Chiang BJ, Yu CC, Lin WY, Wu CC, Chen CS, Weng HY, Tsai YC. Impact of Adjuvant Chemotherapy on Variant Histology of Upper Tract Urothelial Carcinoma: A Propensity Score-Matched Cohort Analysis. Front Oncol 2022; 12:843715. [PMID: 35530335 PMCID: PMC9072967 DOI: 10.3389/fonc.2022.843715] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/26/2021] [Accepted: 03/22/2022] [Indexed: 12/26/2022] Open
Abstract
Background The advantage of adjuvant chemotherapy for upper urinary tract urothelial cancer (UTUC) has been reported, whereas its impact on upper tract cancer with variant histology remains unclear. We aimed to answer the abovementioned question with our real-world data. Design, Setting, and Participants Patients who underwent radical nephroureterectomy (RNU) and were confirmed to have variant UTUC were retrospectively evaluated for eligibility of analysis. In the Taiwan UTUC Collaboration database, we identified 245 patients with variant UTUC among 3,109 patients with UTUC who underwent RNU after excluding patients with missing clinicopathological information. Intervention Those patients with variant UTUC were grouped based on their history of receiving adjuvant chemotherapy or not. Outcome Measurements and Statistical Analysis Propensity score matching was used to reduce the treatment assignment bias. Multivariable Cox regression model was used for the analysis of overall, cancer-specific, and disease-free survival. Results and Limitations For the patients with variant UTUC who underwent adjuvant chemotherapy compared with those without chemotherapy, survival benefit was identified in overall survival in univariate analysis (hazard ratio (HR), 0.527; 95% confidence interval (CI), 0.285–0.973; p = 0.041). In addition, in multivariate analysis, patients with adjuvant chemotherapy demonstrated significant survival benefits in cancer-specific survival (OS; HR, 0.454; CI, 0.208–0.988; p = 0.047), and disease-free survival (DFS; HR, 0.324; 95% CI, 0.155–0.677; (p = 0.003). The main limitations of the current study were its retrospective design and limited case number. Conclusions Adjuvant chemotherapy following RNU significantly improved cancer-related survivals in patients with UTUC with variant histology.
Collapse
Affiliation(s)
- Chi-Wen Lo
- Division of Urology, Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Wei-Ming Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan
- Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Lung Ke
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan
- Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Huei Chang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Urology, China Medical University Beigang Hospital, Yunlin, Taiwan
| | - Hsi-Chin Wu
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Urology, China Medical University Beigang Hospital, Yunlin, Taiwan
| | - I-Hsuan Alan Chen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, and National Taiwan University, Taipei, Taiwan
| | - Chung-Hsin Chen
- Department of Urology, National Taiwan University Hospital, College of Medicine, and National Taiwan University, Taipei, Taiwan
| | - Jen-Shu Tseng
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, Taipei, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wun-Rong Lin
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, Taipei, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yu-Khun Lee
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Chung-You Tsai
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan
| | - Shiu-Dong Chung
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Nursing, College of Healthcare and Management, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
- General Education Center, Eastern University of Science and Technology, New Taipei City, Taiwan
| | - Thomas Y. Hsueh
- Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan
- Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Allen W. Chiu
- Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan
- Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yeong-Chin Jou
- Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
- Department of Health and Nutrition Biotechnology, Asian University, Taichung, Taiwan
| | - Ian-Seng Cheong
- Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
- Department of Health and Nutrition Biotechnology, Asian University, Taichung, Taiwan
| | - Yung-Tai Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Jih-Sheng Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Bing-Juin Chiang
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
| | - Chih-Chin Yu
- Division of Urology, Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Wei Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
- Chang Gung University of Science and Technology, Chia-Yi, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Chang Wu
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Taipei Medical University Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Chuan-Shu Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan
- Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung City, Taiwan
| | - Han-Yu Weng
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yao-Chou Tsai
- Division of Urology, Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
- *Correspondence: Yao-Chou Tsai,
| |
Collapse
|
12
|
Lin CY, Weng HY, Tai TY, Wu HC, Chen WC, Chen CH, Huang CY, Lo CW, Yu CC, Tsai CY, Wu WC, Jiang YH, Lee YK, Hsueh TY, Chiu AW, Chiang BJ, Huang HC, Chen IHA, Chen YT, Lin WY, Wu CC, Tsai YC, Lee HY, Li WM. Clinical Efficacy of Adjuvant Chemotherapy in Advanced Upper Tract Urothelial Carcinoma (pT3-T4): Real-World Data from the Taiwan Upper Tract Urothelial Carcinoma Collaboration Group. J Pers Med 2022; 12:jpm12020226. [PMID: 35207714 PMCID: PMC8877034 DOI: 10.3390/jpm12020226] [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: 11/20/2021] [Revised: 01/09/2022] [Accepted: 01/28/2022] [Indexed: 02/01/2023] Open
Abstract
The clinical efficacy of adjuvant chemotherapy in upper tract urothelial carcinoma (UTUC) is unclear. We aimed to assess the therapeutic outcomes of adjuvant chemotherapy in patients with advanced UTUC (pT3-T4) after radical nephroureterectomy (RNU). We retrospectively reviewed the data of 2108 patients from the Taiwan UTUC Collaboration Group between 1988 and 2018. Comprehensive clinical features, pathological characteristics, and survival outcomes were recorded. Univariate and multivariate Cox proportional hazards models were used to evaluate overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Of the 533 patients with advanced UTUC included, 161 (30.2%) received adjuvant chemotherapy. In the multivariate analysis, adjuvant chemotherapy was significantly associated with a reduced risk of overall death (hazard ratio (HR), 0.599; 95% confidence interval (CI), 0.419–0.857; p = 0.005), cancer-specific mortality (HR, 0.598; 95% CI, 0.391–0.914; p = 0.018), and cancer recurrence (HR, 0.456; 95% CI, 0.310–0.673; p < 0.001). The Kaplan–Meier survival analysis revealed that patients receiving adjuvant chemotherapy had significantly better five-year OS (64% vs. 50%, p = 0.002), CSS (70% vs. 62%, p = 0.043), and DFS (60% vs. 48%, p = 0.002) rates compared to those who did not receive adjuvant chemotherapy. In conclusion, adjuvant chemotherapy after RNU had significant therapeutic benefits on OS, CSS, and DFS in advanced UTUC.
Collapse
Affiliation(s)
- Chung-Yu Lin
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (C.-Y.L.); (H.-Y.L.)
| | - Han-Yu Weng
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-Y.W.); (T.-Y.T.)
| | - Ta-Yao Tai
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-Y.W.); (T.-Y.T.)
| | - Hsi-Chin Wu
- Department of Urology, China Medical University Hospital, Taichung 404, Taiwan; (H.-C.W.); (W.-C.C.)
- School of Medicine, China Medical University, Taichung 404, Taiwan
- Department of Urology, China Medical University Beigang Hospital, Yunlin 651, Taiwan
| | - Wen-Chi Chen
- Department of Urology, China Medical University Hospital, Taichung 404, Taiwan; (H.-C.W.); (W.-C.C.)
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan
| | - Chung-Hsin Chen
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-H.C.); (C.-Y.H.)
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-H.C.); (C.-Y.H.)
| | - Chi-Wen Lo
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City 231, Taiwan; (C.-W.L.); (C.-C.Y.)
| | - Chih-Chin Yu
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City 231, Taiwan; (C.-W.L.); (C.-C.Y.)
- School of Medicine, Buddhist Tzu Chi University, Hualien 970, Taiwan
| | - Chung-You Tsai
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan; (C.-Y.T.); (W.-C.W.)
- Department of Healthcare Information and Management, Ming Chuan University, Taipei 111, Taiwan
| | - Wei-Che Wu
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan; (C.-Y.T.); (W.-C.W.)
- Institute of Biomedical Engineering, National Taiwan University, Taipei 106, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 970, Taiwan; (Y.-H.J.); (Y.-K.L.)
| | - Yu-Khun Lee
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 970, Taiwan; (Y.-H.J.); (Y.-K.L.)
| | - Thomas Y. Hsueh
- Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei 106, Taiwan;
- Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Allen W. Chiu
- College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
| | - Bing-Juin Chiang
- College of Medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan;
- Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City 231, Taiwan;
- Department of Life Science, College of Science, National Taiwan Normal University, Taipei 116, Taiwan
| | - Hsu-Che Huang
- Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City 231, Taiwan;
- Department of Life Science, College of Science, National Taiwan Normal University, Taipei 116, Taiwan
| | - I-Hsuan Alan Chen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan;
| | - Yung-Tai Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei 105, Taiwan;
| | - Wei-Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi 613, Taiwan;
- Chang Gung University of Science and Technology, Chia-Yi 613, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chia-Chang Wu
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan;
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
- TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei 110, Taiwan
| | - Yao-Chou Tsai
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
- Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei 110, Taiwan
| | - Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (C.-Y.L.); (H.-Y.L.)
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Wei-Ming Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (C.-Y.L.); (H.-Y.L.)
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Urology, Ministry of Health and Welfare, Pingtung Hospital, Pingtung 900, Taiwan
- Correspondence:
| |
Collapse
|
13
|
Chen IHA, Chang CH, Huang CP, Wu WJ, Li CC, Chen CH, Huang CY, Lo CW, Yu CC, Tsai CY, Wu WC, Tseng JS, Lin WR, Jiang YH, Lee YK, Jou YC, Cheong IS, Hsueh TY, Chiu AW, Chen YT, Chen JS, Chiang BJ, Tsai YC, Lin WY, Wu CC, Lin JT, Yu CC. Factors Predicting Oncological Outcomes of Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma in Taiwan. Front Oncol 2022; 11:766576. [PMID: 35096575 PMCID: PMC8793058 DOI: 10.3389/fonc.2021.766576] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/21/2021] [Indexed: 12/30/2022] Open
Abstract
Background Taiwan is one of the endemic regions where upper tract urothelial carcinoma (UTUC) accounts for approximately a third of all urothelial tumors. Owing to its high prevalence, extensive experience has been accumulated in minimally invasive radical nephroureterectomy (RNU). Although a variety of predictive factors have been explored in numerous studies, most of them were on a single-center or limited institutional basis and data from a domestic cohort are lacking. Objective This study aims to identify significant predicting factors of oncological outcomes, including overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and intravesical recurrence-free survival (IVRFS), following RNU for UTUC in Taiwan. Methods A multicenter registry database, Taiwan UTUC Collaboration Group, was utilized to analyze oncological outcomes of 3,333 patients undergoing RNU from 1988 to 2021 among various hospitals in Taiwan. Clinicopathological parameters were recorded according to the principles established by consensus meetings. The Kaplan-Meier estimator was utilized to estimate the survival rates, and the curves were compared using the stratified log-rank test. Univariate and multivariate analyses were performed with the Cox proportional hazard model to explore potential predicting factors. Results With a median follow-up of 41.8 months in 1,808 patients with complete information, the 5-year IVRFS, DFS, CSS, and OS probabilities were 66%, 72%, 81%, and 70%, respectively. In total, 482 patients experienced intravesical recurrence, 307 died of UTUC, and 583 died of any cause. Gender predominance was female (57%). A total of 1,531 patients (84.7%) had high-grade tumors; preoperative hydronephrosis presented in 1,094 patients (60.5%). Synchronous bladder UC was identified in 292 patients (16.2%). Minimally invasive procedures accounted for 78.8% of all surgeries, including 768 hand-assisted laparoscopic (42.5%) and 494 laparoscopic (27.3%) approaches. Synchronous bladder UC was the dominant adverse predicting factor for all survival outcomes. Other independent predicting factors for OS, CSS, and DFS included age ≧70, presence of preoperative hydronephrosis, positive surgical margin, LVI, pathological T and N staging, and laparoscopic RNU. Conclusion Synchronous UC of the urinary bladder is an independent adverse prognostic factor for survival in UTUC. The presence of preoperative hydronephrosis was also corroborated as a disadvantageous prognostic factor. Our multivariate analysis suggested that laparoscopic RNU might provide better oncological control.
Collapse
Affiliation(s)
- I-Hsuan Alan Chen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Hsin Chen
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Wen Lo
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Chih-Chin Yu
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chung-You Tsai
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Department of Healthcare Information and Management, Ming Chuan University, Taipei, Taiwan
| | - Wei-Che Wu
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Jen-Shu Tseng
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Wun-Rong Lin
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yu-Khun Lee
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yeong-Chin Jou
- Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.,Department of Health and Nutrition Biotechnology, Asian University, Taichung, Taiwan
| | - Ian-Seng Cheong
- Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Thomas Y Hsueh
- Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan.,Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Allen W Chiu
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Tai Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Jih-Sheng Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Bing-Juin Chiang
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.,Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan.,Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
| | - Yao-Chou Tsai
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wei Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan.,Chang Gung University of Science and Technology, Chia-Yi, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Chang Wu
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan.,TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chia-Cheng Yu
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| |
Collapse
|
14
|
Li CC, Chang CH, Huang CP, Hong JH, Huang CY, Chen IHA, Lin JT, Lo CW, Yu CC, Tseng JS, Lin WR, Wu WC, Chung SD, Hsueh TY, Chiu AW, Chen YT, Chen SH, Jiang YH, Tsai YC, Chiang BJ, Lin WY, Jou YC, Wu CC, Lee HY, Yeh HC. Comparing Oncological Outcomes and Surgical Complications of Hand-Assisted, Laparoscopic and Robotic Nephroureterectomy for Upper Tract Urothelial Carcinoma. Front Oncol 2021; 11:731460. [PMID: 34671556 PMCID: PMC8522474 DOI: 10.3389/fonc.2021.731460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/27/2021] [Accepted: 09/06/2021] [Indexed: 01/15/2023] Open
Abstract
Purpose This study aimed to compare the oncological outcomes and surgical complications of patients with upper tract urothelial carcinoma (UTUC) treated with different minimally invasive techniques for nephroureterectomy. Methods From the updated data of the Taiwan UTUC Collaboration Group, a total of 3,333 UTUC patients were identified. After excluding ineligible cases, we retrospectively included 1,340 patients from 15 institutions who received hand-assisted laparoscopic nephroureterectomy (HALNU), laparoscopic nephroureterectomy (LNU) or robotic nephroureterectomy (RNU) between 2001 and 2021. Kaplan-Meier estimator and Cox proportional hazards model were used to analyze the survival outcomes, and binary logistic regression model was selected to compare the risks of postoperative complications of different surgical approaches. Results Among the enrolled patients, 741, 458 and 141 patients received HALNU, LNU and RNU, respectively. Compared with RNU (41.1%) and LNU (32.5%), the rate of lymph node dissection in HALNU was the lowest (17.4%). In both Kaplan-Meier and univariate analysis, the type of surgery was significantly associated with overall and cancer-specific survival. The statistical significance of surgical methods on survival outcomes remained in multivariate analysis, where patients undergoing HALNU appeared to have the worst overall (p = 0.007) and cancer-specific (p = 0.047) survival rates among the three groups. In all analyses, the surgical approach was not related to bladder recurrence. In addition, HALNU was significantly associated with longer hospital stay (p = 0.002), and had the highest risk of major Clavien-Dindo complications (p = 0.011), paralytic ileus (p = 0.012), and postoperative end-stage renal disease (p <0.001). Conclusions Minimally invasive surgery can be safe and feasible. We proved that compared with the HALNU group, the LNU and RNU groups have better survival rates and fewer surgical complications. It is crucial to uphold strict oncological principles with sophisticated technique to improve outcomes. Further prospective studies are needed to validate our findings.
Collapse
Affiliation(s)
- Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Jian-Hua Hong
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - I-Hsuan Alan Chen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chi-Wen Lo
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan
| | - Chih-Chin Yu
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Jen-Shu Tseng
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Urology, Mackay Medical College, New Taipei City, Taiwan.,Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wun-Rong Lin
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Urology, Mackay Medical College, New Taipei City, Taiwan
| | - Wei-Che Wu
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shiu-Dong Chung
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Graduate Program in Biomedical Informatics, College of Informatics, Yuan-Ze University, Chung-Li, Taiwan
| | - Thomas Y Hsueh
- Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan.,Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Allen W Chiu
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Tai Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Shin-Hong Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yao-Chou Tsai
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Bing-Juin Chiang
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.,Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan.,Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
| | - Wei Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Chang Gung University of Science and Technology, Chiayi, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yeong-Chin Jou
- Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.,Department of Health and Nutrition Biotechnology, Asian University, Taichung, Taiwan
| | - Chia-Chang Wu
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Chih Yeh
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| |
Collapse
|
15
|
Yu CC, Koh EJ, Low JA, Ong ML, Sim AGH, Hong DYQ, Chong R, Low J, Ng R. Correction to: A multi-site study on the impact of an advance care planning workshop on attitudes, beliefs and behavioural intentions over a 6-month period. BMC Med Educ 2021; 21:372. [PMID: 34238268 PMCID: PMC8264986 DOI: 10.1186/s12909-021-02816-3] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- C C Yu
- Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore.
| | - E J Koh
- Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
| | - J A Low
- Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - M L Ong
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - A G H Sim
- Singapore General Hospital, Singapore, Singapore
| | - D Y Q Hong
- Singapore General Hospital, Singapore, Singapore
| | - R Chong
- Tan Tock Seng Hospital, Singapore, Singapore
| | - J Low
- Tan Tock Seng Hospital, Singapore, Singapore
| | - R Ng
- Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Woodlands Health Campus, Singapore, Singapore
| |
Collapse
|
16
|
Yu CC, Koh EJ, Low JA, Ong ML, Sim AGH, Hong DYQ, Chong R, Low J, Ng R. A multi-site study on the impact of an advance care planning workshop on attitudes, beliefs and behavioural intentions over a 6-month period. BMC Med Educ 2021; 21:298. [PMID: 34034725 PMCID: PMC8146668 DOI: 10.1186/s12909-021-02735-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/13/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND This study evaluated the impact of the adapted version of the Respecting Choices® The Living Matters Advance Care Planning (ACP) facilitator training programme on trainees' attitudes on facilitation 6 months post-training. SETTING AND PARTICIPANTS Two hundred and twenty-one healthcare professionals consisting of doctors, nurses, medical social workers from different training venues in Singapore participated in the first phase of the study (pre- and post) of which 107 participated in the second phase 6 months later (follow-up). METHODS Participants self-rated their attitudes, beliefs and behavioural intentions through surveys at three time points in an evaluation design that utilised repeated measures one-way ANOVA (pre-, post-, follow-up). Between-group differences were also examined using independent t-test. RESULTS At follow-up, mean scores increased significantly in understanding, confidence, and competence. Changes in effect sizes were large. Although trainees continued to think that ACP is emotionally draining for facilitators, more than before, facilitation experience was considered pleasant for themselves with the positive change significant and moderate in effect size. Those who had experience completing/initiating ACP significantly held more positive views than those who did not. CONCLUSIONS The ACP facilitator training programme had lasting effects on enhancing the understanding, competence, and confidence of trainees. Importantly, findings showed that experience in actual facilitation within 6 months after training was important and giving trainees opportunities to facilitate is recommended.
Collapse
Affiliation(s)
- C C Yu
- Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore.
| | - E J Koh
- Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
| | - J A Low
- Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - M L Ong
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - A G H Sim
- Singapore General Hospital, Singapore, Singapore
| | - D Y Q Hong
- Singapore General Hospital, Singapore, Singapore
| | - R Chong
- Tan Tock Seng Hospital, Singapore, Singapore
| | - J Low
- Tan Tock Seng Hospital, Singapore, Singapore
| | - R Ng
- Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Woodlands Health Campus, Singapore, Singapore
| |
Collapse
|
17
|
Chang CW, Ou CH, Yu CC, Lo CW, Tsai CY, Cheng PY, Chen YT, Huang HC, Wu CC, Li CC, Lee HY. Comparative analysis of patients with upper urinary tract urothelial carcinoma in black-foot disease endemic and non-endemic area. BMC Cancer 2021; 21:80. [PMID: 33468084 PMCID: PMC7816491 DOI: 10.1186/s12885-021-07799-4] [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: 08/06/2020] [Accepted: 01/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A high incidence of upper urinary tract urothelial carcinoma has been reported in the southwestern area of Taiwan, where arsenic water contamination was considered the main cause. However, there is no definite proof to show a correlation between arsenic water contamination and upper urinary tract urothelial carcinoma. To investigate the clinical and epidemiological features of patients with upper urinary tract urothelial carcinoma between arsenic water endemic and non-endemic areas, we analyzed patients in terms of characteristics, stratified overall survival, disease-free survival, and cancer-specific survival. METHODS The records of a total of 1194 patients diagnosed with upper urinary tract urothelial carcinoma were retrospectively reviewed. Clinical data and current medical status were collected from the medical records. Statistical analyses were performed to determine the clinical variables and stratified survival curves between endemic and non-endemic groups. RESULTS Female predominance was revealed in both endemic and non-endemic groups (male:female ratio = 1:1.2-1.4). No statistical differences were found in histological types, staging, and tumor size between the two groups. Nonetheless, patients with characteristics of aging and having end-stage renal disease were outnumbered in the non-endemic group, while a higher prevalence of previous bladder tumors and more ureteral tumors were found in the endemic group. Adjusted stratified cumulative survival curves suggested a poorer prognosis in endemic patients, especially in disease-free survival of early stage disease. CONCLUSIONS A higher mortality rate with more previous bladder cancer history and ureteral tumors was seen in patients with upper urinary tract urothelial carcinoma residing in the arsenic water contamination area. This may be attributed to the long-term carcinogenic effect of arsenic underground water.
Collapse
Affiliation(s)
- Che-Wei Chang
- Department of Urology, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Chien-Hui Ou
- Department of Urology, National Cheng-Kung University Hospital, Tainan, Taiwan
| | - Chih-Chin Yu
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chi-Wen Lo
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chung-You Tsai
- Department of Urology, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Pai-Yu Cheng
- Department of Urology, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yung-Tai Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Hsu-Che Huang
- Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Chia-Chang Wu
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Hsiang-Ying Lee
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
| |
Collapse
|
18
|
Yu CC, Chen YT, Huang CS, Chueh SCJ, Lo CW, Tsai YC. A comprehensive study comparing tack and glue mesh fixation in laparoscopic total extraperitoneal repair for adult groin hernias. Surg Endosc 2020; 34:4486-4493. [PMID: 31741160 DOI: 10.1007/s00464-019-07234-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 10/28/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Glue mesh fixation is thought to cause less pain compared to tack mesh fixation during laparoscopic total extraperitoneal inguinal hernia repair (TEP). However, the clinical benefits of glue mesh fixation are still controversial. This study aimed to evaluate the acute pain, chronic pain, and recurrence rate between these two fixation methods. METHODS After reviewing all patients in our prospective hernia repair database from February 2008 to December 2017, we identified 583 patients who underwent TEP with tack mesh fixation and 70 patients with glue fixation by a single surgeon. Acute post-operative pain and activity level were evaluated using a Visual Analog Score (VAS) and the modified Medical Outcome Study (MOS) score. The primary endpoint was chronic pain 6 months after TEP. The secondary endpoints were acute pain, activity level, complications, and recurrence. RESULTS After adjustment for potential confounding factors, the glue mesh fixation had significant lower VAS at 2 h post operation during rest and coughing and on the first day after surgery during coughing (p = 0.005, p < 0.001, and p = 0.011). The modified MOS on the first day was higher in the glue group (p < 0.001). There were no reduced risk of chronic pain or increased risk of recurrence for the glue group compared to the tack group [Odds ratio (OR) = 0.237, p = 0.169; OR = 2.498, p = 0.299]. In the sub-group analysis for recurrent hernia repair, glue fixation is associated with better modified MOS (p = 0.031) on first day and lower VAS on the operative day and first day at rest (p = 0.003 and p = 0.024) after surgery. CONCLUSIONS Glue fixation method was superior to tack fixation method in acute post-operative pain and early post-operative activity level after laparoscopic TEP repair. However, both fixation methods had similar incidence of chronic pain-, recurrence-, and procedure-related complications after laparoscopic TEP repair.
Collapse
Affiliation(s)
- Chih-Chin Yu
- Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,Department of Urology, Tzu Chi University, Hualien, Taiwan
| | - Yung-Tai Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Ching-Shui Huang
- Division of General Surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - Shih-Chieh J Chueh
- Cleveland Clinic Lerner College of Medicine and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chi-Wen Lo
- Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
| | - Yao-Chou Tsai
- Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan. .,Department of Urology, Tzu Chi University, Hualien, Taiwan.
| |
Collapse
|
19
|
Lo CW, Chen YT, Jaw FS, Yu CC, Tsai YC. Predictive factors of post-laparoscopic inguinal hernia acute and chronic pain: prospective follow-up of 807 patients from a single experienced surgeon. Surg Endosc 2020; 35:148-158. [PMID: 31932935 DOI: 10.1007/s00464-020-07373-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/06/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Convalescence after hernia repair is one of the main focuses for hernia surgeons. We analyzed our prospectively collected data to identify possible predictive factors for post-operative acute and chronic pain. MATERIALS AND METHODS We prospectively collected the demographic data and peri-operative findings. Post-operative acute pain was evaluated with Visual Analog Pain Scale. The chronic pain (pain persists for > 6 months since operation) was also recorded. RESULTS From June 2008 to August 2018, there were 807 patients with 1029 sites of inguinal hernia enrolled in our analysis. Pain before operation was associated with the severity of acute pain on OP (operation) day, POD 1 (post-operative day 1), and POD 7 (post-operative day 7). Younger patients had significantly higher post-operative acute pain on OP day, POD 1, and POD 7. The staple mesh fixation method resulted in a higher pain score at OP day and POD 1. The predictive factors for chronic pain were sex (female), young age (< 65 years), having no past history of hypertension, pain before operation, and mesh material. CONCLUSION A younger age and inguinal pain before operation were the main predictive factors for higher post-operative pain. Younger patients, females, having inguinal pain before surgery, and using heavy weight mesh have a higher risk of chronic pain.
Collapse
Affiliation(s)
- Chi-Wen Lo
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Yung-Tai Chen
- Department of Urology, Postal Hospital, Taipei, Taiwan
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Fu-Shan Jaw
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chih-Chin Yu
- Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Yao-Chou Tsai
- Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
- Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan.
| |
Collapse
|
20
|
Yu CC, Lo CW, Chen YT, Lin CD, Chueh SCJ, Tsai YC. Novel robot-assisted laparoscopic total extra-peritoneal repair with primary fascial closure plus pre-peritonea mesh for large groin defects. Int J Med Robot 2019; 16:e2052. [PMID: 31677211 DOI: 10.1002/rcs.2052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/19/2019] [Revised: 10/13/2019] [Accepted: 10/24/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Since the introduction of robot-assisted laparoscopic surgery, a variety of conventional laparoscopic procedures have been explored via this approach. In the robotic era, most of the reported robot-assisted laparoscopic hernia repairs were performed with the trans-abdominal pre-peritoneal approach. According to the evidence extrapolated from laparoscopic ventral hernia repair, simultaneous fascial defect closure and mesh repair can significantly decrease the risk of seroma formation and recurrence over those without fascial closure. Therefore, we describe our novel technique of robot-assisted total extra-peritoneal (TEP) repair with primary fascial closure and pre-peritoneal mesh and its preliminary clinical outcomes. METHODS We retrospectively reviewed our prospectively collected hernia database from October 2017 to July 2019, which included 26 consecutive patients with primary or recurrent groin hernias. Patients' baseline characteristics and perioperative outcomes were compared and analyzed. Perioperative factors included operative time, visual analog scale (VAS) score (0-100), hospital stay, perioperative complications, time to return to normal activity, and the modified Medical Outcome Study (MOS; item 3-12/36 items) score. RESULTS All procedures were completed successfully without conversion to open or conventional laparoscopic surgery. The patients' age ranged from 28 to 74 years (median 57.5). The mean operative time was 115 minutes (range 95-172 min). There were no major procedure-related complications. Only four cases experienced asymptomatic seromas, which were detected by ultrasonography; and all resolved spontaneously within 6 weeks after the operation. The VAS and modified MOSs revealed quick recovery after robot-assisted endoscopic TEP repair. CONCLUSIONS Robot-assisted endoscopic TEP repair combined with primary fascial closure and pre-peritoneal mesh is a safe and feasible technique for groin hernia repair.
Collapse
Affiliation(s)
- Chih-Chin Yu
- Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan.,Medical College, Tzu Chi University, Hualien, Taiwan
| | - Chi-Wen Lo
- Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan.,Medical College, Tzu Chi University, Hualien, Taiwan
| | - Yung-Tai Chen
- Department of Urology, Postal Hospital, Taipei, Taiwan.,Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Chia-Da Lin
- Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan.,Medical College, Tzu Chi University, Hualien, Taiwan
| | - Shih-Chieh J Chueh
- Cleveland Clinic Lerner College of Medicine and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Yao Chou Tsai
- Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan.,Medical College, Tzu Chi University, Hualien, Taiwan.,Department of Urology, School of Medicine, College of Medicine.,Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
21
|
Wu CH, Wu V, Yang YW, Lin YH, Yang SY, Lin PC, Chang CC, Tsai YC, Wang SM, Wu VC, Wu CH, Hu YH, Kiaw L, Chang CH, Chang YL, Tsai YC, Yu CC, Lin YH, Chan CK, Lin JH, Wang WJ, Ho YL, Chang HW, Lin LY, Hu FC, Chang CC, Liu KL, Wang SM, Huang KH, Jeff Chueh SC, Liao SC, Lu CC, Yen RF, Wu KD. Plasma Aldosterone After Seated Saline Infusion Test Outperforms Captopril Test at Predicting Clinical Outcomes After Adrenalectomy for Primary Aldosteronism. Am J Hypertens 2019; 32:1066-1074. [PMID: 31216359 DOI: 10.1093/ajh/hpz098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/08/2019] [Accepted: 06/17/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The saline infusion test (SIT) and the captopril test (CT) are widely used as confirmatory tests for primary aldosteronism (PA). We hypothesized that post-SIT and post-CT plasma aldosterone concentrations (PAC) indicate the severity of aldosterone-producing adenoma (APA) and might predict clinical outcome. METHODS We recruited 216 patients with APA in the Taiwan Primary Aldosteronism Investigation (TAIPAI) registry who received both seated SIT and CT as confirmatory tests. The data of 143 patients who underwent adrenalectomy with complete follow-up after diagnosis were included in the final analysis. We determined the proportion of patients achieving clinical success in accordance with the Primary Aldosteronism Surgical Outcome consensus. Logistic regression analysis was conducted to identify preoperative factors associated with cure of hypertension. RESULTS Complete clinical success was achieved in 48 (33.6%) patients and partial clinical success in 59 (41.2%) patients; absent clinical success was seen in 36 (25.2%) of 143 patients. Post-SIT PAC but not post-CT PAC was independently associated with clinical outcome. Higher levels of post-SIT PAC had a higher likelihood of clinical benefit (complete plus partial clinical success; odds ratio = 1.04 per ng/dl increase, 95% confidence interval = 1.01, 1.06; P = 0.004). Patients with post-SIT PAC > 25 ng/dl were more likely to have a favorable clinical outcome after adrenalectomy. This cutoff value translated into a positive predictive value of 86.0%. CONCLUSIONS We suggest that post-SIT PAC is a better predictor than post-CT PAC for clinical success in PA post adrenalectomy.
Collapse
Affiliation(s)
- Che-Hsiung Wu
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Vincent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Wen Yang
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hung Lin
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shao-Yu Yang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Chih Lin
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Chen Chang
- Medical Imagine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yao-Chou Tsai
- Department of Surgery, Taipei Tzuchi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Shuo-Meng Wang
- Fu Jen Catholic University, New Taipei City, Taiwan
- Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Juang JM, Chen CY, Liu YB, Lin LY, Ho LT, Huang HC, Lai LP, Hwang JJ, Wu CK, Lin TT, Yu CC, Lu TP, Chattopadhyay A, Yu QY, Lin JL. P1604Validating previously reported Brugada syndrome-associated common variants identified in caucasian population in the Han Chinese BrS cohort in Taiwan: SADS-BrS registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0363] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Brugada syndrome (BrS) is a sudden arrhythmic death. The prevalence of BrS is higher in the Southeast Asian populations than that in Caucasian patients. A previous genome-wide association study (GWAS) has reported 13 SNPs significantly associated with BrS. However, no study was performed to validate whether these SNPs are enriched in BrS patients in Han Chinese (HC).
Purpose
Evaluating the common variants previously reported in Caucasian BrS patients could be generalized to HC BrS patients in Taiwan
Methods
We genotyped 200 unrelated BrS patients using Affymetrix TWB Array (N=653,291 SNPs, a customized array for HC in Taiwan). The controls are obtained from the Taiwan Biobank (N ≈ 16,000) using the same array. An imputation workflow was shown in Figure 1. To confirm the accuracy of the imputed genotype of each variant, Sanger sequencing was performed in 10% of randomly selected cases.
Results
Among the 3 most important common variants (rs11708996 in SCN5A, rs10428132 in SCN10A and rs9388451 in HEY2/NCOA7) reported in the previous GWAS mainly conducted in Caucasian BrS patients, 2 of them (rs10428132 and rs9388451) were successfully replicated in the HC population in Taiwan (P<0.01). We also found that the differences of minor allele frequency (dMAF: the MAF of cases minus the MAF of controls) of the two variants were relatively smaller between the BrS cases and healthy controls in HC population compared with that in Caucasian populations (dMAF, rs9388451: 0.15 (Caucasian) vs −0.07 (HC); rs10428132: 0.28 (Caucasian) vs 0.11 (HC)). For the remaining 10 common variants reaching genome-wide significance (P=5×10–8) in Caucasian BrS patients, 9 of them were also significantly enriched in the HC BrS patients after the Bonferroni correction (P<0.05/12=0.0042). We next analyzed the variants identified in the previous GWAS on ECG traits (PR interval, QRS duration, QTc interval, and heart rate) in the Caucasian population. Among the reported 75 variants associated with ECG traits, 5 common variants (rs6798015 (PR), rs1760876 (QRS), rs6795970 (PR/QRS), rs2074238 (QTc) and rs314370 (heart rate)) were significant after Bonferroni correction (P<0.05/75=0.00066).
Figure 1
Conclusions
The preliminary results indicated that 85% of common variants of SCN10A and HEY2/NCOA7 previously reported in Caucasian BrS patients are replicated in BrS patients in the HC population but not the common variant of SCN5A (rs11708996). Furthermore, the common variants of SCN10A and HEY2/NCOA7 related to cardiac depolarization or repolarization may also contribute to the development of BrS.
Acknowledgement/Funding
NTUH 106-S3469, NTUH106-S3458 and NTUH 106-018
Collapse
Affiliation(s)
- J.-M Juang
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - C Y Chen
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - Y B Liu
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - L Y Lin
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - L T Ho
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - H C Huang
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - L P Lai
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - J J Hwang
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - C K Wu
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - T T Lin
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - C C Yu
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - T P Lu
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| | - A Chattopadhyay
- National Taiwan University, Bioinformatics and Biostatistics Core, Center of Genomic Medicine, Taipei, Taiwan
| | - Q Y Yu
- National Taiwan University, Bioinformatics and Biostatistics Core, Center of Genomic Medicine, Taipei, Taiwan
| | - J L Lin
- National Taiwan University Hospital, Division of Cardiovascular Center and Department of Internal Medicine, Taipei, Taiwan
| |
Collapse
|
23
|
Hao JX, Wang Y, Xu C, Li XG, Wang XG, Zhao XR, Yu CC, Jiang B, Liu Q. [Detection and Analysis of the peripheral lymphocytes micronucleus rate of radiation workers in a city]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2018; 36:527-529. [PMID: 30248769 DOI: 10.3760/cma.j.issn.1001-9391.2018.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To perform lymphocyte micronucleus analysis on radiation workers with long-term exposure to low doses ionizing radiation, Evaluate the health condition of radiation workers, and provide the evidence for strengthening surveillance of radiation workers. Methods: From January 1, 2013 to December 21, 2016, a statistical analysis and evaluation was conducted of the peripheral lymphocytes micronucleus rate in 5 901 radiation workers who had undergone medical examinations of employees at Chinese Academy of Medical Sciences Institute of Radiation Medicine. Results: The micronucleus rates in radiation workers of the on-job group were higher than the pre-job group (P<0.01) . Significant difference was found among the different sex (t=5.97) , different types (χ(2)=378.69) , different levels of work units (χ(2)=115.48) . Significant difference was found among the micronucleus rates of 672 radiation workers of the on-job group from 2013 to 2016 (χ(2)=92.57, P<0.01) . Conclusion: The peripheral lymphocytes micronucleus rate of radiation workers were significantly higher than non-contact workers. Significant increasing trend of micronucleus rates was noted among the radiation worker with increasing exposure time. The peripheral lymphocytes micronucleus rates of interventional therapy workers were highest. The peripheral lymphocytes micronucleus rates of Private hospitals workers were highest. This phenomenon deserves attention. Protection needs to be strengthened to ensure the health of radiation workers.
Collapse
Affiliation(s)
- J X Hao
- Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300192, China
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Huang KH, Yu CC, Hu YH, Chang CC, Chan CK, Liao SC, Tsai YC, Jeff Chueh SC, Wu VC, Lin YH. Targeted treatment of primary aldosteronism - The consensus of Taiwan Society of Aldosteronism. J Formos Med Assoc 2018; 118:72-82. [PMID: 29506889 DOI: 10.1016/j.jfma.2018.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/25/2017] [Accepted: 01/05/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND/PURPOSE Even with the increasing recognition of primary aldosteronism (PA) as a cause of refractory hypertension and an issue of public health, the consensus of its optimal surgical or medical treatment in Taiwan has not been reached. Our objective was to develop a clinical practice guideline that is feasible for real-world management of PA patients in Taiwan. METHODS The Taiwan Society of Aldosteronism (TSA) Task Force recognized the above-mentioned issues and reached this Taiwan PA consensus at its inaugural meeting, in order to provide updated information of internationally acceptable standards, and also to incorporate our local disease characteristics and constraints into PA management. RESULTS In patients with lateralized PA, including aldosterone producing adenoma (APA), laparoscopic adrenalectomy is the 'gold standard' of treatment. Mini-laparoscopic and laparoendoscopic single-site approaches are feasible only in highly experienced surgeons. Patients with bilateral adrenal hyperplasia or those not suitable for surgery should be treated by mineralocorticoid receptor antagonists. The outcome data of PA patient management from the literature, especially from PA patients in Taiwan, are reviewed. Mental health screening is helpful in early detection and management of psychopathology among PA patients. CONCLUSION We hope this consensus will provide a guideline to help medical professionals to manage PA patients in Taiwan to achieve a better quality of care.
Collapse
Affiliation(s)
- Kuo-How Huang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Chin Yu
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan
| | - Ya-Hui Hu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, Taiwan
| | - Chin-Chen Chang
- Medical Imagine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chieh-Kai Chan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin Chu Branch, Hsinchu County, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Chou Tsai
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan; Department of Urology, Tzu Chi University, Hualien, Taiwan.
| | - Shih-Chieh Jeff Chueh
- Glickman Urological and Kidney Institute, and Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Vin-Cent Wu
- Division of Nephrology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hung Lin
- Division of Cardiology, National Taiwan University Hospital, Taipei, Taiwan
| | | |
Collapse
|
25
|
Liu YB, Yu CC, Wu CC, Lin CD, Chueh SC, Tsai YC. Feasibility and safety of elective laparoscopic total extraperitoneal preperitoneal groin hernia repair in the elderly: a propensity score-matched comparison. Clin Interv Aging 2018; 13:195-200. [PMID: 29440879 PMCID: PMC5798546 DOI: 10.2147/cia.s148608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Several studies of hernia registries have revealed that elderly patients have higher perioperative complication rates compared with younger patients. However, the incidence of hernia increases with the aging process. To evaluate the feasibility and safety of laparoscopic hernia repair in elderly patients (≥75 years), we conducted a prospective case-matched control study to compare perioperative outcomes between patients older and younger than 75 years. Methods Between September 2008 and July 2015, 572 consecutive patients undergoing endoscopic hernia repair were included in this prospective study. This case-matched control study was matched based on sex, American Society of Anesthesiologists score, and body mass index between patients younger and ≥75 years. The propensity-score matching of two groups was carried out on a 1:1 basis. Perioperative data were prospectively recorded for all patients including demographic data, operation time, length of hospital stay, narcotic dose, and complications. Results In the final analysis, 54 patients who were <75 years were extracted to match the 54 patients ≥75 years. These two groups had similar baseline characteristics excluding age. They also had similar perioperative outcomes in hernia recurrence, metachronous contralateral hernia occurrence, complication rate and chronic pain. The patients ≥75 years of age had lower requirements for analgesics than those who were <75 years of age (p=0.047). Conclusion This is the first comparative cohort study investigating the impact of aging in an Asian hernia population. Laparoscopic inguinal hernia repair is feasible and safe for older patients, with comparable perioperative outcomes to patients <75 years.
Collapse
Affiliation(s)
- Ying-Buh Liu
- Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Chih-Chin Yu
- Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Chao-Chuan Wu
- Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,Department of Urology, Tzu Chi University, Medical College, Hualien, Taiwan
| | - Chia-Da Lin
- Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,Department of Urology, Tzu Chi University, Medical College, Hualien, Taiwan
| | - Shih-Chieh Chueh
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.,Cleveland Clinic, Glickman Urologic and Kidney Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Yao-Chou Tsai
- Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,Department of Urology, Tzu Chi University, Medical College, Hualien, Taiwan
| |
Collapse
|
26
|
Yu CC, Chang SJ, Yang SS. Grade of Normalcy Improves Inter-raters' agreement in the interpretation of uroflowmetry. Urological Science 2016. [DOI: 10.1016/j.urols.2016.05.108] [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: 10/21/2022] Open
|
27
|
Yu CC, Yang CK, Ou YC. Three Types of Intravesical Hem-o-Lok Clip Migration After Laparoscopic Radical Prostatectomy. J Laparoendosc Adv Surg Tech A 2015; 25:1005-8. [PMID: 26566082 DOI: 10.1089/lap.2015.0150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hem-o-Lok® clips (HOLCs) (Weck® Surgical Instruments, Teleflex Medical, Durham, NC) are widely used for controlling the lateral pedicles in laparoscopic radical prostatectomy, but intravesical HOLC migrations have been reported in more and more studies. This study aimed to summarize clinical presentations, management, and outcomes of these patients. MATERIALS AND METHODS Six patients with intravesical HOLC migration were retrospectively identified from 750 consecutive patients who underwent robot-assisted laparoscopic prostatectomy between 2005 and 2014 performed by a single surgeon. The PubMed database was also searched for Hem-o-Lok clip migration after laparoscopic prostatectomy. RESULTS The incidence of intravesical HOLC migration in this study was 0.8% (6/750). In total, 22 patients were reported, including six from the current series. Three types of migrations were classified: Type I migration resulted in obstructive lower urinary tract symptoms 2-8 months after prostatectomy, whereas Type II migration led to stone formation, gross hematuria, or bladder spasm; in Type III migration, patients had spontaneous expulsion of the HOLC weeks after surgery. CONCLUSIONS Although the incidence of intravesical HOLC migration is relatively low, Type I migration with long-term sequelae remains a concern. The use of HOLCs adjacent to anastomosis should be minimized, and any loose clip must be retrieved to reduce complications.
Collapse
Affiliation(s)
- Chih-Chin Yu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan, Republic of China
| | - Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan, Republic of China
| | - Yen-Chuan Ou
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan, Republic of China
| |
Collapse
|
28
|
Yu CC, Ho HC, Yu TM, Ou YC, Shu KH, Cheng CL, Su CK, Wang SS, Chen CS, Li JR, Yang CK. Long-term outcomes of kidney transplantation from standard criteria donors with acute kidney injury. Urological Science 2015. [DOI: 10.1016/j.urols.2015.06.145] [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: 10/23/2022] Open
|
29
|
Yu CC, Ou YC, Ho HC, Cheng CL, Li JR. Treatment of metastatic renal cell carcinoma to the brain: a report of long-term survival following multimodal treatment and sequential use of targeted agents. Urological Science 2014. [DOI: 10.1016/j.urols.2012.05.001] [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] [Indexed: 11/16/2022] Open
|
30
|
Abstract
To understand the profile of genetic structure of Xianbei and trace its impacts on the formation and development of the minorities from northern China, we analyzed the sequences of the hypervariable segment I (HVS-I, 16.035-16.398) in mtDNA control region of 17 Tuoba Xianbei remains from Shangdu Dongdajing cemetery (Inner Mongolia). Its haplotype diversity and nucleotide diversity were 0.971 ± 0.032 and 0.0184 ± 0.010, respectively, and the haplogroup status presented 29.5% C, 23.5% D4, 17.6% D5, 17.6% A, 5.9% B and 5.9% G. When the data from Qilang Mountain Tuoba remains and other relevant populations were considered, we found that Dongdajing Tuoba Xianbei presented the closest genetic affinity to Qilang Mountain Tuoba Xianbei. Tuoba Xianbei and Murong Xianbei showed a significant differentiation in the maternal lineages. Tuoba Xianbei may contribute to the gene pool of some northern minorities, and it may mix with Xiongnu in northern China.
Collapse
|
31
|
Guo HH, Yu CC, Sun SX, Ma XJ, Yang XC, Sun KN, Jin QH. Adenovirus-mediated siRNA targeting TNF-α and overexpression of bone morphogenetic protein-2 promotes early osteoblast differentiation on a cell model of Ti particle-induced inflammatory response in vitro. Braz J Med Biol Res 2013; 46:831-8. [PMID: 24141610 PMCID: PMC3854310 DOI: 10.1590/1414-431x20133092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 07/01/2013] [Indexed: 11/21/2022] Open
Abstract
Wear particles are phagocytosed by macrophages and other inflammatory cells,
resulting in cellular activation and release of proinflammatory factors, which
cause periprosthetic osteolysis and subsequent aseptic loosening, the most
common causes of total joint arthroplasty failure. During this pathological
process, tumor necrosis factor-alpha (TNF-α) plays an important role in
wear-particle-induced osteolysis. In this study, recombination adenovirus (Ad)
vectors carrying both target genes [TNF-α small interfering RNA (TNF-α-siRNA)
and bone morphogenetic protein 2 (BMP-2)] were synthesized and transfected into
RAW264.7 macrophages and pro-osteoblastic MC3T3-E1 cells, respectively. The
target gene BMP-2, expressed on pro-osteoblastic MC3T3-E1 cells and silenced by
the TNF-α gene on cells, was treated with titanium (Ti) particles that were
assessed by real-time PCR and Western blot. We showed that recombinant
adenovirus (Ad-siTNFα-BMP-2) can induce osteoblast differentiation when treated
with conditioned medium (CM) containing RAW264.7 macrophages challenged with a
combination of Ti particles and Ad-siTNFα-BMP-2 (Ti-ad CM) assessed by alkaline
phosphatase activity. The receptor activator of nuclear factor-κB ligand was
downregulated in pro-osteoblastic MC3T3-E1 cells treated with Ti-ad CM in
comparison with conditioned medium of RAW264.7 macrophages challenged with Ti
particles (Ti CM). We suggest that Ad-siTNFα-BMP-2 induced osteoblast
differentiation and inhibited osteoclastogenesis on a cell model of a Ti
particle-induced inflammatory response, which may provide a novel approach for
the treatment of periprosthetic osteolysis.
Collapse
Affiliation(s)
- H H Guo
- Affiliated Hospital of Ningxia Medical University, Department of Orthopedic Surgery, Yinchuan, China
| | | | | | | | | | | | | |
Collapse
|
32
|
Yu CC, Lee FY, Li JR. Recurrent pseudotumor of the urinary bladder managed by revision hip arthroplasty. Int J Urol 2012; 20:455-6. [PMID: 23002903 DOI: 10.1111/j.1442-2042.2012.03151.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
33
|
Chen SY, Chiang DP, Yao YD, Yu CC, Chen YY, Wu JM, Lin HM. Effects of Os inserted layers on the microstructures and magnetic properties of the FePt films. J Nanosci Nanotechnol 2011; 11:11133-11137. [PMID: 22409071 DOI: 10.1166/jnn.2011.3997] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The microstructure and magnetic properties of multilayer [Os(t)/FePt(x)]n films on a glass substrate with a 10 nm Os buffer layer by ion beam sputtering have been studied as a function of the annealing temperatures between 300 and 800 degrees C. Here, t = 0.2, 1 or 5 nm and x varied from 10, 20, 25, 50, to 100 nm with its associated n value of 10, 5, 4, 2, and 1, respectively. No diffusion evidence was found in samples with a thin Os layer and t > or = 1 nm. The average grain size of the multilayer films can be well controlled by both annealing temperature and thickness of the FePt layer by a very thin Os space layer with t > or = 1 nm. The enhancement of H(c) can be understood from the fact that for a FePt film with an Os spacer layers, the increasing number of Os layer will inhibit the grain growth of FePt grains and enriches the grain boundary. We have experimentally demonstrated that even with a very thin 1 nm Os spacer layers, the [Os(t)/FePt(x)]n multilayer films can exhibit good hard magnetic properties and are attractive candidates for ultrahigh density magnetic recording media.
Collapse
Affiliation(s)
- S Y Chen
- Institute of Applied Science and Engineering, Fu Jen University, Taipei 242, Taiwan
| | | | | | | | | | | | | |
Collapse
|
34
|
Chang CS, Bergeron L, Yu CC, Chen PKT, Chen YR. Mandible changes evaluated by computed tomography following Botulinum Toxin A injections in square-faced patients. Aesthetic Plast Surg 2011; 35:452-5. [PMID: 21103871 DOI: 10.1007/s00266-010-9624-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 10/18/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND A facial contour that is oval is more pleasing in Asian women. Patients with a square face often seek facial contouring procedures to improve their appearance. Treatment often involves various combinations of Botulinum NeuroToxin A (BoNTA) injections into the masseters and/or mandibular angle resection. Many physicians claim that muscle paralysis with injections alone will decrease pulling on the underlying bone and also treat underlying bony flaring when present. Muscular changes after BoNTA injections have been well documented. However, the effect of BoNTA injections on the underlying mandibular bone morphology has not been studied to the best of the authors' knowledge. The goal of this study was to determine whether there are mandibular changes after masseter injection with botulinum toxin. METHODS In this retrospective study of ten female patients seeking treatment for a square face, three-dimensional CT scans were taken before and 3 months after standardized BoNTA injections in bilateral masseters. Mandibular cortex thickness, mandibular bone thickness, and mandibular volume were measured. RESULTS Soft-tissue changes were observed but no bony changes were observed 3 months after injections. CONCLUSIONS In this study of adult patients, there were no statistically significant mandibular changes 3 months after BoNTA injection. The current theory of mandibular flaring resolution after partial muscle paralysis is not supported by our findings. Therefore, a patient presenting both masseteric hypertrophy and bony flaring will most likely require a combined muscular and bony procedure.
Collapse
Affiliation(s)
- C S Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, 5, Fu-Hsin St., Guei-Shan 333, Taoyuan, Taiwan
| | | | | | | | | |
Collapse
|
35
|
Huang HW, Lee KY, Huang JK, Lin CH, Lin CF, Yu CC, Kuo HC. Light extraction efficiency enhancement of GaN-based light emitting diodes on n-GaN layer using a SiO2 photonic quasi-crystal overgrowth. J Nanosci Nanotechnol 2010; 10:6363-6368. [PMID: 21137731 DOI: 10.1166/jnn.2010.2639] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In this paper, GaN-based LEDs with a SiO2 photonic quasi-crystal (PQC) pattern on an n-GaN layer by nano-imprint lithography (NIL) are fabricated and investigated. At a driving current of 20 mA on Transistor Outline (TO)-can package, the better light output power of LED III (d = 1.2 microm) was enhanced by a factor of 1.20. After 1000 h life test (55 degrees C/50 mA) condition, Normalized output power of LED with a SiO2 PQC pattern (LED III (d = 1.2 microm)) on an n-GaN layer only decreased by 5%. This results offer promising potential to enhance the light output power of commercial light-emitting devices using the technique of nano-imprint lithography.
Collapse
Affiliation(s)
- H W Huang
- Institute of Electro-Optical Engineering, National Chiao-Tung University, Hsinchu 30050, Taiwan, ROC
| | | | | | | | | | | | | |
Collapse
|
36
|
Lee YC, Tseng SC, Chen HL, Yu CC, Cheng WL, Du CH, Lin CH. Using autocloning effects to develop broad-bandwidth, omnidirectional antireflection structures for silicon solar cells. Opt Express 2010; 18 Suppl 3:A421-A431. [PMID: 21165072 DOI: 10.1364/oe.18.00a421] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In this study, we used the autocloning effect on pyramid structures to develop broad-bandwidth, omnidirectional antireflection structures for silicon solar cells. The angular dependence of reflectance on several pyramid structures was systematically investigated. The deposition of three-layer autocloned films reduced the refractive index gap between air and silicon, resulting in an increase in the amount of transmitted light and a decrease in the total light escaping. The average reflectance decreased dramatically to ca. 2-3% at incident angles from 0 to 60° for both sub-wavelength- and micrometer-scale pyramid structures. The measured reflectance of the autocloned structure was less than 4% in the wavelength range from 400 to 1000 nm for incident angles from 0 to 60°. Therefore, the autocloning technique, combined with optical thin films and optical gradient structures, is a practical and compatible method for the fabrication of broad-bandwidth, omnidirectional antireflection structures on silicon solar cells.
Collapse
Affiliation(s)
- Y C Lee
- Department of Materials Science and Engineering, National Taiwan University, Taipei, Taiwan
| | | | | | | | | | | | | |
Collapse
|
37
|
Chen JF, Yu CC, Yang CH. Electron emissions in InAs quantum dots containing a nitrogen incorporation induced defect state: the influence of thermal annealing. Nanotechnology 2008; 19:495201. [PMID: 21730663 DOI: 10.1088/0957-4484/19/49/495201] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
With the incorporation of nitrogen (N) into InAs quantum dots (QDs), the carrier distribution near the QD displays electron emissions from a localized N-induced defect state at 0.34 eV and a weak emission at 0.15 eV from the QD. This defect state causes drastic carrier depletion in the neighboring GaAs bottom layer near the QD, which can effectively suppress tunneling emission for the QD excited states. As a result, electrons escape from the QD ground state through thermal emission to near the GaAs conduction band, rather than through thermal emission to the QD first excited state and a subsequent tunneling to the GaAs conduction band, as observed in InAs QDs without N incorporation. Thermal annealing can weaken the defect emission and enhance the QD emission, suggesting a removal of the defect state and a recovery of carriers in the QD. Increasing annealing temperature can significantly decrease the emission time and energy of the QD emission, which is explained by a weakening of tunneling suppression due to the removal of the defect state.
Collapse
Affiliation(s)
- J F Chen
- Department of Electrophysics, National Chiao Tung University, Hsinchu, Taiwan, Republic of China
| | | | | |
Collapse
|
38
|
Huang HW, Lin CH, Yu CC, Lee BD, Chiu CH, Lai CF, Kuo HC, Leung KM, Lu TC, Wang SC. Enhanced light output from a nitride-based power chip of green light-emitting diodes with nano-rough surface using nanoimprint lithography. Nanotechnology 2008; 19:185301. [PMID: 21825687 DOI: 10.1088/0957-4484/19/18/185301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Enhanced light extraction from a GaN-based power chip (PC) of green light-emitting diodes (LEDs) with a rough p-GaN surface using nanoimprint lithography is presented. At a driving current of 350 mA and with a chip size of 1 mm × 1 mm packaged on transistor outline (TO)-cans, the light output power of the green PC LEDs with nano-rough p-GaN surface is enhanced by 48% when compared with the same device without a rough p-GaN surface. In addition, by examining the radiation patterns, the green PC LED with nano-rough p-GaN surface shows stronger light extraction with a wider view angle. These results offer promising potential to enhance the light output powers of commercial light-emitting devices by using the technique of nanoimprint lithography under suitable nanopattern design.
Collapse
Affiliation(s)
- H W Huang
- Institute of Electro-Optical Engineering, National Chiao Tung University, Hsinchu 30050, Taiwan, Republic of China. Mesophotonics Limited, Hsinchu 300, Taiwan, Republic of China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Tsai HY, Tung CJ, Yu CC, Tyan YS. Survey of computed tomography scanners in Taiwan: Dose descriptors, dose guidance levels, and effective doses. Med Phys 2007; 34:1234-43. [PMID: 17500455 DOI: 10.1118/1.2712412] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The IAEA and the ICRP recommended dose guidance levels for the most frequent computed tomography (CT) examinations to promote strategies for the optimization of radiation dose to CT patients. A national survey, including on-site measurements and questionnaires, was conducted in Taiwan in order to establish dose guidance levels and evaluate effective doses for CT. The beam quality and output and the phantom doses were measured for nine representative CT scanners. Questionnaire forms were completed by respondents from facilities of 146 CT scanners out of 285 total scanners. Information on patient, procedure, scanner, and technique for the head and body examinations was provided. The weighted computed tomography dose index (CTDI(w)), the dose length product (DLP), organ doses and effective dose were calculated using measured data, questionnaire information and Monte Carlo simulation results. A cost-effective analysis was applied to derive the dose guidance levels on CTDI(w) and DLP for several CT examinations. The mean effective dose +/- standard deviation distributes from 1.6 +/- 0.9 mSv for the routine head examination to 13 +/- 11 mSv for the examination of liver, spleen, and pancreas. The surveyed results and the dose guidance levels were provided to the national authorities to develop quality control standards and protocols for CT examinations.
Collapse
Affiliation(s)
- H Y Tsai
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung 402, Taiwan
| | | | | | | |
Collapse
|
40
|
Yu CC, Chen WY, Li PS. Protein phosphatase inhibitor cantharidin inhibits steroidogenesis and steroidogenic acute regulatory protein expression in cultured rat preovulatory follicles. Life Sci 2001; 70:57-72. [PMID: 11764007 DOI: 10.1016/s0024-3205(01)01369-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The effect of cantharidin, a natural toxicant of blister beetles and a strong inhibitor of protein phosphatases types 1 and 2A, on luteinizing hormone (LH)-induced synthesis of steroidogenic acute regulatory (StAR) protein was studied in a serum-free culture of preovulatory follicles. StAR protein is a steroidogenic tissue-specific, hormone-induced, rapidly synthesized protein previously shown to be involved in the acute regulation of steroidogenesis, probably by promoting the transfer of cholesterol to the inner mitochondrial membrane and the cytochrome P450 side-chain cleavage (P450scc) enzyme. Treatment of preovulatory follicles dissected from ovaries of immature rats primed with pregnant mares' serum gonadotropin (10 IU) with LH for 24 h resulted in a dose-dependent increase in the level of StAR protein that reached a maximum at 100 ng LH/ml. This increase was associated with an increase in progesterone production. Treatment of follicles with increasing concentrations (10 - 1000 ng/ml) of cantharidin suppresssed LH (100 ng/ml)-induced StAR protein levels and progesterone production in a dose-dependent manner. The amount of P450scc protein and the conversion of 22R-hydroxycholesterol to progesterone were not affected by cantharidin. This indicates that cantharidin did not interfere with the activity of P450scc. Cantharidin also decreased StAR protein levels and progesterone production induced by the adenylate cyclase activator forskolin (10(-5) M) or a cAMP analog 8-Br-cAMP (0.5 mM). These results demonstrate that cantharidin inhibits the LH-induced StAR protein levels, and, thus, suggest that phosphoprotein phosphatase activity is required for the cAMP-protein kinase A-stimulated steroidogenic activity of the preovulatory follicle.
Collapse
Affiliation(s)
- C C Yu
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Rep. of China
| | | | | |
Collapse
|
41
|
Yu CC, Chen PK, Chen YR. Comparison of speech results after Furlow palatoplasty and von Langenbeck palatoplasty in incomplete cleft of the secondary palate. Chang Gung Med J 2001; 24:628-32. [PMID: 11771185] [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: 02/23/2023]
Abstract
BACKGROUND Due to many confounding factors, it is not easy to answer which method of cleft repair is superior to others. The purpose of this study is to try to compare the treatment result of different types of palatoplasty in patients who had the same cleft type and same treatment protocol besides the method of cleft repair. We selected nonsyndromic patients with incomplete cleft of the secondary palate. The speech results after the two palatoplasties were compared. METHODS Ninety-six children with nonsyndromic incomplete clefts of the secondary palate who received palatoplasty at the Craniofacial Center of Chang Gung Memorial Hospital from 1989 to 1997 were studied. Forty-six patients received Furlow palatoplasty and 50 patients received von Langenbeck palatoplasty. Velopharyngeal function was evaluated by speech pathologists periodically after the patient was two and half years old. Adequacy of velopharyngeal function was used as a measurement of speech outcome. RESULTS The Furlow palatoplasty group showed excellent results with 98% (45/46) adequacy in velopharyngeal function. In the von Langenbeck palatoplasty group, only 70% (35/50) of the patients had adequate velopharyngeal function. Statistical analysis with Fisher's exact test showed a significant difference (p < 0.0001, p < 0.05). Only one patient had an oronasal fistula after Furlow palatoplasty. After von Langenbeck palatoplasty, one patient had an oronasal fistula and one had wound dehiscence. CONCLUSION In this study, there was a better speech outcome after Furlow palatoplasty than von Langenbeck palatoplasty for repair of incomplete cleft of the secondary palate. Also, the number of complications after a Furlow palatoplasty was low. It should be a recommended treatment.
Collapse
Affiliation(s)
- C C Yu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei
| | | | | |
Collapse
|
42
|
Yang JG, Yu CC, Li PS. Dexamethasone enhances follicle stimulating hormone-induced P450scc mRNA expression and progesterone production in pig granulosa cells. CHINESE J PHYSIOL 2001; 44:111-9. [PMID: 11767283] [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: 02/23/2023] Open
Abstract
The effect of dexamethasone on follicle-stimulating hormone (FSH)-stimulated expression of cholesterol side-chain cleavage (P450scc) enzyme and production of progesterone by ovarian granulosa cells was studied in vitro. Granulosa cells from 3- to 5-mm pig antral follicles were cultured for 48 h in the presence or absence of FSH and/or dexamethasone. Treatment with FSH resulted in a dose-dependent increase in the level of P450scc mRNA that reached a submaximum at 100 ng FSH/ml. This increase was associated with an increase in progesterone production. Treatment of the cells with increasing concentrations (10(-9)-10(-6) M) of dexamethasone for 48 h increased constitutive and potentiated FSH-stimulated P450scc mRNA levels and progesterone production in a dose-dependent manner. Increasing duration (12-48 h) of treatment with dexamethasone (100 nM) led to a time-dependent increase in basal and FSH-stimulated progesteorne production, achieving statistical significance by 48 and 24 h, respectively. Dexamethasone also increased P450scc mRNA level and progesterone production induced by the adenylate cyclase activator forskolin (10 microM) or a cAMP analog 8-Br-cAMP (1 mM). The effects of dexamethasone on FSH-induced progesterone production were blocked by cotreatment of the cells with glucocorticoid receptor antagonist RU-486. These results demonstrate that dexamethasone potentiates FSH actions on steroidoogenesis in the pig ovary. Possible mechanisms for this potentiation include the ability of dexamethasone to stimulate P450scc gene expression.
Collapse
Affiliation(s)
- J G Yang
- Department of Medical Research, Chang-Hua Christian Hospital, Taiwan, ROC
| | | | | |
Collapse
|
43
|
Yu CC, Kelly PA, Burckart GJ, Zeevi A. Sirolimus inhibition of lymphocyte proliferation is not antagonized by ciprofloxacin and other quinolone antibiotics. Transplant Proc 2001; 33:2989-91. [PMID: 11543824 DOI: 10.1016/s0041-1345(01)02284-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- C C Yu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | | | | |
Collapse
|
44
|
Abstract
This study was systematically designed to compare bovine serum albumin (BSA) loaded poly(epsilon-caprolactone) (PCL) microparticles based on a 2(3) factorial experiment. The microparticles were prepared by the holt-melt technique without using an organic solvent for polymer solubilization. The influence of the particle size of protein, protein/polymer ratio, and hydrophilic PEG on the surface morphology, particle size as well as the yield of PCL microparticles, encapsulation efficiency of BSA, and in vitro release properties were investigated. The structure of BSA remained its integrity using this technique. The mean particle size of BSA-loaded microparticles were in the range of 12.7 +/- 0.1-16.9 +/- 0.8 microm, and all of the particles were smooth on the surface. The production yield of microparticles and the encapsulation efficiencies were high, and the values were in the range of 94.8 +/- 1.6%-98.1 +/- 1.0% and 94.9 +/- 9.6%-98.6 + 0.3%, respectively. The burst release of BSA was in the range of 8.2 +/- 0.4%-61.0 +/- 0.8%, which strongly depended on the formulation. None of three variables affected the yield of microparticles prepared from eight formulations (p > 0.05). However, the particle size of BSA significantly affected the size and the burst release as well as the cumulative release of protein in these microparticles (p < 0.05). The initial loading of BSA in terms of BSA/PCL ratio and the amount of PEG blended with PCL significantly affected all of the properties, except the yield (p < 0.05). The smaller the particle size of the BSA, the smaller the size of the resulting microparticles. Since the total surface area of the small particles was larger than that of the large particles, this accounted for the high burst release of protein from the microparticles encapsulating triturated-BSA.
Collapse
Affiliation(s)
- W J Lin
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei.
| | | |
Collapse
|
45
|
Jan CR, Yu CC, Huang JK. Dual effect of the antianginal drug fendiline on bladder female transitional carcinoma cells: mobilization of intracellular CA2+ and induction of cell death. Pharmacology 2001; 62:218-23. [PMID: 11359998 DOI: 10.1159/000056098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The effect of fendiline, an antianginal drug, on cytosolic free Ca2+ levels ([Ca2+]i) in populations of bladder female transitional carcinoma (BFTC) cells was explored using fura-2 as a Ca2+ indicator. Fendiline at concentrations between 3 and 200 micromol/l increased [Ca2+]i in a concentration-dependent manner and the signal saturated at 100 micromol/l. The [Ca2+]i signal was biphasic, with an initial rise and a slow decay. Ca2+ removal inhibited the Ca2+ signal by about half in peak amplitude. Adding 3 mmol/l Ca2+ increased [Ca2+]i in cells pretreated with 100 micromol/l fendiline in Ca2+ -free medium, suggesting that fendiline induced Ca2+ influx via capacitative Ca2+ entry. In Ca2+ -free medium, pretreatment with 1 micromol/l thapsigargin (an endoplasmic reticulum Ca2+ pump inhibitor) to deplete the endoplasmic reticulum Ca2+ store inhibited most of the 100 micromol/l fendiline-induced internal Ca2+ release; and conversely, pretreatment with 100 micromol/l fendiline partly inhibited 1 micromol/l thapsigargin-induced Ca2+ release. This indicates that the major internal Ca2+ store of fendiline-induced [Ca2+]i increases is located in the endoplasmic reticulum. The Ca2+ release induced by 100 micromol/l fendiline may be partly mediated by inositol 1,4,5-trisphosphate, because the [Ca2+]i increase was inhibited by 50% by inhibiting phospholipase C with 2 micromol/l U73122. Fendiline (100 micromol/l) decreased cell viability by 12-44% after being added to cells for 2- 30 min. Together, the findings indicate that in BFTC cells, fendiline exerts a dual effect: mobilization of intracellular Ca2+ and induction of cell death.
Collapse
Affiliation(s)
- C R Jan
- Department of Medical Education, National Sun Yat-sen University, Kaohsiung, Taiwan
| | | | | |
Collapse
|
46
|
Jan CR, Lee KC, Chou KJ, Cheng JS, Wang JL, Lo YK, Chang HT, Tang KY, Yu CC, Huang JK. Fendiline, an anti-anginal drug, increases intracellular Ca2+ in PC3 human prostate cancer cells. Cancer Chemother Pharmacol 2001; 48:37-41. [PMID: 11488522 DOI: 10.1007/s002800000262] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The effects of the anti-anginal drug fendiline on intracellular Ca2+ concentrations ([Ca2+]i) in human PC3 prostate cancer cells were examined. METHODS [Ca2+]i was measured using the fluorescent dye fura-2. RESULTS Fendiline (0.5-100 microM) increased [Ca2+]i in a concentration-dependent manner. Ca2+ removal partly inhibited the Ca2+ signals. In Ca2+-free medium, pretreatment with 100 microM fendiline inhibited most of the [Ca2+]i increase induced by 1 microM thapsigargin (an endoplasmic reticulum Ca2+ pump inhibitor), and pretreatment with thapsigargin abolished the fendiline-induced [Ca2+]i increases. Adding 3 mM Ca2+ increased [Ca2+]i in cells pretreated with 0.5-200 microM fendiline in Ca2+-free medium. Pretreatment with 1 microM U73122 to block the formation of inositol-1.4.5-trisphosphate (IP3) did not alter fendiline-induced internal Ca2+ release. CONCLUSIONS The anti-anginal drug fendiline induced internal Ca2+ release and external Ca2+ entry. Because prolonged increases in [Ca2+]i may lead to cell injury and death, the long-term effect of fendiline on the function of prostate cancer cells should be investigated.
Collapse
Affiliation(s)
- C R Jan
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Taiwan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
BACKGROUND It is known that chronic renal insufficiency (CRI) patients with gout may have subtle lead poisoning. In addition, gout episodes frequently aggravate progressive renal insufficiency because of the use of nephrotoxic drugs and urate deposition. Our study was arranged to evaluate the causal effect of environmental lead exposure on urate excretion in CRI patients. METHODS A cross-section study and a randomized, controlled trial were performed. Initially, 101 patients with CRI and without a history of previous lead exposure received ethylenediaminetetraacetic acid mobilization tests to assess body lead stores (BLS). Then, a clinical trial was performed; 30 CRI patients with gout and high-normal BLS and the changes of urate excretion in these patients were compared before and after lead chelating therapy. The treated group received four-week chelating therapy, and the control group received a placebo therapy. RESULTS The BLS of patients with CRI and gout was higher than that of patients with CRI only, and none had subtle lead poisoning. The BLS, not the blood lead level (BLL), significantly correlated to indices of urate excretion in all CRI patients after related factors were adjusted. In addition, after lead chelating therapy, urate clearance markedly improved after a reduction of the BLS of patients with CRI and gout (study group 67.9 +/- 80.0% vs. control group 1.2 +/- 34.0%, P = 0.0056). CONCLUSION Our findings suggest that the chronic low-level environmental lead exposure may interfere with urate excretion of CRI patients. Importantly, the inhibition of urate excretion can be markedly improved by lead chelating therapies. These data shed light on additional treatment of CRI patients with gout; however, more studies are needed to confirm our findings.
Collapse
Affiliation(s)
- J L Lin
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Lin-Kou Medical Center, Chang Gung Medical College and University, Taipei, Taiwan, Republic of China.
| | | | | | | |
Collapse
|
48
|
Yu CC, Yang CW, Wu MS, Ko YC, Huang CT, Hong JJ, Huang CC. Mycophenolate mofetil reduces renal cortical inducible nitric oxide synthase mRNA expression and diminishes glomerulosclerosis in MRL/lpr mice. J Lab Clin Med 2001; 138:69-77. [PMID: 11433230 DOI: 10.1067/mlc.2001.115647] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Overexpression of inducible nitric oxide synthase (iNOS) has been implicated in the pathogenesis of lupus glomerulonephritis. Mycophenolate mofetil (MMF), a novel immunosuppressive agent, is currently used in organ transplantation and under evaluation for treatment of autoimmune disorders. Mycophenolic acid, the active metabolite of MMF, has been shown to suppress cytokine-induced nitric oxide production in vitro. The aim of this study was to evaluate the effect of MMF on the expression of renal cortical iNOS mRNA and protection against glomerulonephritis in MRL/lpr mice. Three-month-old MRL/lpr mice (n = 6) displaying clinical symptoms of glomerulonephritis were treated for 3 months with MMF (90 mg/kg/day) dissolved in a vehicle. Controls were age- and sex-matched mice (n = 6) that received the vehicle alone. By reverse-transcription competitive polymerase chain reaction, we found that the renal cortical iNOS/beta-actin mRNA ratio was reduced by 30.8% (P <.05) in MMF-treated mice. Furthermore, MMF significantly reduced urinary nitrite production and degree of glomerulosclerosis. The glomerular volume was reduced by 17.5% (P <.001). Proteinuria was also significantly reduced in the MMF-treated group. However, by electrophoretic mobility shift assay, the nuclear binding of nuclear factor-kappaB (NF-kappaB) was not affected by MMF treatment. We conclude that in addition to its immunosuppressive action, MMF may reduce renal cortical iNOS mRNA expression and diminish glomerulosclerosis in MRL/lpr mice independent of modulation of the NF-kappaB pathway.
Collapse
Affiliation(s)
- C C Yu
- Department of Nephrology, Chang Gung Memorial Hospital, 199 Tung-Hwa North Road, Taipei, 105, Taiwan
| | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
The pressure-flow (P-Q) curve has been widely used in many studies to describe the effects of various factors on vascular hemodynamics. It is not clear, however, whether unilateral ischemia-reperfusion (IR) alters the P-Q curve of the rat lung. In this study, we developed an in vivo P-Q curve using the unilateral (left) rat lung before and after IR. Animals were divided into two groups: sham and IR. The protocol of the IR group consisted of three periods: baseline, ischemia, and reperfusion. P-Q curves were obtained by altering blood flow of the left lung during the baseline and the reperfusion periods. The sham group received the same operation without IR procedure. An additional group was used to compare pulmonary blood flow measured by the microsphere and the ultrasonic methods. IR treatment rotated the P-Q curve toward the left, indicating an increase in resistance in the left lung. However, this rotation was not found in the sham group. A significant correlation (r = 0.87, P < 0.01) between percentages of blood flow obtained by the microsphere and ultrasonic methods in both right and left lungs was demonstrated. Therefore, we demonstrated a simple and useful technique to evaluate changes in the P-Q curves caused by IR in the unilateral rat lung model.
Collapse
Affiliation(s)
- C C Yu
- Department of Physiology, National Taiwan University College of Medicine, Taipei 100, Taiwan
| | | |
Collapse
|
50
|
Jan CR, Yu CC, Huang JK. Clomiphene, an Ovulation-Inducing Agent, Mobilizes Intracellular Ca 2+ and Causes Extracellular Ca 2+ Influx in Bladder Female Transitional Carcinoma Cells. Horm Res Paediatr 2001; 54:143-8. [PMID: 11357008 DOI: 10.1159/000053248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/METHODS The effect of clomiphene, an ovulation-inducing agent, on cytosolic free Ca2+ levels ([Ca2+]i) in populations of BFTC human bladder cancer cells was explored by using fura-2 as a Ca2+ indicator. RESULTS Clomiphene at concentrations between 10 and 75 microM increased [Ca2+]i in a concentration-dependent manner and the signal saturated at 50 microM. The [Ca2+]i signal was biphasic with an initial rise and a slow decay. Ca2+ removal inhibited the Ca2+ signal by about 40-50% in maximum [Ca2+]i. Adding 3 mM Ca2+ increased [Ca2+]i in cells pretreated with 50 microM clomiphene in Ca2+-free medium, suggesting that clomiphene induced capacitative Ca2+ entry. In Ca2+-free medium, pretreatment with 50 microM brefeldin A (to disrupt the Golgi complex Ca2+ store), 1 microM thapsigargin (to inhibit the endoplasmic reticulum Ca2+ pump), and CCCP (to uncouple mitochondria) inhibited 85% of clomiphene-induced intracellular Ca2+ release. Conversely, pretreatment with 50 microM clomiphene in Ca2+-free medium abolished the [Ca2+]i increase induced by brefeldin, thapsigargin or CCCP. The intracellular Ca2+ release was unaltered by inhibiting formation of inositol-1,4,5-trisphosphate (IP3) with 2 mM 1-(6-((17beta-3-methoxyestra-1,3,5(10)-trien-17-yl)amino)hexyl)-1H-pyrrole-2,5-dione (U73122; a phospholipase C inhibitor). CONCLUSION The [Ca2+]i increase induced by 50 microM clomiphene was not affected by 10 microM of nifedipine, verapamil or diltiazem. Collectively, the results suggest that clomiphene releases intracellular Ca2+ in an IP3-independent manner and also activates extracellular Ca2+ influx.
Collapse
Affiliation(s)
- C R Jan
- Medical Education and Research, National Sun Yat-sen University, Kaohsiung, Taiwan
| | | | | |
Collapse
|