1
|
Duivenvoorden WC, Margel D, Subramony Gayathri V, Duceppe E, Yousef S, Naeim M, Khajehei M, Hopmans S, Popovic S, Ber Y, Heels-Ansdell D, Devereaux PJ, Pinthus JH. Follicle-Stimulating Hormone Exacerbates Cardiovascular Disease in the Presence of Low or Castrate Testosterone Levels. JACC Basic Transl Sci 2024; 9:364-379. [PMID: 38559622 PMCID: PMC10978407 DOI: 10.1016/j.jacbts.2023.10.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 04/04/2024]
Abstract
Low testosterone (T), common in aging men, associates with cardiovascular disease. We investigated whether follicle-stimulating hormone (FSH), which is affected by T, modulates the cardiovascular effects associated with low T or castration. FSHβ-/-:low-density lipoprotein receptor (LDLR)-/- mice, untreated or castrated (orchiectomy, gonadotropin-releasing hormone agonist or antagonist), demonstrated significantly less atherogenesis compared with similarly treated LDLR-/- mice, but not following FSH delivery. Smaller plaque burden in LDLR-/- mice receiving gonadotropin-releasing hormone antagonists vs agonists were nullified in FSHβ-/-:LDLR-/- mice. Atherosclerotic and necrotic plaque size and macrophage infiltration correlated with serum FSH/T. In patients with prostate cancer, FSH/T following androgen-deprivation therapy initiation predicted cardiovascular events. FSH facilitates cardiovascular disease when T is low or eliminated.
Collapse
Affiliation(s)
- Wilhelmina C.M. Duivenvoorden
- Department of Surgery, Division of Urology, Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
- Research Institute of St. Joe’s Hamilton, Hamilton, Ontario, Canada
| | - David Margel
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Emmanuelle Duceppe
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Medicine, Centre Hospitalier de l'Universite de Montréal, Montréal, Québec, Canada
| | - Sadiya Yousef
- Research Institute of St. Joe’s Hamilton, Hamilton, Ontario, Canada
| | - Magda Naeim
- Research Institute of St. Joe’s Hamilton, Hamilton, Ontario, Canada
| | - Mohammad Khajehei
- Department of Surgery, Division of Urology, Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Hopmans
- Department of Surgery, Division of Urology, Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Snezana Popovic
- Department of Pathology and Molecular Medicine, Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Yaara Ber
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Philip J. Devereaux
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Medicine, Centre Hospitalier de l'Universite de Montréal, Montréal, Québec, Canada
| | - Jehonathan H. Pinthus
- Department of Surgery, Division of Urology, Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
- Research Institute of St. Joe’s Hamilton, Hamilton, Ontario, Canada
| |
Collapse
|
2
|
Klimis H, Pinthus JH, Aghel N, Duceppe E, Fradet V, Brown I, Siemens DR, Shayegan B, Klotz L, Luke PP, Niazi T, Lavallee LT, Mousavi N, Hamilton RJ, Chin JL, Gopaul D, Violette PD, Davis MK, Hanna N, Sabbagh R, Ben Zadok OI, Hajjar LA, Kann AG, Mian R, Rangarajan S, Huei Ng KK, Iakobishvili Z, Selvanayagam JB, Avezum A, Leong DP. The Burden of Uncontrolled Cardiovascular Risk Factors in Men With Prostate Cancer: A RADICAL-PC Analysis. JACC CardioOncol 2023; 5:70-81. [PMID: 36875906 PMCID: PMC9982287 DOI: 10.1016/j.jaccao.2022.09.008] [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: 04/25/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 01/18/2023] Open
Abstract
Background Cardiovascular disease (CVD) incidence is higher in men with prostate cancer (PC) than without. Objectives We describe the rate and correlates of poor cardiovascular risk factor control among men with PC. Methods We prospectively characterized 2,811 consecutive men (mean age 68 ± 8 years) with PC from 24 sites in Canada, Israel, Brazil, and Australia. We defined poor overall risk factor control as ≥3 of the following: suboptimal low-density lipoprotein cholesterol (>2 mmol/L if Framingham Risk Score [FRS] ≥15 and ≥3.5 mmol/L if FRS <15), current smoker, physical inactivity (<600 MET min/wk), suboptimal blood pressure (BP) (≥140/90 mm Hg if no other risk factors, systolic BP ≥120 mm Hg if known CVD or FRS ≥15, and ≥130/80 mm Hg if diabetic), and waist:hip ratio >0.9. Results Among participants (9% with metastatic PC and 23% with pre-existing CVD), 99% had ≥1 uncontrolled cardiovascular risk factor, and 51% had poor overall risk factor control. Not taking a statin (odds ratio [OR]: 2.55; 95% CI: 2.00-3.26), physical frailty (OR: 2.37; 95% CI: 1.51-3.71), need for BP drugs (OR: 2.36; 95% CI: 1.84-3.03), and age (OR per 10-year increase: 1.34; 95% CI: 1.14-1.59) were associated with poor overall risk factor control after adjustment for education, PC characteristics, androgen deprivation therapy, depression, and Eastern Cooperative Oncology Group functional status. Conclusions Poor control of modifiable cardiovascular risk factors is common in men with PC, highlighting the large gap in care and the need for improved interventions to optimize cardiovascular risk management in this population.
Collapse
Key Words
- ADT, androgen deprivation therapy
- BP, blood pressure
- CVD, cardiovascular disease
- ECOG, Eastern Cooperative Oncology Group
- GnRH, gonadotropin-releasing hormone
- HDL, high-density lipoprotein
- HbA1c, glycosylated hemoglobin
- LDL, low-density lipoprotein
- PC, prostate cancer
- PHQ-9, Patient Health Questionnaire-9
- PSA, prostate-specific antigen
- androgen deprivation therapy
- cardiovascular disease prevention
- cardiovascular risk
- prospective
- prostate cancer
Collapse
Affiliation(s)
- Harry Klimis
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Nazanin Aghel
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Emmanuelle Duceppe
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Vincent Fradet
- Department of Surgery, Université Laval, Quebec, Canada.,Research Center of CHU de Québec, Université Laval, Oncology Axis, Quebec, Canada.,CHU de Québec, Site L'Hôtel-Dieu de Québec, Quebec, Canada
| | - Ian Brown
- Division of Urology, Niagara Health System, Saint Catharines, Ontario, Canada
| | - D Robert Siemens
- Queen's Cancer Research Institute, Kingston, Ontario, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.,Department of Urology, Queen's University, Kingston, Ontario, Canada
| | - Bobby Shayegan
- Department of Surgery, Division of Urology, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Laurence Klotz
- Department of Surgery, Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Patrick P Luke
- Department of Surgery, Division of Urology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Tamim Niazi
- Radiation Oncology Department, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Luke T Lavallee
- Division of Urology, Department of Surgery, The Ottawa Hospital, The University of Ottawa, Ottawa, Ontario, Canada
| | - Negareh Mousavi
- Department of Medicine, Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Robert J Hamilton
- Department of Surgery, Division of Urology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Joseph L Chin
- Department of Urology, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Darin Gopaul
- Department of Medicine, Division of Radiation Oncology, Grand River Regional Cancer Centre, Kitchener, Ontario, Canada
| | - Philippe D Violette
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada.,Woodstock Hospital, Woodstock, Ontario, Canada
| | - Margot K Davis
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nawar Hanna
- Department of Surgery, Division of Urology, CIUSSS de l'Est-de-l'Île-de-Montréal, Installation Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Robert Sabbagh
- Department of Surgery, Division of Urology, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Ludhmila Abrahão Hajjar
- Department of Cardiology, Instituto do Coração, Universidade de São Paulo, São Paulo, Brazil
| | | | - Rajibul Mian
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Kelvin Kuan Huei Ng
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Zaza Iakobishvili
- Department of Community Cardiology, Tel Aviv Jaffa District, Clalit Health Fund and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph B Selvanayagam
- Department of Medicine, School of Medicine and Public Health, Flinders University, Adelaide, Australia.,Department of Heart Health, South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - Darryl P Leong
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| |
Collapse
|
3
|
Yoneyama T, Yamamoto H, Sutoh Yoneyama M, Tobisawa Y, Hatakeyama S, Narita T, Kodama H, Momota M, Ito H, Narita S, Tsushima F, Mitsuzuka K, Yoneyama T, Hashimoto Y, Duivenvoorden W, Pinthus JH, Kakeda S, Ito A, Tsuchiya N, Habuchi T, Ohyama C. Characteristics of α2,3-sialyl N-glycosylated PSA as a biomarker for clinically significant prostate cancer in men with elevated PSA level. Prostate 2021; 81:1411-1427. [PMID: 34549452 PMCID: PMC9293073 DOI: 10.1002/pros.24239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The presence of glycosylated isoforms of prostate-specific antigen (PSA) in prostate cancer (PC) cells is a potential marker of their aggressiveness. We characterized the origin of α2,3-sialylated prostate-specific antigen (S23PSA) by tissue-based sialylation-related gene expression and studied the performance of S23PSA density (S23PSAD) alone and in combination with multiparametric magnetic resonance imaging (MRI) for the detection of clinically significant prostate cancer in men with elevated PSA. METHODS Tissue-based quantification of S23PSA and sialyltransferase and sialidase gene expression was evaluated in 71 radical prostatectomy specimens. The diagnostic performance of S23PSAD was studied in 1099 men retrospectively enrolled in a multicenter systematic biopsy (SBx) cohort. We correlated the S23PSAD with Prostate Imaging Reporting and Data System (PI-RADS) scores in 98 men prospectively enrolled in a single-center MRI-targeted biopsy (MRI-TBx) cohort. The primary outcome was the PC-diagnostic performance of the S23PSAD, the secondary outcome was the avoidable biopsy rate of S23PSAD combined with DRE and total PSA (tPSA), and with or without PI-RADS. RESULTS S23PSA was significantly higher in Gleason pattern 4 and 5 compared with benign prostate tissue. In the retrospective cohort, the performance of S23PSAD for detecting PC was superior to tPSA or PSA density (PSAD) (AUC: 0.7758 vs. 0.6360 and 0.7509, respectively). In the prospective cohort, S23PSAD was superior to tPSA, PSAD, and PI-RADS (AUC: 0.7725 vs. 0.5901, 0.7439 and 0.7305, respectively), and S23PSAD + PI-RADS + DRE + tPSA was superior to DRE + tPSA+PI-RADS with avoidance rate of MRI-TBx (13% vs. 1%) at 30% risk threshold. CONCLUSIONS The diagnostic performance of S23PSAD was superior to conventional strategies but comparable to mpMRI.
Collapse
Affiliation(s)
- Tohru Yoneyama
- Department of Glycotechnology, Center for Advanced Medical ResearchHirosaki University Graduate School of MedicineHirosakiAomoriJapan
| | - Hayato Yamamoto
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiAomoriJapan
| | - Mihoko Sutoh Yoneyama
- Department of Cancer Immunology and Cell BiologyOyokyo Kidney Research Institute90 Yamazaki KozawaHirosakiAomoriJapan
| | - Yuki Tobisawa
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiAomoriJapan
| | - Shingo Hatakeyama
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiAomoriJapan
- Department of Advanced Blood Purification TherapyHirosaki University Graduate School of MedicineHirosakiAomoriJapan
| | - Takuma Narita
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiAomoriJapan
- Department of UrologyNational Hospital Organization Hirosaki National HospitalHirosakiAomoriJapan
| | - Hirotake Kodama
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiAomoriJapan
- Department of UrologyTsugaru General HospitalGoshogawaraAomoriJapan
| | - Masaki Momota
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiAomoriJapan
- Department of UrologyMutsu General HospitalMutsuAomoriJapan
| | - Hiroyuki Ito
- Department of UrologyAomori Rosai HospitalHachinoheAomoriJapan
| | - Shintaro Narita
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Fumiyasu Tsushima
- Department of RadiologyHirosaki University Graduate School of MedicineHirosakiAomoriJapan
| | - Koji Mitsuzuka
- Department of UrologyTohoku University Graduate School of MedicineSendaiMiyagiJapan
| | - Takahiro Yoneyama
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiAomoriJapan
| | - Yasuhiro Hashimoto
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiAomoriJapan
| | | | | | - Shingo Kakeda
- Department of RadiologyHirosaki University Graduate School of MedicineHirosakiAomoriJapan
| | - Akihiro Ito
- Department of UrologyTohoku University Graduate School of MedicineSendaiMiyagiJapan
| | - Norihiko Tsuchiya
- Department of UrologyYamagata University Faculty of MedicineYamagataJapan
| | - Tomonori Habuchi
- Department of UrologyAkita University Graduate School of MedicineAkitaJapan
| | - Chikara Ohyama
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiAomoriJapan
- Department of Advanced Blood Purification TherapyHirosaki University Graduate School of MedicineHirosakiAomoriJapan
| |
Collapse
|
4
|
Kaur Rai H, Goucher G, Pinthus JH, Williams P. Primary large cell neuroendocrine carcinoma of the distal ureter: A rare entity. Human Pathology: Case Reports 2021. [DOI: 10.1016/j.ehpc.2021.200545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
5
|
Kim J, Randhawa H, Sands D, Lambe S, Puglia M, Serrano PE, Pinthus JH. Muscle-Invasive Bladder Cancer in Patients with Liver Cirrhosis: A Review of Pertinent Considerations. Bladder Cancer 2021. [DOI: 10.3233/blc-211536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The incidence of liver cirrhosis is increasing worldwide. Patients with cirrhosis are generally at a higher risk of harbouring hepatic and non-hepatic malignancies, including bladder cancer, likely due to the presence of related risk factors such as smoking. Cirrhosis can complicate both the operative and non-surgical management of bladder cancer. For example, cirrhotic patients undergoing abdominal surgery generally demonstrate worse postoperative outcomes, and chemotherapy in patients with cirrhosis often requires dose reduction due to its direct hepatotoxic effects and reduced hepatic clearance. Multiple other considerations in the peri-operative management for cirrhosis patients with muscle-invasive bladder cancer must be taken into account to optimize outcomes in these patients. Unfortunately, the current literature specifically related to the treatment of cirrhotic bladder cancer patients remains sparse. We aim to review the literature on treatment considerations for this patient population with respect to perioperative, surgical, and adjuvant management.
Collapse
Affiliation(s)
- John Kim
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - David Sands
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Shahid Lambe
- Division of Urology, McMaster University, Hamilton, ON, Canada
- McMaster Institute of Urology, St. Joseph’s Hospital, Hamilton, ON, Canada
| | - Marco Puglia
- Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
| | | | - Jehonathan H. Pinthus
- Division of Urology, McMaster University, Hamilton, ON, Canada
- Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
| |
Collapse
|
6
|
Duivenvoorden WCM, Naeim M, Hopmans SN, Yousef S, Werstuck GH, Dason S, Pinthus JH. Correction: Protective effect of pharmacological castration on metabolic perturbations and cardiovascular disease in the hyperglycemic male ApoE -/-:Ins2 +/Akita mouse model. Prostate Cancer Prostatic Dis 2021; 25:596. [PMID: 34413483 DOI: 10.1038/s41391-021-00408-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Wilhelmina C M Duivenvoorden
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada.,Research Institute of St. Joe's, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Magda Naeim
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Sarah N Hopmans
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Sadiya Yousef
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Geoff H Werstuck
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada.,Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada
| | - Shawn Dason
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada.,Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Jehonathan H Pinthus
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada. .,Research Institute of St. Joe's, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
| |
Collapse
|
7
|
Fervaha G, Izard JP, Tripp DA, Aghel N, Shayegan B, Klotz L, Niazi T, Fradet V, Taussky D, Lavallée LT, Hamilton RJ, Brown I, Chin J, Gopaul D, Violette PD, Davis MK, Karampatos S, Pinthus JH, Leong DP, Siemens DR. Psychological morbidity associated with prostate cancer: Rates and predictors of depression in the RADICAL PC study. Can Urol Assoc J 2020; 15:181-186. [PMID: 33212008 DOI: 10.5489/cuaj.6912] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Across all cancer sites and stages, prostate cancer has one of the greatest median five-year survival rates, highlighting the important focus on survivorship issues following diagnosis and treatment. In the current study, we sought to evaluate the prevalence and predictors of depression in a large, multicenter, contemporary, prospectively collected sample of men with prostate cancer. METHODS Data from the current study were drawn from the baseline visit of men enrolled in the RADICAL PC study. Men with a new diagnosis of prostate cancer or patients initiating androgen deprivation therapy for prostate cancer for the first time were recruited. Depressive symptoms were evaluated using the nine-item version of the Patient Health Questionnaire (PHQ-9). To evaluate factors associated with depression, a multivariable logistic regression model was constructed, including biological, psychological, and social predictor variables. RESULTS Data from 2445 patients were analyzed. Of these, 201 (8.2%) endorsed clinically significant depression. Younger age (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.16-1.60 per 10-year decrease), being a current smoker (OR 2.77, 95% CI 1.66-4.58), former alcohol use (OR 2.63, 95% CI 1.33-5.20), poorer performance status (OR 5.01, 95% CI 3.49-7.20), having a pre-existing clinical diagnosis of depression or anxiety (OR 3.64, 95% CI 2.42-5.48), and having high-risk prostate cancer (OR 1.49, 95% CI 1.05-2.12) all conferred independent risk for depression. CONCLUSIONS Clinically significant depression is common in men with prostate cancer. Depression risk is associated with a host of biopsychosocial variables. Clinicians should be vigilant to screen for depression in those patients with poor social determinants of health, concomitant disability, and advanced disease.
Collapse
Affiliation(s)
- Gagan Fervaha
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Urology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jason P Izard
- Department of Urology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Oncology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Dean A Tripp
- Department of Urology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Psychology, Faculty of Arts and Sciences, Queen's University, Kingston, ON, Canada.,Department of Anesthesia, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Nazanin Aghel
- Division of Cardiology, Cardio-Oncology Program, McMaster University, Hamilton, ON, Canada
| | - Bobby Shayegan
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Laurence Klotz
- Sunnybrook Health Sciences Centre, and Department of Surgery (Urology), University of Toronto, Toronto, ON, Canada
| | - Tamim Niazi
- Department of Oncology, McGill University, Montreal, QC, Canada
| | - Vincent Fradet
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada, and Centre de recherche du CHU de Québec-Université Laval, axe Oncologie, Quebec City, QC, Canada
| | - Daniel Taussky
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal-CHUM, Montreal, QC, Canada
| | - Luke T Lavallée
- Division of Urology, Department of Surgery, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robert J Hamilton
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, and Department of Surgery (Urology), University of Toronto, Toronto, ON, Canada
| | | | | | - Darin Gopaul
- Grand River Regional Cancer Centre, Kitchener, ON, Canada
| | - Philippe D Violette
- Department of Surgery and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Margot K Davis
- Department of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Karampatos
- The Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jehonathan H Pinthus
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Darryl P Leong
- The Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - D Robert Siemens
- Department of Urology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Oncology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | | |
Collapse
|
8
|
Duivenvoorden WCM, Naeim M, Hopmans SN, Yousef S, Werstuck GH, Dason S, Pinthus JH. Protective effect of pharmacological castration on metabolic perturbations and cardiovascular disease in the hyperglycemic male ApoE -/-:Ins2 +/Akita mouse model. Prostate Cancer Prostatic Dis 2020; 24:389-397. [PMID: 32989260 DOI: 10.1038/s41391-020-00288-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/09/2020] [Accepted: 09/16/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Unlike in other mouse models of atherogenesis, it has recently been suggested that orchiectomy plays a role in accelerating atherosclerosis and inhibiting the progression of cardiovascular disease in the ApoE-/-:Ins2+/Akita mouse model of hyperglycemia. Androgen-deprivation therapy (ADT) is a common treatment for prostate cancer, a population with high prevalence of cardiovascular disease and its risk factors. Our objectives were to test and further characterize the effects of pharmacological castration which is currently the acceptable modality to deliver ADT in the clinic. METHODS Male ApoE-/-:Ins2+/Akita mice received one of three modes of ADT (gonadotropin-releasing hormone (GnRH)-antagonist (degarelix), GnRH-agonist (leuprolide), or bilateral orchiectomy) and were compared to corresponding untreated control mice (n = 9-13/group). Mice were followed for 5 months. Body weight, fasting blood glucose, glucose tolerance, serum C-peptide, leptin, and testosterone levels along with atherosclerotic aortic plaque size and characteristics were determined. In a separate experiment, the survival of mice, untreated and on ADT, was determined. RESULTS Castration was achieved for all three modes of ADT. However, degarelix-treated mice gained significantly less weight, had lower serum leptin levels and systolic blood pressure compared to orchiectomy and leuprolide-treated mice. ADT improved dysglycemia and atherosclerotic burden. GnRH-antagonist significantly improved survival compared to GnRH-agonist but not compared to orchiectomy. CONCLUSIONS Further characterization of the ApoE-/-:Ins2+/Akita mouse model confirms that pharmacological ADT ameliorated metabolic syndrome and cardiovascular complications. Improved dysglycemia and atherosclerosis associated with increased survival which was longest after degarelix followed by orchiectomy.
Collapse
Affiliation(s)
- Wilhelmina C M Duivenvoorden
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada.,Research Institute of St. Joe's, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Magda Naeim
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Sarah N Hopmans
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Sadiya Yousef
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Geoff H Werstuck
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada.,Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada
| | - Shawn Dason
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada.,Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Jehonathan H Pinthus
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada. .,Research Institute of St. Joe's, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
| |
Collapse
|
9
|
Roshanov PS, Eikelboom JW, Sessler DI, Kearon C, Guyatt GH, Crowther M, Tandon V, Borges FK, Lamy A, Whitlock R, Biccard BM, Szczeklik W, Panju M, Spence J, Garg AX, McGillion M, VanHelder T, Kavsak PA, de Beer J, Winemaker M, Le Manach Y, Sheth T, Pinthus JH, Siegal D, Thabane L, Simunovic MRI, Mizera R, Ribas S, Devereaux PJ. Bleeding Independently associated with Mortality after noncardiac Surgery (BIMS): an international prospective cohort study establishing diagnostic criteria and prognostic importance. Br J Anaesth 2020; 126:163-171. [PMID: 32768179 DOI: 10.1016/j.bja.2020.06.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 05/25/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND We aimed to establish diagnostic criteria for bleeding independently associated with mortality after noncardiac surgery (BIMS) defined as bleeding during or within 30 days after noncardiac surgery that is independently associated with mortality within 30 days of surgery, and to estimate the proportion of 30-day postoperative mortality potentially attributable to BIMS. METHODS This was a prospective cohort study of participants ≥45 yr old having inpatient noncardiac surgery at 12 academic hospitals in eight countries between 2007 and 2011. Cox proportional hazards models evaluated the adjusted relationship between candidate diagnostic criteria for BIMS and all-cause mortality within 30 days of surgery. RESULTS Of 16 079 participants, 2.0% (315) died and 36.1% (5810) met predefined screening criteria for bleeding. Based on independent association with 30-day mortality, BIMS was identified as bleeding leading to a postoperative haemoglobin <70 g L-1, transfusion of ≥1 unit of red blood cells, or that was judged to be the cause of death. Bleeding independently associated with mortality after noncardiac surgery occurred in 17.3% of patients (2782). Death occurred in 5.8% of patients with BIMS (161/2782), 1.3% (39/3028) who met bleeding screening criteria but not BIMS criteria, and 1.1% (115/10 269) without bleeding. BIMS was associated with mortality (adjusted hazard ratio: 1.87; 95% confidence interval: 1.42-2.47). We estimated the proportion of 30-day postoperative deaths potentially attributable to BIMS to be 20.1-31.9%. CONCLUSIONS Bleeding independently associated with mortality after noncardiac surgery (BIMS), defined as bleeding that leads to a postoperative haemoglobin <70 g L-1, blood transfusion, or that is judged to be the cause of death, is common and may account for a quarter of deaths after noncardiac surgery. CLINICAL TRIAL REGISTRATION NCT00512109.
Collapse
Affiliation(s)
- Pavel S Roshanov
- Division of Nephrology, London Health Science Centre, London, ON, Canada.
| | - John W Eikelboom
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada
| | - Daniel I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Clive Kearon
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Thrombosis and Atherosclerosis Research Institute, Canada
| | - Gordon H Guyatt
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, Canada
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Vikas Tandon
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Flavia Kessler Borges
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada
| | - Andre Lamy
- Department of Health Research Methods, Evidence, and Impact, Canada; Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Richard Whitlock
- Population Health Research Institute, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, Canada; Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Bruce M Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Observatory, Cape Town, Western Cape, South Africa; University of Cape Town, Rondebosch, Cape Town, Western Cape, South Africa
| | - Wojciech Szczeklik
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Mohamed Panju
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jessica Spence
- Population Health Research Institute, Hamilton, ON, Canada
| | - Amit X Garg
- Division of Nephrology, London Health Science Centre, London, ON, Canada; Institute for Clinical Evaluative Sciences at Western, London, ON, Canada
| | - Michael McGillion
- Population Health Research Institute, Hamilton, ON, Canada; School of Nursing, Faculty of Health Sciences, Canada
| | | | - Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Justin de Beer
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Yannick Le Manach
- Population Health Research Institute, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, Canada; Department of Anesthesia, Canada
| | - Tej Sheth
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Deborah Siegal
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Population Health Research Institute, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, Canada; Biostatistics Unit, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Marko R I Simunovic
- Department of Health Research Methods, Evidence, and Impact, Canada; Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ryszard Mizera
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sebastian Ribas
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Philip J Devereaux
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, Canada
| |
Collapse
|
10
|
Margel D, Ber Y, Peer A, Shavit-Grievink L, Pinthus JH, Witberg G, Baniel J, Kedar D, Rosenbaum E. Cardiac biomarkers in patients with prostate cancer and cardiovascular disease receiving gonadotrophin releasing hormone agonist vs antagonist. Prostate Cancer Prostatic Dis 2020; 24:177-185. [PMID: 32737420 DOI: 10.1038/s41391-020-0264-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/12/2020] [Accepted: 07/24/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Gonadotrophin releasing hormone (GnRH) agonists and antagonists reduce testosterone levels for the treatment of advanced and metastatic prostate cancer. Androgen deprivation therapy (ADT) is associated with increased risk of cardiovascular (CV) events and CV disease (CVD), especially in patients with preexisting CVD treated with GnRH agonists. Here, we investigated the potential relationship between serum levels of the cardiac biomarkers N-terminal pro-B-type natriuretic peptide (NTproBNP), D-dimer, C-reactive protein (CRP), and high-sensitivity troponin (hsTn) and the risk of new CV events in prostate cancer patients with a history of CVD receiving a GnRH agonist or antagonist. METHODS Post-hoc analyses were performed of a phase II randomized study that prospectively assessed CV events in patients with prostate cancer and preexisting CVD, receiving GnRH agonist or antagonist. Cox proportional hazards models were used to determine whether the selected biomarkers had any predictive effect on CV events at baseline and across a 12-month treatment period. RESULTS Baseline and disease characteristics of the 80 patients who took part in the study were well balanced between treatment arms. Ischemic heart disease (66%) and myocardial infarction (37%) were the most common prior CVD and the majority (92%) of patients received CV medication. We found that high levels of NTproBNP (p = 0.008), and hsTn (p = 0.004) at baseline were associated with the development of new CV events in the GnRH agonist group but not in the antagonist. In addition, a nonsignificant trend was observed between higher levels of NTproBNP over time and the development of new CV events in the GnRH agonist group. CONCLUSIONS The use of cardiac biomarkers may be worthy of further study as tools in the prediction of CV risk in prostate cancer patients receiving ADT. Analysis was limited by the small sample size; larger studies are required to validate biomarker use to predict CV events among patients receiving ADT.
Collapse
Affiliation(s)
- David Margel
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yaara Ber
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Avivit Peer
- Department of Oncology, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Liat Shavit-Grievink
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel.,Davidoff Cancer Centre, Rabin Medical Center, Petach Tikva, Israel
| | - Jehonathan H Pinthus
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel
| | - Jack Baniel
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Kedar
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Eli Rosenbaum
- Davidoff Cancer Centre, Rabin Medical Center, Petach Tikva, Israel
| |
Collapse
|
11
|
Roshanov PS, Guyatt GH, Tandon V, Borges FK, Lamy A, Whitlock R, Biccard BM, Szczeklik W, Panju M, Spence J, Garg AX, McGillion M, Eikelboom JW, Sessler DI, Kearon C, Crowther M, VanHelder T, Kavsak PA, de Beer J, Winemaker M, Le Manach Y, Sheth T, Pinthus JH, Siegal D, Thabane L, Simunovic MRI, Mizera R, Ribas S, Devereaux PJ. Preoperative prediction of Bleeding Independently associated with Mortality after noncardiac Surgery (BIMS): an international prospective cohort study. Br J Anaesth 2020; 126:172-180. [PMID: 32718723 DOI: 10.1016/j.bja.2020.02.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 01/14/2020] [Accepted: 02/01/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diagnostic criteria for Bleeding Independently associated with Mortality after noncardiac Surgery (BIMS) have been defined as bleeding that leads to a postoperative haemoglobin <70 g L-1, leads to blood transfusion, or is judged to be the direct cause of death. Preoperative prediction guides for BIMS can facilitate informed consent and planning of perioperative care. METHODS In a prospective cohort study of 16 079 participants aged ≥45 yr having inpatient noncardiac surgery at 12 academic hospitals in eight countries between 2007 and 2011, 17.3% (2782) experienced BIMS. An electronic risk calculator for BIMS was developed and internally validated by logistic regression with bootstrapping, and further simplified to a risk index. Decision curve analysis assessed the potential utility of each prediction guide compared with a strategy of identifying risk of BIMS based on preoperative haemoglobin <120 g L-1. RESULTS With information about the type of surgery, preoperative haemoglobin, age, sex, functional status, kidney function, history of high-risk coronary artery disease, and active cancer, the risk calculator accurately predicted BIMS (bias-corrected C-statistic, 0.84; 95% confidence interval, 0.837-0.852). A simplified index based on preoperative haemoglobin <120 g L-1, open surgery, and high-risk surgery also predicted BIMS, but less accurately (C-statistic, 0.787; 95% confidence interval, 0.779-0.796). Both prediction guides could improve decision making compared with knowledge of haemoglobin <120 g L-1 alone. CONCLUSIONS BIMS, defined as bleeding that leads to a postoperative haemoglobin <70 g L-1, leads to blood transfusion, or that is judged to be the direct cause of death, can be predicted by a simple risk index before surgery. CLINICAL TRIAL REGISTRATION NCT00512109.
Collapse
Affiliation(s)
- Pavel S Roshanov
- Division of Nephrology, London Health Science Centre, London, ON, Canada.
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Vikas Tandon
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Flavia K Borges
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada
| | - Andre Lamy
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Richard Whitlock
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Bruce M Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Observatory, Cape Town, Western Cape, South Africa; University of Cape Town, Rondebosch, Cape Town, Western Cape, South Africa
| | - Wojciech Szczeklik
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Mohamed Panju
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jessica Spence
- Population Health Research Institute, Hamilton, ON, Canada
| | - Amit X Garg
- Division of Nephrology, London Health Science Centre, London, ON, Canada; Institute for Clinical Evaluative Sciences at Western, London, ON, Canada
| | - Michael McGillion
- Population Health Research Institute, Hamilton, ON, Canada; School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - John W Eikelboom
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada
| | - Daniel I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Clive Kearon
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Tomas VanHelder
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Justin de Beer
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Yannick Le Manach
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Tej Sheth
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Deborah Siegal
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Biostatistics Unit, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Marko R I Simunovic
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ryszard Mizera
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sebastian Ribas
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Philip J Devereaux
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada
| |
Collapse
|
12
|
Pinthus JH, Shayegan B, Klotz L, Siemens DR, Luke PP, Niazi T, Fradet V, Fradet Y, Duceppe E, Lavallee L, Mousavi N, Hamilton RJ, Brown I, Chin J, Gopaul D, Violette P, Davis M, Mian R, Karampatos S, Leong D. The prevalence of cardiovascular disease and its risk factors among prostate cancer patients treated with and without androgen deprivation. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.364] [Citation(s) in RCA: 4] [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: 11/20/2022] Open
Abstract
364 Background: Cardiovascular disease (CVD) is the second most common cause of death in prostate cancer (PC) patients, yet the prevalence of CVD and its risk factors have been incompletely described in this population. Androgen deprivation therapy (ADT) is a risk factor for CVD. The objective of this study were to describe the CVD characteristics and risk factors in PC patients and the relationship between CVD risk and how ADT is used in real-world practice. Methods: RADICAL-PC (Role of Androgen Deprivation Therapy in CArdiovascular Disease – A Longitudinal Prostate Cancer Study) is an ongoing prospective cohort study. We recruited 2395 consecutive men (mean age 68 years) with newly diagnosed PC or with a plan to prescribe ADT for the first time. Cardiovascular risk was estimated by calculating Framingham risk scores. A Framingham score >17 (corresponding with a predicted 10-year CVD risk of >30%) was considered high-risk. Multivariable logistic regression was performed with ADT use as the outcome variable and CVD risk factors as the exposures of interest. Results: The prevalence of known CVD for the entire cohort was 22% and 35% had a Framingham risk score >17. Most participants (58%) were current or former smokers; 16% had diabetes; 45% had hypertension and 23% had high blood pressure but had not received a diagnosis of hypertension; 31% were obese (BMI ≥30kg/m2); 24% had low levels of physical activity. There was a positive relationship between each major cardiovascular risk factor and the use of ADT. However, after adjustment for age, education, alcohol use, BMI and time from PC diagnosis to eligibility assessment, these associations were significantly attenuated. Participants in whom ADT was planned had higher Framingham risk scores than those not intending to receive ADT. This risk was abolished after adjustment for confounders. Conclusions: One in three men with PC is at high cardiovascular risk. Men receiving ADT are a priori at higher CVD risk than PC patients whose treatment strategy does not include ADT. These differences are explained by confounding factors. Clinical trial information: NCT03127631.
Collapse
Affiliation(s)
| | - Bobby Shayegan
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Laurence Klotz
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | | | - Tamim Niazi
- Jewish General Hospital, McGill University, Montreal, QC, Canada
| | | | | | | | | | | | - Robert James Hamilton
- Division of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ian Brown
- Niagara Health System, Niagara Falls, ON, Canada
| | - Joseph Chin
- London Health Sciences Centre, London, ON, Canada
| | | | | | - Margot Davis
- UBC Faculty of Medicine, Department of Cardiology, Vancouver, BC, Canada
| | | | | | | | | |
Collapse
|
13
|
Nguyen EK, Yu H, Pond G, Shayegan B, Pinthus JH, Kapoor A, Mukherjee SD, Neville A, Lalani AKA, Hotte SJ, Corbett TB, Dayes IS, Lukka HR. Outcomes of trimodality bladder-sparing therapy for muscle-invasive bladder cancer. Can Urol Assoc J 2019; 14:122-129. [PMID: 31702551 DOI: 10.5489/cuaj.5945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although radical cystectomy is considered the standard of care for muscle-invasive bladder cancer (MIBC), recent data has suggested comparable survival outcomes for bladder-sparing trimodality therapy (TMT). We conducted a retrospective, single-institution analysis of MIBC patients to evaluate the efficacy of TMT as an alternative, curative approach to surgical intervention. METHODS We conducted a retrospective analysis of MIBC patients assessed by a multidisciplinary team at the Juravinski Cancer Centre from 2010-2016. Patients underwent transurethral resection of bladder tumor (TURBT) followed by radiotherapy with or without concurrent chemotherapy. Patients could receive neoadjuvant treatment. Clinical data and response rates were summarized, and overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. RESULTS Our analytic cohort included 115 patients, of whom 53 underwent TMT and 62 underwent radiotherapy alone following TURBT. Median age at diagnosis was 79 years and median followup was 21 months. Complete response rates in those receiving TMT and radiation without chemotherapy were 84.4% and 66.7%, respectively. For TMT patients, three-year OS and DFS were 68.5% and 49.6%, respectively. Patients who received TMT had reduction in risk of mortality (hazard ratio [HR] 0.49; p=0.026) and disease recurrence (HR 0.55; p=0.017) compared to those who had radiation without chemotherapy. Overall, four patients had grade 3 or higher late toxicity. CONCLUSIONS In this single-institution analysis, TMT appears to be a safe and effective approach in the short-term management of MIBC in appropriately selected patients. Extended followup and analysis are necessary to validate these results.
Collapse
Affiliation(s)
- Eric K Nguyen
- Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | - Hang Yu
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gregory Pond
- Escarpment Cancer Research Institute, McMaster University, Hamilton, ON, Canada
| | - Bobby Shayegan
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jehonathan H Pinthus
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Anil Kapoor
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Som D Mukherjee
- Division of Medical Oncology, McMaster University, Hamilton, ON, Canada
| | - Alan Neville
- Division of Medical Oncology, McMaster University, Hamilton, ON, Canada
| | - Aly-Khan A Lalani
- Division of Medical Oncology, McMaster University, Hamilton, ON, Canada
| | - Sebastien J Hotte
- Division of Medical Oncology, McMaster University, Hamilton, ON, Canada
| | - Thomas B Corbett
- Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | - Ian S Dayes
- Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | - Himanshu R Lukka
- Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
14
|
Yoneyama T, Tobisawa Y, Kaneko T, Kaya T, Hatakeyama S, Mori K, Sutoh Yoneyama M, Okubo T, Mitsuzuka K, Duivenvoorden W, Pinthus JH, Hashimoto Y, Ito A, Koie T, Suda Y, Gardiner RA, Ohyama C. Clinical significance of the LacdiNAc-glycosylated prostate-specific antigen assay for prostate cancer detection. Cancer Sci 2019; 110:2573-2589. [PMID: 31145522 PMCID: PMC6676104 DOI: 10.1111/cas.14082] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/27/2019] [Accepted: 05/29/2019] [Indexed: 01/02/2023] Open
Abstract
To reduce unnecessary prostate biopsies (Pbx), better discrimination is needed. To identify clinically significant prostate cancer (CSPC) we determined the performance of LacdiNAc‐glycosylated prostate‐specific antigen (LDN‐PSA) and LDN‐PSA normalized by prostate volume (LDN‐PSAD). We retrospectively measured LDN‐PSA, total PSA (tPSA), and free PSA/tPSA (F/T PSA) values in 718 men who underwent a Pbx in 3 academic urology clinics in Japan and Canada (Pbx cohort) and in 174 PC patients who subsequently underwent radical prostatectomy in Australia (preop‐PSA cohort). The assays were evaluated using the area under the receiver operating characteristics curve (AUC) and decision curve analyses to discriminate CSPC. In the Pbx cohort, LDN‐PSAD (AUC 0.860) provided significantly better clinical performance for discriminating CSPC compared with LDN‐PSA (AUC 0.827, P = 0.0024), PSAD (AUC 0.809, P < 0.0001), tPSA (AUC 0.712, P < 0.0001), and F/T PSA (AUC 0.661, P < 0.0001). The decision curve analysis showed that using a risk threshold of 20% and adding LDN‐PSA and LDN‐PSAD to the base model (age, digital rectal examination status, tPSA, and F/T PSA) permitted avoidance of even more biopsies without missing CSPC (9.89% and 18.11%, respectively vs 2.23% [base model]). In the preop‐PSA cohort, LDN‐PSA values positively correlated with tumor volume and tPSA and were significantly higher in pT3, pathological Gleason score ≥ 7. Limitations include limited sample size, retrospective nature, and no family history information prior to biopsy. LacdiNAc‐glycosylated PSA is significantly better than the conventional PSA test in identifying patients with CSPC. This study was approved by the ethics committee of each institution (“The Study about Carbohydrate Structure Change in Urological Disease”; approval no. 2014‐195).
Collapse
Affiliation(s)
- Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Takatoshi Kaya
- Corporate R&D Headquarters, Konica Minolta, Tokyo, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kazuyuki Mori
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Mihoko Sutoh Yoneyama
- Department of Cancer Immunology and Cell Biology, Oyokyo Kidney Research Institute, Hirosaki, Japan
| | - Teppei Okubo
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koji Mitsuzuka
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | | | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yoshihiko Suda
- Corporate R&D Headquarters, Konica Minolta, Tokyo, Japan
| | - Robert A Gardiner
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Chikara Ohyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
15
|
Margel D, Peer A, Ber Y, Sela S, Shavit Grievink L, Tabachnik T, Witberg G, Baniel J, Kedar D, Duivenvoorden WCM, Rosenbaum E, Pinthus JH. Cardiovascular morbidity in a randomized trial comparing GnRH-agonist and antagonist among patients with advanced prostate cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5015] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5015 Background: Androgen-deprivation therapy (ADT) used in prostate-cancer may increase risk of cardiovascular disease (CVD). Limited preclinical and retrospective clinical data suggest that use of gonadotrophin-releasing hormone (GnRH)-antagonist may be associated with lower risk of CVD compared to GnRH-agonist. Methods: We conducted a randomized open-label study comparing the one year incidence of major cardiovascular and cerebrovascular event (MACCE) in prostate-cancer patients with pre-existing CVD commencing on GnRH-agonists or antagonists. Patients were followed every 3 months for the development of MACCE defined as either death, myocardial infarction (MI), cerebrovascular event (CVA), or percutaneous-coronary intervention (PCI). Serum levels of N-terminal pro-B-type natriuretic peptide (NTproBNP) were analyzed at baseline, 3, 6 and 12-months. Results: Eighty patients were enrolled (41 randomized to GnRH-antagonist, 39 to GnRH-agonist). Patients in both arms had similar age, baseline cardiovascular and prostate-cancer characteristics. During follow-up 15 patients developed a new cardiovascular event. Of these, nine patients developed MACCE (two deaths, one MI, two CVAs, and four PCI). Twenty percent (n = 8) of patients randomized to GnRH-agonists had a MACCE compared to 3% (n = 1) randomized to antagonists (log-rank p = 0.013). The absolute risk reduction for MACCE at 12 months using GnRH-antagonist was 18% (95%CI 5-31). Baseline levels of NTproBNP predicted events (AUC = 0.73 95%CI 0.54-0.91 p = 0.03) and increased over time only among patients with CV events. Conclusions: This is the first prospective study to test cardiovascular outcome among prostate-cancer patients receiving ADT. We demonstrated that in patients with pre-existing CVD, GnRH-antagonists was associated with development of fewer cardiovascular events compared to GnRH-agonists. Clinical trial information: NCT02475057.
Collapse
Affiliation(s)
| | | | - Yaara Ber
- Rabin Medical Center, Petah Tikva, Israel
| | - Sivan Sela
- Rabin Medical Center, Petah Tikva, Israel
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Zareba P, Pinthus JH, Russo P. The contemporary role of lymph node dissection in the management of renal cell carcinoma. Ther Adv Urol 2018; 10:335-342. [PMID: 30344645 DOI: 10.1177/1756287218794094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 06/22/2018] [Indexed: 01/19/2023] Open
Abstract
The appropriate role of lymph node dissection (LND) in the management of patients with renal cell carcinoma (RCC) is still a matter of debate. There is ample evidence that LND is the most accurate modality for staging the regional lymph nodes (LNs), which may harbor metastatic disease in greater than one-third of patients with high-risk RCC. The presence of LN metastases is an independent negative prognostic factor in this disease and accurate determination of LN status not only helps with patient counselling regarding prognosis and tailoring of postoperative surveillance schedules, but it also identifies patients at high risk of systemic disease recurrence who may qualify for clinical trials of adjuvant systemic therapies. Meanwhile, the therapeutic value of LND has been brought into question by a randomized trial (European Organisation for Research and Treatment of Cancer; EORTC 30881) that showed no difference in progression-free or overall survival between patients who were treated with radical nephrectomy (RN) and LND and those treated with RN alone. Given that most patients enrolled in this trial had small renal masses and therefore were at low risk for LN metastases, the question of whether patients with high-risk tumors derive a therapeutic benefit from a standardized, extended LND remains unanswered.
Collapse
Affiliation(s)
- Piotr Zareba
- Juravinski Hospital and Cancer Centre, B3-146, 711 Concession Street, Hamilton, Ontario, Canada, L8V 1C3
| | - Jehonathan H Pinthus
- Division of Urology, McMaster University, Hamilton, Ontario, Canada Juravinski Hospital and Cancer Centre, Hamilton, Ontario, Canada
| | - Paul Russo
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
17
|
Di Sebastiano KM, Pinthus JH, Duivenvoorden WCM, Mourtzakis M. Glucose impairments and insulin resistance in prostate cancer: the role of obesity, nutrition and exercise. Obes Rev 2018; 19:1008-1016. [PMID: 29573216 DOI: 10.1111/obr.12674] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/04/2018] [Accepted: 01/15/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hyperinsulinemia, obesity and related metabolic diseases are associated with prostate cancer development. Prostate cancer patients undergoing androgen deprivation therapy (ADT) are at increased risk for metabolic syndrome, cardiovascular disease and diabetes, while pre-existing metabolic conditions may be exacerbated. PURPOSE An integrative approach is used to describe the interactions between insulin, glucose metabolism, obesity and prostate cancer. The potential role of nutrition and exercise will also be examined. FINDINGS Hyperinsulinemia is associated with prostate cancer development, progression and aggressiveness. Prostate cancer patients who undergo ADT are at risk of diabetes in survivorship. It is unclear whether this is a direct result of treatment or related to pre-existing metabolic features (e.g. hyperinsulinemia and obesity). Obesity and metabolic syndrome are also associated with prostate cancer development and poorer outcomes for cancer survivors, which may be driven by hyperinsulinemia, pro-inflammation, hyperleptinemia and/or hypoadiponectinemia. CONCLUSIONS Independently evaluating changes in glucose metabolism near the time of prostate cancer diagnosis and during long-term ADT treatment is important to distinguish their unique contributions to the development of metabolic disturbances. Integrative approaches, including metabolic, clinical and body composition measures, are needed to understand the role of adiposity and insulin resistance in prostate cancer and to develop effective nutrition and exercise interventions to improve secondary diseases in survivorship.
Collapse
Affiliation(s)
- K M Di Sebastiano
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - J H Pinthus
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - W C M Duivenvoorden
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - M Mourtzakis
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| |
Collapse
|
18
|
Abstract
Patients with bladder cancer are at high risk of developing both venous and arterial thromboembolic events. Factors that contribute to this phenomenon include the hypercoagulable state induced by the malignancy itself, medical comorbidities that are common in this predominantly elderly patient population as well as treatments such as prolonged pelvic surgery and cisplatin-based chemotherapy. While formal guidelines address prevention of venous thromboembolism in patients undergoing radical cystectomy, consensus regarding the role of pharmacologic prophylaxis in patients with bladder cancer being treated with chemotherapy, either with neoadjuvant or adjuvant intent in conjunction with radical cystectomy, as part of bladder preservation protocols or for metastatic disease, has proved elusive. The present narrative review was undertaken to define the incidence of and identify risk factors for thromboembolism among patients with bladder cancer, as well as to assess the efficacy of pharmacologic prophylaxis in reducing the risk of thromboembolism in this patient population.
Collapse
Affiliation(s)
- Piotr Zareba
- Division of Urology, McMaster University, Hamilton, ON, Canada
- Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
| | | | - Jehonathan H. Pinthus
- Division of Urology, McMaster University, Hamilton, ON, Canada
- Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
| |
Collapse
|
19
|
Yoneyama T, Ishikawa T, Tobisawa Y, Hatakeyama S, Date M, Nakamura K, Narita S, Mitsuzuka K, Duivenvoorden W, Pinthus JH, Hashimoto Y, Koie T, Habuchi T, Arai Y, Ohyama C. PD56-07 COMPARISON WITH DIAGNOSTIC PERFORMANCE BETWEEN ABERRANT GLYCOSYLATED S2,3PSA TEST AND CONVENTIONAL PSA TESTS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Al-Hashimi AA, Lebeau P, Majeed F, Polena E, Lhotak Š, Collins CAF, Pinthus JH, Gonzalez-Gronow M, Hoogenes J, Pizzo SV, Crowther M, Kapoor A, Rak J, Gyulay G, D'Angelo S, Marchiò S, Pasqualini R, Arap W, Shayegan B, Austin RC. Autoantibodies against the cell surface-associated chaperone GRP78 stimulate tumor growth via tissue factor. J Biol Chem 2017; 292:21180-21192. [PMID: 29066620 PMCID: PMC5743090 DOI: 10.1074/jbc.m117.799908] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 05/31/2017] [Revised: 09/05/2017] [Indexed: 12/24/2022] Open
Abstract
Tumor cells display on their surface several molecular chaperones that normally reside in the endoplasmic reticulum. Because this display is unique to cancer cells, these chaperones are attractive targets for drug development. Previous epitope-mapping of autoantibodies (AutoAbs) from prostate cancer patients identified the 78-kDa glucose-regulated protein (GRP78) as one such target. Although we previously showed that anti-GRP78 AutoAbs increase tissue factor (TF) procoagulant activity on the surface of tumor cells, the direct effect of TF activation on tumor growth was not examined. In this study, we explore the interplay between the AutoAbs against cell surface-associated GRP78, TF expression/activity, and prostate cancer progression. First, we show that tumor GRP78 expression correlates with disease stage and that anti-GRP78 AutoAb levels parallel prostate-specific antigen concentrations in patient-derived serum samples. Second, we demonstrate that these anti-GRP78 AutoAbs target cell-surface GRP78, activating the unfolded protein response and inducing tumor cell proliferation through a TF-dependent mechanism, a specific effect reversed by neutralization or immunodepletion of the AutoAb pool. Finally, these AutoAbs enhance tumor growth in mice bearing human prostate cancer xenografts, and heparin derivatives specifically abrogate this effect by blocking AutoAb binding to cell-surface GRP78 and decreasing TF expression/activity. Together, these results establish a molecular mechanism in which AutoAbs against cell-surface GRP78 drive TF-mediated tumor progression in an experimental model of prostate cancer. Heparin derivatives counteract this mechanism and, as such, represent potentially appealing compounds to be evaluated in well-designed translational clinical trials.
Collapse
Affiliation(s)
- Ali A Al-Hashimi
- From the Department of Medicine, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8N 4A6, Canada
- the Department of Surgery, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8N 4A6, Canada
| | - Paul Lebeau
- From the Department of Medicine, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8N 4A6, Canada
| | - Fadwa Majeed
- From the Department of Medicine, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8N 4A6, Canada
| | - Enio Polena
- From the Department of Medicine, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8N 4A6, Canada
| | - Šárka Lhotak
- From the Department of Medicine, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8N 4A6, Canada
| | - Celeste A F Collins
- From the Department of Medicine, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8N 4A6, Canada
| | - Jehonathan H Pinthus
- From the Department of Medicine, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8N 4A6, Canada
- the Department of Surgery, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8N 4A6, Canada
| | - Mario Gonzalez-Gronow
- the Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710
| | - Jen Hoogenes
- From the Department of Medicine, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8N 4A6, Canada
- the Department of Surgery, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8N 4A6, Canada
| | - Salvatore V Pizzo
- the Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710
| | - Mark Crowther
- From the Department of Medicine, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8N 4A6, Canada
| | - Anil Kapoor
- From the Department of Medicine, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8N 4A6, Canada
- the Department of Surgery, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8N 4A6, Canada
| | - Janusz Rak
- the Department of Pediatrics, Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec H3A 0G4, Canada
| | - Gabriel Gyulay
- From the Department of Medicine, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8N 4A6, Canada
| | - Sara D'Angelo
- the University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico 87106
- the Divisions of Molecular Medicine and
| | - Serena Marchiò
- the University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico 87106
- the Divisions of Molecular Medicine and
- the Department of Oncology, University of Turin, 10124 Turin, Italy, and
- the Candiolo Cancer Institute-Fondazione del Piemonte per l'Oncologia (FPO)-Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 10060 Candiolo, Italy
| | - Renata Pasqualini
- the University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico 87106
- the Divisions of Molecular Medicine and
| | - Wadih Arap
- the University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico 87106
- Hematology/Oncology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131
| | - Bobby Shayegan
- From the Department of Medicine, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8N 4A6, Canada
- the Department of Surgery, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8N 4A6, Canada
| | - Richard C Austin
- From the Department of Medicine, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario L8N 4A6, Canada,
| |
Collapse
|
21
|
Roshanov PS, Eikelboom JW, Crowther M, Tandon V, Borges FK, Kearon C, Lamy A, Whitlock R, Biccard BM, Szczeklik W, Guyatt GH, Panju M, Spence J, Garg AX, McGillion M, VanHelder T, Kavsak PA, de Beer J, Winemaker M, Sessler DI, Le Manach Y, Sheth T, Pinthus JH, Thabane L, Simunovic MRI, Mizera R, Ribas S, Devereaux PJ. Bleeding impacting mortality after noncardiac surgery: a protocol to establish diagnostic criteria, estimate prognostic importance, and develop and validate a prediction guide in an international prospective cohort study. CMAJ Open 2017; 5:E594-E603. [PMID: 28943515 PMCID: PMC5963363 DOI: 10.9778/cmajo.20160106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/30/2022] Open
Abstract
INTRODUCTION Various definitions of bleeding have been used in perioperative studies without systematic assessment of the diagnostic criteria for their independent association with outcomes important to patients. Our proposed definition of bleeding impacting mortality after noncardiac surgery (BIMS) is bleeding that is independently associated with death during or within 30 days after noncardiac surgery. We describe our analysis plan to sequentially 1) establish the diagnostic criteria for BIMS, 2) estimate the independent contribution of BIMS to 30-day mortality and 3) develop and internally validate a clinical prediction guide to estimate patient-specific risk of BIMS. METHODS In the Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) study, we prospectively collected bleeding data for 16 079 patients aged 45 years or more who had noncardiac inpatient surgery between 2007 and 2011 at 12 centres in 8 countries across 5 continents. We will include bleeding features independently associated with 30-day mortality in the diagnostic criteria for BIMS. Candidate features will include the need for reoperation due to bleeding, the number of units of erythrocytes transfused, the lowest postoperative hemoglobin concentration, and the absolute and relative decrements in hemoglobin concentration from the preoperative value. We will then estimate the incidence of BIMS and its independent association with 30-day mortality. Last, we will construct and internally validate a clinical prediction guide for BIMS. INTERPRETATION This study will address an important gap in our knowledge about perioperative bleeding, with implications for the 200 million patients who undergo noncardiac surgery globally every year. Trial registration: ClinicalTrials.gov, no NCT00512109.
Collapse
Affiliation(s)
- Pavel S Roshanov
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - John W Eikelboom
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Mark Crowther
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Vikas Tandon
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Flavia K Borges
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Clive Kearon
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Andre Lamy
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Richard Whitlock
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Bruce M Biccard
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Wojciech Szczeklik
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Gordon H Guyatt
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Mohamed Panju
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Jessica Spence
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Amit X Garg
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Michael McGillion
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Tomas VanHelder
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Peter A Kavsak
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Justin de Beer
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Mitchell Winemaker
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Daniel I Sessler
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Yannick Le Manach
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Tej Sheth
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Jehonathan H Pinthus
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Lehana Thabane
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Marko R I Simunovic
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Ryszard Mizera
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - Sebastian Ribas
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| | - P J Devereaux
- Affiliations: Lilibeth Caberto Kidney Clinical Research Unit (Roshanov, Garg), London Health Sciences Centre, London, Ont.; Department of Medicine (Eikelboom, Tandon, Borges, Kearon, Panju, Sheth, Mizera, Ribas, Devereaux), Department of Surgery (Lamy, Whitlock, de Beer, Winemaker, Pinthus, Simunovic), Department of Health Research Methods, Evidence, and Impact (Lamy, Guyatt, Le Manach, Thabane, Simunovic, Devereaux), Department of Pathology and Molecular Medicine (Crowther, Kavsak), Department of Anesthesia (Spence, VanHelder, Le Manach), Thrombosis and Atherosclerosis Research Institute (Kearon) and School of Nursing (McGillion), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Population Health Research Institute (Eikelboom, Borges, Lamy, Whitlock, Spence, McGillion, Le Manach, Devereaux), Hamilton, Ont.; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital, Observatory, South Africa, and University of Cape Town, South Africa; Department of Intensive Care and Perioperative Medicine (Szczeklik), Jagiellonian University Medical College, Krakow, Poland; Institute for Clinical Evaluative Sciences at Western (Garg), London, Ont.; Faculty of Health and Life Sciences (McGillion), Coventry University, Coventry, United Kingdom; Department of Outcomes Research (Sessler), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.; Biostatistics Unit (Thabane), St. Joseph's Healthcare, Hamilton, Ont
| |
Collapse
|
22
|
Pinthus JH, Duivenvoorden WC. Does androgen-deprivation therapy for prostate cancer increase the risk for thromboembolic disease? Can Urol Assoc J 2017; 11:39-40. [PMID: 28443143 DOI: 10.5489/cuaj.4394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jehonathan H Pinthus
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | | |
Collapse
|
23
|
Duivenvoorden WCM, Hopmans SN, Austin RC, Pinthus JH. Endoplasmic reticulum protein ERp46 in prostate adenocarcinoma. Oncol Lett 2017; 13:3624-3630. [PMID: 28521463 PMCID: PMC5431273 DOI: 10.3892/ol.2017.5908] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/31/2017] [Indexed: 11/23/2022] Open
Abstract
Endoplasmic reticulum (ER) protein ERp46 is a member of the protein disulfide isomerase family of oxidoreductases, which facilitates the reduction of disulfides in proteins and their folding. Accumulation of misfolded proteins has been implicated in cancer. The objectives of the present study were to investigate the role of ERp46 in prostate cancer, its expression and its effects on prostate cancer growth. A tissue microarray with human prostate cancer and normal prostate tissue samples was stained for ERp46 followed by image analysis. Human prostate adenocarcinoma 22Rv1 cells were stably transfected with short hairpin RNA (shRNA) specific for ERp46, a non-effective scrambled control or a plasmid containing full-length human ERp46 cDNA, and cell growth was determined. Subcloned cells were treated with thapsigargin or tunicamycin to induce ER stress and lysates were subjected to western blot analysis for ER stress proteins. Subcutaneous xenografts of parental 22Rv1, ERp46-overexpressing (ERp46+), shERp46 or scrambled control cells were established in male inbred BALB/c nude mice (n=10/group). Tumor growth curves of the xenografts were constructed over a period of 30 days and subsequently the mice were sacrificed and the amount of serum prostate-specific antigen was determined. The results demonstrated increased ERp46 expression levels in prostate cancer tissue samples of Gleason ≥7 compared with normal prostate tissue samples. When ERp46 was stably knocked down using shRNA or overexpressed in prostate carcinoma 22Rv1 cells, tumor growth in vitro and in BALB/c nude mice was inhibited and accelerated, respectively. ERp46 overexpression led to reduced sensitivity to ER stress as indicated by higher half maximal inhibitory concentrations for tunicamycin and thapsigargin in ERp46+ cells. The shERp46 cells lost the ability to upregulate protein disulfide isomerase following tunicamycin-induced ER stress. The present study suggests a role for ERp46 as a therapeutic target in prostate cancer, given its expression profile in human prostate cancer, and its effect on prostate cancer cell growth.
Collapse
Affiliation(s)
- Wilhelmina C M Duivenvoorden
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON L8V 1C3, Canada.,Research Institute of St. Joseph's, St. Joseph's Healthcare, Hamilton, ON L8N 4A6, Canada
| | - Sarah N Hopmans
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON L8V 1C3, Canada
| | - Richard C Austin
- Research Institute of St. Joseph's, St. Joseph's Healthcare, Hamilton, ON L8N 4A6, Canada.,Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Jehonathan H Pinthus
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON L8V 1C3, Canada.,Research Institute of St. Joseph's, St. Joseph's Healthcare, Hamilton, ON L8N 4A6, Canada
| |
Collapse
|
24
|
Crawford ED, Schally AV, Pinthus JH, Block NL, Rick FG, Garnick MB, Eckel RH, Keane TE, Shore ND, Dahdal DN, Beveridge TJR, Marshall DC. The potential role of follicle-stimulating hormone in the cardiovascular, metabolic, skeletal, and cognitive effects associated with androgen deprivation therapy. Urol Oncol 2017; 35:183-191. [PMID: 28325650 DOI: 10.1016/j.urolonc.2017.01.025] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 01/20/2017] [Accepted: 01/24/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore how follicle-stimulating hormone (FSH) may contribute to cardiovascular, metabolic, skeletal, and cognitive events in men treated for prostate cancer, with various forms of androgen deprivation therapy (ADT). MATERIALS AND METHODS A colloquium of prostate cancer experts was convened in May 2015, to discuss the role of FSH in the development of unwanted effects associated with ADT. Subsequently, a literature review (Medline, PubMed, and relevant congress abstract databases) was performed to further explore and evaluate the collected evidence. RESULTS It has become evident that, in the setting of ADT, FSH can promote the development of atherosclerotic plaque formation, metabolic syndrome, and insulin resistance. Data also suggest that FSH is an important mediator of bone remodeling, particularly bone resorption, and thereby increases the risk for bone fracture. Additional evidence implicates a role for FSH in bone metastasis as well. The influence of FSH on ADT-induced cognitive deficits awaits further elucidation; however, the possibility that FSH may be involved therein cannot be ruled out. CONCLUSIONS The widespread molecular and physiological consequences of FSH system activation in normal and pathological conditions are becoming better understood. Progress in this area has been achieved by the development of additional investigative and clinical measures to better evaluate specific adverse effects. More research is needed on FSH function in the development of cancer as well as its association with cardiovascular, metabolic, musculoskeletal, and cognitive effects in ADT.
Collapse
Affiliation(s)
- E David Crawford
- Department of Urologic Oncology, School of Medicine, University of Colorado, Denver, Denver, CO.
| | - Andrew V Schally
- Endocrine, Polypeptide and Cancer Institute, Miami Veterans Affairs Medical Center, Miami, FL; Department of Pathology, University of Miami School of Medicine, Miami, FL; Department of Medicine, University of Miami School of Medicine, Miami, FL
| | - Jehonathan H Pinthus
- Department of Surgery, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Norman L Block
- Endocrine, Polypeptide and Cancer Institute, Miami Veterans Affairs Medical Center, Miami, FL; Department of Pathology, University of Miami School of Medicine, Miami, FL; Department of Medicine, University of Miami School of Medicine, Miami, FL
| | - Ferenc G Rick
- Endocrine, Polypeptide and Cancer Institute, Miami Veterans Affairs Medical Center, Miami, FL; Department of Urology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Marc B Garnick
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Robert H Eckel
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado, Denver, CO
| | - Thomas E Keane
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC
| | | | | | | |
Collapse
|
25
|
Ishikawa T, Yoneyama T, Tobisawa Y, Hatakeyama S, Kurosawa T, Nakamura K, Narita S, Mitsuzuka K, Duivenvoorden W, Pinthus JH, Hashimoto Y, Koie T, Habuchi T, Arai Y, Ohyama C. An Automated Micro-Total Immunoassay System for Measuring Cancer-Associated α2,3-linked Sialyl N-Glycan-Carrying Prostate-Specific Antigen May Improve the Accuracy of Prostate Cancer Diagnosis. Int J Mol Sci 2017; 18:ijms18020470. [PMID: 28241428 PMCID: PMC5344002 DOI: 10.3390/ijms18020470] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/17/2017] [Accepted: 02/18/2017] [Indexed: 11/16/2022] Open
Abstract
The low specificity of the prostate-specific antigen (PSA) for early detection of prostate cancer (PCa) is a major issue worldwide. The aim of this study to examine whether the serum PCa-associated α2,3-linked sialyl N-glycan-carrying PSA (S2,3PSA) ratio measured by automated micro-total immunoassay systems (μTAS system) can be applied as a diagnostic marker of PCa. The μTAS system can utilize affinity-based separation involving noncovalent interaction between the immunocomplex of S2,3PSA and Maackia amurensis lectin to simultaneously determine concentrations of free PSA and S2,3PSA. To validate quantitative performance, both recombinant S2,3PSA and benign-associated α2,6-linked sialyl N-glycan-carrying PSA (S2,6PSA) purified from culture supernatant of PSA cDNA transiently-transfected Chinese hamster ovary (CHO)-K1 cells were used as standard protein. Between 2007 and 2016, fifty patients with biopsy-proven PCa were pair-matched for age and PSA levels, with the same number of benign prostatic hyperplasia (BPH) patients used to validate the diagnostic performance of serum S2,3PSA ratio. A recombinant S2,3PSA- and S2,6PSA-spiked sample was clearly discriminated by μTAS system. Limit of detection of S2,3PSA was 0.05 ng/mL and coefficient variation was less than 3.1%. The area under the curve (AUC) for detection of PCa for the S2,3PSA ratio (%S2,3PSA) with cutoff value 43.85% (AUC; 0.8340) was much superior to total PSA (AUC; 0.5062) using validation sample set. Although the present results are preliminary, the newly developed μTAS platform for measuring %S2,3PSA can achieve the required assay performance specifications for use in the practical and clinical setting and may improve the accuracy of PCa diagnosis. Additional validation studies are warranted.
Collapse
Affiliation(s)
- Tomokazu Ishikawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
- Diagnostics Research Laboratories, Wako Pure Chemical Industries, Hyogo 661-0963, Japan.
| | - Tohru Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
| | - Tatsuo Kurosawa
- Diagnostics Research Laboratories, Wako Pure Chemical Industries, Hyogo 661-0963, Japan.
| | - Kenji Nakamura
- Diagnostics Research Laboratories, Wako Pure Chemical Industries, Hyogo 661-0963, Japan.
| | - Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan.
| | - Koji Mitsuzuka
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan.
| | | | | | - Yasuhiro Hashimoto
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
| | - Takuya Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan.
| | - Yoichi Arai
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan.
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
| |
Collapse
|
26
|
Di Sebastiano KM, Pinthus JH, Duivenvoorden WCM, Patterson L, Dubin JA, Mourtzakis M. Elevated C-Peptides, Abdominal Obesity, and Abnormal Adipokine Profile are Associated With Higher Gleason Scores in Prostate Cancer. Prostate 2017; 77:211-221. [PMID: 27699825 DOI: 10.1002/pros.23262] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/12/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prostate cancer development is associated with numerous lifestyle factors (i.e., physical activity, nutrition intake) and metabolic perturbations. These factors have been studied independently; here, we used an integrative approach to characterize these lifestyle and metabolic parameters in men undergoing diagnostic prostate biopsies. METHODS We prospectively evaluated 51 consecutive men for body composition, metabolic factors including glucose- and lipid-related measures, as well as lifestyle factors prior to prostate biopsy. Evaluations were performed in a blinded manner and were subsequently related to biopsy outcomes for: (i) presence or absence of cancer; and (ii) where cancer was present, Gleason score. RESULTS Serum C-peptide concentrations were significantly greater in participants with Gleason scores ≥4 + 3 (2.8 ± 1.1 ng/ml) compared to those with Gleason 3 + 3 (1.4 ± 0.6 ng/ml) or Gleason 3 + 4 (1.3 ± 0.8 ng/ml, P = 0.002), suggesting greater insulin secretion despite lack of differences in fasting glucose concentrations. Central adiposity, measured by waist circumference, was significantly greater in participants with Gleason ≥4 + 3 (110.1 ± 7.4 cm) compared to those with Gleason 3 + 4 (102.0 ± 9.5 cm, P = 0.028). Men with Gleason ≥4 + 3 also had significantly greater leptin concentrations than those with lower Gleason scores (Gleason ≥4 + 3: 15.6 ± 3.3 ng/ml vs. Gleason 3 + 4: 8.1 ± 8.1 ng/ml, P < 0.05) and leptin:adiponectin ratio (Gleason ≥4 + 3: 9.7 ± 6.1 AU, Gleason 3 + 4: 2.9 ± 3.2, Gleason 3 + 3: 2.4 ± 2.1 AU, P = 0.013). CONCLUSIONS We profiled a cluster of obesity-related metabolic perturbations (C-peptide, central adiposity, leptin, and leptin:adiponectin ratios) which may associate with more aggressive prostate cancer histology. Prostate 77:211-221, 2017. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
| | - Jehonathan H Pinthus
- Department of Surgery, Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | | | - Laurel Patterson
- Department of Surgery, Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Joel A Dubin
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Marina Mourtzakis
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
27
|
Duivenvoorden WC, Daneshmand S, Canter D, Lotan Y, Black PC, Abdi H, van Rhijn BW, Fransen van de Putte EE, Zareba P, Koskinen I, Kassouf W, Traboulsi SL, Kukreja JE, Boström PJ, Shayegan B, Pinthus JH. Incidence, Characteristics and Implications of Thromboembolic Events in Patients with Muscle Invasive Urothelial Carcinoma of the Bladder Undergoing Neoadjuvant Chemotherapy. J Urol 2016; 196:1627-1633. [DOI: 10.1016/j.juro.2016.06.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2016] [Indexed: 11/15/2022]
Affiliation(s)
| | - Siamak Daneshmand
- University of Southern California-Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Daniel Canter
- Fox Chase Cancer Center, Einstein Health Network and Urologic Institute of Southeastern Pennsylvania, Philadelphia, Pennsylvania
| | - Yair Lotan
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Peter C. Black
- Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hamidreza Abdi
- Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bas W.G. van Rhijn
- Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Piotr Zareba
- McMaster University and Juravinski Hospital, Hamilton, Ontario, Canada
| | - Ilmari Koskinen
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | | | | | - Peter J. Boström
- Turku University Hospital and University of Turku, Turku, Finland
| | - Bobby Shayegan
- McMaster University and Juravinski Hospital, Hamilton, Ontario, Canada
| | | |
Collapse
|
28
|
Pinthus JH, Di Sebastiano KM, Duivenvoorden WC, Dubin JA, Mourtzakis M. MP07-12 ABDOMINAL OBESITY, ALTERED ADIPOKYNES AND ELEVATED C-PEPTIDE LEVELS ARE ASSOCIATED WITH HIGH GLEASON SCORE IN PATIENTS UNDERGOING DIAGNOSTIC PROSTATE BIOPSY: DATA FROM PROSPECTIVE REGISTRY. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
29
|
Yan J, Ojo D, Kapoor A, Lin X, Pinthus JH, Aziz T, Bismar TA, Wei F, Wong N, De Melo J, Cutz JC, Major P, Wood G, Peng H, Tang D. Neural Cell Adhesion Protein CNTN1 Promotes the Metastatic Progression of Prostate Cancer. Cancer Res 2016; 76:1603-14. [PMID: 26795349 DOI: 10.1158/0008-5472.can-15-1898] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 12/28/2015] [Indexed: 11/16/2022]
Abstract
Prostate cancer metastasis is the main cause of disease-related mortality. Elucidating the mechanisms underlying prostate cancer metastasis is critical for effective therapeutic intervention. In this study, we performed gene-expression profiling of prostate cancer stem-like cells (PCSC) derived from DU145 human prostate cancer cells to identify factors involved in metastatic progression. Our studies revealed contactin 1 (CNTN1), a neural cell adhesion protein, to be a prostate cancer-promoting factor. CNTN1 knockdown reduced PCSC-mediated tumor initiation, whereas CNTN1 overexpression enhanced prostate cancer cell invasion in vitro and promoted xenograft tumor formation and lung metastasis in vivo. In addition, CNTN1 overexpression in DU145 cells and corresponding xenograft tumors resulted in elevated AKT activation and reduced E-cadherin (CDH1) expression. CNTN1 expression was not readily detected in normal prostate glands, but was clearly evident on prostate cancer cells in primary tumors and lymph node and bone metastases. Tumors from 637 patients expressing CNTN1 were associated with prostate cancer progression and worse biochemical recurrence-free survival following radical prostatectomy (P < 0.05). Collectively, our findings demonstrate that CNTN1 promotes prostate cancer progression and metastasis, prompting further investigation into the mechanisms that enable neural proteins to become aberrantly expressed in non-neural malignancies.
Collapse
Affiliation(s)
- Judy Yan
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Diane Ojo
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Anil Kapoor
- Department of Surgery, McMaster University, Hamilton, Canada
| | - Xiaozeng Lin
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Tariq Aziz
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Tarek A Bismar
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
| | - Fengxiang Wei
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Canada. The Genetics Laboratory, Institute of Women and Children's Health, Longgang District, Shenzhen, China
| | - Nicholas Wong
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Jason De Melo
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Jean-Claude Cutz
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Pierre Major
- Department of Oncology, McMaster University, Hamilton, Canada
| | - Geoffrey Wood
- Department of Veterinary Pathology, University of Guelph, Guelph, Canada
| | - Hao Peng
- Department of Medical Physics and Applied Radiation Sciences, McMaster University, Hamilton, Canada
| | - Damu Tang
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Canada.
| |
Collapse
|
30
|
Pinthus JH, Klotz L, Lukka H, Duivenvoorden WCM, Pettit S, Pohl K, Siemens DR, Fradet V, Mourtzakis M, Kavsac P, Devereaux PJ, Leong D. The RADICAL-PC trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
178 Background: Cardiovascular disease (CVD) occurs frequently in men with prostate cancer (PC), but the reasons are unclear. Specifically, the role of androgen deprivation therapy (ADT) in promoting CVD remains uncertain. There is a lack of evidence to inform preventive strategies against CVD in this high risk group. It is unknown if the evidence to support CVD preventive strategies in the general population can be validly extrapolated to men with PC. Methods: RADICAL-PC combines two prospective studies, one of which is embedded in the other. The Role of Androgen Deprivation Therapy in Cardiovascular Disease – A Longitudinal Prostate Cancer Study (RADICAL PC1) is a prospective cohort study of men within one year of their first diagnosis of PC, or who are within one month of commencing ADT for the first time. Its goal is to identify factors associated with the development of CVD among men with PC, with a particular focus on ADT. The Randomized Intervention for Cardiovascular and Lifestyle Risk Factors in Prostate Cancer Patients (RADICAL PC2) is a randomized, controlled trial embedded in RADICAL PC1. RADICAL PC2 will test a systematic approach to modifying CV and lifestyle risk factors. The intervention group will receive: 1) Standardized advice on healthy diet and exercise; 2) Low-dose antiplatelet agent; 3) Low- to moderate-dose statin; and 4) ACE-I for baseline systolic blood pressure ≥ 130mmHg. Results: The study has been recently funded by Movember clinical trial program of Prostate Cancer Canada, and is launched across Canada. The primary outcome is the occurrence of the composite of cardiovascular death, myocardial infarction, stroke, heart failure, or arterial revascularization. For RADICAL-PC1, 6000 participants will have 90% power to detect a hazard ratio 0.86 for a given exposure. For RADICAL-PC2, 4116 participants randomized, with 434 primary outcome events will have 85% power to detect a hazard ratio of 0.75 in the intervention group. Conclusions: RADICAL PC will be one of the largest prospective studies of CVD – the main competing risk – in men with PC. It will clarify the determinants of CVD in these men, the role of ADT in CVD, and will simultaneously test an intervention to lower the CVD risk in this high-risk population.
Collapse
Affiliation(s)
| | | | | | | | | | - Kayla Pohl
- McMaster University, Hamilton, ON, Canada
| | - D. Robert Siemens
- Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Kingston, ON, Canada
| | | | | | | | | | | |
Collapse
|
31
|
Duivenvoorden WCM, Daneshmand S, Canter DJ, Lotan Y, Black PC, Abdi H, Van Rhijn BW, Fransen van de Putte EE, Bostrom PJ, Koskinen I, Zareba P, Baack Kukreja JE, Kassouf W, Traboulsi S, Pinthus JH. Incidence, characteristics, and implications of thrombo-embolic events in patients with urothelial carcinoma of the bladder undergoing neoadjuvant chemotherapy. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
393 Background: Neoadjuvant chemotherapy (NAC), in combination with radical cystectomy (RC), is associated with a significant survival advantage for patients with muscle-invasive bladder cancer. Chemotherapy as well as pelvic surgery are significant risk factors for thrombo-embolic events (TEE). The objectives of this study were to investigate the incidence and characteristics of TEE during and after NAC and subsequent RC for urothelial bladder cancer patients. Methods: A retrospective study was carried out on 827 consecutive patients who underwent NAC and cystectomy for urothelial bladder carcinoma from 2002 to 2014 at ten different tertiary centers across North America and Europe. The median time of follow-up from bladder cancer diagnosis was 13 months (range 1-119 months). The incidence (venous, arterial, port-site or deep vein thrombosis, thrombosis, clinical or incidentally detected pulmonary embolism) and timing of TEE (before or after ( < or > 30 days) RC) and Khorana score (based on baseline hemoglobin, platelet and leukocyte counts, BMI and tumor site, which was established for cancer patients treated with chemotherapy) was determined for all patients. Multivariate analysis was performed on 827 patients. Kaplan Meier survival curves and log rank test were used to compare survival between patients who developed TEE and those who did not. Results: The Khorana criteria indicated intermediate TEE risk in most patients. Khorana risk score was 1 or 2 in 88% of patients. Nevertheless, the incidence of TEE in patients undergoing NAC was 15%. 59 TEE were detected pre-operatively (7.1%), 21 early within 30 days of RC (2.5%) and 36 late post-operatively (4.3%). 32% of the TEE events were detected incidentally by imaging, 68% were detected clinically. Median overall survival of patients who developed TEE was 28 months compared to 71 months for those who did not develop TEE (p = 0.012). Conclusions: This multi-centre retrospective study suggests that TEE are very common in bladder cancer patients undergoing NAC followed by RC and is associated with poorer survival. Further investigation with a prospective prevention trial is warranted.
Collapse
Affiliation(s)
| | - Siamak Daneshmand
- Institute of Urology, University of Southern California, Los Angeles, CA
| | | | - Yair Lotan
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Hamidreza Abdi
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Bas W.G. Van Rhijn
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Badhoevedorp, Netherlands
| | | | - Peter J. Bostrom
- University Health Network, Princess Margaret Hospital, Toronto, ON, Canada
| | | | | | | | - Wassim Kassouf
- McGill University Health Centre, McGill University, Montreal, QC, Canada
| | | | | |
Collapse
|
32
|
Zareba P, Duivenvoorden W, Leong DP, Pinthus JH. Androgen deprivation therapy and cardiovascular disease: what is the linking mechanism? Ther Adv Urol 2015; 8:118-29. [PMID: 27034724 DOI: 10.1177/1756287215617872] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The past decade has brought increased awareness of the potential adverse effects of androgen deprivation therapy (ADT) in men with prostate cancer. Arguably the most important and controversial of these is the increased risk of cardiovascular morbidity and mortality. Although multiple observational studies have shown that men treated with ADT are at increased risk of developing atherosclerotic cardiovascular disease, our understanding of the biological mechanisms that might underlie this phenomenon is still evolving. In this review, we discuss some of the mechanisms that have been proposed to date, including ADT-induced metabolic changes that promote the development and progression of atherosclerotic plaques as well as direct local effects of hormonal factors on plaque growth, rupture and thrombosis.
Collapse
Affiliation(s)
- Piotr Zareba
- Division of Urology, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Wilhelmina Duivenvoorden
- Division of Urology, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Darryl P Leong
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jehonathan H Pinthus
- Department of Surgery, Juravinski Hospital and Cancer Centre, 711 Concession St, Hamilton, Ontario L8V 1C3, Canada
| |
Collapse
|
33
|
Rosenzweig B, Pinthus JH, Kleinmann N, Joffe E, Erlich T, Fridman E, Winkler H, Mor Y, Ramon J, Dotan ZA. The relative contribution of urine extravasation to elevate plasma creatinine levels in acute unilateral ureteral obstruction. Can Urol Assoc J 2015; 9:E428-33. [PMID: 26279711 DOI: 10.5489/cuaj.2804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Rising levels of plasma creatinine in the setting of acute unilateral ureteral obstruction (AUUO) often reflects acute renal failure, mandating kidney drainage. We hypothesize that re-absorption of peri-renal urine extravasation (PUE), a common result of UUO, contributes significantly to the elevation in plasma creatinine, rendering the latter an inaccurate benchmark for renal function. We explored this hypothesis in a rat model of AUUO and PUE. METHODS In total, 20 rats were equally divided into 4 groups. Groups 1 and 2 underwent unilateral ligation of the ureter with infiltration of rat's urine (index group) or saline (control) into the peri-renal space. Two additional control groups underwent peri-renal injection of either urine or saline without AUUO. Plasma creatinine levels were determined immediately prior to the procedure (T0), and hourly for 3 hours (T1, T2 and T3). Renal histology was investigated after 3 hours. RESULTS Rats in the index group had a significantly greater increase in plasma creatinine levels over 3 hours compared to all other groups (p < 0.05). At T3, average plasma creatinine levels for the index group increased by 96% (0.49 ± 0.18 mg/dL) compared to 46% (0.23 ± 0.06 mg/dL increase) in the AUUO and saline group, and less than 15% rise in both the non-obstructed control groups. Our study limitations includes lack of spontaneous PUE and intraperitoneal surgical approach. CONCLUSIONS Absorption of peri-renal urine in the presence of AUUO is a significant contributor to rising plasma creatinine levels, beyond those attributable to the obstruction alone, and may overestimate the extent of the true renal functional impairment.
Collapse
Affiliation(s)
- Barak Rosenzweig
- Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Sackler School of Medicine, Tel-Aviv University, Israel
| | | | - Nir Kleinmann
- Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Erel Joffe
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX
| | - Tomer Erlich
- Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Eddie Fridman
- Department of Pathology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Harry Winkler
- Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Yoram Mor
- Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Jacob Ramon
- Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Zohar A Dotan
- Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Sackler School of Medicine, Tel-Aviv University, Israel
| |
Collapse
|
34
|
Tivesten Å, Pinthus JH, Clarke N, Duivenvoorden W, Nilsson J. Cardiovascular risk with androgen deprivation therapy for prostate cancer: potential mechanisms. Urol Oncol 2015; 33:464-75. [PMID: 26141678 DOI: 10.1016/j.urolonc.2015.05.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 11/19/2014] [Revised: 05/27/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
Androgen deprivation therapy (ADT) is frequently used for the treatment of advanced prostate cancer. ADT is associated with numerous side effects related to its mode of action, namely the suppression of testosterone to castrate levels. Recently, several large retrospective studies have also reported an increased risk of diabetes and cardiovascular disease in men receiving ADT, although these risks have not been confirmed by prospective randomized trials. We review the literature to consider the risk of cardiovascular disease with different forms of ADT and examine in detail potential mechanisms by which any such risk could be mediated. Mechanisms discussed include the metabolic syndrome resulting from low testosterone level and the potential roles of testosterone flare, gonadotropin-releasing hormone receptors outside the pituitary gland, and altered levels of follicle-stimulating hormone. Finally, the clinical implications for men prescribed ADT for the treatment of advanced prostate cancer are considered.
Collapse
Affiliation(s)
- Åsa Tivesten
- Wallenberg Laboratory for Cardiovascular and Metabolic Research, Sahlgrenska University Hospital, Göteborg, Sweden.
| | - Jehonathan H Pinthus
- Department of Surgery, Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Noel Clarke
- Department of Urology, The Christie and Salford Royal Hospitals, Manchester, UK
| | | | - Jan Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| |
Collapse
|
35
|
Pinthus JH. Follicle-stimulating hormone: A potential surrogate marker for androgen deprivation therapy oncological and systemic effects. Can Urol Assoc J 2015; 9:E226-7. [PMID: 26085887 DOI: 10.5489/cuaj.2874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jehonathan H Pinthus
- Associate Professor, Department of Surgery, Division of Urology, Surgical Oncology, Jurvavinski Cancer Program, Hamilton Health Sciences, Hamilton, ON
| |
Collapse
|
36
|
Pinthus JH. Uncovering the metabolic complications of androgen deprivation therapy in patients with prostate cancer--where do we take it next? J Urol 2015; 193:1882-3. [PMID: 25794833 DOI: 10.1016/j.juro.2015.03.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Jehonathan H Pinthus
- Department of Surgery, Division of Urology, McMaster University, Ontario, Canada
| |
Collapse
|
37
|
Hopmans SN, Duivenvoorden WC, Werstuck GH, Klotz L, Pinthus JH. GnRH antagonist associates with less adiposity and reduced characteristics of metabolic syndrome and atherosclerosis compared with orchiectomy and GnRH agonist in a preclinical mouse model1Contributed equally and share first authorship. Urol Oncol 2014; 32:1126-34. [DOI: 10.1016/j.urolonc.2014.06.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/14/2014] [Accepted: 06/05/2014] [Indexed: 10/24/2022]
|
38
|
Cole E, Margel D, Greenspan M, Shayegan B, Matsumoto E, Fischer MA, Patlas M, Daya D, Pinthus JH. Is there a role for anterior zone sampling as part of saturation trans-rectal ultrasound guided prostate biopsy? BMC Urol 2014; 14:34. [PMID: 24884966 PMCID: PMC4018265 DOI: 10.1186/1471-2490-14-34] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 11/09/2013] [Accepted: 04/25/2014] [Indexed: 11/10/2022] Open
Abstract
Background The prostatic anterior zone (AZ) is not targeted routinely by TRUS guided prostate biopsy (TRUS-Pbx). MRI is an accurate diagnostic tool for AZ tumors, but is often unavailable due to cost or system restrictions. We examined the diagnostic yield of office based AZ TRUS-Pbx. Methods 127 men at risk for AZ tumors were studied: Patients with elevated PSA and previous extended negative TRUS-Pbx (group 1, n = 78) and actively surveyed low risk prostate cancer patients (group 2, n = 49). None of the participants had a previous AZ biopsy. Biopsy template included suspicious ultrasonic areas, 16 peripheral zone (PZ), 4 transitional zone (TZ) and 6 AZ cores. All biopsies were performed by a single urologist under local peri-prostatic anaesthetic, using the B-K Medical US System, an end-firing probe 4-12 MHZ and 18 ga/25 cm needle. All samples were reviewed by a single specialized uro-pathologist. Multivariate analysis was used to detect predictors for AZ tumors accounting for age, PSA, PSA density, prostate volume, BMI, and number of previous biopsies. Results Median PSA was 10.4 (group 1) and 7.3 (group 2). Age (63.9, 64.5), number of previous biopsies (1.5) and cores (17.8, 21.3) and prostate volume (56.4 cc, 51 cc) were similar for both groups. The overall diagnostic yield was 34.6% (group 1) and 85.7% (group 2). AZ cancers were detected in 21.8% (group 1) and 34.7% (group 2) but were rarely the only zone involved (1.3% and 4.1% respectively). Gleason ≥ 7 AZ cancers were often accompanied by equal grade PZ tumors. In multivariate analysis only prostate volume predicted for AZ tumors. Patients detected with AZ tumors had significantly smaller prostates (36.9 cc vs. 61.1 cc p < 0.001). Suspicious AZ ultrasonic findings were uncommon (6.3%). Conclusions TRUS-Pbx AZ sampling rarely improves the diagnostic yield of extended PZ sampling in patients with elevated PSA and previous negative biopsies. In low risk prostate cancer patients who are followed by active surveillance, AZ sampling changes risk stratification in 6% but larger studies are needed to define the role of AZ sampling in this population and its correlation with prostatectomy final pathological specimens.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Jehonathan H Pinthus
- Department of Surgery Division of Urology, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
39
|
Rosenzweig B, Kleinmann N, Pinthus JH, Erlich T, Winkler H, Mor Y, Ramon J, Dotan ZA. MP20-09 SUGGESTIVE MECHANISM OF RISING PLASMA CREATININE FOLLOWING AN ACUTE UNILATERAL URETERAL OBSTRUCTION – A RAT MODEL. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
40
|
Duivenvoorden WCM, Paschos A, Hopmans SN, Austin RC, Pinthus JH. Endoplasmic reticulum protein ERp46 in renal cell carcinoma. PLoS One 2014; 9:e90389. [PMID: 24594673 PMCID: PMC3940878 DOI: 10.1371/journal.pone.0090389] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 01/28/2014] [Indexed: 11/22/2022] Open
Abstract
An established inverse clinical correlation between serum adiponectin levels and renal cell carcinoma (RCC) aggressiveness exists. We have recently demonstrated that adiponectin suppresses clear cell RCC (ccRCC) progression through interaction with its receptor, adiponectin receptor 1 (AdipoR1). ERp46 has been shown to inhibit adiponectin signaling via interaction with AdipoR1 in HeLa cells. However, the expression of ERp46 in RCC has not been described thus far. The objectives of this study were to investigate ERp46 in RCC, its expression, its effects on RCC growth in a mouse model and whether it interacts with AdipoR1. We demonstrated a higher ERp46/AdipoR1 expression ratio in metastatic compared to non-metastatic ccRCC, as determined by immunohistochemistry of tissue microarrays and subsequent image analysis. When ERp46 was stably knocked down using shRNA or overexpressed in murine RCC RAG cells, RCC growth after subcutaneous injection in BALB/c nude mice was inhibited and accelerated, respectively. In vitro analysis to determine the molecular interaction between AdipoR1 and ERp46 included co-immunoprecipitation using human ccRCC 786-O cells and a bacterial adenylate cyclase-based two hybrid system and demonstrated no sustained AdipoR1-ERp46 interaction. This is the first report to suggest a role for ERp46 as a potential therapeutic target in RCC given its expression profile in human RCC samples and its effect on in vivo RCC growth. Since a stable interaction with AdipoR1 could not be established, we suggest that the tumorigenic properties of ERp46 in RCC cells are not related to an inhibitory modulation of AdipoR1.
Collapse
Affiliation(s)
| | - Athanasios Paschos
- Department of Surgery, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Sarah N. Hopmans
- Department of Surgery, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Richard C. Austin
- Department of Surgery, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Jehonathan H. Pinthus
- Department of Surgery, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| |
Collapse
|
41
|
Pinthus JH, Hopmans S, Werstuck G, Duivenvoorden WCM. The role of FSH in castration-induced adipogenesis and cardiovascular diseases: Highlighting differences between orchiectomy, GNRH agonists, and antagonists. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.4_suppl.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
191 Background: Androgen deprivation therapy (ADT) is associated with weight gain and development of the metabolic syndrome (MS). Different modes of ADT can achieve castration but with different affects on serum FSH levels. Inspired by the observation that adiposity accompanies the incremental increase in serum follicle stimulating hormone (FSH) levels in menopause, we hypothesized that gonadotrophin-releasing hormone (GnRH) antagonists which maximally inhibit FSH levels will associate with reduced adiposity and MS development compared to GNRH analogues and orchiectomy. Methods: In-vitro models of adipocyte differentiations were used to investigate FSH effects on lipid accumulation and expression of the rate limiting enzyme in this process-FAS. In-vivo models for adipogenesis and MS (LDL receptor KO mice) were used to investigate and compare the effects of orchiectomy (n=12), sham surgery (control, n=12), sham surgery plus GNRH antagonist (Degarelix, n=12) and sham surgery plus GNRH agonist (Enanton, n=12). Mice were also manipulated by two nutritional conditions (normal/high fat diet). Longitudinal weight gain (four month), visceral fat accumulation (CT measurements), fasting blood glucose, two hours glucose tolerance tests, serum triglycerides, FSH, LH, and testosterone levels were studied along with number and characteristics of aortic atherosclerotic plaques. Results: The lowest and highest serum FSH levels were recorded in mice treated with degarelix versus orchiectomy and significantly lower levels of FSH and LH in mice treated with degarelix versus enanthon were recorded. Mice treated with enantone gained significantly more weight and visceral fat compared to mice treated with degarelix. Significant lower levels of serum triglycerides and better response to glucose loading were recorded in mice treated with degarelix. Data on atherosclerotic plaques is currently processed and will be discussed, but preliminary analysis reveal lower plauque size in mice treated with degarelix. Conclusions: Usage of GNRH antagonists as ADT attenuates weight gain and development of the MS in preclinical models.
Collapse
|
42
|
Kleinmann N, Duivenvoorden WCM, Hopmans SN, Beatty LK, Qiao S, Gallino D, Lhotak S, Daya D, Paschos A, Austin RC, Pinthus JH. Underactivation of the adiponectin-adiponectin receptor 1 axis in clear cell renal cell carcinoma: implications for progression. Clin Exp Metastasis 2013; 31:169-83. [PMID: 24096711 DOI: 10.1007/s10585-013-9618-1] [Citation(s) in RCA: 11] [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] [Received: 12/11/2012] [Accepted: 09/17/2013] [Indexed: 12/11/2022]
Abstract
Energy-sensing pathways, normally coordinated by 5' AMP-activated protein kinase (AMPK), are dysregulated in renal cell carcinoma (RCC). Obesity can accentuate the pre-existing pro-tumorigenic metabolic machinery in RCC cells through its associated obesogenic hormonal milieu, characterized by lower circulating levels of adiponectin. In RCC patients, low adiponectin levels associate clinically with more aggressive disease. We investigated the adiponectin signaling pathway in RCC, focusing on adiponectin receptor 1 (AdipoR1) and associated activation of AMPK. AdipoR1 protein in RCC and normal surrounding renal tissues was determined by Western blot analysis and immunohistochemistry. Anti-tumorigenic effects of adiponectin in RCC cells in vitro were investigated via VEGF and MMP ELISA and invasion assays. Using in vivo models of RCC, the effect of AdipoR1-knockdown (shRNA) on tumor latency, growth and dissemination were determined. AdipoR1 protein was significantly reduced in clear cell RCC specimens. Adiponectin treatment inhibited VEGF, MMP-2 and MMP-9 secretion and activity and invasive and migratory capacities of RCC cells. AMPKα1-knockdown (shRNA) attenuated adiponectin's effects. In cells stably expressing AdipoR1-specific shRNA, AMPK activation by adiponectin was significantly reduced compared to cells expressing control shRNA. In vivo, AdipoR1 knockdown increased the growth, dissemination and angiogenesis of RCC. These findings suggest that deficiencies in the entire adiponectin hormonal axis (the hormone and its receptor) result in underactivation of AMPK leading to increased angiogenic and invasive capacities of RCC. The established link between obesity and RCC can therefore be further explained by the adiponectin deficiency in obese individuals together with reduced AdipoR1 protein in RCC.
Collapse
Affiliation(s)
- Nir Kleinmann
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Pinthus JH, Hopmans S, Duivenvoorden W, Kapoor A. The role of FSH in castration-induced adipogenesis: Highlighting differences between orchiectomy, GNRH agonists, and antagonists. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e16011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16011 Background: Androgen deprivation therapy (ADT) results in weight gain and development of the metabolic syndrome. Inspired by the observation that adiposity accompanies the incremental increase in serum FSH levels in menopause, we hypothesized that GNRH antagonist which lower FSH levels will associate with reduced adiposity as compared to GNRH analogues and orchiectomy. Methods: 3T3-L1 fibroblasts differentiation into adipocytes and intracellular lipid accumulation were examined in the presence of escalating FSH doses (0-1000 IU/L) in charcoal stripped FCS supplemented medium to simulate castration. Cellular lipogenesis was assessed by image analysis (oil red staining) and by immunoblotting for fatty acid synthase (FAS) expression. In vivo, 6-week old C57Bl/6 male mice (n=30) were divided to receive either: orchiectomy + vehicle, sham procedure + vehicle, orchiectomy + GNRH antagonist (degarelix 50 mg/kg in vehicle), sham + degarelix, orchiectomy + GNRH analogue (enantone 2 mg/kg in vehicle), or sham + enantone. Serum testosterone, LH and FSH levels and differences in animal weight, visceral fat mass (VFm) and liver lipogenesis (oil red staining) were determined following sacrifice at 6 weeks. BMI was measured as weight (gr) divided by the distance between the tail root and the lower incisors (cm2). Results: The mean lowest and highest serum FSH levels were recorded in mice treated with Degarelix vs. orchiectomy (0.43 and 0.935 mIU/mL resp,) and the mean lowest and highest serum testosterone levels were in mice treated with orchiectomy+degarelix vs. sham control (0.12 and 13.1 ng/ml resp). Mice treated with degarelix had a significantly lower BMI compared to enantone (p=0.02). VFm (perirenal fat weight) was significantly lower (p=0.035) in mice castrated by degarelix (mean 0.38gr) as compared to enantone(mean 0.47gr)). Addition of degarelix or enanton to orchiectomy increased the differences in VFm and BMI between the two groups (0.12gr vs. 0.47gr and 3.73 vs. 4.29 gr/cm2 resp.) In vitro, FSH increased lipid accumulation and FAS expression in 3T3-L1 cells. Conclusions: FSH level elevation following castration promotes fat accumulation and weight gain in preclinical models.
Collapse
|
44
|
Paschos A, Pandya R, Duivenvoorden WCM, Pinthus JH. Oxidative stress in prostate cancer: changing research concepts towards a novel paradigm for prevention and therapeutics. Prostate Cancer Prostatic Dis 2013; 16:217-25. [PMID: 23670256 DOI: 10.1038/pcan.2013.13] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/14/2013] [Accepted: 03/30/2013] [Indexed: 02/07/2023]
Abstract
A mounting body of evidence suggests that increased production of reactive oxygen species (ROS) is linked to aging processes and to the etiopathogenesis of aging-related diseases, such as cancer, diabetes, atherosclerosis and degenerative diseases like Parkinson's and Alzheimer's. Excess ROS are deleterious to normal cells, while in cancer cells, they can lead to accelerated tumorigenesis. In prostate cancer (PC), oxidative stress, an innate key event characterized by supraphysiological ROS concentrations, has been identified as one of the hallmarks of the aggressive disease phenotype. Specifically, oxidative stress is associated with PC development, progression and the response to therapy. Nevertheless, a thorough understanding of the relationships between oxidative stress, redox homeostasis and the activation of proliferation and survival pathways in healthy and malignant prostate remains elusive. Moreover, the failure of chemoprevention strategies targeting oxidative stress reduced the level of interest in the field after the recent negative results of the Selenium and Vitamin E Cancer Prevention Trial (SELECT) trial. Therefore, a revisit of the concept is warranted and several key issues need to be addressed: The consequences of changes in ROS levels with respect to altered redox homeostasis and redox-regulated processes in PC need to be established. Similarly, the key molecular events that cause changes in the generation of ROS in PC and the role for therapeutic strategies aimed at ameliorating oxidative stress need to be identified. Moreover, the issues whether genetic/epigenetic susceptibility for oxidative stress-induced prostatic carcinogenesis is an individual phenomenon and what measurements adequately quantify prostatic oxidative stress are also crucial. Addressing these matters will provide a more rational basis to improve the design of redox-related clinical trials in PC. This review summarizes accepted concepts and principles in redox research, and explores their implications and limitations in PC.
Collapse
Affiliation(s)
- A Paschos
- Department of Surgery, McMaster University and Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | | | | | | |
Collapse
|
45
|
Pinthus JH. ADT and the metabolic syndrome: no good deed goes unpunished. Can Urol Assoc J 2013. [DOI: 10.5489/cuaj.670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
46
|
Patterson L, Pandya R, Margel D, Hotte SJ, Shayegan B, Mukherjee SD, Pinthus JH. 1441 INCIDENCE, CHARACTERISTICS, AND IMPLICATIONS OF THROMBOEMBOLIC EVENTS IN PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER UNDERGOING CISPLATIN BASED NEO-ADJUVANT CHEMOTHERAPY. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
47
|
Pandya R, Margel D, Patterson L, Hotte SJ, Daya D, Shayegan B, Mukherjee SD, Pinthus JH. 1440 EMERGENCE OF VARIANT HISTOLOGY DURING NEO-ADJUVANT CHEMO-THERAPY FOR MUSCLE INVASIVE URETHELIAL BLADDER CANCER IS COMMON AND ASSOCIATED WITH POOR PROGNOSIS. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
48
|
Hopmans S, Duivenvoorden W, Pinthus JH. 497 THE ROLE OF FSH IN CASTRATION INDUCED ADIPOGENESIS. HIGHLIGHTING DIFFERENCES BETWEEN ORCHIECTOMY, GNRH AGONISTS AND ANTAGONISTS. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
49
|
Pinthus JH. The question of repeat biopsies. Can Urol Assoc J 2012; 1:250. [DOI: 10.5489/cuaj.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
50
|
Allard CB, Shuster A, Pinthus JH, Farrokhyar F, Raees A, Patlas M, Matsumoto ED, Whelan JP. Obesometric factors associated with increased skin-to-stone distances in renal stone patients. Can J Urol 2012; 19:6554-6559. [PMID: 23228291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Obese patients are at increased risk for renal stones as well as treatment failures due to increased skin-to-stone distances (SSD) and harder stone compositions. We investigated the relationships between obesometric parameters (body mass index [BMI], body fat distribution and obesity-related hormone levels) with SSD and stone hardness. MATERIALS AND METHODS We prospectively enrolled patients undergoing stone interventions at our institution. Computed tomography (CT) scans were analyzed; adipose tissue was identified according to Hounsfield units (HU) and separated into subcutaneous (SAT) and visceral (VAT) components. The pixels were averaged at three levels to calculate fat distribution: %VAT = (VAT)/(VAT + SAT). SSD was measured and HU were used as a surrogate for stone hardness. Obesity-related hormones leptin and adiponectin were measured by ELISA. RESULTS Seventy-nine patients were prospectively enrolled. Mean BMI and %VAT were 30.02 kg/m2 and 40.13 kg/m2. Mean leptin and adiponectin levels were 17.5 ng/mL and 7.67 mcg/mL indicating high risk for metabolic consequences of obesity. Females had greater proportions of subcutaneous fat than males (%VAT 28.4 versus 46.94, p < 0.001) and greater SSD (11.26 cm versus 9.86 cm, p = 0.025). Among obese patients, subcutaneous fat correlated with SSD independently of BMI (r = 0.454, p = 0.008). Obese patients with %VAT > 40 versus < 40 had SSD of 11.35 cm versus 13.7 cm (p = 0.005). Diabetics had harder stone compositions as measured by HU than non-diabetics (982.86 versus 648.86, p = 0.001). CONCLUSION Obesometric parameters such as BMI, body fat distribution, and the presence of diabetes mellitus are important considerations in the management of renal stone disease. A large proportion of subcutaneous fat, which can be estimated by physical examination, predicts SSD among obese patients and may aid treatment decisions in patients, particularly those without pre-treatment CT scans. Further studies are needed to refine the role of obesometrics in personalizing treatment decisions.
Collapse
|