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Marcon J, Di Natale R, Weng S, Ghanaat M, Silagy A, Mano R, Blum K, Attalla K, Reznik E, Carlo M, Motzer R, Coleman J, Russo P, Hakimi A, Chen Y. Neutrophil-to-lymphocyte ratio in unclassified renal cell carcinoma is associated with clinical outcome and varies between genomic subgroups. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00990-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chen Y, Di Natale RG, Jayakumaran G, Ghanaat M, Marcon J, Brannon AR, Al-Ahmadie H, Fine S, Gopalan A, Sirintrapun SJ, Tickoo S, Arcila ME, Motzer RJ, Hakimi AA, Reuter VE. Molecular stratification of high-grade unclassified renal cell carcinoma to improve prognostication and management strategy. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.640] [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
640 Background: Unclassified renal cell carcinoma (uRCC) constitutes a large portion of aggressive non-clear cell RCC with limited response to standard therapy. Clinicopathologic parameters or biomarkers to stratify this heterogeneous group of tumors are currently lacking. In a recently reported analysis of 62 high-grade primary uRCC [“discovery cohort (DC)”], we identified distinct molecular subsets. We aimed to validate this molecular schema in an independent clinical cohort and further delineate the clinicopathologic and molecular features that may refine prognostication and management. Methods: All cases was reviewed by experienced GU pathologists based on the current WHO criteria. Primary (n = 54) or metastatic (n = 21) tumor samples from 75 uRCC patients [“validation cohort (VC)”] were analyzed by a CLIA-approved targeted NGS platform for somatic alterations. 37 had germline testing results available. We performed integrative analysis of both VC and DC. Results: Somatic mutations found in VC were NF2 (24%), SETD2 (13%), SMARCB1 (9%), TP53 (9%), TSC1 (9%), FH (8%), TSC2 (5%), MTOR (5%), EP300 (5%), BAP1 (5%), PBRM1 (5%) and PIK3CA (5%), highly consistent with findings in DC. Germline alterations [ FH (11), SDHB (4), and SMARCB1 (1)] were detected in previously unsuspected patients. Integrative analysis supported the presence of NF2-loss (NF2), hyperactive mTOR-driven (MTOR), FH/SDH-deficient (FH/SDH), and chromatin/DNA damage response (Chrom/DDR) molecular subsets. Univariate analysis of combined DC and VC (n = 137, median f/u 26 mos, death 74%) showed a significantly higher risk associated with NF2 subset than the MTOR group (Table). Clonality analysis confirmed NF2 inactivating mutation as a main driver in the NF2 subset. Rare cases with alterations indicating sensitivity or resistance to immunotherapy were also identified. Conclusions: Molecular features of high-grade uRCC improve risk stratification and provide rationale for distinct management strategies. [Table: see text]
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Affiliation(s)
- Yingbei Chen
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Julian Marcon
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Samson Fine
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Satish Tickoo
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - A. Ari Hakimi
- Memorial Sloan Kettering Cancer Center, New York, NY
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Gatto F, Blum KA, Hosseini SS, Ghanaat M, Kashan M, Maccari F, Galeotti F, Hsieh JJ, Volpi N, Hakimi AA, Nielsen J. Plasma Glycosaminoglycans as Diagnostic and Prognostic Biomarkers in Surgically Treated Renal Cell Carcinoma. Eur Urol Oncol 2018; 1:364-377. [PMID: 31158075 PMCID: PMC8253162 DOI: 10.1016/j.euo.2018.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/11/2018] [Accepted: 04/26/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Plasma glycosaminoglycan (GAG) measurements, when aggregated into diagnostic scores, accurately distinguish metastatic clear-cell renal cell carcinoma (RCC) from healthy samples and correlate with prognosis. However, it is unknown if GAG scores can detect RCC in earlier stages or if they correlate with prognosis after surgery. OBJECTIVE To explore the sensitivity and specificity of plasma GAGs for detection of early-stage RCC and prediction of recurrence and death after RCC surgery. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective case-control study consisting of a consecutive series of 175 RCC patients surgically treated between May 2011 and February 2014 and 19 healthy controls. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Plasma GAGs in preoperative and postoperative RCC and healthy samples were measured using capillary electrophoresis with laser-induced fluorescence in a single blinded laboratory. A discovery set was first analyzed to update the historical GAG score. The sensitivity of the new GAG score for RCC detection versus healthy subjects was validated using the remaining samples. The correlation of the new GAG score to histopathologic variables, overall survival, and recurrence-free survival was evaluated using nonparametric and log-rank tests and multivariable Cox regression analyses. RESULTS AND LIMITATIONS The RCC cohort included 94 stage I, 58 stage II-III, and 22 stage IV cases. In the first discovery set (n=67), the new GAG score distinguished RCC from healthy samples with an area under the receiver operating characteristic curve (AUC) of 0.999. In the validation set (n=108), the GAG score achieved an AUC of 0.991, with 93.5% sensitivity. GAG scores were elevated in RCC compared to healthy samples, irrespective of and uncorrelated to stage, grade, histology, age, or gender. The total chondroitin sulfate concentration was an independent prognostic factor for both overall and recurrence-free survival (hazard ratios 1.51 and 1.25) with high concordance when combined with variables available at pathologic diagnosis (C-index 0.926 and 0.849) or preoperatively (C-index 0.846 and 0.736). Limitations of the study include its retrospective nature and moderate variability in GAG laboratory measurements. CONCLUSIONS Plasma GAGs are highly sensitive diagnostic and prognostic biomarkers in surgically treated RCC independent of stage, grade, or histology. Prospective validation studies on GAG scores for early detection, prediction, and surveillance for RCC recurrence are thus warranted. PATIENT SUMMARY In this study, we examined if a new molecular blood test can detect renal cell carcinoma in the early stages and predict if the cancer might relapse after surgery. The trial is registered on ClinicalTrial.gov as NCT03471897.
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Affiliation(s)
- Francesco Gatto
- Department of Biology and Biological Engineering, Chalmers University of Technology, Göteborg, Sweden
| | - Kyle A Blum
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Mazyar Ghanaat
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mahyar Kashan
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Francesca Maccari
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Galeotti
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - James J Hsieh
- Department of Medicine, Genitourinary Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicola Volpi
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - A Ari Hakimi
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jens Nielsen
- Department of Biology and Biological Engineering, Chalmers University of Technology, Göteborg, Sweden.
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Ghanaat M, Winer AG, Sjoberg DD, Poon BY, Kashan M, Tin AL, Sfakianos JP, Cha EK, Donahue TF, Dalbagni G, Herr HW, Bochner BH, Vickers AJ, Donat SM. Comparison of Postradical Cystectomy Ileus Rates Using GIA-80 Versus GIA-60 Intestinal Stapler Device. Urology 2018; 122:121-126. [PMID: 30244117 DOI: 10.1016/j.urology.2018.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/24/2018] [Accepted: 09/11/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the impact on recovery of bowel function using an 80 mm versus 60 mm gastrointestinal anastomosis (GIA) stapler following radical cystectomy and urinary diversion (RC/UD) for bladder cancer. METHODS We identified 696 patients using a prospectively maintained RC/UD database from January 2006 to November 2010. Two nonrandomized consecutive cohorts were compared. Patients between January 2006- and December 2007 (n = 180) were treated using a 60 mm GIA stapler, and 331 patients between January 2008 and December 2010 were subject to an 80 mm GIA stapler. All patients were treated on the same standardized postoperative recovery pathway. After accounting for baseline patient and perioperative characteristics, using a multivariable logistic regression model, we directly compared rates of postoperative ileus using a standardized definition. RESULTS Of 511 evaluable patients, ileus was observed in 32% (57/180) for 60 mm GIA versus 33% (110/331) for the 80 mm GIA. Preoperative renal function, age, gender, body mass index, and type of diversion were comparable between cohorts. On multivariate analysis, stapler size was not significantly associated with the development of ileus (GIA-60 vs GIA-80: OR 1.11; 95% CI 0.75, 1.66; P = .6). Positive fluid balance was associated with an increased risk (P = .019) and female sex a decreased risk (P = .008) of developing ileus compared to patients with negative fluid balance. CONCLUSION The size of the intestinal bowel anastomosis (GIA 80 mm vs 60 mm) does not independently impact the time to bowel recovery following RC/UD.
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Affiliation(s)
- Mazyar Ghanaat
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Andrew G Winer
- SUNY Downstate College of Medicine and Kings County Hospital Center, New York, NY
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bing Ying Poon
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mahyar Kashan
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; SUNY Downstate College of Medicine and Kings County Hospital Center, New York, NY
| | - Amy L Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Eugene K Cha
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Timothy F Donahue
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Guido Dalbagni
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Harry W Herr
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bernard H Bochner
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - S Machele Donat
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Mendonca SJ, Sanchez A, Blum KA, Ghanaat M, Kashan MY, Benfante N, Russo P, Coleman JA, Crago AM, Hakimi AA. The association of renal cell carcinoma with gastrointestinal stromal tumors. J Surg Oncol 2018; 117:1716-1720. [PMID: 29878354 DOI: 10.1002/jso.25080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 03/27/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Prior small studies have reported a possible association between renal cell carcinoma (RCC) and gastrointestinal stromal tumors (GISTs). In the largest known series, our objective was to describe the prevalence of RCC among patients with GISTs over 26 years at Memorial Sloan Kettering Cancer Center (MSKCC). METHODS We retrospectively reviewed MSKCC's prospectively maintained sarcoma and RCC databases and identified all patients with both RCC and GIST between 1980 and 2016. Demographic and clinicopathological characteristics were obtained. RESULTS A total of 9/405 (2.2%) GIST patients were identified with RCC, with a mean follow-up of 9.2 (range 3.8-28.4) years. Five out of nine (55.6%) patients had RCC and GIST diagnosis within 6 months of each other. Mean RCC tumor size was 3.0 (range 1.8-8) cm and 8/9 (88.9%) patients were RCC stage 1. A total of 4/9 (44.4%) patients had papillary RCC (pRCC) histology, 5/9 (55.6%) had additional alternative malignancies, and 4/9 (44.4%) had primary small bowel GIST. CONCLUSIONS Our series suggests a possible association of RCC with GISTs. In addition, we found a high frequency of pRCC histology, alternative malignancies, and small bowel GISTs in co-occurring RCC-GIST patients. Further investigation to identify genetic mutations, in this population, would assist in surveillance and treatment.
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Affiliation(s)
- Shawn J Mendonca
- Division of Urology, Department of Surgery, Sidney Kimmel Center for Prostate, and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York.,Department of Urology, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Alejandro Sanchez
- Division of Urology, Department of Surgery, Sidney Kimmel Center for Prostate, and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Kyle A Blum
- Division of Urology, Department of Surgery, Sidney Kimmel Center for Prostate, and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Mazyar Ghanaat
- Division of Urology, Department of Surgery, Sidney Kimmel Center for Prostate, and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Mahyar Y Kashan
- Division of Urology, Department of Surgery, Sidney Kimmel Center for Prostate, and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Nicole Benfante
- Division of Urology, Department of Surgery, Sidney Kimmel Center for Prostate, and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Paul Russo
- Division of Urology, Department of Surgery, Sidney Kimmel Center for Prostate, and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jonathan A Coleman
- Division of Urology, Department of Surgery, Sidney Kimmel Center for Prostate, and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Aimee M Crago
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - A Ari Hakimi
- Division of Urology, Department of Surgery, Sidney Kimmel Center for Prostate, and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York
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DiNatale R, Becerra M, Sanchez A, Blum K, John N, Ghanaat M, Xie W, Heng D, Choueiri T, Russo P, Hakimi A. PD24-01 DOES TUMOR SIZE AT THE TIME OF CYTOREDUCTIVE NEPHRECTOMY INFLUENCE SURVIVAL? J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1194] [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: 11/25/2022]
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Kashan M, Ghanaat M, Hötker AM, Duzgol C, Sanchez A, DiNatale RG, Blum KA, Becerra MF, Manley BJ, Casuscelli J, Chiok M, Coleman JA, Russo P, Tickoo SK, Akin O, Hakimi AA. Cystic Renal Cell Carcinoma: A Report on Outcomes of Surgery and Active Surveillance in Patients Retrospectively Identified on Pretreatment Imaging. J Urol 2018; 200:275-282. [PMID: 29496470 DOI: 10.1016/j.juro.2018.02.3087] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE We evaluated the outcomes of surgical intervention and active surveillance in patients diagnosed with cystic renal cell carcinoma at our hypothesized radiological cutoff of greater than 50% cystic. MATERIALS AND METHODS We identified all 430 patients with a pathologically confirmed cystic renal mass that fit our criteria from 2000 to 2015. The 292 patients with a lack of computerized tomography, tumors less than 50% cystic on imaging, multifocal tumors and prior renal cell carcinoma were excluded from study. Patients were stratified into benign or malignant subgroups, and radiological, clinicopathological and oncologic features were determined. Univariate and multivariate associations between clinicoradiological parameters in each group were analyzed. We similarly reviewed the records of a separate cohort of patients treated with active surveillance for cystic renal cell carcinoma. RESULTS Of the 138 identified cases of cystic renal cell carcinoma 102 (73.9%) were renal cell carcinoma and 36 (26.1%) were benign masses. Of the tumors 77.5% were Fuhrman grade 1-2, 83.4% were stage pT2 or less and 65.9% showed clear cell histology. On univariate analysis male gender, a solid component and increasing Bosniak classification were significant for malignancy. In a separate cohort we identified 38 patients on active surveillance. The growth rate was 1.0 mm per year overall and 2.3 mm per year for the solid component. At a median followup of more than 4 years in all cohorts there was no evidence of recurrence or metastasis of cystic renal cell carcinoma. CONCLUSIONS Patients with unifocal cystic renal cell carcinoma evaluated using a standardized radiological threshold of greater than 50% cystic had an excellent prognosis on active surveillance and after surgical resection.
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Affiliation(s)
- Mahyar Kashan
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mazyar Ghanaat
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andreas M Hötker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cihan Duzgol
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alejandro Sanchez
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Renzo G DiNatale
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kyle A Blum
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maria F Becerra
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Brandon J Manley
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jozefina Casuscelli
- Department of Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Michael Chiok
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Satish K Tickoo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - A Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
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Blum KA, DiNatale R, Sanchez A, John NT, Axler E, Ghanaat M, Kashan M, Becerra M, Russo P, Coleman J, Tickoo S, Hakimi AA. Sarcomatoid renal cell carcinoma: Does stage impact survival? J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.693] [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
693 Background: Sarcomatoid differentiation is associated with poor clinical outcomes and is present in approximately 4% of patients with renal cell carcinoma (sRCC). However, limited studies have evaluated the impact of sarcomatoid differentiation among patients, especially with lower stage pT1−2 disease. Methods: This study evaluated 3,850 patients with RCC who underwent partial or radical nephrectomy between 2000−2017. Patients were divided into four groups for analysis: pT1−2NxMx RCC without sarcomatoid features, pT1−2NxMx sRCC, pT3−4 RCC without sarcomatoid features and pT3−4 sRCC. Clinicopathological outcomes including sex, race, age, primary histology, lymph node involvement and margin status were compared between groups using Chi−squared and T-tests. Overall survival rates were analyzed by constructing Kaplan−Meier curves, p−values were calculated using log−rank tests and fitting Cox proportional hazards models for adjusted analyses. Results: Among 3,850 cases, 168 (4.4%) sRCC patients were identified. Of these, 33 (19.6%) were pT1−2. The mean overall follow up time was 59.9 months. When comparing CSS between groups, survival was poorer in patients with sarcomatoid features regardless of pT stage (p < 0.0001). Of note, CSS was worse in sRCC pT1−2 patients compared to non−sarcomatoid pT3−4 patients. Overall survival (OS) results were similar, with sarcomatoid tumors having worse estimates on survival analysis (p < 0.0001). Conclusions: Patients with pT1−2 sRCC demonstrated worse CSS when compared to pT1-2 and pT3−T4 RCC without sarcomatoid features, regardless of primary histology. Sarcomatoid differentiation in low−stage disease may be a marker of poor oncologic outcomes requiring more vigilant surveillance and possible inclusion in adjuvant therapy trials. Our next step, which is currently ongoing, is to pursue a multi−institutional collaborative effort and establish a larger cohort of sRCC for analysis.
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Affiliation(s)
- Kyle A Blum
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Nirmal T John
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Mahyar Kashan
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maria Becerra
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Russo
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Satish Tickoo
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - A. Ari Hakimi
- Memorial Sloan Kettering Cancer Center, New York, NY
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Sanchez A, Liu M, Nixon B, Ghanaat M, DiNatale R, Blum KA, Russo P, Reuter VE, Li M, Hakimi AA. Association of preoperative neutrophil-to-lymphocyte ratio with immune populations in the tumor microenvironment of patients with clear cell renal cell carcinoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.688] [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
688 Background: Currently, there are no blood biomarkers that reflect the composition of immune cells in the tumor microenvironment (TME) of patients with clear cell renal cell carcinoma (ccRCC). High pre-operative neutrophil-to-lymphocyte ratio (NLR) is associated with adverse oncologic outcomes in ccRCC. However, how NLR relates to the immune cell composition in the TME is not well understood. Methods: We performed flow cytometry on tumor and adjacent normal renal tissue from a prospective cohort of patients who underwent surgery from 6/2015-7/2017. Immune cell populations, as a percent of total CD45+, were compared to baseline age, sex, body mass index (BMI), SSIGN score, sarcomatoid differentiation, and AJCC stage (I-IV). NLR was calculated using pre-operative absolute neutrophil-to-lymphocyte counts and further categorized as inflamed if NLR was ≥ 3. Correlations between continuous variables were performed using Spearman’s rank correlation. Comparisons of means were made using the Wilcoxon signed-rank test. Results: Among 48 patients, 32 (71%) were male, median age was 59 (IQR 52-66), BMI of 38.5 (IQR 26-32.6), SSIGN score of 8 (IQR 5-12), 9 (20%) had sarcomatoid differentiation, and 20 (44%) had metastases at presentation. No correlations were found between age, BMI, and different immune cell populations or NLR. A higher ratio of tissue resident (CD8a+CD49a+CD103+) to circulating (CD8a+CD49a-CD103-) CD8+ T-cells in the TME was associated with increasing stage at presentation (p = 0.02). Inflamed patients had similar total CD45+, CD8+ T cell, CD4+ T cell, and macrophage immune infiltration. However, inflamed patients had a higher proportion of CD8+ Tres infiltration (p = 0.04) and a trend towards higher neutrophil infiltration (p = 0.15). Conclusions: A higher proportion of resident CD8+T-cells correlated with advanced disease at presentation. NLR may reflect a change in the type of CD8+T cell population found in the TME. This population of CD8+ T-cells, and NLR as a possible biomarker should be validated and further investigated in a larger cohort of patients. Funding: Ruth L. Kirschstein Research Service Award T32CA082088 (A.S., M.G.)
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Affiliation(s)
| | - Ming Liu
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Briana Nixon
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Kyle A Blum
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Russo
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ming Li
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - A. Ari Hakimi
- Memorial Sloan Kettering Cancer Center, New York, NY
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Manley BJ, Reznik E, Ghanaat M, Kashan M, Becerra MF, Casuscelli J, Tennenbaum D, Redzematovic A, Carlo MI, Sato Y, Arcila M, Voss MH, Feldman DR, Motzer RJ, Russo P, Coleman J, Hsieh JJ, Hakimi AA. Characterizing recurrent and lethal small renal masses in clear cell renal cell carcinoma using recurrent somatic mutations. Urol Oncol 2017; 37:12-17. [PMID: 29132830 DOI: 10.1016/j.urolonc.2017.10.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 02/17/2017] [Revised: 06/29/2017] [Accepted: 10/12/2017] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Small renal masses (SRMs) with evidence of clear cell renal cell carcinoma (ccRCC) are understudied. Current algorithms for the management of SRMs include surgical resection, ablation, and active surveillance. We sought to identify genomic biomarkers that could potentially refine the management of ccRCC in SRMs, especially in patients being evaluated for active surveillance. METHODS We identified patients who had SRMs (4cm or less) at time of surgery, had sequencing performed on their primary tumor and had a diagnosis of ccRCC. Patients were selected from 3 publicly available cohorts, The Cancer Genome Atlas (n = 110), University of Tokyo (n = 37), The International Cancer Genome Consortium (n = 31), and from our own institutional prospective database (n = 25). Among this cohort we analyzed mutations present in at least 5% of tumors, assessing for the enrichment of mutations and progression-free survival using the composite endpoint of recurrence or death of disease. Analysis was adjusted for multiple testing. A Cox regression model was used to assess clinical variables with significant mutations. RESULTS In total, 203 patients were available for analysis. Median follow-up was 43.1 months among survivors. Mutations in VHL, PBRM1, SETD2, BAP1, KDM5C, and MTOR were present in more than 5% of tumors. Twenty-three patients (11.3%) had recurrence or died of their disease. Mutations in KDM5C were associated with inferior survival from either recurrence or death from disease, adjusted P 0.033. CONCLUSIONS We identified mutations in SRMs in ccRCC that are associated with recurrence and lethality. The strongest association was seen in those with KDM5C mutations. Use of these genomic biomarkers may improve stratification of patients with SRMs and for those who may be appropriate for active surveillance. Prospective evaluation of these markers is needed.
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Affiliation(s)
- Brandon J Manley
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
| | - Ed Reznik
- Department of Medicine, Molecular Oncology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Mazyar Ghanaat
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
| | - Mahyar Kashan
- Department of Medicine, Molecular Oncology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Maria F Becerra
- Department of Medicine, Molecular Oncology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | | | - Daniel Tennenbaum
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
| | - Almedina Redzematovic
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maria I Carlo
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yusuke Sato
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Maria Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Martin H Voss
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Darren R Feldman
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert J Motzer
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Russo
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
| | - Jonathan Coleman
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
| | - James J Hsieh
- Department of Medicine, Molecular Oncology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO; Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ari A Hakimi
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.
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Becerra M, Sanchez-Vega F, Reznik E, Manley B, Kashan M, Ghanaat M, Casuscelli J, Redzematovic A, Mendonca S, Arcila M, Coleman J, Russo P, Hsieh J, Hakimi AA. MP39-03 IMPACT OF SOMATIC MUTATIONS ON PATTERNS OF METASTASIS IN CLEAR CELL RENAL CELL CARCINOMA. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1177] [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: 12/01/2022]
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Ghanaat M, Kashan M, Becerra M, Manley B, Casuscelli J, Mendonca S, Redzematovic A, Arcila M, Russo P, Coleman J, Hsieh J, Chen Y, Hakimi AA. MP39-04 MOLECULAR AND CLINICAL CHARACTERIZATION OF RENAL CELL CARCINOMA WITH UNCLASSIFIED HISTOLOGY:
NF2
LOSS PREDICTS WORST OUTCOMES. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1178] [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: 10/19/2022]
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Mendonca S, Ghanaat M, Kashan M, Becerra M, Manley B, Benfante N, Russo P, Coleman J, Crago A, Hakimi AA. MP67-14 CHARACTERIZATION OF RENAL CELL CARCINOMA IN PATIENTS WITH GASTROINTESTINAL STROMAL TUMORS COMPARED TO OTHER SOFT TISSUE SARCOMAS. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2050] [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: 10/19/2022]
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Becerra M, Reznik E, Tennenbaum D, Kashan M, Ghanaat M, Casuscelli J, Manley B, Redzematovic A, Mendonca S, Arcila M, Coleman J, Russo P, Hsieh J, Hakimi AA. MP39-02 COMPARATIVE GENOMIC PROFILING OF MATCHED PRIMARY AND METASTATIC TUMORS IN RENAL CELL CARCINOMA. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Manley B, Reznik E, Becerra M, Casuscelli J, Tennenbaum D, Ghanaat M, Kashan M, Redzematovic A, Sato Y, Arcila M, Voss M, Feldman D, Russo P, Coleman J, Hsieh J, Hakimi A. MP39-01 CHARACTERIZING RECURRENT AND LETHAL SMALL RENAL MASSES IN CLEAR CELL RENAL CELL CARCINOMA USING SOMATIC MUTATIONS. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1175] [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: 10/19/2022]
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Ghanaat M, Liu M, Manley B, Kashan M, Becerra M, Redzematovic A, Coleman J, Russo P, Hsieh J, Li M, Hakimi AA. Immune cell phenotyping of clear cell renal cell carcinoma. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.511] [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
511 Background: Clear cell renal cell carcinoma (ccRCC) tumors develop mechanisms that impair function and/or prevent entry of the host infiltrating immune cells (immune exclusion) within the tumor microenvironment. The goal of immunotherapy is to overcome this immune resistance. We aim to characterize the T−cell populations in a cohort of largely untreated high risk patients with ccRCC. Methods: We prospectively collected ccRCC tumor and adjacent normal kidney (NK) from patients undergoing surgical resection at our institution from 6/2015-8/2016. Immune cell phenotyping was performed by immune cell staining of single cell suspensions. Analysis of immune cell populations were determined by CD45+ staining and corresponding proportions of different T−cell populations (CD3+, CD4+, CD4+Treg, and CD8+ T cells). Staining for CD4+Treg was not available for two patients. Student t−test was utilized to compare the immune populations between tumor and adjacent NK tissue. Analysis was also conducted by stratifying patients who presented with localized versus metastatic disease. Results: A total of 31 tumor and adjacent NK were analyzed. Median tumor pathological size was 8.5cm (2.9cm−18cm), 27(87%) had pT3a−pT3b and 13(42%) presented with metastatic disease. Overall 84% of tumors had higher immune infiltrate with an average ratio of four-fold increase compared to adjacent NK as determined by CD45+ cells. Intriguingly, the other 16% presented with metastatic (4) or rapidly metastatic disease (1). Orthogonal validation with inferred immune populations using RNAseq data from the The Cancer Genome Atlas (TCGA) demonstrated similar aggressive behavior in tumors with lower immune infiltrate compared to NK. Comparison of immune cell populations of tumor and NK tissue is shown in table 1. No specific T-cell subtype was associated with specific clinical outcomes in this cohort. Conclusions: Our data shows a general trend of immune infiltration in ccRCC when compared to adjacent NK with a diversity of T-cell subsets and possible evidence of immune exclusion. Further genomic characterization of these tumors is currently underway. [Table: see text]
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Affiliation(s)
| | | | | | | | - Maria Becerra
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Paul Russo
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - James Hsieh
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - A. Ari Hakimi
- Memorial Sloan Kettering Cancer Center, New York, NY
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Winer AG, Vertosick EA, Ghanaat M, Corradi RB, Carlsson S, Sjoberg DD, Sankin AI, Sfakianos JP, Cha EK, Dalbagni G, Coleman JA. Prognostic value of lymph node yield during nephroureterectomy for upper tract urothelial carcinoma. Urol Oncol 2016; 35:151.e9-151.e15. [PMID: 27932270 DOI: 10.1016/j.urolonc.2016.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/07/2016] [Accepted: 11/04/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Lymph node dissection (LND) performed during radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) remains controversial and difficult to evaluate. The aim of this study was to investigate whether removal of more lymph nodes during RNU is safe and improves oncologic outcomes. METHODS We evaluated 422 patients who underwent RNU with concomitant LND for upper tract urothelial carcinoma between 1976 and 2015, assessing for an association between total nodes removed, recurrence-free survival, and cancer-specific survival using Cox proportional hazards models. We also investigated the relationship between nodal yield and perioperative metrics and intersurgeon variability using linear regression. RESULTS In our cohort of 442 patients, 239 developed recurrences and 94 patients died of disease. Median follow-up among survivors was 3.7 years (interquartile range: 1.2, 7.4). The median nodal yield was 9 (interquartile range: 4, 16). Among patients with node-positive disease (pN1), we observed a significant improvement in recurrence-free survival (hazard ratio = 0.84 per 5 nodes removed, P = 0.039) and a nonsignificant improvement in cancer-specific survival with an increase in the nodal yield (hazard ratio = 0.90 per 5 nodes removed, P = 0.2). There was no evidence of an association between node yield and operative time, estimated blood loss, or 30-day complications on multivariable analysis. There was significant heterogeneity among surgeons regarding the extent of LND (P<0.0001). CONCLUSIONS We found that a more extensive node dissection may improve oncologic outcomes in a subset of high-risk patients without significantly increasing operative time or serious complications. Additionally, we identified considerable intersurgeon heterogeneity regarding the extent of LND furthering the notion of surgeon variability as a nonstandardized factor.
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Affiliation(s)
- Andrew G Winer
- SUNY Downstate College of Medicine and Kings County Hospital Center, Brooklyn, NY
| | - Emily A Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - Mazyar Ghanaat
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - Renato B Corradi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - Sigrid Carlsson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, NY; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY; Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - Alexander I Sankin
- Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, New York City, NY
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Eugene K Cha
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - Guido Dalbagni
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY.
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Winer AG, Chakiryan NH, Mooney RP, Verges D, Ghanaat M, Allaei A, Robinson L, Zinn H, Lang EK. Secondary pelvic congestion syndrome: description and radiographic diagnosis. Can J Urol 2014; 21:7365-7368. [PMID: 25171280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Pelvic congestion syndrome (PCS) is a complex condition of the pelvic venous system leading to nonspecific pelvic pain that was initially described in females alone. The underlying abnormalities, though diverse, all result in increased pressure in the left gonadal vein which is transmitted retrograde into the pelvic venous system. Our primary aim was to describe our findings of secondary PCS as a distinct entity from primary PCS in that it has an identifiable vascular etiology and is gender nonspecific. We also aimed to assess the adequacy of late-arterial phase CT urography (CTU) as the initial imaging modality in diagnosing and evaluating secondary PCS. MATERIALS AND METHODS We retrospectively reviewed 59 patients with PCS, 36 males and 23 females ages 24 to 63, from 2000-2011. To maximize opacification, CTU images were taken in the late-arterial phase with a 35-50 second delay after contrast administration. RESULTS Review of our cases revealed multiple etiologies for PCS, including: Nutcracker syndrome (19 cases), cirrhosis (17), retroaortic left renal vein (11), tumor thrombosis of the IVC (5), portal vein thrombosis (4), renal cell carcinoma with left renal vein thrombosis (2), and left kidney AVF (1). The most common symptom was unexplained chronic pelvic pain. The patients in our series had clearly identifiable vascular flow abnormalities leading to the development of PCS, and were therefore diagnosed as having secondary PCS. All cases were easily identified utilizing CTU to visualize and measure dilation of the left gonadal vein and pelvic varices. This modality also proved valuable in the identification and management of the various underlying causes of secondary PCS. CONCLUSION Secondary PCS is distinct from primary PCS in that it arises from clearly identifiable vascular flow abnormalities and occurs in both males and females. The diverse set of underlying etiologies, as well as the resulting congested varices, can be reliably and adequately visualized using CTU as the initial imaging modality.
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Tsui JF, Shah MB, Weinberger JM, Ghanaat M, Weiss JP, Purohit RS, Blaivas JG. Pad count is a poor measure of the severity of urinary incontinence. J Urol 2013; 190:1787-90. [PMID: 23727311 DOI: 10.1016/j.juro.2013.05.055] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2013] [Indexed: 01/06/2023]
Abstract
PURPOSE We analyzed the correlation between pad use, as determined by objective pad count, and the severity of urinary incontinence, as measured by pad weight. MATERIALS AND METHODS We performed a retrospective study of consecutive incontinent patients who wore pads on a daily basis and were instructed to complete a 24-hour pad test. They were told to use the usual pads, change them as usual and place each in a separate plastic bag the day before the scheduled appointment. All pads were weighed and total urine loss was calculated by subtracting dry pad weight from wet pad weight, assuming that a 1 gm weight increase was equivalent to 1 ml of urine loss. The number of pads was correlated to pad weight using the Spearman rank correlation coefficient due to the nonparametric nature of the data. RESULTS The 116 patients included 51 men 39 to 89 years old (mean age 66) and 65 women 27 to 95 years old (mean age 72). When comparing the number of pads used to the gm of urine lost, the Spearman ρ was 0.26 (p=0.005) in the total cohort, and 0.40 and 0.26 (each p<0.05) in males and females, respectively. CONCLUSIONS There was little correlation between the number of pads used and the severity of urinary incontinence (r=0.26). These data suggest that pad count should not be used as an objective measure of incontinence severity. Instead, pad weight on a 24-hour pad test should be used.
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Affiliation(s)
- Johnson F Tsui
- State University of New York Downstate Medical Center, Brooklyn, New York; Institute for Bladder and Prostate Research, New York, New York
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Blaivas JG, Ghanaat M, Weiss JP, Liang LM. 1044 END STAGE BLADDER: DIAGNOSIS AND TREATMENT. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.2122] [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]
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