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1.
Hang Xu Ping Tan Xiaonan Zheng Jianzhong Ai Tianhai Lin Xi Jin Lina Gong Haoran Lei Lu Yang Qiang Wei 《Urologic oncology》2019,37(4):291.e19-291.e28
Background
Metabolic syndrome (MetS) has been reported to be associated with adverse outcomes in cancer patients. However, the relationship between MetS and upper tract urothelial carcinoma (UTUC) has yet to be explored.Objectives
To investigate the prognostic value of MetS in UTUC after radical nephroureterectomy.Patients and methods
A total of 644 patients with UTUC after radical nephroureterectomy were identified at West China Hospital from May 2003 to December 2016. MetS was defined as the co-existence of 3 or more of 5 components (obesity, hypertension, elevated fasting glucose, decreased high-density lipoprotein-cholesterol, and hypertriglyceridemia). Logistic and Cox regression analyses were performed to evaluate the associations of MetS with pathological features and survival outcomes. Decision curve analysis and Harrell concordance index were used to determine the clinical utility of the prediction models.Results
Of 644 patients, 157 (24.4%) had MetS. Over a median follow-up of 39 months, 269 (41.8%) experienced disease recurrence, 233 (36.2%) died, and 185 (28.7%) died of UTUC. MetS was independently associated with high-grade disease, advanced pT stage (≥pT3), and lymphovascular invasion (each P < 0.05). Multivariate Cox regression analysis showed that MetS was an independent factor for decreased cancer-specific survival (hazard ratio [HR]: 1.38, 95% confidence intervals [CI]: 1.01–1.89, P?=?0.042) but not for recurrence-free survival (HR: 1.27, 95% CI: 0.97–1.67, P?=?0.078), and overall survival (HR: 1.24, 95% CI: 0.95–1.62, P?=?0.121). The estimated c-index of the multivariate models for cancer-specific survival was 0.763 compared with 0.769 when MetS added.Conclusions
MetS is a negative prognostic factor in UTUC. Further studies of MetS in UTUC are demanded. 相似文献2.
Firas G. Petros Wei Qiao Nirmish Singla Timothy N. Clinton Haley Robyak Jay D. Raman Vitaly Margulis Surena F. Matin 《Urologic oncology》2019,37(4):292.e1-292.e9
Background
Accurate risk stratification prior to radical nephroureterectomy remains a challenge with upper-tract urothelial carcinoma (UTUC). Herein, we generated an optimized preoperative tool predicting high-risk nonorgan-confined (NOC)-UTUC.Materials and Methods
Retrospective evaluation of 699 patients undergoing radical nephroureterectomy at 3 academic centers. Multiplex preoperative patient, imaging, endoscopic, and laboratory values were evaluated. Model derivation and validation were based on a split-sample method. Patients were divided randomly into a development (training) cohort (70% of patients) and validation (test) cohort (30% of patients). Univariate and multivariate logistic regression addressed the prediction of NOC disease (pT3/pT4 and/or pN+) based on training cohort. A backward stepdown selection process achieved the most informative nomogram. The ROC analysis identified a cut-off point predicting high-risk disease. The test cohort served as “external” validation to verify the findings based on the training cohort. Bootstrap resampling was conducted for both internal and “external” validation to evaluate the model fitting.Results
Total of 566 patients included for analysis, mean age 69.7 years, 85% Caucasian, 64% male, 62% high grade. NOC-UTUC was found in 184 (32.5%) patients on final pathology. Of 184 patients with NOC-UTUC, an equal number of renal pelvis and ureter only tumors (n?=?74; 40.2% for each location) were noted; 36 (19.6%) had tumors in both locations. Multivariate model based on development cohort (n?=?396) demonstrated clinical stage (odds ratio [OR] 14.0, P < 0.01), biopsy tumor grade (OR 3.3, P?=?0.01), tumor architecture (OR 2.65, P?=?0.09), and Hgb (OR 0.8, P?=?0.02) level were independently associated with NOC disease. A preoperative nomogram incorporating these 4 variables achieved 82% accuracy, 48% sensitivity, and 95% specificity in predicting NOC-UTUC. The cut-off point for predicting high-risk disease was ≥0.49.Conclusions
We established and validated an accurate tool for the prediction of locally advanced NOC-UTUC. This preoperative nomogram can be used to more optimally select patients for preoperative systemic chemotherapy, and facilitate clinical trial enrollment. 相似文献3.
4.
Soroush T. Bazargani Thomas G. Clifford Hooman Djaladat Anne K. Schuckman Kevin Wayne Gus Miranda Jie Cai Sarmad Sadeghi Tanya Dorff David I Quinn Siamak Daneshmand 《Urologic oncology》2019,37(1):1-11
Introduction and Objectives
We previously reported that elevated precystectomy serum levels of epithelial tumor markers predict worse oncological outcome in patients with invasive bladder cancer (BC). Herein, we evaluated the effect of neoadjuvant chemotherapy (NAC) on elevated tumor marker levels and their association with oncological outcomes.Methods
Under IRB approval, serum levels of Carbohydrate Antigen 125 (CA-125), Carbohydrate Antigen 19-9 (CA 19-9) and Carcinoembryonic Antigen (CEA) were prospectively measured in 480 patients with invasive BC from August 2011 through December 2016. In the subgroup undergoing NAC, markers were measured prior to the first and after the last cycle of chemotherapy (prior to cystectomy).Results
Three hundred and thirty-seven patients were eligible for the study, with a median age was 71 years (range 34–93) and 81% (272) male. Elevated precystectomy level of any tumor markers (31% of patients) was independently associated with worse recurrence-free survival (hazard ratio [HR]?=?2.81; P < 0.001) and overall survival (HR?=?3.97; P < 0.001). One hundred and twenty-five (37%) patients underwent NAC, of whom 59 had a complete tumor marker profile and 30 (51%) had an elevated pre-NAC tumor marker. Following completion of chemotherapy, 10/30 (33%) patients normalized their tumor markers, while 20/30 (67%) had one or more persistently elevated markers. There was no difference in clinical or pathological stage between groups (P = 0.54 and P = 0.09, respectively). Further analysis showed a significantly lower rate and longer median time to recurrence/progression in the responder group (50% in responders vs. 90% in nonresponders at a median time of 22 vs. 4.8 months, respectively; P = 0.015). There was also significant difference in mortality rates and median overall survival between the study groups (30% in responders vs. 70% in nonresponders at a median time of 27.3 vs. 11.6 months respectively; P = 0.037). Two of the three patients that died in the normalized tumor marker group had tumor marker relapse at recurrence prior to their death.Conclusions
To our knowledge, this is the first study showing tumor marker response to NAC. Patients with persistently elevated markers following NAC have a very poor prognosis following cystectomy, which may help identifying chemotherapy-resistant tumors. A larger, controlled study with longer follow up is needed to determine their role in predicting survival. 相似文献5.
Michael Lin-Brande Azadeh Nazemi Shane M. Pearce Eli R. Thompson Akbar N. Ashrafi Hooman Djaladat Anne Schuckman Siamak Daneshmand 《Urologic oncology》2019,37(3):180.e1-180.e9
Objectives
We assessed recent trends in both urinary diversion after radical cystectomy for bladder cancer in the United States and patient- and hospital-related characteristics. We also identified variables associated with undergoing continent diversion.Materials and methods
We queried the National Cancer Database and identified 27,170 patients who underwent radical cystectomy with urinary diversion from 2004 to 2013. Patient demographics, socioeconomic variables, and hospital-related factors were compared between incontinent and continent diversion and trended over time. Multivariable logistic regression was used to identify variables associated with undergoing continent diversion.Results
Overall, 23,224 (85.5%) and 3,946 (14.5%) patients underwent incontinent and continent diversion, respectively. Continent diversion declined from 17.2% in 2004 to 2006 to 12.1% in 2010 to 2013 (P < 0.01). When analyzing high-volume facilities, those performing ≥75% minimally invasive radical cystectomy had fewer continent diversions (10.2%) compared to centers with higher rate of open approach (19.7%), P < 0.01. Higher income, facility located in the West, academic programs, high-volume facilities, and patients traveling >60 miles for care were significantly associated with undergoing continent diversion. Rate of continent diversion has declined in most patient- and hospital-related subgroups. Compared to 2004 to 2006, patients in 2010 to 2013 were more likely to be older, have more comorbidities, and be operated on at a high-volume academic facility.Conclusion
The rate of continent diversion has declined to 12.1% in the United States. Hospital volume and type, patient income, distance traveled for care, and geography are significantly associated with undergoing continent diversion. Even among high-volume and academic centers, the rate of continent diversion is declining. 相似文献6.
India Anderson-Carter Natasza Posielski Jinn-ing Liou Tariq A. Khemees Tracy M. Downs E. Jason Abel David F. Jarrard Kyle A. Richards 《Urologic oncology》2019,37(2):130-137
Background
Statins are thought to possess antineoplastic properties related to their effect on cell proliferation and steroidogenesis. Progression to castrate resistant prostate cancer (CaP) includes de-regulation of androgen synthesis suggesting a role for statins in this setting. Our goal was to assess the role of statin use on oncologic outcomes in patients with advanced CaP being treated with androgen deprivation therapy (ADT).Methods
The national VA database was used to identify all men diagnosed with CaP who were treated with ADT for at least 6 months between 2000 and 2008 with follow-up through May 2016. Our cohort was stratified based on statin use of at least 6 months duration during the same time. Multivariable Cox proportional hazards analyses with inverse propensity score weighted (IPSW) adjustment were calculated to assess for primary outcomes of CaP-specific survival (CSS), overall survival (OS) and skeletal related events (SREs).Results
A total of 87,346 patients on ADT were included in the study cohort, 53,360 patients used statins and 33,986 did not. Statin users were younger in age (median 73 vs. 76, P < 0.001), more likely to have a higher Charlson comorbidity index (CCI) >3 (3.1% vs. 2.5%, P < 0.001) and more likely to have a high grade (Gleason score 8–10) cancer (12.3% vs. 10.9%, P < 0.001). Statin users had longer OS (median 6.5 vs. 4.0 years P < 0.001) and decreased death from CaP (5-year CSS 94.0% vs. 87.3%, P < 0.001). Statin use was also associated with longer time to a SRE (median 5.9 vs. 3.7 years, P < 0.001). On multivariable Cox proportional hazards analysis with inverse propensity score weighted, statin use was an independent predictor of improved OS (hazard ratio [HR] 0.66, confidence interval [CI] 0.63–0.68; P < 0.001), CSS (HR 0.56, 95% CI 0.53–0.60; P < 0.001), and SREs (HR 0.64, 95%CI 0.59–0.71; P < 0.001) when controlling for age, race, Charlson comorbidity index, prostate-specific antigen, and Gleason score.Conclusion
The use of statins in men on ADT for CaP is associated with improved CSS and OS. Statins are inexpensive, well-tolerated medications that offer a promising adjunct to ADT, but require further prospective studies. 相似文献7.
François Audenet Kyrollis Attalla Morgane Giordano John Pfail Marc A. Lubin Nikhil Waingankar Daniel Gainsburg Ketan K. Badani Alan Sim John P. Sfakianos 《Urologic oncology》2019,37(5):300.e17-300.e23
Objectives
To evaluate the feasibility and outcomes of a nonopioid (NOP) perioperative pain management protocol for patients undergoing robot-assisted radical cystectomy (RARC).Materials and Methods
We prospectively included 52 consecutive patients undergoing RARC at our institution for bladder cancer. Patients received a multimodal pain management protocol, including a combination of nonopioid pain medications and regional anesthesia. For comparison, we retrospectively included 41 consecutive patients who received the same procedure before implementation of the NOP protocol.Results
There was no significant difference in demographic and perioperative characteristics between the two groups. Patients included in the NOP protocol received a much lower dose of postoperative morphine milligram equivalents (2.5 [IQR: 0–23] vs. 44 [14.5–128], P < 0.001), with no difference in pain scores. In the NOP protocol, the median time to regular diet was significantly shorter (4days [IQR: 3–5] vs. 5days [IQR: 4–8], P?=?0.002) and the length of stay was 2days shorter compared to the control group (5days [IQR: 4–7] vs. 7days [IQR: 6–11], P < 0.001). When evaluating the direct costs within 30days after initial surgery, the NOP protocol was associated with an 8.6% reduction as compared to the control group (P?=?0.032). In multivariate analysis, the receipt of the NOP protocol was a significant predictor of a length of stay <7days after RARC (OR: 12.09; 95% CI: 1.70–140; P?=?0.023).Conclusions
The prospective implementation of a NOP protocol for patients undergoing RARC is feasible, allowing for minimal narcotic usage and provides benefits to patients, institutions, and population. 相似文献8.
Zsófia Küronya Farkas Sükösd Linda Varga Krisztina Bíró Fruzsina Gyergyay Lajos Géczi Krisztián Nagyiványi Kliton Jorgo Tibor Szarvas Ágnes Kovács Ibolya Laczó Zoltán Varga Boglárka Pósfai Judit Pepó Anikó Maráz 《Urologic oncology》2019,37(4):289.e1-289.e9
Background
Our study aimed to analyze the potential association between clinical parameters and ERG expression and the outcome of docetaxel chemotherapy among patients with metastatic hormone-sensitive prostate cancer.Patients and Methods
Fifty-five patients with metastatic hormone-sensitive prostate cancer were treated with docetaxel in addition to androgen deprivation therapy. Patient characteristics, clinical factors, and tumor expression of ERG by immunohistochemistry were analyzed with respect to therapeutic response and survival data.Results
Relapse free survival (RFS) and overal survival (OS) were 10.5 and 40.4 months, respectively, and both correlated with PSA response (RFS: 16.8 with a ≥50% decrease in PSA vs. 5.9 months in the case of <50% decrease, P < 0.001; OS: 40.4 vs. 11.6 months, respectively, P < 0.001). There was an association between OS and early progression (OS: 40.4 months with progression after 12 months vs. 17.9 months with progression within 12 months, P = 0.009). ERG expression was detected in 21 (42%) samples. ERG positivity was associated with favorable RFS (ERG pos. vs. neg.: 26.0 vs. 11.4 months, P = 0.003).Conclusion
ERG expression may have a potential predictive value with respect to the effectiveness and outcome of docetaxel chemotherapy combined with androgen deprivation therapy. 相似文献9.
Kevin T. Lynch J. Hunter Mehaffey Robert B. Hawkins Taryn E. Hassinger Peter T. Hallowell Jennifer L. Kirby 《Surgery for obesity and related diseases》2019,15(2):279-285
Background
Obesity is associated with an increased risk of atrial fibrillation (AF). Bariatric surgery results insubstantial long-term weight loss and the amelioration of several chronic comorbidities. We hypothesized that weightreduction with bariatric surgery would reduce the long-term incidence of AF.Objectives
To assess the association between bariatric surgery and AF prevention.Setting
University Hospital, United States.Methods
All patients who underwent bariatric surgery at a single institution from 1985–2015 (n?=?3,572) were propensity score matched 1:1 to a control population of obese patients with outpatient appointments (n?=?45,750) in our clinical data repository. Patients with a prior diagnosis of AF were excluded. Demographics, relevant comorbidities, and insurance status were collected and a chart review was performed for all patients with AF. Paired univariate analyses were used to compare the two groups.Results
After propensity score matching, 5,044 total patients were included (2,522 surgical, 2,522 non-surgical). There were no differences in preoperative body mass index (BMI) (47.1 vs 47.7 kg/m2, P?=?0.76) or medical comorbidities between groups. The incidence of AF was lower among surgical patients (0.8% vs 2.9%, P?=?0.0001). In patients ultimately diagnosed with AF, time from enrollment to development of AF did not differ between groups; however, surgical patients with AF experienced a significantly higher reduction in excess BMI compared to non-surgical patients with AF (57.9% vs ?3.8%, P<0.001).Conclusion
The incidence of AF was lower among patients who underwent bariatric surgery compared to their medically managed counterparts. Weight reduction with bariatric surgery may reduce the long-term incidence of AF. 相似文献10.
Marc A. Furrer Juerg Huesler Adrian Fellmann Fiona C. Burkhard George N. Thalmann Patrick Y. Wuethrich 《Urologic oncology》2019,37(4):291.e9-291.e18
Objective
To optimize complication reporting in patients undergoing cystectomy and urinary diversion (UD) using the Comprehensive Complication Index (CCI). The original CCI ranging from 0 (no complications) to 100 (death) integrates all complications weighted by severity over time in a single formula. However, due to the large number of complications after cystectomy and UD, the CCI may exceed the upper limit.Methods
In an observational single-center cohort, 90-day postoperative complications in 1,313 consecutive patients undergoing cystectomy and UD from 2000 to 2017 were evaluated. Prospectively collected complications were graded according to the Clavien-Dindo classification (CDC). A modified Berne CCI was developed using an exponential function, which transforms the sum of the weights into a value between 0 and 100. The correlation between the Berne and original CCI values was depicted graphically. Finally, original CCI and Berne CCI values for each patient were extracted and compared. Predictive values of CCI scores for mortality or severe complications (CDC ≥IV) within 1 year postoperatively were investigated by use of multiple logistic regression analyses.Results
Overall complication rate was 82%, with CDC grade I to II in 56% and CDC grade IIIa to V in 27% respectively. Applying the original CCI, the upper limit was exceeded in 8 patients, with a maximal value of 119.1 (median 25.7 [interquartile range: 20.9–37.2]). The maximal value of the Berne CCI was 99.4 (21.2 [14.6–39.3]) for nondeath cases. The Berne CCI predicted the onset of death and severe complications between postoperative day 91 and 365 (both P <0.0001), whereas the original CCI was only predictive in interaction with other variables but not alone (P?=?0.2772 and P?=?0.0862, respectively).Conclusion
The optimized Berne CCI depicts postoperative morbidity and burden within 90 days after cystectomy and UD without exceeding the upper index limit. It is specifically suited for longitudinal assessment of complications after cystectomy and UD taking into consideration every single complication and corresponding treatment. As the Berne CCI well predicted the onset of mortality and severe complications within 1 year postoperatively, this may allow a better preoperative patient counselling. It therefore warrants consideration for standardized reporting of complications after cystectomy and UD. 相似文献11.
Pia Henfridsson Anna Laurenius Ola Wallengren Eva Gronowitz Jovanna Dahlgren Carl-Erik Flodmark Claude Marcus Torsten Olbers Lars Ellegård 《Surgery for obesity and related diseases》2019,15(1):51-58
Background
Information is scarce on long-term changes in energy intake (EI), dietary energy density (DED), and body composition in adolescents undergoing laparoscopic Roux-en-Y gastric bypass (RYGB).Objectives
To investigate long-term changes in EI, DED, and body composition in adolescents after LRYGB.Setting
University hospitals, multicenter study, Sweden.Methods
Eighty-five adolescents (67% girls; mean ± standard deviation, age 16.0 ± 1.2 yr, body mass index 45.5 ± 6.1 kg/m2) were assessed preoperatively (baseline) and 1, 2, and 5 years after LRYGB with diet history interviews and dual-energy x-ray absorptiometry. Matched obese adolescent controls receiving nonsurgical treatment were assessed only at 5 years.Results
Weight decreased 31%, 33%, and 28% at 1, 2, and 5 years after LRYGB (P < .001) while controls gained 13% over 5 years (P < .001). Dietary assessments were completed in 98%, 93%, 87%, and 75% at baseline and 1, 2, and 5 years, respectively, and in 65% of controls. Baseline EI (2558 kcal/d), decreased by 34%, 22%, and 10% after 1, 2, and 5 years (P < .05). DED decreased at 1 year (P?=?.03). Macronutrient distribution was not different from controls at 5 years, but EI and DED were 31% and 14% lower (P < .015). Fat, fat-free, and muscle mass decreased through 5 years after LRYGB (P < .001). Boys preserved muscle mass more than girls (P < .01). Adequate protein intake was associated with preservation of muscle mass (P?=?.003).Conclusions
In adolescents undergoing LRYGB EI remained 10% lower 5 years after surgery. Decreased EI and DED, rather than macronutrient distribution, are important factors in weight loss after surgery. Higher protein intake may facilitate preservation of muscle mass. 相似文献12.
Katherine D. Gray Sahar Bannani Cécile Caillard Sonia Amanat Timothy M. Ullmann Pavel Romanov Laurent Brunaud Toni Beninato Thomas J. Fahey Eric Mirallie Rasa Zarnegar 《Surgery》2019,165(1):37-43
Objectives
We aimed to determine the effect of adjuvant radioactive iodine dose on recurrence rate in high-risk papillary thyroid cancer.Methods
More than 1,500 patients treated for papillary thyroid cancer at high-volume centers in France and the United States from 2004–2014 were reviewed. Patients considered at high risk for recurrence per the 2015 American Thyroid Association guidelines were analyzed and grouped by initial radioactive iodine dose: intermediate (median 100 mCi) or high dose (median 150 mCi). Propensity score matching was performed to control for baseline characteristics.Results
In a propensity-matched cohort of 66 patient pairs, there were equivalent rates of gross extrathyroidal extension (71% vs 71%, P?=?1.00), positive margins (55% vs 55%, P?=?1.00), lymph node metastases ≥ 3 cm (9% vs 9%, P?=?1.00), extranodal extension (32% vs 33%, P?=?.85), and distant metastases (2% vs 5%, P?=?.31). Over a median follow-up of 4.5 years (interquartile ratio 2.0–7.5 years), the intermediate-dose radioactive iodine group had a significantly higher rate of recurrence than patients in the high-dose radioactive iodine group: 24 out of 66 (36%) vs 13 out of 66 (20%), P?=?.03.Conclusion
High-dose radioactive iodine is associated with lower recurrence rate compared with intermediate-dose radioactive iodine for patients with American Thyroid Association high-risk papillary thyroid cancer. 相似文献13.
Objectives
To assess the relationship between nodal disease burden and overall survival (OS) among patients with lymph node (LN) metastases from renal cell carcinoma (RCC)Methods
The National Cancer Data Base was used to identify 2,975 patients with RCC who were treated with radical nephrectomy and were found to have regional LN metastases. Associations between the number of positive and negative LN removed and OS were assessed using Cox proportional hazards regression. The median follow-up time among survivors was 3.6years.Results
The median number of positive LN was 1 (interquartile range 1–3). A higher number of positive LN was associated with higher all-cause mortality on multivariable analysis (HR 1.06 per 1 positive LN, 95% CI 1.04, 1.07, P < 0.001). Conversely, higher negative LN counts were associated with better OS (HR 0.97 per 1 negative LN, 95% CI 0.96, 0.99, P < 0.001). The adjusted probability of a patient with 1 LN removed that was positive surviving at least 2 years was 56%, a figure that increased to 64% when 1 out of 10 LN removed was positive and decreased to 38% when 10 out of 10 LN removed were positive.Conclusions
Ours is the first study to show that differences in nodal disease burden translate into clinically significant differences in survival among patients with LN metastases from RCC. 相似文献14.
Timothy D. Lyon Stephen A. Boorjian Paras H. Shah Robert Tarrell John C. Cheville Igor Frank R. Jeffrey Karnes R. Houston Thompson Matthew K. Tollefson 《Urologic oncology》2019,37(4):292.e11-292.e17
Introduction
To examine the nature, timing, and risk factors underlying return to the operating room (ROR) following radical cystectomy (RC). ROR has been proposed as a surgical quality metric based on data from the general surgery literature, but ROR has not been comprehensively characterized following RC.Patients and methods
We queried our institutional Cystectomy Registry from 2000 to 2016 to identify patients with ROR within 90 days of RC. Multivariable logistic regression was used to examine associations between patient features and ROR. Survival outcomes were studied based on whether ROR was necessary.Results
Of 1968 patients treated with RC, 112 (5.7%) underwent 125 reoperations within 90 days of RC, of which 93% were unanticipated and due to postsurgical complications. The most common reasons for ROR were facial dehiscence (29%), bowel obstruction (21%), and enteric anastomotic leak (8%). On multivariable analysis, increasing body mass index (odds ratio 1.04, 95% confidence interval (CI) 1.01–1.08, P = 0.045) and albumin <3.5 g/dl (odds ratio 2.15, 95% CI 1.28–3.59, P = 0.004) were associated with greater odds of ROR. Patients with a ROR had significantly decreased 5-year overall survival compared to patients who did not undergo ROR (43% vs. 55%; P = 0.003), and ROR was associated with increased all-cause mortality after multivariable adjustment (hazard ratio 1.33, 95% CI 1.01–1.74, P?=?0.04).Conclusion
ROR principally occurred due to unanticipated complications and was associated with increased mortality after RC. These data suggest ROR may be a useful metric by which urological programs can track the efficacy of interventions aimed at improving perioperative care for RC patients. 相似文献15.
Mohit Gupta Ridwan Alam Hiten D Patel Alice Semerjian Michael A. Gorin Michael H. Johnson Peter Chang Andrew A. Wagner James M. McKiernan Mohamad E. Allaf Phillip M. Pierorazio 《Urologic oncology》2019,37(1):18-25
Introduction
A number of patients who elect active surveillance of their small renal masses (≤4 cm) subsequently pursue delayed intervention (DI). The indications, timing, and rates of DI have not been well determined prospectively.Materials and methods
Data from Delayed Intervention and Surveillance for Small Renal Masses, a prospective, multi-institutional registry was utilized to evaluate factors associated with DI between 2009 and 2018.Results
Of 371 patients enrolled in AS, 46 (12.4%) pursued DI. Patients who pursued DI spent a median 12 months on surveillance (interquartile range 5.5–23.6), had better functional status (P < 0.01), and had greater median growth rate vs. those who remained on surveillance (0.38 vs. 0.05, P < 0.001). Indications for intervention included growth rate >0.5 cm/y for 23 (50%) patients, patient preference for 22 (47.8%) patients, and qualification for renal transplant in 1 (2.2%) patient. Thirty-two patients (69.6%) underwent nephron-sparing surgery, 5 (10.9%) underwent radical nephrectomy, and 9 (19.6%) underwent percutaneous cryoablation. Renal mass biopsy was utilized in 37 (11.4%) and 15 (32.7%) patients in the AS and DI arms, respectively (P = 0.04). No patients experienced metastatic progression or died of kidney cancer.Conclusions
As nearly 50% of patients pursue DI secondary to anxiety in the absence of clinical progression, comprehensive counseling is essential to determine if patients are suitable for a surveillance protocol. AS remains a safe initial management option for many patients but may not be a durable strategy for patients who are acceptable surgical candidates with an extended life expectancy. DI does not compromise oncologic outcomes or limit treatment options. 相似文献16.
Kristian Kiim Jensen Jannie Dressler Niklas Nygaard Baastrup Henrik Kehlet Lars Nannestad Jørgensen 《Surgery》2019,165(2):393-397
Background
Enhanced recovery after surgery has been shown to lead to improved postoperative outcomes after several surgical procedures. However, only a few studies have examined the application of enhanced recovery after surgery after abdominal wall reconstruction. The aim of the current observational cohort study was to evaluate the outcomes of enhanced recovery after surgery after abdominal wall reconstruction in a large cohort.Method
This was a retrospective cohort study comparing patients undergoing abdominal wall reconstruction in a standard care pathway (control group) with patients undergoing abdominal wall reconstruction in an enhanced recovery after surgery pathway. Registered outcomes included 30-day postoperative complications, length of stay, and readmission rate.Results
A total of 190 patients undergoing abdominal wall reconstruction for large incisional hernias were included in the study, of which 96 were treated according to standard protocol, and 94 underwent enhanced recovery after surgery pathway. Length of stay was significantly reduced after the introduction of enhanced recovery after surgery (median 4, interquartile range 3–6 days vs. control 5, 4–7 days, P < .001). There was no difference between the cohorts in the incidence of postoperative complications requiring operative intervention (enhanced recovery after surgery 10.6% vs control 10.4%, P?=?1.0) or the rate of readmissions (enhanced recovery after surgery 16.0% vs control 12.5%, P?=?.635).Conclusion
Enhanced recovery after surgery is feasible after abdominal wall reconstruction, leading to reduced length of stay without increasing the rate of complications or readmissions. Enhanced recovery should be implemented as standard in centers performing abdominal wall reconstruction. 相似文献17.
Shuxiong Zeng Lihe Dai Jun Yang Xiaomin Gao Xiaowen Yu Qian Ren Kaijian Wang Jinshan Xu Zeyu Yang Bo Yang Huiqing Wang Qing Yang Huamao Ye Jianguo Hou Yue Pan Zhensheng Zhang Zhiliang Weng Yinghao Sun Chuanliang Xu 《Urologic oncology》2019,37(4):290.e17-290.e24
Objective
To create multivariable models with readily available clinicopathologic variables for predicting the prognosis of upper tract urothelial carcinomas (UTUC).Patients and methods
We retrospectively analyzed patients diagnosed as UTUC and underwent radical nephroureterectomy in 2 high volumes, tertiary care centers. A total of 445 patients and 227 patients met the inclusion criteria were included for constructing the prediction model and external validation, respectively. Univariable and multivariable Cox regression models were used to analyze independent risk factors, and nomogram and calibration curve were constructed by R project.Results
The median follow-up for the development and external validation cohorts were 33.5 and 32.5 months, respectively. Multivariable analysis detected older age (≥65 years), with concurrent bladder cancer at diagnosis, with both ureter and renal pelvic tumor, lymphovascular invasion, urothelial carcinoma with divergent differentiation, higher pathological grade and stage, and positive lymph node were significantly associated with poorer outcome of UTUC. The c-index of the nomogram with these above-mentioned independent risk factors to predict the cancer specific survival was 0.74 (95% CI, 0.64–0.84) and 0.73 (95%CI, 0.59–0.87) for the development cohort and external validation cohort, respectively.Conclusions
We developed and externally validated a novel and accurate nomogram with readily available clinicopathological information for predicting the cancer specific survival of UTUC. This nomogram could help clinicians stratify patients with UTUC into different risk groups with distinct prognosis by the total scores obtained from the prediction tool, thus facilitate decision-making and clinical trial designing. 相似文献18.
Mihai Dorin Vartolomei David D&#x;Andrea Daher C. Chade Francesco Soria Shoji Kimura Beat Foerster Mohammad Abufaraj Romain Mathieu Marco Moschini Morgan Rouprêt Alberto Briganti Pierre I. Karakiewicz Shahrokh F. Shariat 《Urologic oncology》2019,37(2):123-129
Background
Serum cholinesterase (ChE) a serine hydrolase that catalyses the hydrolysis of esters of choline, is involved in cellular proliferation and differentiation, therefore affecting carcinogenesis. The aim of this study was to understand the prognostic role of preoperative serum ChE in patients with radiation-recurrent prostate cancer (CaP) treated with salvage radical prostatectomy (SRP).Material and methods
This retrospective study included 214 patients with radiation-recurrent CaP treated with SRP from January 2007 to December 2015 at 5 academic centers. Patients were considered with abnormal/decreased ChE levels if <5 kU/l. Biochemical recurrence-free and metastases-free (MFS) survival analyses were performed.Results
Median serum ChE level was 6.9 (interquartile range) 6–7.7) kU/l. Serum ChE level (<5 kU/l) was decreased in 25 (11.7%) patients. Decreased serum ChE level was associated with lower body mass index (P = 0.006) and metastasis to lymph nodes (P = 0.004). In multivariable analysis, continuous ChE was an independent predictor of MFS (hazard ratio [HR] 0.48, confidence interval [CI] 0.33–0.71, P < 0.001), overall survival (HR 0.68, CI 0.48–0.96, P = 0.03) and cancer-specific survival (HR 0.41, CI 0.2–0.84, P = 0.01). Serum ChE improved the C-index (by 2.54%) to 87.8% for prediction of overall survival and (by 3%) to 92% for prediction of MFS.Conclusion
Preoperative serum ChE is associated with the development of metastasis in patients with radiation-recurrent CaP who underwent SRP. The biological underpinning of this association with the biological and clinical aggressiveness of CaP needs to be further elucidated. 相似文献19.
Séverine Ledoux Ouidad Sami Daniela Calabrese Maud Le Gall Martin Flamant Muriel Coupaye 《Surgery for obesity and related diseases》2019,15(2):220-226
Background
Numerous studies have shown that Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) differently affect metabolic disorders associated with obesity. While bariatric surgery has been shown to improve nonalcoholic fatty liver disease, very few studies have compared liver parameters after both procedures.Objectives
To compare the evolution of liver parameters after SG and RYGB and their relationships with improvement of metabolic disorders.Methods
Metabolic parameters and abdominal ultrasonography were recorded before and 1 year after bariatric surgery in all patients who underwent SG or RYGB between 2004 and 2016 in our institution.Setting
University hospital, Colombes, France.Results
Five hundred thirty-three patients (15% men, age 43 ± 11 yr) were analyzed, including 326 who underwent RYGB and 207 who underwent SG. Before surgery, body mass index (44.7 ± 5.7 versus 44.4 ± 7.4 kg/m²) and metabolic parameters were not significantly different. One year after surgery, RYGB induced greater weight loss (31.9 ± 7.7 versus 28.6 ± 8.3 %, P < .001). Metabolic parameters improved in both groups, but fasting insulin, low-density lipoprotein cholesterol, C-reactive protein, and ferritin were lower after RYGB (P < .001). In contrast, transaminases were higher after RYGB compared with SG (alanine aminotransferase: 31.6 ± 18.7 versus 22.6 ± 7.7 IU/L; P < .001). The persistence of alanine aminotransferase >34 IU/L (27% versus 7% of patients, P < .001) was independent of the persistence of steatosis on ultrasonography (39% versus 37% of patients) 1 year after RYGB and SG, respectively.Conclusion
Despite a greater improvement of metabolic disorders, RYGB has less beneficial effect on liver parameters compared with SG. Further studies are required to define the mechanisms explaining these differences between both procedures. 相似文献20.
Tammy Ju Lisbi Rivas Suzanne Arnott Samantha Olafson Ashlyn Whitlock Andrew Sparks Ivy N. Haskins Paul P. Lin Khashayar Vaziri 《Surgery for obesity and related diseases》2019,15(2):261-268