共查询到20条相似文献，搜索用时 541 毫秒
1.
2.
Tamarah D. de Jong Jérémie Sellam Rabia Agca Saskia Vosslamber Birgit I. Witte Michel Tsang-A-Sjoe Elise Mantel Johannes W. Bijlsma Alexandre E. Voskuyl Mike T. Nurmohamed Cornelis L. Verweij Xavier Mariette 《Joint, bone, spine : revue du rhumatisme》2018,85(2):219-226
Objectives
To validate the IFN response gene (IRG) set for the prediction of non-response to rituximab in rheumatoid arthritis (RA) and assess the predictive performance upon combination of this gene set with clinical parameters.Methods
In two independent cohorts of 93 (cohort I) and 133 (cohort II) rituximab-starting RA patients, baseline peripheral blood expression of eight IRGs was determined, and averaged into an IFN score. Predictive performance of IFN score and clinical parameters was assessed by logistic regression. A multivariate prediction model was developed using a forward stepwise selection procedure. Patients with a decrease in disease activity score (ΔDAS28) ≥ 1.8 after 6 months of therapy were considered responders.Results
The mean IFN score was higher in non-responders compared to responders in both cohorts, but this difference was most pronounced in patients who did not use prednisone, as described before. Univariate analysis in cohort I showed that baseline DAS28, IFN score, DMARD use and negativity for IgM-RF and/or ACPA were associated with rituximab non-response. The multivariate model consisted of DAS28, IFN score and DMARD use, which showed an area under the curve (AUC) of 0.82. In cohort II, this model revealed a comparable AUC in PREDN-negative patients (0.78), but AUC in PREDN-positive patients was significantly lower (0.63), which seemed due to effect modification of the IFN score by prednisone.Conclusions
Combination of predictive parameters provided a promising model for the prediction of non-response to rituximab, with possibilities for optimization via definition of the exact interfering effect of prednisone on IFN score.3.
4.
Nicholas J. Giacalone William U. Shipley Rebecca H. Clayman Andrzej Niemierko Michael Drumm Niall M. Heney Marc D. Michaelson Richard J. Lee Philip J. Saylor Matthew F. Wszolek Adam S. Feldman Douglas M. Dahl Anthony L. Zietman Jason A. Efstathiou 《European urology》2017,71(6):952-960
Background
Tri-modality therapy (TMT) is a recognized treatment strategy for selected patients with muscle-invasive bladder cancer (MIBC).Objective
Report long-term outcomes of patients with MIBC treated by TMT.Design, setting, and participants
Four hundred and seventy-five patients with cT2–T4a MIBC were enrolled on protocols or treated as per protocol at the Massachusetts General Hospital between 1986 and 2013.Intervention
Patients underwent transurethral resection of bladder tumor followed by concurrent radiation and chemotherapy. Patients with less than a complete response (CR) to chemoradiation or with an invasive recurrence were recommended to undergo salvage radical cystectomy.Outcome measurements and statistical analysis
Disease-specific survival (DSS) and overall survival (OS) were calculated using the Kaplan-Meier method.Results and limitations
Median follow-up for surviving patients was 7.21 yr. Five- and 10-yr DSS rates were 66% and 59%, respectively. Five- and 10-yr OS rates were 57% and 39%, respectively. The risk of salvage cystectomy at 5 yr was 29%. In multivariate analyses, T2 disease (OS hazard ratio [HR]: 0.57, 95% confidence interval [CI]: 0.44–0.75, DSS HR: 0.51, 95% CI: 0.36–0.73), CR to chemoradiation (OS HR: 0.61, 95% CI: 0.46–0.81, DSS HR: 0.49, 95% CI: 0.34–0.71), and presence of tumor-associated carcinoma in situ (OS HR: 1.56, 95% CI: 1.17–2.08, DSS HR: 1.50, 95% CI: 1.03–2.17) were significant predictors for OS and DSS. When evaluating our cohort over treatment eras, rates of CR improved from 66% to 88% and 5-yr DSS improved from 60% to 84% during the eras of 1986–1995 to 2005–2013, while the 5-yr risk of salvage radical cystectomy rate decreased from 42% to 16%.Conclusions
These data demonstrate high rates of CR and bladder preservation in patients receiving TMT, and confirm DSS rates similar to modern cystectomy series. Contemporary results are particularly encouraging, and therefore TMT should be discussed and offered as a treatment option for selected patients.Patient summary
Tri-modality therapy is an alternative to radical cystectomy for patients with muscle-invasive bladder cancer, and is associated with comparable long-term survival and high rates of bladder preservation. 相似文献5.
Matthew D. Galsky Huan Wang Noah M. Hahn Przemyslaw Twardowski Sumanta K. Pal Costantine Albany Mark T. Fleming Alexander Starodub Ralph J. Hauke Menggang Yu Qianqian Zhao Guru Sonpavde Michael J. Donovan Vaibhav G. Patel John P. Sfakianos Josep Domingo-Domenech William K. Oh Nicholas Akers Andrew V. Uzilov 《European urology》2018,73(5):751-759
Background
Chemotherapy may exert immunomodulatory effects, thereby combining favorably with the immune checkpoint blockade. The pharmacodynamic effects of such combinations, and potential predictive biomarkers, remain unexplored.Objective
To determine the safety, efficacy, and immunomodulatory effects of gemcitabine and cisplatin (GC) plus ipilimumab and explore the impact of somatic DNA damage response gene alterations on antitumor activity.Design, setting, and participants
Multicenter single arm phase 2 study enrolling 36 chemotherapy-naïve patients with metastatic urothelial cancer. Peripheral blood flow cytometry was performed serially on all patients and whole exome sequencing of archival tumor tissue was performed on 28/36 patients.Intervention
Two cycles of GC followed by four cycles of GC plus ipilimumab.Outcome measurements and statistical analysis
The primary endpoint was 1-yr overall survival (OS). Secondary endpoints included safety, objective response rate, and progression-free survival.Results and limitations
Grade ≥3 adverse events occurred in 81% of patients, the majority of which were hematologic. The objective response rate was 69% and 1-yr OS was 61% (lower bound 90% confidence interval: 51%). On exploratory analysis, there were no significant changes in the composition and frequency of circulating immune cells after GC alone. However, there was a significant expansion of circulating CD4 cells with the addition of ipilimumab which correlated with improved survival. The response rate was significantly higher in patients with deleterious somatic DNA damage response mutations (sensitivity = 47.6%, specificity = 100%, positive predictive value = 100%, and negative predictive value = 38.9%). Limitations are related to the sample size and single-arm design.Conclusions
GC + ipilimumab did not achieve the primary endpoint of a lower bound of the 90% confidence interval for 1-yr OS of >60%. However, within the context of a small single-arm trial, the results may inform current approaches combining chemotherapy plus immunotherapy from the standpoint of feasibility, appropriate cytotoxic backbones, and potential predictive biomarkers. Trial registration: ClinicalTrials.gov NCT01524991.Patient summary
Combining chemotherapy and immune checkpoint blockade in patients with metastatic urothelial cancer is feasible. Further studies are needed to refine optimal combinations and evaluate tests that might identify patients most likely to benefit. 相似文献6.
Martijn G. Schouten Marloes van der Leest Morgan Pokorny Martijn Hoogenboom Jelle O. Barentsz Les C. Thompson Jurgen J. Fütterer 《European urology》2017,71(6):896-903
Background
Knowledge of significant prostate (sPCa) locations being missed with magnetic resonance (MR)- and transrectal ultrasound (TRUS)-guided biopsy (Bx) may help to improve these techniques.Objective
To identify the location of sPCa lesions being missed with MR- and TRUS-Bx.Design, setting, and participants
In a referral center, 223 consecutive Bx-naive men with elevated prostate specific antigen level and/or abnormal digital rectal examination were included. Histopathologically-proven cancer locations, Gleason score, and tumor length were determined.Intervention
All patients underwent multi-parametric MRI and 12-core systematic TRUS-Bx. MR-Bx was performed in all patients with suspicion of PCa on multi-parametric MRI (n = 142).Outcome measurements and statistical analysis
Cancer locations were compared between MR- and TRUS-Bx. Proportions were expressed as percentages, and the corresponding 95% confidence intervals were calculated.Results and limitations
In total, 191 lesions were found in 108 patients with sPCa. From these lesion 74% (141/191) were defined as sPCa on either MR- or TRUS-Bx. MR-Bx detected 74% (105/141) of these lesions and 61% (86/141) with TRUS-Bx. TRUS-Bx detected more lesions compared with MR-Bx (140 vs 109). However, these lesions were often low risk (39%). Significant lesions missed with MR-Bx most often had involvement of dorsolateral (58%) and apical (37%) segments and missed segments with TRUS-Bx were located anteriorly (79%), anterior midprostate (50%), and anterior apex (23%).Conclusions
Both techniques have difficulties in detecting apical lesions. MR-Bx most often missed cancer with involvement of the dorsolateral part (58%) and TRUS-Bx with involvement of the anterior part (79%).Patient summary
Both biopsy techniques miss cancer in specific locations within the prostate. Identification of these lesions may help to improve these techniques. 相似文献7.
Boris Gershman Daniel M. Moreira R. Houston Thompson Stephen A. Boorjian Christine M. Lohse Brian A. Costello John C. Cheville Bradley C. Leibovich 《European urology》2018,73(3):469-475
Background
There are little data regarding the morbidity of lymph node dissection (LND) for renal cell carcinoma (RCC) to assess its risk–benefit ratio.Objective
To evaluate the association of LND with 30-d complications among patients undergoing radical nephrectomy (RN) for RCC.Design, setting, and participants
A total of 2066 patients underwent RN for M0 or M1 RCC between 1990 and 2010, of whom 774 (37%) underwent LND.Intervention
RN with or without LND.Outcome measurements and statistical analysis
Associations of LND with 30-d complications were examined using logistic regression with several propensity score techniques. Extended LND, defined as removal of ≥13 lymph nodes, was examined in a sensitivity analysis.Results and limitations
A total of 184 (9%) patients were pN1 and 302 (15%) were M1. Thirty-day complications occurred in 194 (9%) patients, including Clavien grade ≥3 complications in 81 (4%) patients. Clinicopathologic features were well balanced after propensity score adjustment. In the overall cohort, LND was not statistically significantly associated with Clavien grade ≥3 complications, although there was an approximately 40% increased risk of any Clavien grade complication that did not reach statistical significance. Likewise, LND was not significantly associated with any Clavien grade or Clavien grade ≥3 complications when separately evaluated among M0 or M1 patients. Extended LND was not significantly associated with any Clavien grade or Clavien grade ≥3 complications. LND was not associated with length of stay or estimated blood loss. Limitations include a retrospective design.Conclusions
LND is not significantly associated with an increased risk of Clavien grade ≥3 complications, although it may be associated with a modestly increased risk of minor complications. In the absence of increased morbidity, LND may be justified in a predominantly staging role in the management of RCC.Patient summary
Lymph node dissection for renal cell carcinoma is not associated with increased rates of major complications. 相似文献8.
Giulio Nicita Donata Villari Simone Caroassai Grisanti Michele Marzocco Vincenzo Li Marzi Alberto Martini 《European urology》2017,71(1):133-138
Background
Rectourethral fistulas (RUFs) represent an uncommon complication of pelvic surgery, especially radical prostatectomy. To date there is no standardised treatment for managing RUFs. This represents a challenge for surgeons, mainly because of the potential recurrence risk.Objective
To describe our minimally invasive transanal repair (MITAR) of RUFs and to assess its safety and outcomes.Design, setting, and participants
We retrospectively evaluated 12 patients who underwent MITAR of RUF at our centre from October 2008 to December 2014. Exclusion criteria were a fistula diameter greater than 1.5 cm, sepsis, and/or faecaluria.Surgical procedure
After fistula identification through cystoscopy and 5F-catheter positioning within the fistula, MITAR is performed using laparoscopic instruments introduced through Parks’ anal retractor. The fibrotic margins of the fistula are carefully dissected by a lozenge incision of the rectal wall, parallel to the rectal axis. Under the healthy flap of the rectal wall the urothelium is located and the fistulous tract is sutured with interrupted stitches. After a leakage test of the bladder, the rectal wall is sutured with interrupted stitches. Electrocoagulation is never used during this procedure.Measurements
Fistula closure, postoperative complications, and recurrence.Results and limitations
Median follow-up was 21 (range, 12–74) mo. Median operative time was 58 (range, 50–70) min. Median hospital stay was 1.5 (range, 1–4) d. Early surgical complications occurred in one patient (8.3%). Recurrence did not occur in any of the cases. Limitations included retrospective analysis, small case load, and lack of experience with radiation-induced fustulas.Conclusions
MITAR is a safe, effective, and reproducible procedure. Its advantages are low morbidity and quick recovery, and no need for a colostomy.Patient summary
We studied the treatment of rectourethral fistulas. Our technique, transanally performed using laparoscopic instruments, was found to be safe, feasible, and effective, with limited risk of complications. 相似文献9.
Sumanta Kumar Pal Jean Hoffman-Censits Hanzhe Zheng Constanze Kaiser Darren Tayama Joaquim Bellmunt 《European urology》2018,73(5):800-806
Background
Atezolizumab (anti–programmed death-ligand 1) was approved in the USA, Europe, and elsewhere for treatment-naive and platinum-treated locally advanced/metastatic urothelial carcinoma (mUC).Objective
To report efficacy and safety from an atezolizumab expanded access study.Design, setting, and participants
This single-arm, open-label study enrolled 218 patients at 36 US sites. Key eligibility criteria included progression during/following ≥1 platinum-based chemotherapy for mUC or in perioperative setting (progression within 12 mo) and Eastern Cooperative Oncology Group performance status (ECOG PS) 0–2.Intervention
Patients received atezolizumab1200 mg intravenously every 3 wk until loss of clinical benefit, unacceptable toxicity, consent withdrawal, decision to discontinue, death, atezolizumab commercial availability, or study closure.Outcome measurements and statistical analysis
Key end points reported herein included Response Evaluation Criteria in Solid Tumors v1.1 objective response rate and duration, disease control rate (DCR; response or stable disease), and safety.Results and limitations
All patients received prior systemic therapy (68% mUC; 27% adjuvant; and 26% neoadjuvant). At baseline, 57% of 214 treated patients had ECOG PS ≥1, 19% had hemoglobin <10 g/dl, and 25% had liver metastases. Median treatment duration was 9 wk (interquartile range [IQR], 6–12 wk). Median follow-up duration was 2.3 mo (IQR, 1.6–3.4 mo) overall and 2.7 mo (IQR, 2.0–3.5 mo) in patients not known to have died. Seventeen of 114 evaluable patients (15%) had objective responses (16 ongoing at study termination). DCR was 49%. Treatment-related adverse events (mostly fatigue) occurred in 98 of 214 treated patients.Conclusions
The benefit/risk profile of atezolizumab was consistent with that observed in previous studies, despite pretreatment and poor prognostic factors. These results suggest a potential role for atezolizumab in a broader patient range than typically eligible for phase 1–3 studies.Patient summary
In this expanded access study, atezolizumab was active and tolerable in a range of patients with platinum-treated metastatic urothelial carcinoma. 相似文献10.
Behfar Ehdaie Melissa Assel Nicole Benfante Deepak Malhotra Andrew Vickers 《European urology》2017,71(6):866-871
Background
Physicians report difficulty convincing patients with prostate cancer about the merits of active surveillance (AS); as a result, a majority of patients unnecessarily choose to undergo radical treatment.Objective
To develop and evaluate a systematic approach for physicians to counsel patients with low-risk prostate cancer to increase acceptance of AS.Design, setting, and participants
A systematic counseling approach was developed and piloted in one clinic. Then five surgeons participated in a 1-h training session in which they learned about the approach. A total of 1003 patients with Gleason 3 + 3 prostate cancer were included in the study. We compared AS rates for 761 patients who were counseled over a 24-mo period before the training intervention with AS rates for 242 patients who were counseled over a 12-mo period afterwards, controlling for temporal trends and case mix.Intervention
A systematic approach for communicating the merits of AS using appropriate framing techniques derived from principles studied by negotiation scholars.Outcome measurements and statistical analysis
The rate of AS acceptance by patients for management of low-risk prostate cancer.Results and limitations
In the pilot phase, 81 of 86 patients (94%) accepted AS after counseling by the physician who developed the counseling approach. In the subsequent study, the cohort for the training intervention comprised 1003 consecutive patients, 80% of whom met the Epstein criteria for very low-risk disease. The proportion of patients who selected AS increased from 69% before the training intervention to 81% afterwards. After adjusting for time trends and case mix, the rate of AS after the intervention was 9.1% higher (95% confidence interval ?0.4% to 19.4%) than expected, a relative reduction of approximately 30% in the risk of unnecessary curative treatment.Conclusions
A systematic approach to counseling can be taught to physicians in a 1-h lecture. We found evidence that even this minimal intervention can decrease overtreatment. Our novel approach offers a framework to help address cancer screening–related overtreatment that occurs across medicine.Patient summary
In this study, we evaluated the impact of teaching physicians how to better communicate the benefits and risks of prostate cancer treatments on the willingness of patients to choose active surveillance. Decisions related to cancer are often guided by emotions and biases that lead most patients to seek radical treatment; however, we demonstrated that if discussions are framed differently, these biases can be overcome and more patients will choose active surveillance. 相似文献11.
Hind Letaief Cédric Lukas Thomas Barnetche Cécile Gaujoux-Viala Bernard Combe Jacques Morel 《Joint, bone, spine : revue du rhumatisme》2018,85(1):15-22
Objective
In this review, we summarise the clinical efficacy and safety of B-cell targeted therapies for primary Sjögren's syndrome (pSS).Methods
A systematic literature review was conducted using databases including MEDLINE, EMBASE and Cochrane. Only articles reporting controlled or prospective studies of b-DMARDs modulating B cells in treatment of pSS were selected. The highest-quality studies were selected for meta-analysis. The primary outcome of interest was clinical efficacy at week 24 on fatigue, dryness, Schirmer test, salivary flow rate and the full ESSDAI score including biological domain. For the efficacy criteria used, the difference between rituximab and placebo groups was expressed as mean difference (MD).Results
Eighteen articles (13 of rituximab, 3 of belimumab, 1 of epratuzumab and 1 of baminercept) were identified for detailed evaluation. 4 controlled randomised trials of rituximab treatment vs. placebo involving 300 patients were included for quantitative analysis. No significant differences were observed between groups in the meta-analysis of mean improvements between baseline and week 24 in fatigue VAS [MD ?3,24 95% CI (?30,21 to 23,72)], oral dryness VAS [MD ?8,41 95% CI (?35,06 to 18,24)], salivary flow rate [MD 0,04 95% CI (?0,03 to 0,11)] and Schirmer test [MD 0,35 95% CI (?2,13 to 2,82)]. Rituximab was relatively safe compared to placebo.Conclusion
Our review shows that rituximab is not effective in pSS with the designs and outcomes proposed in the trials. Controlled randomised trials are needed to prove the efficacy of belimumab and epratuzumab in this indication. The randomised controlled trial evaluating baminercept failed to achieve its primary endpoint. 相似文献12.
Mohammad Abufaraj Guido Dalbagni Siamak Daneshmand Simon Horenblas Ashish M. Kamat Ryu Kanzaki Alexandre R. Zlotta Shahrokh F. Shariat 《European urology》2018,73(4):543-557
Context
The role of surgery in metastatic bladder cancer (BCa) is unclear.Objective
In this collaborative review article, we reviewed the contemporary literature on the surgical management of metastatic BCa and factors associated with outcomes to support the development of clinical guidelines as well as informed clinical decision-making.Evidence acquisition
A systematic search of English language literature using PubMed-Medline and Scopus from 1999 to 2016 was performed.Evidence synthesis
The beneficial role of consolidation surgery in metastatic BCa is still unproven. In patients with clinically evident lymph node metastasis, data suggest a survival advantage for patients undergoing postchemotherapy radical cystectomy with lymphadenectomy, especially in those with measurable response to chemotherapy (CHT). Intraoperatively identified enlarged pelvic lymph nodes should be removed. Anecdotal reports of resection of pulmonary metastasis as part of multimodal approach suggest possible improved survival in well-selected patients. Cytoreductive radical cystectomy as local treatment has also been explored in patients with metastatic disease, although its benefits remain to be assessed.Conclusions
Consolidative extirpative surgery may be considered in patients with clinically evident pelvic or retroperitoneal lymph nodal metastases but only if they have had a response to CHT. Surgery for limited pulmonary metastases may also be considered in very selected cases. Best candidates are those with resectable disease who demonstrate measurable response to CHT with good performance status. In the absence of data from prospective randomized studies, each patient should be evaluated on an individual basis and decisions made together with the patient and multidisciplinary teams.Patient summary
Surgical resection of metastases is technically feasible and can be safely performed. It may help improve cancer control and eventually survival in very selected patients with limited metastatic burden. In a patient who is motivated to receive chemotherapy and to undergo extirpative surgical intervention, surgery should be discussed with the patient among other consolidation therapies in the setting of multidisciplinary teams. 相似文献13.
Daniel J. Serie Richard W. Joseph John C. Cheville Thai H. Ho Mansi Parasramka Tracy Hilton R. Houston Thompson Bradley C. Leibovich Alexander S. Parker Jeanette E. Eckel-Passow 《European urology》2017,71(6):979-985
Background
Intratumor molecular heterogeneity has been reported for primary clear cell renal cell carcinoma (ccRCC) tumors; however, heterogeneity in metastatic ccRCC tumors has not been explored.Objective
To evaluate intra- and intertumor molecular heterogeneity in resected metastatic ccRCC tumors.Design, setting, and participants
We identified 111 patients who had tissue available from their primary tumor and at least one metastasis. ClearCode34 genes were analyzed for all tumors.Outcome measurements and statistical analysis
Primary and metastatic tumors were classified as clear cell type A (ccA) or B (ccB) subtypes. Logistic and Cox regression were used to evaluate associations with pathologic features and survival.Results and limitations
Intratumor heterogeneity of ccA/ccB subtypes was observed in 22% (95% confidence interval [CI] 3–60%) of metastatic tumors. Subtype differed across longitudinal metastatic tumors from the same patient in 23% (95% CI 10–42%) of patients and across patient-matched primary and metastatic tumors in 43% (95% CI 32–55%) of patients. Association of subtype with survival was validated in primary ccRCC tumors. The ccA/ccB subtype in metastatic tumors was significantly associated with metastatic tumor location, metastatic tumor grade, and presence of tumor necrosis. A limitation of this study is that we only analyzed patients who had both a nephrectomy and metastasectomy.Conclusions
Approximately one quarter of metastatic tumors displayed intratumor heterogeneity; a similar rate of heterogeneity was observed across longitudinal metastatic tumors. Thus, for biomarker studies it is likely adequate to analyze a single sample per metastatic tumor provided that pathologic review is incorporated into the study design. Subtypes across patient-matched primary and metastatic tumors differed 43% of the time, suggesting that the primary tumor is not a good surrogate for the metastatic tumor.Patient summary
Primary and secondary/metastatic cancers of the kidney differed in nearly one half of ccRCC patients. The pattern of this relationship may affect tumor growth and the most suitable treatment. 相似文献14.
15.
Introduction
Painless hematuria is the presenting symptom in 85–90% of patients with bladder cancer.Objectives
To evaluate the efficacy of voided urinary cytology and ultrasonography in the diagnosis and follow up of bladder cancer compared to cystoscopy as a gold standard with reference to its grade. To recommend a protocol that improves the overall sensitivity and specificity of detection of new cases and recurrence in the follow up of patients with bladder cancer.Subjects and methods
A prospective analysis of patients with painless hematuria and follow up patients of bladder cancer was done. They were subjected to voided urinary cytology and ultrasonography. The results were compared with the inferences drawn from cystoscopy and histopathological examination of the resected tumor, wherever applicable.Results
The sensitivity of urinary cytology and ultrasonography was 13.33% and 66.67%, respectively, compared to cystoscopy as a gold standard, whereas the specificity of urinary cytology and ultrasonography was 100% and 93.33%, respectively. Cytology was positive only in high grade cases.Conclusions
Voided urinary cytology can be omitted as a screening test. Ultrasonography can be recommended as the initial imaging investigation for detection of bladder carcinoma in patients presenting with hematuria and for follow up of bladder carcinoma patients. 相似文献16.
Context
Pelvic organ prolapse is a common condition affecting at least a half of adult women. Most women are asymptomatic, but a significant proportion of women choose to have an operation.Objective
The aim of this paper is to review the various surgical procedures for the correction of pelvic organ prolapse.Evidence acquisition
Guidelines from professional organizations, meta-analysis, reviews, and high-quality studies were referred to collect the evidence for the various surgical techniques.Evidence synthesis
Management of pelvic organ prolapse is considered under anterior vaginal wall prolapse, apical prolapse, and posterior vaginal wall prolapse to help the reader organize the information to counsel women in a systematic way.Conclusions
Surgical management of prolapse can be challenging, and various factors affect the procedure of choice and the outcomes. Providing information, careful counseling, and informed choice are crucial to deliver patient expectations. All these factors should be considered when deciding on the surgical procedure. 相似文献17.
Nick Watkin 《European Urology Supplements》2018,17(6):154-159
Introduction
Nodal involvement is the most important prognostic factor in patients with squamous cell carcinoma of the penis (SCCp). However, optimal staging of regional lymph node remains controversial.Methods
The literature was reviewed to examine current management of regional lymph nodes in SCCp patients with clinically nonpalpable inguinal lymph nodes (cN0).Results
Radiological staging and selective risk-profile nomograms are unreliable in the detection of occult micrometastases in cN0 patients. Prophylactic inguinal lymph node dissection (ILND) is associated with significant morbidity and a high rate of postoperative complications. Dynamic sentinel lymph node biopsy (DSNB) is a reliable minimally invasive surgical staging technique for cN0 patients. Ipsilateral ILND is indicated only in inguinal basins with positive DSNB.Conclusions
DSNB has excellent performance characteristics in staging cN0 patients, with high sensitivity and a low morbidity rate. 相似文献18.
Introduction
The knowledge urethral stricture patients in a developing country Specialist Clinic have regarding their own disease, remains uncertain.Objectives
To measure patient’s knowledge of own disease attending Tygerberg Urethral Stricture clinic.Patients and methods
A total of 81 patients were assessed from May to August 2015, presented with a questionnaire containing questions on demographics, ten knowledge questions and qualitative comments. Subgroups were created for patient less and more than 50 years of age, and education level up to Grade 10 and more than Grade 10. Means were compared using the Student t-test, correlations were assessed using Pearson’s correlation coefficient and the significance was assumed at an alpha level of 0.05.Results
Average age of patients attending the clinic was 55, the average level of education Grade 7 (completed Primary School). The average level of knowledge for all patients was 46%, with the highest score for Question 2 (80%) relating to the definition of a urethral stricture. The lowest score was achieved for Question 8 (28%) relating to self-catheterization frequency. There was no linear correlation between knowledge and age, and a very weak correlation between patient knowledge and level of education.Conclusion
This study demonstrates that the level of knowledge of own disease is unacceptably poor across the whole patient profile. Interventions to improve patient knowledge regarding urethral stricture disease is indicated. 相似文献19.
Ian D. Davis Wanling Xie Carmel Pezaro Frede Donskov J. Connor Wells Neeraj Agarwal Sandy Srinivas Takeshi Yuasa Benoit Beuselinck Lori A. Wood D. Scott Ernst Ravindran Kanesvaran Jennifer J. Knox Allan Pantuck Sadia Saleem Ajjai Alva Brian I. Rini Jae-Lyun Lee Daniel Y.C. Heng 《European urology》2017,71(6):970-978
Background
We hypothesized that changes in International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic category at start of second-line therapy (2L) for metastatic renal cell carcinoma (mRCC) might predict response.Objective
To assess outcomes of 2L according to type of therapy and change in IMDC prognostic category.Design, setting, and participants
We performed a retrospective review of the IMDC database for mRCC patients who received first-line (1L) VEGF inhibitors (VEGFi) and then 2L with VEGFi or mTOR inhibitors (mTORi). IMDC prognostic categories were defined before each line of therapy (favorable, F; intermediate, I; poor, P). Data were analyzed for 1516 patients, of whom 89% had clear cell histology.Intervention
All included patients received targeted therapy for mRCC.Outcome measurements and statistical analysis
Overall survival (OS), time to treatment failure, and response to 2L were analyzed using Cox or logistic regression.Results and limitations
At start of 2L, 60% of patients remained in the same prognostic category; 9.0% improved (3% I → F; 6% P → I); 31% deteriorated (15% F → I or P; 16% I → P). Patients with the same or better IMDC prognostic category had a longer time to treatment failure if they remained on VEGFi compared to those who switched to mTORi (adjusted hazard ratio [AHR] ranging from 0.33 to 0.78, adjusted p < 0.05). Patients who deteriorated from F to I appeared more likely to benefit from switching to mTORi (median OS 16.5 mo, 95% confidence interval [CI] 12.0–19.0 for VEGFi; 20.2 mo, 95% CI 14.3–26.1 for mTORi; AHR 1.53, 95% CI 1.04–2.24; adjusted p = 0.03).Conclusions
Changes in IMDC prognostic category predict the subsequent clinical course for patients with mRCC and provide a rational basis for selection of subsequent therapy.Patient summary
The pattern of treatment failure might help to predict what the next treatment should be for patients with metastatic renal cell carcinoma. 相似文献20.