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1.
Souhil Lebdai Romain Mathieu Julie Leger Olivier Haillot Sébastien Vincendeau Nathalie Rioux-Leclercq Georges Fournier Marie-Aimée Perrouin-Verbe Laurent Doucet Abdel Rahmene Azzouzi Jérome Rigaud Karine Renaudin Thomas Charles Franck Bruyere Gaelle Fromont 《Urologic oncology》2018,36(2):80.e17-80.e24
Background
Previous studies have suggested a link between metabolic syndrome (MetS) and prostate cancer (PCa). In the present study, we aimed to assess the association between MetS and markers of PCa aggressiveness on radical prostatectomy (RP).Methods
All patients consecutively treated for PCa by RP in 6 academic institutions between August 2013 and July 2016 were included. MetS was defined as at least 3 of 5 components (obesity, elevated blood pressure, diabetes, low high-density lipoprotein (HDL)-cholesterol, and hypertriglyceridemia). Demographic, biological, and clinical parameters were prospectively collected, including: age, biopsy results, preoperative serum prostate-specific antigen, surgical procedure, and pathological data of RP specimen. Locally advanced disease was defined as a pT-stage ≥3. International Society of Urological Pathology (ISUP) groups were used for pathological grading. Qualitative and quantitative variables were compared using chi-square and Wilcoxon tests; logistic regression analyses assessed the association of MetS and its components with pathological data. Statistical significance was defined as a P<0.05.Results
Among 567 men, 249 (44%) had MetS. In a multivariate model including preoperative prostate-specific antigen, biopsy ISUP-score, clinical T-stage, age, and ethnicity: we found that MetS was an independent risk factor for positive margins, and ISUP group ≥4 on the RP specimen (odds ratio [OR] = 1.5; 95% CI: 1.1–2.3; P = 0.035; OR = 2.0; 95% CI: 1.1–4.0; P = 0.044, respectively). In addition, low HDL-cholesterol level was associated with locally advanced PCa (OR = 1.6; 95% CI: 1.1–2.4; P = 0.024). Risks of adverse pathological features increased with the number of MetS components: having ≥ 4 MetS components was significantly associated with higher risk of ISUP group ≥ 4 and higher risk of positive margins (OR = 1.9; 95% CI: 1.1–3.3; P = 0.017; OR = 1.8; 95% CI: 1.1–2.8; P = 0.007, respectively).Conclusion
MetS was an independent predictive factor for higher ISUP group and positive margins at RP. Low HDL-cholesterol alone, and having 4 and more MetS components were also associated with higher risk of adverse pathological features. 相似文献2.
Sangjun Yoo Jun Hyuk Hong Seok-Soo Byun Ji Youl Lee Byung Ha Chung Choung-Soo Kim 《Urologic oncology》2017,35(7):459.e7-459.e13
Background and objective
To evaluate the clinical effects of suspicious upstaging on multiparametric magnetic resonance imaging (mpMRI) for improving the quality of Prostate Cancer Research International Active Surveillance (PRIAS) criteria.Material and methods
A total of 363 patients with low-risk prostate cancer (PCa) were selected from the K-CaP registry (the multicenter Korean PCa Database). Patients were divided into 2 groups according to the results of mpMRI (with or without suspicious upstaging). The variables for predicting significant PCa, defined as locally advanced PCa, Gleason score≥7, or tumor volume>0.5 cc or all of these, and adverse PCa, defined as locally advanced PCa, Gleason score≥7 (4+3), or tumor volume>2.5 cc or all of these, were assessed.Results
The mpMRI led to “suspicious” upstaging in 56 patients (15.4%). Significant PCa (98.2% vs. 74.6%, P<0.001) and adverse PCa (85.7% vs. 32.6%, P<0.001) were more common in patients with suspicious upstaging. The sensitivity/specificity of mpMRI for significant PCa and adverse PCa were 25.4%/98.2% and 32.4%/96.3%, respectively. On multivariate analyses, suspicious upstaging on mpMRI (odds ratio: 15.82, P = 0.007) was a predictor for significant PCa in addition to PRIAS criteria and age at diagnosis. In addition, suspicious upstaging on mpMRI (odds ratio: 11.11, P<0.001) was a significant predictor for adverse PCa in addition to PRIAS criteria, age at diagnosis, and body mass index.Conclusion
Along with the PRIAS criteria, suspicious upstaging on mpMRI is a potent diagnostic tool for distinguishing patients suitable for active surveillance among patients with low-risk PCa. 相似文献3.
Felix Preisser Sebastiano Nazzani Marco Bandini Michele Marchioni Zhe Tian Francesco Montorsi Fred Saad Alberto Briganti Thomas Steuber Lars Budäus Hartwig Huland Markus Graefen Derya Tilki Pierre I. Karakiewicz 《Urologic oncology》2018,36(8):365.e1-365.e7
Objectives
To investigate lymph node invasion (LNI) rates in prostate cancer (PCa) patients. Recent studies demonstrated an inverse stage migration in PCa patients toward more advanced and unfavorable diseases. We hypothesized that this trend is also evident in LNI rates, in PCa patients treated with radical prostatectomy (RP) and pelvic lymph node dissection (PLND).Patients and methods
Within the Surveillance, Epidemiology, and End Results database (2004–2014), we identified patients who underwent RP and PLND. Annual trends of LNI rates and PLND extent were plotted. Univariable and multivariable logistic regression models tested the hypothesis that LNI rates are increasing annually, even after adjustment for clinical or pathological characteristics.Results
Of 96,874 patients treated with RP and PLND, 4.1% (n = 4,002) exhibited LNI. The rate of LNI (2.5%–6.6%.), the mean (6.5–8.4) and median (5–6) number of removed lymph nodes increased during the study period. In multivariable logistic regression models, more contemporary year of diagnosis was associated with higher LNI rate, when year of diagnosis was modeled as a continuous, categorized or cubic spline variable, with adjustment for either clinical (prostate specific antigen, clinical tumor stage, and biopsy Gleason group) or pathological characteristics (pathologic tumor stage and Gleason group), as well as PLND extent (number of removed lymph nodes).Conclusion
We confirmed the hypothesis about increasing LNI rate over time in RP patients. This observation implies an increasing rate of unfavorable PCa defined as LNI. This finding is novel for contemporary epidemiological North American or European databases. 相似文献4.
Objective
Protein kinase, DNA-activated, catalytic polypeptide (PRKDC) is a critical component of DNA repair machinery and its dysregulated expression has been observed in various cancer types or premalignant cells. However, its role in prostate cancer (PCa) development and its prognostic significance in PCa is unknown.Methods
The mRNA and protein levels of PRKDC were analyzed in 15 pairs of PCa and benign prostatic hyperplasia tissues as well as PCa cell lines by quantitative real-time polymerase chain reaction and Western blot, respectively. Small interfering RNA and short hairpin RNA-mediated knockdown of PRKDC, followed by cell proliferation, colony formation, and soft agar assays were performed. Xenograft mouse model was used to evaluate in vivo effects of PRKDC knockdown. The association between PRKDC expression and clinicopathologic features was assessed by χ2 tests. Kaplan-Meier analysis was performed to investigate the association between PRKDC expression and overall survival. Cox proportional hazards regression models were used to examine the prognostic significance of PRKDC.Results
Expression of PRKDC mRNA and protein was notably higher in PCa tissues and PCa cell lines. Knockdown of PRKDC markedly reduced cell proliferation, colony formation efficiency, and soft agar growth in DU145 cells. Down-regulation of PRKDC inhibited tumor growth of DU145 xenografts and enhance mice survival. In addition, PRKDC expression in PCa was significantly associated with Gleason score (P = 0.01), tumor stage (P = 0.028), and distant metastasis (P = 0.025). Patients with PCa having higher PRKDC expression had substantially shorter survival than patients with lower PRKDC expression.Conclusion
Down-regulation of PRKDC attenuates tumor progression in PCa. PRKDC may potentially be a prognostic biomarker in PCa. 相似文献5.
Isabel Heidegger Willi Oberaigner Wolfgang Horninger Renate Pichler 《Urologic oncology》2017,35(4):152.e1-152.e5
Aim
To analyze prostate cancer (PCa) incidence, clinical significance, and recurrence in 213 patients who underwent radical cystectomy (RC) for advanced bladder cancer (BC).Patients and methods
We conducted a 10-year retrospective analysis of a single-center database comprising the effect of PCa in RC specimens.Results
In total, 113/213 male patients (53.1%) had PCa in the RC specimen. Patients? age, prostate-specific antigen (PSA), and also free PSA% were significant predictors for PCa. In addition, adverse bladder histology (≥pT3) was found in 63.7% of patients with PCa. A total of 52.2% (59/113) of patients had at least a Gleason score (GS) 7 in final pathology and 10.6% of RC specimens showed an organ border growth (≥pT3a). It was noted that 28.3% of patients experienced a biochemical recurrence (PSA≥0.2 ng/ml), among them 86.7% had GS≥7 in the RC specimen; however, 2 patients were diagnosed with a GS 5. Moreover, we found that 80% of patients with biochemical recurrence had an organ-extended (≥pT3) histology of the bladder and 40% of patients with biochemical recurrence died of PCa rather than from BC.Conclusion
Concomitant PCa is occurring in>50% of RC specimens with a significant proportion having characteristics (GS, pathological stage) of clinically relevant disease. Adverse bladder histology is a risk factor for both PCa and biochemical PSA recurrence. Follow-up analyses after RC should include PSA measurements also in low-risk PCa as a considerable number of patients develop biochemical recurrence and metastases from PCa partly ending up with death related to PCa in patients suffering from BC. 相似文献6.
Dmitry Zavlin Kevin T. Jubbal Jeffrey L. Van Eps Barbara L. Bass Warren A. Ellsworth Anthony Echo Jeffrey D. Friedman Brian J. Dunkin 《Surgery for obesity and related diseases》2018,14(2):206-213
Background
Metabolic syndrome (MetS) entails the simultaneous presence of a constellation of dangerous risk factors including obesity, diabetes, hypertension, and dyslipidemia. The prevalence of MetS in Western society continues to rise and implies an elevated risk for surgical complications and/or poor surgical outcomes within the affected population.Objective
To assess the risks and outcomes of multi-morbid patients with MetS undergoing open ventral hernia repair.Setting
Multi-institutional case-control study in the United States.Methods
The American College of Surgeons National Surgical Quality Improvement Program database was sampled for patients undergoing initial open ventral hernia repair from 2012 through 2014 and then stratified into 2 cohorts based on the presence or absence of MetS. Statistical analyses were performed to evaluate preoperative co-morbidities, intraoperative details, and postoperative morbidity and mortality to identify risk factors for adverse outcomes.Results
Mean age (61.0 versus 56.0 yr, P<.001), body mass index (39.2 versus 31.1, P<.001), and prevalence of co-morbidities of multiple organ systems were significantly higher (P<.001) in the MetS cohort compared to control. Patients with MetS received higher American Society of Anesthesiologists classifications (81.0% versus 43.1% class 3 or higher, P<.001), were more likely to require operation as emergency cases (11.4% versus 7.2%, P<.001), required longer operative times (103 versus 87 min, P<.001), had longer hospitalizations (3.5 versus 2.4 d, P<.001), and had more contaminated wounds (15.9% versus 12.0% class 2 or higher, P<.001). Overall, they had more medical (7.5% versus 4.2%, P<.001), and surgical complications (9.7% versus 5.4%, P<.001), experienced more readmissions (8.3% versus 5.7%, P<.001) and reoperations (3.4% versus 2.5%, P<.001), and were at higher risk for eventual death (.8% versus .5%, P=.008).Conclusions
The presence of MetS is related to a multitude of unfavorable outcomes and increased mortality after open ventral hernia repair compared with a non-MetS control group. MetS is a useful marker for high operative risk in a population that is generally prone to obesity and its associated diseases. 相似文献7.
Katarina L. Matthes Giulia Pestoni Dimitri Korol Mieke Van Hemelrijck Sabine Rohrmann 《Urologic oncology》2018,36(6):309.e15-309.e23
Purpose
To assess the risk of prostate cancer (PCa) specific mortality (PCSM) compared to cardiovascular disease mortality (CVDM), or other-cause mortality (OCM) of men with nonmetastatic PCa according to PCa risk groups, primary treatment, and age.Patients and methods
This retrospective population-based cohort study identified 1,908 nonmetastatic PCa patients in the cancer registry Zurich and Zug, diagnosed between 2000 and 2009 living in the City of Zurich. Multiple imputation methods were applied to handle missing PCa information. Fine and Gray competing risk regression analysis was used to estimate subdistribution hazard ratios for the outcomes PCSM, CVDM, or OCMResults
Ten years after diagnosis the cumulative probability of PCSM and CVDM was 16.4% and 10.0%, respectively. We observed an increased adjusted risk of PCSM in men treated with androgen deprivation therapy (ADT) compared to surgery, but could not observe an association between ADT and CVDM. The probability of PCSM was significantly higher for patients on active surveillance or watchful waiting, compared to surgery. Age and PCa risk categories were positively associated with risk of PCSM, whereas there was no evidence for an association with CVDM or OCM based on risk groups.Conclusions
Overall, men with PCa were more likely to die from non-PCa related outcomes. Nevertheless, the analyses showed a high proportion of PCSM among men on ADT, older men and men with a high-risk tumor. However, further research is needed to understand comprehensively the benefits of the respective treatments. 相似文献8.
Yohei Sekino Naohide Oue Yoshinori Shigematsu Akira Ishikawa Naoya Sakamoto Kazuhiro Sentani Jun Teishima Akio Matsubara Wataru Yasui 《Urologic oncology》2017,35(1):31.e13-31.e20
Objectives
Prostate cancer (PCa) is a common malignancy worldwide. Docetaxel has been an important treatment option for patients with metastatic castration-resistant prostate cancer (CRPC). However, nearly all patients with CRPC treated with docetaxel eventually become refractory. In the present study, we analyzed the expression and distribution of kinesin family member C1 (KIFC1) in human PCa by immunohistochemistry and examined the effect of inhibiting KIFC1 expression on docetaxel resistance.Methods
Expression of KIFC1 was determined using immunohistochemistry. RNA interference was used to inhibit KIFC1 expression in PCa cell lines. To examine cell viability, we performed 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays.Conclusions
These results indicate that KIFC1 plays an important role in PCa progression. Immunohistochemical analysis of KIFC1 would facilitate identification of patients with poor prognoses after radical prostatectomy, as well as patients with poor therapeutic outcomes after docetaxel-based chemotherapy. 相似文献9.
Daniel N. Costa Fernando U. Kay Ivan Pedrosa Lauren Kolski Yair Lotan Claus G. Roehrborn Brad Hornberger Yin Xi Franto Francis Neil M. Rofsky 《Urologic oncology》2017,35(4):149.e15-149.e21
Background
Targeted prostate biopsies are changing the landscape of prostate cancer (PCa) diagnosis with the degree of suspicion on multiparametric magnetic resonance imaging (mpMRI) being a strong predictor of targeted biopsy outcome. Data regarding the rate and potential causes of false-negative magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion–targeted biopsy in patients with highly suspicious mpMRI findings are lacking.Objectives
To determine the rate of clinically significant PCa detection in repeat targeted biopsy or surgery in patients with highly suspicious mpMRI findings and in an initial negative MRI-TRUS fusion–targeted biopsy.Materials and methods
In this single-center, retrospective study of prospectively generated data, men with highly suspicious lesions (Likert 5 score) on mpMRI and an initial negative MRI-TRUS fusion–targeted biopsy were reviewed. The rate of PCa detection in a subsequent MRI-TRUS fusion–targeted biopsy or radical prostatectomy was determined. Tumors in the intermediate- and high-risk groups according to the National Comprehensive Cancer Network criteria were considered clinically significant.Results
A total of 32 men with 38 Likert 5 lesions were identified. Repeat targeted biopsy or surgery detected cancer in 42% (16/38) of the Likert 5 lesions with initial negative targeted biopsy. Most of these cancers were intermediate- (69%; 11/16) or high-risk (25%; 4/16) tumors.Conclusion
A negative round of targeted biopsies does not exclude clinically significant PCa in men with highly suspicious mpMRI findings. Patients with imaging-pathology disagreement should be carefully reviewed and considered for repeat biopsy or for strict surveillance. 相似文献10.
Giorgio Gandaglia R. Jeffrey Karnes Arjun Sivaraman Marco Moschini Nicola Fossati Emanuele Zaffuto Paolo DellʼOglio Xavier Cathelineau Francesco Montorsi Rafael Sanchez-Salas Alberto Briganti 《Urologic oncology》2017,35(7):461.e7-461.e14
Background
According to the novel prostate cancer (PCa) grade grouping, men with Gleason score 8 should be included in the grade group 4 regardless of primary and secondary scores. We aimed at evaluating the effect of Gleason patterns on the risk of recurrence in men with grade group 4 PCa.Patients and methods
Overall, 1,089 patients treated with radical prostatectomy with grade group 4 PCa at final pathology were identified. Biochemical recurrence (BCR) was defined as 2 consecutive prostate-specific antigen values≥0.2 ng/ml and rising. Clinical recurrence (CR) was defined as positive imaging after BCR. Kaplan-Meier analyses assessed time to BCR and CR. Multivariable Cox regression analyses assessed the impact of Gleason patterns on the risk of BCR and CR.Results
Overall, 295 (27.1%), 651 (59.8%), and 143 (13.1%) patients had pathologic Gleason pattern 3+5, 4+4, and 5+3. Overall, 435 (39.9%) patients had positive margins and 439 (30.2%), 300 (27.5%), 350 (32.1%), and 216 (19.8%) had pT2, pT3a, pT3b/4, and pN1 disease. Median follow-up was 83 months. Overall, 536 and 221 patients experienced BCR and CR. The 10-year BCR- and CR-free survival rates were 42.9% and 67.5% vs. 38.3% and 59.7% vs. 40.6% and 50.4% for patients with pathologic Gleason pattern 3+5 vs. 4+4 vs. 5+3, respectively (all P≤0.005). In multivariable analyses, patients with Gleason pattern 3+5 were at lower risk of BCR compared to those with 4+4 (P = 0.002). Men with Gleason pattern 3+5 were at lower risk of CR compared to those with 4+4 and 5+3 (all P≤ 0.01).Conclusions
Patients with a primary Gleason score 3 are at reduced risk of recurrence as compared to their counterparts with 4 or 5. Primary and secondary Gleason scores should be considered to stratify the risk of recurrence after surgery in patients with grade group 4 PCa. 相似文献11.
João Lobo Ângelo Rodrigues Luís Antunes Inês Graça João Ramalho-Carvalho Filipa Quintela Vieira Ana Teresa Martins Jorge Oliveira Carmen Jerónimo Rui Henrique 《Urologic oncology》2018,36(4):161.e7-161.e17
Introduction
Overtreatment is a major concern in patients with prostate cancer (PCa). Prognostic biomarkers discriminating indolent from aggressive disease in prostate biopsy are urgently needed. We aimed to evaluate the prognostic value of Ki67, EZH2, LSD1, and SMYD3 immunoexpression in diagnostic biopsies from a cohort of PCa patients with long term follow-up.Materials and methods
A series of 189 consecutive prostate biopsies diagnosed with PCa (1997–2001) in a cancer center was included in the study, with follow-up last updated in November 2016. Biopsies were reviewed and graded according to 2016 WHO criteria. Immunohistochemistry was performed in the most representative block. Nuclear staining was assessed using digital image analysis. Study outcomes included disease-specific, disease-free, and progression-free survival. Statistical analysis was tabulated using SPSS version 22.0. Survival curves and hazard ratios (HRs) were estimated using Kaplan-Meyer and Cox-regression models, respectively. Statistical significance was set at P<0.05.Results
The proportion of patients who completed the study was 177/189 (94%). In univariable analysis, high Ki67, EZH2, and SMYD3 immunoexpression associated with significantly worse disease-specific survival (HR = 1.86, 95% CI: 1.05–3.29; HR = 1.87, 95% CI: 1.10–3.27; HR = 2.68, 95% CI: 1.02–7.92). In multivariable analysis, the 3 biomarkers displayed significantly worse DSS adjusted for CAPRA score (HR = 1.78, 95% CI: 1.01–3.16; HR = 1.93, 95% CI: 1.12–3.32; HR = 2.71, 95% CI: 1.04–7.10). Among patients with low/intermediate risk CAPRA score, high Ki67 immunoexpression identified those more prone to experience disease recurrence (HR = 9.20, 95% CI: 1.27–66.44) and progression (HR = 2.97, 95% CI: 1.05–8.43).Conclusions
High Ki67, EZH2, and SMYD3 immunoexpression, adjusted for standard clinicopathological parameters, independently predicts outcome in patients with PCa, at diagnosis. This might assist in discriminating indolent from aggressive PCa, improving treatment selection. 相似文献12.
Prevathe Poniah Shamsul Mohd Zain Azad Hassan Abdul Razack Shanggar Kuppusamy Shankar Karuppayah Hooi Sian Eng Zahurin Mohamed 《Urologic oncology》2017,35(9):545.e1-545.e11
Background
Two key issues in prostate cancer (PCa) that demand attention currently are the need for a more precise and minimally invasive screening test owing to the inaccuracy of prostate-specific antigen and differential diagnosis to distinguish advanced vs. indolent cancers. This continues to pose a tremendous challenge in diagnosis and prognosis of PCa and could potentially lead to overdiagnosis and overtreatment complications. Copy number variations (CNVs) in the human genome have been linked to various carcinomas including PCa. Detection of these variants may improve clinical treatment as well as an understanding of the pathobiology underlying this complex disease.Methods
To this end, we undertook a pilot genome-wide CNV analysis approach in 36 subjects (18 patients with high-grade PCa and 18 controls that were matched by age and ethnicity) in search of more accurate biomarkers that could potentially explain susceptibility toward high-grade PCa. We conducted this study using the array comparative genomic hybridization technique. Array results were validated in 92 independent samples (46 high-grade PCa, 23 benign prostatic hyperplasia, and 23 healthy controls) using polymerase chain reaction–based copy number counting method.Results
A total of 314 CNV regions were found to be unique to PCa subjects in this cohort (P<0.05). A log2 ratio-based copy number analysis revealed 5 putative rare or novel CNV loci or both associated with susceptibility to PCa. The CNV gain regions were 1q21.3, 15q15, 7p12.1, and a novel CNV in PCa 12q23.1, harboring ARNT, THBS1, SLC5A8, and DDC genes that are crucial in the p53 and cancer pathways. A CNV loss and deletion event was observed at 8p11.21, which contains the SFRP1 gene from the Wnt signaling pathway. Cross-comparison analysis with genes associated to PCa revealed significant CNVs involved in biological processes that elicit cancer pathogenesis via cytokine production and endothelial cell proliferation.Conclusion
In conclusion, we postulated that the CNVs identified in this study could provide an insight into the development of advanced PCa. 相似文献13.
Adam B. Weiner Richard S. Matulewicz Jeffrey J. Tosoian Joseph M. Feinglass Edward M. Schaeffer 《Urologic oncology》2018,36(3):91.e1-91.e6
Background
Understanding the characteristics of men who initially present with metastatic prostate cancer (mPCa) can better enable directed improvement initiatives. The objective of this study was to assess the relationship between socioeconomic status (SES) and newly diagnosed mPCa.Materials Methods
All men diagnosed with PCa in the National Cancer Data Base from 2004 to 2013 were identified. Characteristics of men presenting with and without metastatic disease were compared. A 4-level composite metric of SES was created using Census-based income and education data. Multivariable logistic regression was used to evaluate the association between SES, race/ethnicity, and insurance and the risk of presenting with mPCa at the time of diagnosis.Results
Of 1,034,754 patients diagnosed with PCa, 4% had mPCa at initial presentation. Lower SES (first vs. fourth quartile; odds ratio [OR] = 1.39, 95% CI: 1.35–1.44), black and Hispanic race/ethnicity (vs. white; OR = 1.47, 95% CI: 1.43–1.51 and OR = 1.22, 95% CI: 1.17–1.28, respectively), and having Medicaid or no insurance (vs. Medicare or private; OR = 3.91, 95% CI: 3.78–4.05) were each independently associated with higher odds of presenting with mPCa after adjusting for all other covariates.Conclusions
Lower SES, race/ethnicity, and having Medicaid or no insurance were each independently associated with higher odds of presenting with metastases at the time of PCa diagnosis. Our findings may partially explain current PCa outcomes disparities and inform future efforts to reduce disparities. 相似文献14.
Gautam Sharma Andrew T. Strong Chao Tu Stacy A. Brethauer Philip R. Schauer Ali Aminian 《Surgery for obesity and related diseases》2018,14(3):304-310
Background
The current literature comparing robot-assisted Roux-en-Y gastric bypass (RA-RYGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) is limited to single center retrospective series.Objectives
This study aims to compare perioperative outcomes of patients who underwent RA-RYGB with those who underwent LRYGB.Setting
National database.Methods
Data on patients who underwent RA-RYGB and LRYGB were extracted from the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participant use file. A 1:8 propensity score matching (RA-RYGB:LRYGB) was performed, and the 30-day outcomes of the propensity-matched cohorts were compared.Results
In total, 36,158 patients met inclusion criteria, including 2660 RA-RYGB (7.4%) cases, which were propensity matched (1:8) with 21,280 LRYGB cases having similar preoperative characteristics. RA-RYGB was associated with longer median operative time (136 versus 107 min; P<.001) and a higher 30-day readmission rate (7.3% versus 6.2%; P = .03). There were no statistical differences between the RA-RYGB and LRYGB cohorts with respect to all-cause morbidity (10.6% versus 10.7%; P = .8), serious morbidity (1.2% versus 1.7%; P = .07), mortality (0.1% versus .2%; P = .2), unplanned intensive care unit admission (1.1% versus 1.3%; P = .3), reoperation (2.4% versus 2.4%; P = .97), or reintervention (3.0% versus 2.5%; P = .2) within 30 days after surgery.Conclusion
Based on available national data, RA-RYGB appears safe compared with a conventional laparoscopic approach for gastric bypass. However, RA-RYGB was associated with longer operative time and higher readmission rate, indicating greater resource use. Further studies are needed to better delineate the role of robotic platforms in bariatric surgery. 相似文献15.
Paolo Dell’Oglio Marco Bandini Sami-Ramzi Leyh-Bannurah Zhe Tian Vincent Trudeau Alessandro Larcher Nicola Fossati Marco Moschini Giorgio Gandaglia Umberto Capitanio Alberto Briganti Markus Graefen Francesco Montorsi Fred Saad Pierre I. Karakiewicz 《Urologic oncology》2018,36(5):239.e9-239.e15
Objective
Several randomized controlled trials have documented significant overall survival benefit in high metastatic risk prostate cancer (PCa) patients treated with combination of androgen deprivation therapy (ADT) at radiotherapy (RT) relative to RT alone. Unfortunately, elderly patients are either not included or are underrepresented in these trials. In consequence, the survival benefit of combination of ADT at RT in the elderly warrants detailed reassessment, including its cost.Methods
Between 1991 and 2009 within the Surveillance Epidemiology and End Results (SEER)-Medicare-linked database, we identified 3,692 patients aged 80 years or more with clinical T1–T2 PCa and WHO histological grade 3, or clinical T3–T4 PCa and any histological grade, treated with or without combination of ADT at RT. Competing risks analyses focused on cancer-specific mortality (CSM) and other-cause mortality, after accounting for confounders. All analyses were repeated in patients with no comorbidity and in most contemporary patients, treated between 2001 and 2009. Finally, we assessed median annual cost according to use of combination of ADT at RT, after adjusting for patient and tumor characteristics.Results
In competing-risks multivariable analyses, no statistically significant difference was observed in CSM and other-cause mortality between patients treated with or without combination of ADT at RT. Same results were recorded in subgroup analyses of patients with no comorbidity and in most contemporary patients. The median annual costs of $36,140 and of $47,510 were recorded, respectively in patients treated without and with ADT at RT.Conclusion
Our findings failed to confirm that combination of ADT at RT reduces CSM rates in high metastatic risk PCa patients aged 80 years or more. Moreover, combination of ADT at RT resulted in a significant cost increase, relative to RT alone. 相似文献16.
Cosimo De Nunzio Riccardo Lombardo Giorgia Tema Hassan Alkhatatbeh Giorgio Gandaglia Alberto Briganti Andrea Tubaro 《Urologic oncology》2018,36(8):364.e1-364.e7
Objectives
The aim of our study was to analyze the performance of 5 different risk calculators for prostate cancer diagnosis: Prostate Cancer Prevention Trial Risk Calculator (PCPT-RC), European Randomized Study of Screening for Prostate Cancer Risk Calculator (ERSP-RC), Karakiewicz nomogram, Chun nomogram, and Kawakami Nomogram.Methods
From 2008 onwards, we consecutively enrolled, at a single institution in Italy, men undergoing 12-core transrectal ultrasound-guided prostate needle biopsy. Demographic, clinical, and pathological data were collected. The risk of prostate cancer (PCa) was calculated according to the PCPT-RC, ERSPC-RC, Karakiewicz, Kawakami, and Chun nomograms. Calibration and discrimination were assessed using calibration plots and receiver operator characteristic analysis. Additionally, decision curve analyses (DCA) were used to assess the net benefit associated with the adoption of each model.Results
Overall, 1,100 patients were evaluated, 39% presented PCa and out of them 26% presented high-grade PCa (defined as Gleason ≥ 4 + 3). All the models showed good discrimination capacities for PCa on receiver operator characteristic analysis (area under the curve: 0.59–0.72) On calibration curves the ERSCP, the PCPT and the Chun nomogram underestimated the risk of PC while the Kawakami overestimated it. At DCA, the net benefit associated with the use of the models in the prediction of cancer was observed when the threshold probability was between 40% and 60%.Conclusion
In a cohort of Italian men undergoing prostate biopsy, the performance accuracy of these calculators for the prediction prostate cancer is suboptimal. According to our experience the use of these calculator in clinical practice should be encouraged. Although integration with new serum/urine markers or magnetic resonance imaging results is warranted. 相似文献17.
Tarik Benidir Karen Hersey Antonio Finelli Rob Hamilton Anthony M. Joshua Girish Kulkarni Alexandre Zlotta Neil Fleshner 《Urologic oncology》2018,36(5):240.e13-240.e20
Several new compounds are now available for castration resistant prostate cancer (CRPC). Individual costs range between $40,000 and $93,000 with mean survival extensions from 2.4 to 4.8 months. Currently, it remains unclear how patients with prostate cancer (PCa) value the effect of these therapies in the setting of CRPC.
Objective
To assess patient understanding of core cancer concepts, opinions on the cost and overall benefit of CRPC drugs, whether out-of-pocket costs would change opinions and whether patients would ultimately opt out of CRPC drug treatment for an end-of-life (EOL) premium.Patients and methods
We conducted a qualitative survey among patients with various PCa states ranging from active surveillance to CRPC and from various familial, financial and educational demographics. Through a series of hypothetical scenarios, we extrapolated opinions on CRPC drug value, efficacy and monetary worth. We assessed patient willingness to accept an EOL ($50,000) premium in lieu of CRPC drug treatment. Statistically, chi-squared analysis and Fisher’s exact test were used when appropriate.Results
In total, 103 patients completed the questionnaire, one-half of whom did not understand “advanced PCa” state and more than one-third of the concept of palliative care despite multiple meetings with Urologists. Patients willingness-to-pay and proposed drug value was higher than that accepted by government when government funded, with costs exceeding $250,000 per person, but lower than that accepted by government when self-funded. A majority (60%) would accept/consider the EOL premium in the setting of CRPC. Patients with higher education were more skeptical about CRPC drug value and more likely to accept the EOL premium (P = 0.003.)Conclusion
Patients have an incomplete understanding of their own disease prognosis and its therapeutic options. This ultimately influences patient decision-making. Education, income and out-of-pocket costs diminished opinion of CRPC drugs considerably. As such, an EOL premium should be considered in subsets of patients. 相似文献18.
Eberechukwu Onukwugha Candice Yong Michael Naslund Corinne Woods C. Daniel Mullins Brian Seal Arif Hussain 《Urologic oncology》2017,35(4):150.e17-150.e23
Background
The urologist generally manages the treatment of men immediately following the diagnosis of prostate cancer (PCa). The role of other physician specialists in this setting is less clear. We investigated whether involvement of other physician specialty types immediately following diagnosis affects initiation of cancer-directed treatment.Methods
This is a retrospective cohort study using linked cancer registry and claims data from 1999 to 2009, excluding stage I/II PCa. A physician visit index (PVI) served as the exposure variable and captured the “dispersion of care” across specialties, that is, the extent to which patient care involved different types of physician specialties such as the primary care physician, urologist, or oncologist. The PVI score was calculated using visits occurring within 30 days postdiagnosis. This score was dichotomized to measure “low PVI” (reflects seeing multiple specialist types). Competing risk Cox proportional hazard regression models provided adjusted hazard ratios (HR) for treatment receipt associated with a low PVI.Results
The sample included 33,380 patients: 4,910 metastatic and 28,470 nonmetastatic groups. The top 3 visit categories within 30 days postdiagnosis were “urologist only” (59%) and “urologist plus primary care physician” (21%) and no visit (6%). The median time to receipt of cancer-directed treatment was 51 days. Overall, 29% of individuals in the metastatic group and 38% in the nonmetastatic group were categorized as low PVI. A low PVI was associated with a shorter time to treatment receipt in the nonmetastatic (HR = 1.12 [95% CI: 1.09–1.15]) and metastatic (HR = 1.21 [95% CI: 1.14–1.29]) groups.Conclusions
Multispecialist involvement in the weeks following diagnosis is associated with a shorter time to treatment initiation, highlighting a role for exposure to different specialty types in the weeks following an initial diagnosis of PCa. This study provides important baseline data for future studies examining coordination of care across cancer and noncancer specialists. 相似文献19.
Katia P. Souto Nelson G. Meinhardt Maurício J. Ramos Jane M. Ulbrich-Kulkzynski Airton T. Stein Daniel C. Damin 《Surgery for obesity and related diseases》2018,14(1):66-73
Background
Bariatric surgery has been investigated as a treatment option for obese patients with nonalcoholic fatty liver disease (NAFLD). Because patients with NAFLD and type 2 diabetes show accelerated progression from liver disease to cirrhosis, it has been suggested that surgery could be indicated for patients with lower degrees of obesity and type 2 diabetes.Objective
To analyze the degree of tissue damage in liver biopsies obtained from patients undergoing bariatric surgery, correlating histopathologic findings with their baseline glucose status.Setting
General hospital in the public health system.Methods
Intraoperative liver biopsies were obtained from 521 obese patients undergoing bariatric surgery. Patients were divided into 3 study groups according to their preoperative glucose levels: 167 (32.05%) type 2 diabetic, 132 (25.33%) prediabetic, and 222 (42.61%) normoglycemic patients. Tissue samples were classified in accordance with Brunt and Clinical Research Network Nonalcoholic Steatohepatis criteria.Results
Prevalence of NAFLD was 95%. Higher rates of hepatic fibrosis were observed in diabetic patients (56.4%) compared with prediabetic (29.2%), and normoglycemic patients (28.6%) (P<.001). Nonalcoholic steatohepatitis was diagnosed in 59.4% of the diabetics, in 49.2% of the prediabetics, and in 36% of the normoglycemic obese (P<.001). Only 1.5% of the diabetics had no histologic hepatic alterations.Conclusion
NAFLD is markedly more severe in diabetic patients. Our data suggest that intraoperative liver biopsy should be considered for diabetic patients undergoing bariatric surgery. Early bariatric surgery should be investigated as a means to prevent progression of NAFLD. 相似文献20.
Khalid Elias Zakaria Bekhali Jakob Hedberg Wilhelm Graf Magnus Sundbom 《Surgery for obesity and related diseases》2018,14(2):144-149