共查询到20条相似文献，搜索用时 31 毫秒
1.
Brandon J. Manley Daniel M. Tennenbaum Emily A. Vertosick James J. Hsieh Daniel D. Sjoberg Melissa Assel Nicole E. Benfante Seth A. Strope Eric Kim Jozefina Casuscelli Maria F. Becerra Jonathan A. Coleman Abraham Ari Hakimi Paul Russo 《Urologic oncology》2017,35(1):35.e1-35.e5
Purpose
To externally evaluate a preoperative points system and a preoperative nomogram, both created to assess time to death after cytoreductive nephrectomy (CN).Materials and methods
We identified 298 patients who underwent CN at our institution, a tertiary cancer center, between 1989 and 2015. To validate the points system, we compared reported overall survival (OS) for each criterion to observed OS in our cohort. To evaluate the nomogram, we prognosticated risk of death at 6 months after surgery for 280 patients with sufficient follow-up in our cohort and evaluated discrimination using area under the curve (AUC) and calibration. Decision curve analysis was performed to assess clinical utility of the nomogram.Results
Significant differences in OS were observed between patients with and without 5 of 7 criteria on univariate analysis: low albumin (P<0.0001), high lactate dehydrogenase (P = 0.002), liver metastasis (P = 0.004), retroperitoneal lymphadenopathy (P = 0.002), and supradiaphragmatic lymphadenopathy (P = 0.019). Discrimination from the preoperative model, predicting death within 6 months of surgery was lower in our cohort (AUC = 0.65, 95% CI: 0.52–0.79) than the original publication (AUC = 0.76). Decision curve analysis demonstrated little benefit for applicability.Conclusions
Five previously defined risk factors are predictive of decreased OS after CN in our cohort. We found lower discrimination using the preoperative model and minimal clinical utility according to decision analysis in our study cohort. These findings suggest the need for improved models to aid patient stratification and consequent treatment choice. 相似文献2.
Francesco Soria Ilaria Lucca Marco Moschini Romain Mathieu Morgan Rouprêt Pierre I. Karakiewicz Alberto Briganti Michael Rink Kilian M. Gust Melanie R. Hassler Beat Foerster Mohammad Abufarraj Andrea Haitel Tobias Klatte Shahrokh F. Shariat 《Urologic oncology》2017,35(6):356-362
Purpose
Overexpression of Caveolin-1 has been associated with cancer growth, migration, and metastases in several malignancies, but only few data are available on its role in bladder cancer (BCa). The aim of this study is to validate Caveolin-1 as a prognosticator of recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) in a large cohort of patients treated with radical cystectomy (RC) for BCa.Methods
Caveolin-1 expression was evaluated by immunochemistry on a tissue microarray from 424 patients treated with RC for UCB at a single institution. Caveolin-1 was considered overexpressed when at least 50% of the tumor cells stained positively. Univariable and multivariable Cox proportional hazards regression models were used to assess the association of Caveolin-1 expression with RFS, OS, and CSS.Results
Overexpression of Caveolin-1 was observed in 116 (27.4%) patients and was associated with lymph node metastasis (P = 0.003). Median follow-up for patients alive at last follow-up was 129 months (interquartile range [IQR]: 82–178). Patients with overexpression of Caveolin-1 had significant worse RFS, OS, and CSS compared to those with normal expression (log-rank test, P = 0.008, P = 0.001, and P = 0.005, respectively). At multivariable analyses that adjusted for the effects of standard clinicopathologic features, Caveolin-1 remained associated with OS (hazard ratio = 1.47, P = 0.002) and CSS (hazard ratio = 1.42, P = 0.03). Conversely, no association with RFS was found (P = 0.1). Addition of Caveolin-1 in a model for prediction of survival did not improve the accuracy of the prognostic model. Actually, C-index did not differ among models with or without Caveolin-1 (0.72 for a model predicting RFS, 0.65 for OS, and 0.71 for CSS).Conclusions
Caveolin-1 is overexpressed in one-third of patients with BCa treated with RC. Overexpression of Caveolin-1 is significantly associated with OS and CSS, but not with RFS, in patients with BCa treated with RC. However, it is not clinically useful as it does not improve upon the predictive accuracy of survival achieved by pathologic variables alone. 相似文献3.
E. Du Changwen Zhang Zhenbang Qin Kuo Yang Changying Li Aixiang Wang Zhihong Zhang Yong Xu 《Urologic oncology》2017,35(4):152.e7-152.e12
Objectives
The aim of the study was to evaluate the expression of TMEM67 in urothelial carcinoma of the bladder (UCB) tissues and to determine the potential relevance between the expression of TMEM67 and prognosis of UCB.Material and methods
In this study, the expression of TMEM67 mRNA was performed by quantitative real-time PCR in 80 UCB and 54 noncancerous tissues. The expression of TMEM67 protein was identified by immunohistochemistry and western blotting. Chi-square test was conducted to verify the relevance between the expression of TMEM67 and clinical parameters. Kaplan-Meier survival analysis was demonstrated between high or low expression level of TMEM67 mRNA and recurrence-free survival probability. Cox regression analysis was conducted to evaluate the relevance between the expression of TMEM67 and the prognosis in UCB.Results
Low expression of TMEM67 mRNA and protein was detected in most of UCB tissues using quantitative real-time polymerase chain reaction and western blotting, compared with noncancerous tissues. Low expressions of TMEM67 were associated with TNM stage, grade, and lymph node metastasis (P<0.05). Kaplan-Meier analysis showed that the low expression of TMEM67 mRNA had significantly shorter recurrence-free survival probability (P = 0.018). Cox regression analysis confirmed that low expression of TMEM67 mRNA predicted poor prognosis of patients with UCB (HR = 2.950, P = 0.029, 95% CI: 1.116–7.796).Conclusions
TMEM67 expression is low in UCB tissues, and the TMEM67 low expression predicted poor prognosis of patients with UCB. 相似文献4.
Pascal Mouracade Jaya S. Chavali Onder Kara Julien Dagenais Matthew J. Maurice Ryan J. Nelson Brian I. Rini Jihad H. Kaouk 《Urologic oncology》2017,35(11):660.e1-660.e8
Objectives
The aim of this study was to analyze the outcomes of surveillance after partial nephrectomy (PN) in a single institution and the relevance of imaging studies in detecting recurrence.Material and methods
Retrospective study of 830 patients who underwent PN for localized renal cell carcinoma between 2007 and 2015 at a single institution. We studied the characteristics of recurrence according to pathological and clinical features and elaborated risk groups. The type and the total number of imaging studies performed during surveillance or until recurrence were evaluated. Outcomes of surveillance were analyzed.Results
There were 48 patients (5.8%) diagnosed with recurrence during median 36 [21–52] months follow-up, including local recurrence in 18 patients (37.5%) and metastasis in 30 patients (62.5%). Totally, 17/18 patients (94.4%) with local recurrence and 26/30 patients (86.6%) with metastasis were diagnosed within the first 36 months after PN. When studying the recurrence rate, and time-to-recurrence, 2 risk groups emerged. Patients with pathological characteristics (tumors with pT1b or higher or high-grade tumor or positive surgical margin status) or patients with anatomical characteristics (high or moderate R.E.N.A.L. score) or both had high recurrence rate. Chest x-ray and abdominal ultrasound detected 7.7% and 3.4% of all recurrences, respectively, whereas computed tomography scan and magnetic resonance imaging scan detected the rest. Of the 48 patients diagnosed with recurrence, 44 (91.6%) were suitable for secondary active treatment (systemic, surgery, and radiotherapy) including 26 (54.2%) suitable for metastasectomy. The rate of relapse after secondary treatment was 43.5% (16.6% for the local recurrence group and 60.7% for metastasis group).Conclusion
Local recurrence emerges earlier than distant metastasis. Patients with any adverse pathological or anatomical features should be considered as high-risk group and followed closely in the first 36 months after PN with cross-sectional studies. Secondary active treatment is suitable for most patients, while surgical treatment fits fewer patients. Local recurrence is associated with increased rates of metastatic progression. 相似文献5.
Chenzhang Ou Li Liu Jiajun Wang Siyuan Dai Yang Qu Ying Xiong Wei Xi Jiejie Xu Jianming Guo 《Urologic oncology》2017,35(10):607.e1-607.e8
Purpose
Sialic acid-binding immunoglobulin-like lectins (siglecs) family has important functions in tumor progression. The purpose of our study is to figure out the correlation between the expression level of Siglec-8 and prognosis of patients with clear cell renal cell carcinoma (ccRCC), and then to predict the overall survival (OS) via a novel nomogram.Materials and methods
A group of patients (n = 267) histologically diagnosed with ccRCC from Zhongshan Hospital were included into our study. Immunohistochemistry of Siglec-8 was performed in the tissue microarray, and the staining intensity was divided into high/low according to the median value of the H-score grading. Survival analyses including Kaplan-Meier analyses and Cox regression analyses were performed to evaluate the association between Siglec-8 expression and the survival of patients in different risk groups. Stage, size, grade, and necrosis score and University of California Los Angeles Integrated Staging System score were used in the risk stratification. A nomogram incorporating Siglec-8 and several other clinical parameters was plotted for predicting the 5-year and 8-year OS.Results
Siglec-8 was observed dominantly on the membrane of tumor cells. The enhanced expression level of Siglec-8 had significant correlation with adverse overall and disease-free survival of patients (P<0.0001 and P = 0.0186, respectively). The association was more significant in patients with lower risk. Cox regression analyses defined Siglec-8 as an independent prognostic factor of OS (P<0.001 for univariate analysis, P = 0.003 for multivariate analysis). The new nomogram integrating Siglec-8 with several traditional prognostic factors proved to be more accurate than conventional prognostic system using tumor node metastasis stage only (Harrell c-index: 0.801, 95% CI: 0.755–0.847 vs. 0.717, 95% CI: 0.662–0.772).Conclusion
Our study has found that the elevated expression level of Siglec-8 was correlated with poor prognosis of patients with ccRCC. Siglec-8, incorporation with other clinical parameters, could perform better in prediction of patients? OS. 相似文献6.
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7.
Yidong Liu Zheng Liu Qiang Fu Zewei Wang Hangcheng Fu Weisi Liu Yiwei Wang Jiejie Xu 《Urologic oncology》2017,35(6):349-355
Purpose
Galectin-9, a member of the “tandem repeat” type galectins performing as animal lectins with an affinity for β-galactosides, has been well documented to exert crucial functions in immunomodulation, survival, and growth of various tumors. This study aims to reveal the clinical significance of galectin-9 in urothelial carcinoma of the bladder (UCB) postoperatively.Materials and methods
We retrospectively included 202 patients with UCB who underwent radical cystectomy at a single institute from 2002 to 2014. Galectin-9 expression was assessed by immunohistochemistry on tissue microarrays. The Kaplan-Meier method was conducted to plot survival curves. Prognostic nomograms were constructed via integrating all the independent indicators from multivariate Cox analysis for recurrence-free survival (RFS) and cancer-specific survival (CSS). In addition, we evaluate whether patients with increased or decreased galectin-9 expression might benefit from adjuvant chemotherapy.Results
Low galectin-9 expression was significantly correlated with lymphovascular invasion (P = 0.002), early recurrence (P = 0.010), and short CSS (P = 0.002). Furthermore, multivariate analysis identified galectin-9 expression as a potential independent indicator for RFS (hazard ratio = 0.62; 95% CI: 0.40–0.95; P = 0.030) and CSS (hazard ratio = 0.46; 95% CI: 0.26–0.81; P = 0.008). Moreover, the benefit associated with adjuvant chemotherapy was superior among galectin-9 low patients than among galectin-9 high patients (P = 0.014).Conclusions
Expression of galectin-9 is an independent prognostic factor for RFS and CSS in patients with UCB. Evaluation of galectin-9 expression may predict the benefit from adjuvant chemotherapy. 相似文献8.
Johan Abrahamsson Kristina Aaltonen Helgi Engilbertsson Fredrik Liedberg Oliver Patschan Lisa Rydén Gottfrid Sjödahl Sigurdur Gudjonsson 《Urologic oncology》2017,35(10):606.e9-606.e16
Background
There are currently no methods in clinical use that can detect early systemic dissemination of urothelial tumor cells.Objective
To evaluate measurement of circulating tumor cells (CTCs) as a biomarker for disseminated disease in patients with advanced bladder cancer.Design, setting, and participants
Between March 2013 and October 2015, 88 patients were prospectively included in the study: 78 were scheduled for radical cystectomy (RC) ± perioperative chemotherapy and 10 treated with palliative chemotherapy. The CellSearch CTC test was further assessed in this context by investigating expression of epithelial cell adhesion molecule (EpCAM) in primary tumors obtained at cystectomy from an independent cohort of 409 patients.Outcome measurements and statistical analysis
Presence of CTCs was tested for association with tumor stage, lymph node metastases, metastatic disease on [18 F]-fluorodeoxyglucose-positron emission tomography (FDG-PET), and cancer-specific and progression-free survival.Results
CTCs were detected in 17/88 patients (19%). In 61 patients who underwent FDG-PET-computed tomography (CT), a statistically significant association with presence of CTCs was found for radiological metastatic disease but not for normal PET-CT results (12/35 [34%] vs. 2/26 [8%], P = 0.014). After a median follow-up time of 16.5 months (95% CI: 9.6–21.4), presence of CTCs was associated with an increased risk of progression among patients treated with RC with or without perioperative chemotherapy (n = 75, P = 0.049). A multivariate analysis adjusted for clinical tumor stage, clinical lymph node status, and age showed that CTCs were an independent marker of progression (n = 75; hazard ratio = 2.78; 95% CI: 1.005–7.69; P = 0.049) but not of cancer-specific death (P = 0.596). In 409 cystectomised patients, more than 392 (96%) of the bladder tumors expressed EpCAM.Conclusions
CTCs were present in 19% of patients with advanced urothelial tumors and were associated with metastatic disease on FDG-PET-CT and with increased risk of disease progression after RC. A significant portion of urothelial cancer cells do express EpCAM and can thus be identified using EpCAM-antigen–based CTC detection methods. 相似文献9.
Takashige Abe Junji Ishizaki Hiroshi Kikuchi Keita Minami Ryuji Matsumoto Toru Harabayashi Ataru Sazawa Tango Mochizuki Satoshi Chiba Tomoshige Akino Masashi Murakumo Naoto Miyajima Kunihiko Tsuchiya Satoru Maruyama Sachiyo Murai Nobuo Shinohara 《Urologic oncology》2017,35(2):38.e1-38.e8
Aim
To clarify prognostic factors of metatstatic urothelial carcinoma treated by systemic chemotherapy in real-world clinical practice in the Japanese population.Materials and methods
A total of 228 patients with metastatic urothelial carcinoma undergoing systemic chemotherapy between 2000 and 2013 were included in the present multi-institutional study. The gemcitabine plus cisplatin regimen was administered as first-line chemotherapy to 131 patients, whereas methotrexate, vinblastine, doxorubicin, and cisplatin or its modified regimen was given to 71 patients. Of the 228 patients, 119 received at least 2 different regimens and 22 underwent resection of metastases (metastasectomy). Multivariate survival analysis was performed using the Cox proportional hazards model. The characteristics included were age, sex, Eastern Cooperative Oncology Group performance status (PS), primary site, pathology of primary site, hemoglobin levels, lactate dehydrogenase levels, C-reactive protein levels, corrected calcium levels, estimated glomerular filtration rate levels, history of prior chemotherapy, metastatic sites, resection of primary site, number of metastatic organs, and metastasectomy.Results
The median overall survival (OS) time was 17 months. On multivariate analysis, female sex, good Eastern Cooperative Oncology Group PS at presentation, hemoglobin level≥10 g/dl, and single organ metastasis were significant independent predictors of prolonged OS. For the survival effect of metastasectomy, the median OS time of the 22 patients with metastasectomy was 53 months, which was significantly longer when compared with patients not undergoing metastasectomy (15 mo). After adjustment for the 4 aforementioned prognostic factors, metastasectomy still remained significant (hazard ratio: 0.364, P = 0.0008).Conclusions
Female sex, more favorable PS at presentation, hemoglobin level>10 g/dl, and single organ metastasis were favorable prognostic factors. In addition, metastasectomy was associated with long-term disease control. 相似文献10.
Jung Kwon Kim Kyung Chul Moon Chang Wook Jeong Cheol Kwak Hyun Hoe Kim Ja Hyeon Ku 《Urologic oncology》2017,35(7):458.e9-458.e15
Objectives
To investigate the effect of variant histology (VH) on survival after radical nephroureterectomy in patients with upper urinary tract urothelial carcinoma (UTUC) and the effect of adjuvant chemotherapy on the survival of patients with UTUC with VH.Materials and methods
A total of 452 patients who underwent radical nephroureterectomy for UTUC without neoadjuvant chemotherapy in our institution between 1991 and 2012 were retrospectively analyzed. We performed a comparative analysis between pure UTUC and UTUC with VH groups. The Kaplan-Meier method was used to calculate survival estimates for cancer-specific survival (CSS) and overall survival (OS), and log-rank test was used to conduct comparisons between the groups. Univariate and multivariate Cox-proportional hazard regression analyses were performed to evaluate significant variables associated with CSS and OS.Results
UTUC with VH was present in 41 (9.1%) patients. UTUC with VH showed aggressive clinicopathological features in comparison with pure UTUC. The Kaplan-Meier curves showed significantly decreased 5-year CSS and OS (both, P<0.001) in UTUC with VH group. Multivariate analysis revealed that VH was an independent predictor of CSS (P<0.001) and OS (P<0.002). The Kaplan-Meier curves also showed significantly decreased 5-year CSS and OS in UTUC with the VH group compared to the pure UTUC group in patients who received adjuvant chemotherapy.Conclusions
We found that UTUC with VH harbored aggressive biologic features, and VH was an independent prognostic factor for CSS and OS on both univariate and multivariate analyses. In addition, UTUC with VH group had poorer survival outcomes than pure UTUC group in patients who received adjuvant chemotherapy. Consequently, adjuvant treatment modalities other than adjuvant chemotherapy should be considered in this group. 相似文献11.
Marco Moschini Shahrokh F. Shariat Mohammad Abufaraj Beat Foerster David D′Andrea Francesco Soria Paolo Dell′Oglio Agostino Mattei Francesco Montorsi Renzo Colombo Alberto Briganti Andrea Gallina 《Urologic oncology》2017,35(12):672.e1-672.e6
Objective
To evaluate incidence and predictors of local failure (LF) after radical cystectomy (RC) due to bladder cancer.Methods
We focused on 1,112 patients treated with RC, between 1990 and 2012, at a single center. LF was defined as imaging evidence of recurrence in the pelvic soft tissues or nodes below the aortic bifurcation at least 3 months before the detection of distant metastases. Competing risk analyses tested the relationship between clinical and pathological factors and the risk to develop LF. Regression tree analysis stratified patients into risk-groups based on their characteristics and the corresponding LF rate.Results
Overall, 50 (4.5%) patients developed LF during a median follow-up period of 62 (35–92) months. On univariable competing risk regression analyses, pathological T stage (pT4 vs. pT3; hazard ratio [HR] = 2.55, P = 0.003), soft tissue surgical margin (STSM; HR = 2.95, P = 0.005), and variant histology (HR = 1.79, P = 0.03) were associated with an increased risk of developing LF. The cohort was stratified into 4 risk groups: very low (≤pT3a disease and pure urothelial histology), low (≤pT3a disease and variant histology), intermediate (pT4 disease), and high (positive STSM).Conclusions
LF is an important event in RC patients. We developed a new risk model based on bladder cancer characteristics. Our findings could help with the identification of the best candidate for consideration of adjuvant radiotherapy. 相似文献12.
Romain Boissier Jennifer Campagna Nicolas Branger Gilles Karsenty Eric Lechevallier 《Urologic oncology》2017,35(4):135-141
Background
The neutrophil-lymphocyte ratio (NLR) is a biological marker of inflammation with a significant prognostic value in the field of oncology.Aim
In this review, we discuss the prognostic value of the NLR in renal cell carcinoma (RCC).Material and Method
We conducted a literature review of the PubMed database in August 2016. Initial research identified 31 publications. Following full-text screening, 15 studies were finally included: 7 studies concerning metastatic or locally advanced renal cancer, 6 studies dealing with localized renal cancer, 2 articles evaluating the NLR in renal cancer whatever the status of the disease (metastatic or localized).Results
For localized RCC, an NLR o 3 was predictive of a reduced risk of recurrence (hazard ratio ¼ 1.63 [1.15, 2.29]). The prognostic value of the NLR was stronger for metastatic or locally advanced RCC. An NLR o 3 predicted increased overall survival (hazard ratio ¼ 1.55 [1.36, 1.76]), progression-free survivals (hazard ratio ¼ 3.19 [2.23, 4.57]), and a response to systemic treatment.Conclusion
In current practice, the NLR is a simple and inexpensive prognostic factor with potential improvement in the prognostic performance of nomograms used in renal oncology. 相似文献13.
Christopher B. Anderson Renee Gennarelli Harry W. Herr Elena B. Elkin 《Urologic oncology》2017,35(8):528.e7-528.e13
Purpose
Radical cystectomy (RC) has become increasingly regionalized to high-volume hospitals. Our objective was to describe changes in regional market concentration and the distribution of RCs among hospitals, and examine how these changes affect patient travel distance to surgery.Materials and methods
We used the surveillance, epidemiology, and end results-Medicare database to identify patients who had RC for bladder cancer from 2001 to 2011. We defined RC market concentration within each Hospital Referral Regions (HRR) in surveillance, epidemiology, and end results using the Hirschman-Herfindhal Index. We measured straight-line patient travel distance to the nearest cystectomy provider hospital and used linear regression to evaluate the effect of market concentration on travel distance for surgery. We performed a similar analysis on patients who had laparoscopic cholecystectomy as a comparator.Results
We identified 10,802 patients with bladder cancer who had RC. From 2001 to 2011, 40% of HRRs had a statistically significant increase in Hirschman-Herfindhal Index, 53% had no significant change and 7% had a statically significant decrease. The median patient travel distance increased significantly from 10.4 miles (interquartile range: 2.6–30.2) to 16 miles (interquartile range: 6.3–40.4, P<0.0001). Patients who lived in a highly concentrated HRR had to travel significantly further than patients who lived in an unconcentrated HRR (β = 37.5, P<0.001). These trends were not seen for laparoscopic cholecystectomy.Conclusions
Between 2001 and 2011, RC became increasingly regionalized to a small group of hospitals with a resultant increase in regional RC market concentration and patient travel distance. The clinical consequences on these changes to patients who require RC are uncertain. 相似文献14.
Marco Moschini Paolo Dell’Oglio Roberta Luciano’ Giorgio Gandaglia Francesco Soria Agostino Mattei Tobias Klatte Rocco Damiano Shahrokh F. Shariat Andrea Salonia Francesco Montorsi Alberto Briganti Renzo Colombo Andrea Gallina 《Urologic oncology》2017,35(6):335-341
Introduction
We sought to describe incidence of histological variants after radical cystectomy (RC) due to bladder cancer (BCa). Moreover, we investigated survival outcomes accounting for this parameter.Methods
We retrospectively evaluated data from 1,067 patients with BCa treated with RC between 1990 and 2013 at a single tertiary care referral center. All specimen were evaluated by dedicated uropathologists. Univariable and multivariable Cox regression analyses tested the effect of different histopathological variant on recurrence, cancer-specific mortality (CSM), and overall mortality (OM) after accounting for all available confounders.Results
Of 1,067 patients, 729 (68.3%) harbored pure urothelial BCa while 338 (31.7%) were found to have a variant. Considering uncommon variants, 21 (2.0%) were sarcomatoid, 10 (0.9%) lymphoepitelial, 19 (1.8%) small cell, 109 (10.2%) squamous, 89 (8.3%) micropapillary, 23 (2.2%) glandular, 34 (3.2%) mixed variants, and 33 (3.1%) were found with other types of variants. With a median follow-up of 6.2 years, 343 recurrence, 365 CSM, and 451 OM were recorded, respectively. At multivariable Cox regression analyses, the presence of small cell variant was associated with higher recurrence (hazard ratio [HR] = 3.47, P<0.001), CSM (HR = 3.30, P<0.04), and OM (HR = 2.97, P<0.003) as compared with pure urothelial cancer. Conversely, no survival differences were recorded considering other histological variants (all P> 0.1).Conclusion
Our study confirms that histological variant is not an infrequent event at RC specimen. However, in our single-center series, only patients found with small cell variant were associated with a negative effect on survival after RC. 相似文献15.
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16.
Marco Moschini Shahrokh F. Shariat Mohammad Abufaraj Francesco Soria Tobias Klatte Giovanni La Croce Agostino Mattei Rocco Damiano Andrea Salonia Francesco Montorsi Alberto Briganti Renzo Colombo Andrea Gallina 《Urologic oncology》2017,35(4):151.e17-151.e23
Introduction
To evaluate the incidence of carcinoma in situ (CIS) in patients treated with radical cystectomy (RC) due to bladder cancer and to assess its effect on recurrence and survival rates.Methods
The study focused on 1,128 consecutive nonmetastatic patients with bladder cancer treated with RC at a single tertiary care referral center from 1994 to 2014. The Kaplan-Meier method was used to compare recurrence, cancer-specific mortality (CSM), and overall mortality–free rates in the overall population and in pT0–pT2 and pT3–pT4 patients after stratifying according to the presence of CIS. Multivariable (MVA) Cox regression analyses tested the effect of the presence of CIS on survival outcomes. MVA competing risk analyses were performed to assess the effect of CIS on urothelial recurrence.Results
The presence of CIS was reported in 277 (24.6%) patients. During a median follow-up of 6 years, 355 recurrences, 377 CSM, and 468 overall mortality were reported. At MVA Cox regression analyses, the presence of concomitant CIS was not associated with any survival effect when the overall population was considered (all P≥0.3). At MVA Cox regression analyses, there was no effect of CIS on survival outcomes in pT3–pT4 patients (all P>0.2); on the contrary, the presence of CIS was associated with worse CSM in pT0–pT2 patients only (hazard ratio [HR] = 1.82; CI: 1.01–3.29; P = 0.04). At MVA competing risk analyses predicting urothelial recurrence only, the presence of CIS was associated to an increased risk of urothelial recurrence in pT0–pT2 patients (HR = 2.99; CI: 1.05–8.53; P = 0.04), pT3–pT4 patients (HR = 10.29; CI: 1.40–75.75; P = 0.02), and in the overall population (HR = 4.47; CI: 1.81–11.07; P = 0.001).Conclusion
An increased risk of developing urothelial recurrence only was recorded in patients diagnosed with CIS at RC. Physicians should consider this aspect ensuring a more severe follow-up schemes in patients who harbored this pathological feature. 相似文献17.
Yuan Chang Lin Zhou Le Xu Qiang Fu Yuanfeng Yang Zongming Lin Jiejie Xu 《Urologic oncology》2017,35(12):675.e17-675.e24
Purpose
Accumulating evidence indicates that CXC chemokine receptor 6 (CXCR6) has a crucial role in cancer development and progression, however, its role in clear cell renal cell carcinoma (ccRCC) remains obscure. The aim of this study is to investigate the prognostic value of CXCR6 expression in patients with ccRCC following surgery.Materials and methods
This study retrospectively included 239 patients with ccRCC who underwent nephrectomy and had paraffin tissue available at a single center. CXCR6 expression in tumor tissue was evaluated by immunohistochemistry and its associations with overall survival (OS) and recurrence-free survival (RFS) were investigated.Results
A total of 47.3% tumors were considered as high expression of CXCR6, which was significantly associated with the male sex (P = 0.003) and high Fuhrman grade (P<0.001). A high expression of CXCR6 indicated a reduced OS (P<0.001) and RFS (P = 0.007). Multivariate analysis demonstrated that CXCR6 expression was an independent prognostic factor of OS (hazard ratio = 2.604; 95% CI: 1.338–5.068; P = 0.005) and RFS (hazard ratio = 1.957; 95% CI: 1.065–3.595; P = 0.031). Subgroup analysis found that CXCR6 expression could differentiate survival risks among patients with high-risk disease. Moreover, a nomogram integrating CXCR6 expression and traditional clinical and pathologic features was established and predicted postsurgical recurrence-risk well at 3- and 5-year.Conclusions
The expression of CXCR6 in tumor tissue may serve as a potential prognostic biomarker to refine clinical prognosis prediction combined with traditional clinical and pathological analysis for patients with ccRCC after surgery. 相似文献18.
Guo-liang Yang Lian-hua Zhang Qiang Liu Zhao-liang Wang Xue-hui Duan Yi-ran Huang Juan-jie Bo 《Urologic oncology》2017,35(2):38.e9-38.e15
Background
Management of high-grade T1 (formerly T1G3) bladder cancer continues to be controversial. Should patients with T1G3 bladder cancer have an immediate radical cystectomy or should they receive intravesical bacillus Calmette-Guérin–preserving bladder? Gemcitabine and cisplatin (GC) adjuvant chemotherapy may help to strike a balance between intravesical and early cystectomy. For purposes of this study, we continue to refer high-grade T1 lesion as “T1G3.”Objective
To evaluate the characteristics and the long-term outcome of GC adjuvant chemotherapy in T1G3 bladder cancer after transurethral resection of bladder tumor (TURBT).Materials and methods
We retrospectively reviewed 48 patients who were newly diagnosed with T1G3 bladder cancer between January 2009 and December 2012. A total of 48 patients received 4 cycles of GC adjuvant chemotherapy after TURBT. One month after 4 cycles of GC adjuvant chemotherapy, response was evaluated by re-TURBT. Median follow-up was 59.5 (range: 18–70) months, all patients have been observed for more than 3 years. Salvage cystectomy was recommended for patients with persistent disease and for tumor progression after initial complete response.Result
Complete response was achieved in 44 (91.7%) patients. Of complete responders, 5 patients experienced recurrence and 5 patients showed progression. The progression rate and disease-specific survival rate were 10.4% and 91.7% at 3 years, respectively. More than 80% of survivors preserved their bladder. Kaplan-Meier curves showed that concomitant carcinoma in situ (CIS) was the only factor that had an influence on progression-free survival (P = 0.022) and disease-specific survival (P = 0.017). Concomitant CIS was the prognostic factor for progression rate and disease-specific survival rate at 3 years (P = 0.008 and P = 0.035).Conclusion
GC adjuvant chemotherapy is a safe conservative treatment for T1G3 bladder cancer, but effective is really a phase II study. Patients with T1G3 bladder cancer with concomitant CIS should be treated more aggressively because of the high risk of progression. 相似文献19.
Raman Jay RR McKay L Werner MB Atkins EM Van Allen KM Olivier J Song S Signoretti DF McDermott TK Choueiri 《Urologic oncology》2017,35(3):117-118
Background
Sarcomatoid renal cell carcinoma (RCC) is associated with an aggressive biology and a poor prognosis. Poor-risk RCC is defined by clinical prognostic factors and demonstrates similarly aggressive behavior. No standard treatment exists for patients with sarcomatoid RCC, and treatment options for patients with poor-risk disease are of limited benefit. The objective of this study was to investigate the efficacy of antiangiogenic therapy in combination with cytotoxic chemotherapy in clinically aggressive RCC.Methods
This was a phase 2, single-arm trial of sunitinib and gemcitabine in patients with sarcomatoid or poor-risk RCC. The primary end point was the objective response rate (ORR). Secondary end points included the time to progression (TTP), overall survival (OS), safety, and biomarker correlatives.Results
Overall, 39 patients had sarcomatoid RCC, and 33 had poor-risk RCC. The ORR was 26% for patients with sarcomatoid RCC and 24% for patients with poor-risk RCC. The median TTP and OS for patients with sarcomatoid RCC were 5 and 10 months, respectively. For patients with poor-risk disease, the median TTP and OS were 5.5 and 15 months, respectively. Patients whose tumors had>10% sarcomatoid histology had a higher clinical benefit rate (ORR plus stable disease) than those with≤10% sarcomatoid histology (P = 0.04). The most common grade 3 or higher treatment-related adverse events included neutropenia (n = 20), anemia (n = 10), and fatigue (n = 7).Conclusions
These results suggest that antiangiogenic therapy and cytotoxic chemotherapy are an active and well-tolerated combination for patients with aggressive RCC. The combination may be more efficacious than either therapy alone and is currently under further investigation. 相似文献20.
Magnus Lindskog Thomas Wahlgren Rickard Sandin Jan Kowalski Maria Jakobsson Sven Lundstam Börje Ljungberg Ulrika Harmenberg 《Urologic oncology》2017,35(9):541.e15-541.e22