共查询到20条相似文献，搜索用时 31 毫秒
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Alp Tuna Beksac David J. Paulucci John P. Sfakianos Balaji N. Reddy Greg E. Gin Susan M. Lerner Ketan K. Badani 《Urologic oncology》2017,35(8):529.e17-529.e22
Introduction
Patients with end-stage renal disease are under increased risk for renal cell carcinoma development, and radical nephrectomy is the preferred treatment in this setting. Owing to the increased surgical morbidity and mortality, active surveillance (AS) may be a valid option for treatment of small renal masses (SRM). As there is a lack of high-level evidence for treatment recommendations, we performed a survey analysis to analyze the treatment patterns of transplant surgeons.Material and methods
A 21-question online survey designed to analyze the practice patterns to treat SRM in renal transplant recipient candidates was sent to active transplant centers in the United States. The list of recipients to whom the survey was distributed was obtained with permission from the American Society of Transplant Surgeons.Results
We received 62 responses. All regions of United Network of Organ Sharing were represented. Radical nephrectomy was the preferred treatment (59%, n = 61), followed by AS (21.3%, n = 13), partial nephrectomy (14.8%, n = 9), and focal ablative therapy (4.9%, n = 3). Among the responders whose institutions did not allow AS, 77.4% indicated that if presented with long-term data showing safety of AS, they would perform immediate transplantation and monitor SRM. Responders were more likely to allow immediate transplantation after radical nephrectomy (77.4%), as opposed to partial nephrectomy (58.1%) and focal ablation (45.2%).Conclusion
Though radical nephrectomy is the preferred treatment, most transplant surgeons would consider AS if long-term safety data were available. 相似文献2.
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Francesco Castagna Barry J. McDonnell Eric J. Stöhr Melana Yuzefpolskaya Pauline N. Trinh Veli K. Topkara A. Reshad Garan Margaret A. Flannery Koji Takeda Hiroo Takayama Yoshifumi Naka Ryan T. Demmer Siegfried Wassertheurer John Cockcroft Paolo C. Colombo 《The Journal of heart and lung transplantation》2017,36(6):694-697
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Andrea R. Marcadis Pablo Valderrabano Allen S. Ho Justin Tepe Christina E. Swartzwelder Serena Byrd Wendy L. Sacks Brian R. Untch Ashok R. Shaha Bin Xu Oscar Lin Ronald A. Ghossein Richard J. Wong Jennifer L. Marti Luc G.T. Morris 《Surgery》2019,165(1):17-24
Background
The ThyroSeq v2 next-generation sequencing assay estimates the probability of malignancy in indeterminate thyroid nodules. Its diagnostic accuracy in different practice settings and patient populations is not well understood.Methods
We analyzed 273 Bethesda III/IV indeterminate thyroid nodules evaluated with ThyroSeq at 4 institutions: 2 comprehensive cancer centers (n?=?98 and 102), a multicenter health care system (n?=?60), and an academic medical center (n?=?13). The positive and negative predictive values of ThyroSeq and distribution of final pathologic diagnoses were analyzed and compared with values predicted by Bayes theorem.Results
Across 4 institutions, the positive predictive value was 35% (22%–43%) and negative predictive value was 93% (88%–100%). Predictive values correlated closely with Bayes theorem estimates (r2?=?0.84), although positive predictive values were lower than expected. RAS mutations were the most common molecular alteration. Among 84 RAS-mutated nodules, malignancy risk was variable (25%, range 10%–37%) and distribution of benign diagnoses differed across institutions (adenoma/hyperplasia 12%–85%, noninvasive follicular thyroid neoplasm with papillary-like nuclear features 5%–46%).Conclusion
In a multi-institutional analysis, ThyroSeq positive predictive values were variable and lower than expected. This is attributable to differences in the prevalence of malignancy and variability in pathologist interpretations of noninvasive tumors. It is important that clinicians understand ThyroSeq performance in their practice setting when evaluating these results. 相似文献8.
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Study DesignSystematic review of intervention studies (level 3a).IntroductionOccupation-based intervention (OBI) uses daily activities as a treatment modality. Its growing use with patients diagnosed with upper extremity musculoskeletal disorders (UE MSK) has driven interest in its supporting body of evidence.Purpose of the StudyThe purpose of this study was to locate, appraise, and summarize current evidence of the effectiveness of OBI in treating patients with UE MSK.MethodsSearches of PubMed, CINAHL, the Cochrane Register for Controlled Trials, and PEDro databases were conducted using predetermined keywords. Studies included in this systematic review described the use of OBI in UE MSK. Two examiners independently reviewed and assessed the quality of each study using the PEDro scale.ResultsResults of the database searches yielded 991 studies, 13 of which were deemed eligible to include in this review (6 randomized controlled trials, 4 pretreatment/post-treatment cohort or case series studies, and 3 single case reports). Quality of the studies varied, with 4 rated poor, 2 moderate, and 4 excellent. Overall, individuals receiving OBI showed superior benefits in patient-reported, performance, and physical measures assessing the upper extremity.DiscussionFindings of this review provide preliminary evidence for the use of OBI with patients with UE MSK, however, generalizability of the evidence was compromised due to heterogeneity in study subjects as well as conceptualization, dosage, and delivery of OBI.ConclusionsThe existing literature reflects promising trends in the use of OBI, underscoring its utility as a treatment option for UE MSK-related impairment, limitations, and restrictions. Nonetheless, scientific evidence concerning the effectiveness of OBI needs to be improved by conducting high-quality studies that clearly conceptualize this intervention and heighten understanding of its role in hand therapy practice. 相似文献
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Katherine D. Gray Sahar Bannani Cécile Caillard Sonia Amanat Timothy M. Ullmann Pavel Romanov Laurent Brunaud Toni Beninato Thomas J. Fahey Eric Mirallie Rasa Zarnegar 《Surgery》2019,165(1):37-43
Objectives
We aimed to determine the effect of adjuvant radioactive iodine dose on recurrence rate in high-risk papillary thyroid cancer.Methods
More than 1,500 patients treated for papillary thyroid cancer at high-volume centers in France and the United States from 2004–2014 were reviewed. Patients considered at high risk for recurrence per the 2015 American Thyroid Association guidelines were analyzed and grouped by initial radioactive iodine dose: intermediate (median 100 mCi) or high dose (median 150 mCi). Propensity score matching was performed to control for baseline characteristics.Results
In a propensity-matched cohort of 66 patient pairs, there were equivalent rates of gross extrathyroidal extension (71% vs 71%, P?=?1.00), positive margins (55% vs 55%, P?=?1.00), lymph node metastases ≥ 3 cm (9% vs 9%, P?=?1.00), extranodal extension (32% vs 33%, P?=?.85), and distant metastases (2% vs 5%, P?=?.31). Over a median follow-up of 4.5 years (interquartile ratio 2.0–7.5 years), the intermediate-dose radioactive iodine group had a significantly higher rate of recurrence than patients in the high-dose radioactive iodine group: 24 out of 66 (36%) vs 13 out of 66 (20%), P?=?.03.Conclusion
High-dose radioactive iodine is associated with lower recurrence rate compared with intermediate-dose radioactive iodine for patients with American Thyroid Association high-risk papillary thyroid cancer. 相似文献13.
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Daniel W. Lin E. David Crawford Thomas Keane Brent Evans Julia Reid Saradha Rajamani Krystal Brown Alexander Gutin Jonathan Tward Peter Scardino Michael Brawer Steven Stone Jack Cuzick 《Urologic oncology》2018,36(6):310.e7-310.e13
Background
A combined clinical cell-cycle risk (CCR) score that incorporates prognostic molecular and clinical information has been recently developed and validated to improve prostate cancer mortality (PCM) risk stratification over clinical features alone. As clinical features are currently used to select men for active surveillance (AS), we developed and validated a CCR score threshold to improve the identification of men with low-risk disease who are appropriate for AS.Methods
The score threshold was selected based on the 90th percentile of CCR scores among men who might typically be considered for AS based on NCCN low/favorable-intermediate risk criteria (CCR = 0.8). The threshold was validated using 10-year PCM in an unselected, conservatively managed cohort and in the subset of the same cohort after excluding men with high-risk features. The clinical effect was evaluated in a contemporary clinical cohort.Results
In the unselected validation cohort, men with CCR scores below the threshold had a predicted mean 10-year PCM of 2.7%, and the threshold significantly dichotomized low- and high-risk disease (P = 1.2 × 10–5). After excluding high-risk men from the validation cohort, men with CCR scores below the threshold had a predicted mean 10-year PCM of 2.3%, and the threshold significantly dichotomized low- and high-risk disease (P = 0.020). There were no prostate cancer-specific deaths in men with CCR scores below the threshold in either analysis. The proportion of men in the clinical testing cohort identified as candidates for AS was substantially higher using the threshold (68.8%) compared to clinicopathologic features alone (42.6%), while mean 10-year predicted PCM risks remained essentially identical (1.9% vs. 2.0%, respectively).Conclusions
The CCR score threshold appropriately dichotomized patients into low- and high-risk groups for 10-year PCM, and may enable more appropriate selection of patients for AS. 相似文献17.
Alexander Sankin Deepa Narasimhulu Peter John Benjamin Gartrell Mark Schoenberg Xingxing Zang 《Urologic oncology》2018,36(10):459-468
Over the last decade, a new understanding of tumor-immune system interplay has been ushered in, lead in large part by the discovery of immune checkpoints mediated through B7-CD28 family interactions. Therapeutic blockade of the PD-L1 immune checkpoint pathway has already shown great success as a cancer immunotherapy for advanced urothelial carcinoma, leading to durable clinical remissions in an otherwise incurable disease. There are newly described members of the B7-CD28 family including B7-H3, B7x, and HHLA2. These ligands are thought to play an essential role in suppressing T-cell response, leading to immune tolerance of tumors. This feature makes them attractive targets for novel immunotherapy treatment paradigms. Here, we review the literature of current strategies and future directions of immune checkpoint blockade therapy for bladder cancer. 相似文献
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Angela B. Smith 《Urologic oncology》2018,36(3):95-96
An upsurge of advances in the management of bladder cancer has rapidly occurred over the past 2 years. In this issue, recent developments in the management of bladder cancer will be discussed, including the emerging role of immunotherapy, biomarkers, and advanced imaging. 相似文献
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