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Vidit Sharma Avinash Nehra Michele Colicchia Mary E. Westerman Akira Kawashima Adam T. Froemming Eugene D. Kwon Lance A. Mynderse R. Jeffrey Karnes 《European urology》2018,73(6):879-887
Background
The Stephenson nomogram is widely used to estimate the success of salvage radiotherapy (sXRT) for prostate cancer (PCa) recurrence after radical prostatectomy (RP).Objective
To determine whether multiparametric pelvic magnetic resonance imaging (mpMRI) performed for biochemical recurrence after RP improves prognostication of sXRT relative to the Stephenson nomogram.Design, setting, and participants
Men undergoing RP at our institution from 2003 to 2012 who had biochemical recurrence evaluated by mpMRI within 12 mo of sXRT were retrospectively reviewed. Exclusion criteria included PCa treatment prior to RP, adjuvant XRT after RP, salvage cryotherapy before sXRT, and hormone refractory disease prior to sXRT.Outcome measurements and statistical analysis
Multivariable Cox regression analyses (adjusting for Stephenson nomogram covariates) associated mpMRI findings with prostate-specific antigen (PSA) recurrence and metastasis after sXRT. The mpMR images were compared in a binary fashion: no lesion versus vesicourethral/seminal vesical bed/prostate fossa lesions.Results and limitations
Among 473 sXRT patients, 57%(204) had lesions on mpMRI: 26%(124) vesicourethral, 28%(135) seminal vesical bed/prostatic fossa, 7%(34) nodal, and 1%(3) bone. Median PSA at mpMRI with lesions was 0.46 versus 0.40 ng/ml without lesions. After excluding nodal/bone lesions, 29% of men developed PSA recurrence and 14% metastasis (median follow-up 45 mo after sXRT). For patients with a pre-sXRT PSA of ≤0.5 ng/ml, negative mpMRI was associated with increased PSA recurrence (39% vs 12%, p < 0.01) and metastasis (16% vs 2%, p < 0.01) at 4 yr after sXRT. For patients with a PSA of ≤0.5 ng/ml, the addition of mpMRI to the propensity score (created using variables from the original Stephenson nomogram) improved the c-statistic from 0.71 to 0.77 for PSA recurrence (hazard ratio [HR] 3.60, p < 0.01) and from 0.66 to 0.77 for metastasis (HR 6.68, p < 0.01). Limitations include evolutions in MRI technique and lack of a cohort of men undergoing mpMRI electing against sXRT.Conclusions
Pre-sXRT mpMRI improves clinicopathologic variables to estimate sXRT success, particularly in the early sXRT setting.Patient summary
Men who have biochemically recurrent prostate cancer after radical prostatectomy often receive salvage radiotherapy. In our study, multiparametric pelvic magnetic resonance imaging prior to salvage radiotherapy was a significant predictor of prostate-specific antigen failure and metastasis after radiotherapy. 相似文献12.
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Giorgio Gandaglia Nicola Fossati R. Jeffrey Karnes Stephen A. Boorjian Michele Colicchia Alberto Bossi Thomas Seisen Cesare Cozzarini Nadia Di Muzio Barbara Noris Chiorda Emanuele Zaffuto Thomas Wiegel Shahrokh F. Shariat Gregor Goldner Steven Joniau Antonino Battaglia Karin Haustermans Gert De Meerleer Alberto Briganti 《European urology》2018,73(4):512-518
Background
Hormonal manipulation concomitant to salvage radiotherapy (SRT) given for biochemical recurrence (BCR) after radical prostatectomy (RP) improved outcomes in two randomized trials. However, neither of these studies focused on men treated at low prostate-specific antigen (PSA) levels.Objective
To test if the impact of androgen deprivation therapy (ADT) on metastasis in patients undergoing early SRT varies according to prostate cancer (PCa) features.Design, setting, and participants
A total of 525 patients received SRT at PSA levels ≤2 ng/ml.Outcome measurements and statistical analyses
Multivariable Cox regression analyses assessed factors associated with metastasis. We tested the hypothesis that the impact of ADT varied according to the risk of metastasis. An interaction with groups (concomitant ADT vs no ADT) and the probability of distant metastasis according to a newly developed model was tested. A nonparametric curve explored the relationship between the risk of metastasis and 10-yr metastasis rates according to ADT.Results and limitations
Median PSA and radiotherapy dose were 0.42 ng/ml and 66 Gy, respectively. Overall, 178 (34%) patients received ADT. At a median follow-up of 104 mo, 71 patients experienced metastasis. Grade group ≥4 (hazard ratio [HR]: 1.66; 95% confidence interval [CI]: 1.01–3.30), pT3b/4 (HR: 2.61; 95% CI: 1.51–4.52), and dose (HR: 0.82; 95% CI: 0.76–0.89) were associated with metastasis. The impact of ADT differed according to the risk of metastasis calculated using a multivariable model (p = 0.01). This was confirmed when considering patients treated with early SRT (p = 0.046), where ADT was associated with a reduction in the rate of metastasis only in eSRT; patients with more aggressive characteristics (ie, pT3b/4 and grade group ≥4, or pT3b/4 and PSA at eSRT ≥0.4 ng/ml).Conclusions
The beneficial effect of ADT concomitant to eSRT varied significantly according to disease characteristics, such that only men with more aggressive PCa features benefit from ADT in the eSRT setting for BCR after RP.Patient summary
The oncological benefits of concomitant androgen deprivation therapy (ADT) in patients undergoing salvage radiotherapy (SRT) vary according to pathological characteristics. Only patients with more aggressive disease characteristics seemed to benefit from the use of hormonal manipulation at the time of early SRT. Conversely, the potential side effects of ADT could be spared in patients with low prostate-specific antigen levels and favorable pathological features. 相似文献14.
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A new copper potentiated IUD, No-Gravid, manufactured and marketed in Italy, was inserted in 100 women in the University Hospital in Rome, Italy. 56% of acceptors was over 30; 46% had been using OC (oral contraception) for the past 2 years; 55% had 2 children and only 14% were nulliparous; 30% had undergone previous abortions. Insertion of the device was very easy in all cases, with a few cases of abdominal pain, spontaneously regressed. Menstrual flow was sensibly increased at 6 months in about 20% of patients; appearance of menstrual and intermenstrual cramps was improved. Libido and sexual satisfaction increased over 30%, as did the number of monthly sexual encounters. There were 2 pregnancies, due not to IUD failure but to partial expulsion of unchecked devices. Cupremia and Hb values were normal; there were no removals of any kind. 相似文献
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Valerio Cervelli Monica Grimaldi Pietro Gentile Antonino Araco Gianfranco Maria Colicchia Gianpiero Gravante 《Nordisk plastikkirurgisk forening [and] Nordisk klubb for handkirurgi》2008,42(2):96-100
We describe the miniabdominoplasty technique adopted in patients with unfavourable aesthetic defects after Pfannenstiel incisions and give our results from 32 patients. Eligibility criteria were cutaneous ptosis after Pfannenstiel incisions, and skin elastic enough to do the miniabdominoplasty. Exclusion criteria were obese or previously fat subjects in whom the operation was not possible. The technique is based on the combination of a miniabdominoplasty done obliquely up to the fascia, and liposuction. We operated on 32 patients from September 2005 to May 2006. We saw no postoperative bleeding, haematoma, or seroma. Thirty-one patients had a good final result. In one case postoperative asymmetry required secondary remodelling, which was done under local anaesthesia as an outpatient. After six months follow-up we recorded no asymmetry or change in body shape. We use the miniabdominoplasty technique for the correction of cosmetic abnormalities after Pfannenstiel incisions. It is feasible and safe, with a short operating time, and gives good aesthetic results and few postoperative complications. Further studies, with more patients, are now required to validate these results. 相似文献