M. Stöckle

Universität des Saarlandes, Saarbrücken, Saarland, Germany

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Publications (413)1405.36 Total impact

  • Der Onkologe 09/2015; 21(9):787-796. DOI:10.1007/s00761-014-2898-5 · 0.14 Impact Factor
  • Carsten-Henning Ohlmann · Michael Stöckle
    European Urology 08/2015; DOI:10.1016/j.eururo.2015.08.013 · 13.94 Impact Factor
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    ABSTRACT: To assess clinical outcomes and reimbursement costs of open and robotic-assisted radical prostatectomies in Germany. Perioperative data of 499 open (2003-2006) and 932 (2008-2010) robotic-assisted radical prostatectomies as well as longitudinal reimbursement costs of an anonymized health insurance research database from Germany containing data of patients who underwent robotic-assisted or open radical prostatectomy were retrospectively analysed in a single-centre study. Significantly better outcomes after robotic-assisted vs. open prostatectomy were observed in regards to positive surgical margins (13.3 vs. 22.4%; p < 0.0001), intraoperative transfusions (0.1 vs. 2.6%; p < 0.0001), hospitalization (8.7 vs. 15.2 days; p < 0.0001) and duration of catheter (6.6 vs. 12.8 days; p < 0.0001). Operating time was significantly longer with robotic-assisted radical prostatectomy when compared to open surgery (184.4 vs. 128.0 min; p < 0.0001), while intraoperative complications showed a similar occurrence between both groups. Significant fewer postoperative complications were observed after robotic-assisted radical prostatectomy (26.5 vs. 42.5%; p < 0.0001) and rate of re-admission was lower for the robotic patients (13.6 vs. 19.4%; p = 0.0050). While insurance costs were higher in the 2 years before radical prostatectomy for the patients who underwent a robotic procedure (4,241.60 vs. 3,410.23 €; p = 0.202), additive costs of care of the year of surgery plus the 2 following years were less for the robotic cohort when compared to the costs incurred by the open group (21,673.71 vs. 24,512.37 €; p = 0.1676). The observed clinical advantages of robotic-assisted radical prostatectomy seem to result in reduced health insurance cost postoperatively when compared to open surgery. This should be taken into consideration regarding reimbursement and implementation of a clinically superior method. © 2015 S. Karger AG, Basel.
    Urologia Internationalis 07/2015; DOI:10.1159/000431104 · 1.43 Impact Factor
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    ABSTRACT: In vivo model systems in prostate cancer research that authentically reproduce tumor growth are still sparse. While orthotopic implantation is technically difficult, particularly in the mouse, most models favor subcutaneous tumor growth. This however provides little information about natural tumor growth behavior and tumor stroma interaction. Furthermore, established prostate cancer cell lines grown as in vivo xenografts are not able to reflect the variety of tumor specific growth patterns and growth behavior in men. Primary cell cultures are difficult to handle and an induction of orthotopic tumors has not been successful yet. Therefore, a tumorgraft model using tumor tissue from prostatectomy specimens was developed. Balb/c nude mice were used to graft fresh prostate tumor tissue by renal subcapsular and orthotopic implantation. Testosterone propionate was supplemented. Animals were tracked by means of 30 MHz ultrasound to monitor tumor engraftment and growth. Autopsy, histology, PSA measurements as well as immunostaining and PCR for human tissue were performed to confirm orthotopic tumor growth. Renal subcapsular engraftment was seen in 2 of 3 mice. Orthotopic engraftment was observed in 7 of 11 animals (63.6%) with an overall engraftment of 5 out of 9 patient specimens (55.6%). Ultrasound confirmed the tumor growth over time. Of interest, the tumorgrafts not only retained essential features of the parental tumors, but also stained positive for tumor specific markers such as AR, PSA, and AMACR. Tumor positive animals showed highly elevated serum PSA levels with confirmation of a human specific PCR sequence and a human endothelial cell lining in the tumor vessels. Standardized implantation of fresh tumor tissue in nude mice prostates generates tumorgrafts with histological properties of organ-confined prostate cancer. These tumorgrafts display a new approach for an optimized in vivo model of prostate cancer and will allow further investigations on specific pathways of tumor initiation and progression as well as therapeutic response. Prostate © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    The Prostate 06/2015; 13(1). DOI:10.1002/pros.23027 · 3.57 Impact Factor
  • Der Urologe 05/2015; 54(6). DOI:10.1007/s00120-015-3863-7 · 0.44 Impact Factor
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    ABSTRACT: Long-term oncologic data on patients undergoing robot-assisted radical cystectomy (RARC) are limited and based largely on single-institution series. Report survival outcomes of patients who underwent RARC ≥5 yr ago. Retrospective review of the prospectively populated International Robotic Cystectomy Consortium multi-institutional database identified 743 patients with RARC performed ≥5 yr ago. Clinical, pathologic, and survival data at the latest follow-up were collected. Patients with palliative RARC were excluded. Final analysis was performed on 702 patients from 11 institutions in 6 countries. RARC. Outcomes of interest, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were plotted using Kaplan-Meier survival curves. A Cox proportional hazards model was used to identify factors that predicted outcomes. Pathologic organ-confined (OC) disease was found in 62% of patients. Soft tissue surgical margins (SMs) were positive in 8%. Median lymph node (LN) yield was 16, and 21% of patients had positive LNs. Median follow-up was 67 mo (interquartile range: 18-84 mo). Five-year RFS, CSS, and OS were 67%, 75%, and 50%, respectively. Non-OC disease and SMs were associated with poorer RFS, CSS, and OS on multivariable analysis. Age predicted poorer CSS and OS. Adjuvant chemotherapy and positive SMs were predictors of RFS (hazard ratio: 3.20 and 2.16; p<0.001 and p<0.005, respectively). Stratified survival curves demonstrated poorer outcomes for positive SM, LN, and non-OC disease. Retrospective interrogation and lack of contemporaneous comparison groups that underwent open radical cystectomy were major limitations. The largest multi-institutional series to date reported long-term survival outcomes after RARC. Patients who underwent robot-assisted radical cystectomy for bladder cancer have acceptable long-term survival. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    European Urology 05/2015; 68(4). DOI:10.1016/j.eururo.2015.04.021 · 13.94 Impact Factor
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    ABSTRACT: Piwi-like 2 (Piwil 2) belongs to the family of Argonaute genes/proteins. The expression of Piwil 2 is associated with stem cells. A role in tumorigenesis and/or tumor progression is proposed for different cancers but not yet for bladder cancer (BCa). We investigated the Piwil 2 expression by immunohistochemistry in a cohort of 202 BCa patients treated by cystectomy and adjuvant chemotherapy. The association between Piwil 2 expression and disease-specific (DSS) or progression-free survival (PFS) was calculated using Kaplan Meier analyses and univariate/multivariate Cox's regression hazard models.In a multivariate Cox's regression, Piwil 2 expression, either in the cytoplasm or the nucleus, was significantly associated with DSS and PFS. A weak cytoplasmic staining pattern was associated with poor DSS and tumor progression (RR=2.7; P=0.004 and RR=2.4; P=0.027). Likewise,, absent nuclear Piwil 2 immunoreactivity was associated with poor DSS and tumor progression (RR=2.3; P=0.023 and RR=2.2; P=0.022). BCa patients whose tumors exhibited a combination of weak cytoplasmic and absent nuclear immunoreactivity had a 6-fold increased risk of tumor-related death (P=0.005) compared to patients with strong expression. Considering only patients with high grade G3 tumors, a 7.8-fold risk of tumor-associated death and a 3.6-fold risk of tumor progression were detected independently of the histologic tumor subtype or the chemotherapy regimen. In summary, a combination of weak cytoplasmic and absent nuclear expression of Piwil 2 is significantly associated with an increased risk of DSS and tumor progression. This implicates that Piwil 2 could be a valuable prognostic marker for high-risk BCa patients.
    Molecular Medicine 05/2015; 21. DOI:10.2119/molmed.2014.00250 · 4.51 Impact Factor
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    ABSTRACT: Sclerosing epithelioid fibrosarcoma (SEF) is a rare fibrosarcoma variant with specific histomorphology and consistent translocation (EWSR1-CREB3L1/2). To date, 110 cases have been reported; only 15 originated within the abdomen. With only 2 cases reported parallel to our study and one case briefly mentioned in a previous series, primary renal SEF is exceptionally rare but might be underrecognized. We herein describe 2 cases affecting a 23-year-old woman and a 43-year-old man. Tumor size was 22 and 4.2 cm, respectively. Patient 1 developed skeletal and multiple pulmonary metastases. She died of disease 82 months later, despite aggressive multimodality therapy. Patient 2 has no evidence of recurrence or metastasis (8 months after surgery). Histologic examination showed similar appearance with monotonous bland medium-sized epithelioid cells with rounded slightly vesicular nuclei and clear cytoplasm imparting a carcinoma-like appearance set within a highly sclerotic hyaline fibrous stroma. The tumor cells were arranged in nests, single cell cords, trabeculae, or solid sheets with frequent entrapment of renal tubules and glomeruli. Immunohistochemistry showed strong expression of vimentin, bcl2, CD99, and MUC4, whereas cytokeratin and other markers were negative. Fluorescence in situ hybridization showed a translocation involving the EWSR1 gene locus in case 2. Molecular analysis in case 1 was not successful due to poor signal quality. To our knowledge, this is the second report documenting primary renal SEF. Awareness of this entity would help avoid misinterpretation as clear cell carcinoma, sclerosing perivascular epithelioid cell tumor, Xp.11 translocation carcinoma, and other more frequent neoplasms at this site. Copyright © 2015. Published by Elsevier Inc.
    Annals of diagnostic pathology 05/2015; 19(4). DOI:10.1016/j.anndiagpath.2015.04.005 · 1.12 Impact Factor
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    European Urology Supplements 04/2015; 193(4):e722. DOI:10.1016/j.juro.2015.02.2142 · 3.37 Impact Factor
  • European Urology Supplements 04/2015; 14(2):e860. DOI:10.1016/S1569-9056(15)60848-X · 3.37 Impact Factor
  • European Urology Supplements 04/2015; 14(2):e228. DOI:10.1016/S1569-9056(15)60227-5 · 3.37 Impact Factor
  • European Urology Supplements 04/2015; 193(4):e421. DOI:10.1016/j.juro.2015.02.1107 · 3.37 Impact Factor
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    European Urology Supplements 04/2015; 14(2):e163. DOI:10.1016/S1569-9056(15)60165-8 · 3.37 Impact Factor
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    European Urology Supplements 04/2015; 14(2):e166. DOI:10.1016/S1569-9056(15)60168-3 · 3.37 Impact Factor
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    The Journal of Urology 04/2015; 193(4):e81. DOI:10.1016/j.juro.2015.02.288 · 4.47 Impact Factor
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    ABSTRACT: The efficacy of second-line treatment after failure of platinum-based chemotherapy in patients with advanced urothelial cancer is limited. Based on encouraging preclinical and clinical phase I data, we evaluated the safety and efficacy of the combination of paclitaxel and everolimus in these patients. In this trial, patients having failed to respond to prior platinum-based combination treatment of urothelial cancer were treated with paclitaxel (175 mg/m(2) i.v., 3-weekly) and the mTOR-inhibitor everolimus (10 mg p.o., once daily). The patients were treated until tumor progression or until a maximum of 6 cycles was completed. A one-stage design was used to evaluate the objective response rate (ORR) as the primary endpoint. A total of 27 patients (67% male; median age 63 years) were enrolled. The most frequent grade III/IV toxicities were anemia (28%), peripheral neuropathy (28%), and fatigue (24%). No treatment-related deaths were reported. Complete and partial remissions were observed in 0/24 and 3/24 patients eligible for efficacy analysis, respectively (ORR 13%). Progression-free survival was 2.9 months [95% confidence interval (95% CI) 1.9-4.2], and the median overall survival was 5.6 months (95% CI 4.8-10.2). The combination of paclitaxel and everolimus has not achieved the expected efficacy in second-line treatment of urothelial cancer and should not be further explored. © 2015 S. Karger AG, Basel.
    Oncology 03/2015; 89(2). DOI:10.1159/000376551 · 2.42 Impact Factor
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    ABSTRACT: Im Januar 2014 startete die Deutsche Prostatakrebsstudie PREFERE (www.prefere.de). PREFERE ist eine randomisiert kontrollierte und präferenzbasierte Studie, die erstmalig alle vier zur Behandlung des organbegrenzten Prostatakarzinoms infrage kommenden Behandlungsmöglichkeiten untersucht. Das sind- entsprechend der ‚Interdisziplinären Leitlinie der Qualität S3 zur Früherkennung, Diagnose und Therapie der verschiedenen Stadien des Prostatakarzinoms‘ [1] - die radikale Prostatektomie, die perkutane Strahlentherapie, die Brachytherapie mittels Seed-Implantation und die aktive Überwachung (Active Surveillance). Die Präferenzbasierung der PREFERE-Studie sieht vor, dass potenzielle Studienteilnehmer, die sich nicht auf alle vier Optionen randomisieren lassen möchten, bis zu maximal zwei Optionen ablehnen können. Das stellt große Anforderungen an die Aufklärungsstrategie und die hierzu erforderlichen Informationsmaterialien. Zur Patientenaufklärung im Rahmen der PREFERE-Studie waren Materialien (Broschüre und Patientenvideo) zu entwickeln, die Patienten ausgewogen und leitlinienbasiert über ihre Erkrankung und die Behandlungsoptionen informieren, über die Notwendigkeit einer Randomisierung und insbesondere über die PREFERE-Studie aufklären und die individuelle Präferenz- und partizipative Entscheidungsfindung zur Studienteilnahme unterstützen. Die Entwicklung der Materialien erfolgte in einem strukturierten, iterativen Verfahren basierend auf einer vorangegangenen Literaturrecherche. An der Entwicklung und Testung der Patientenbroschüre und des Patientenvideos waren sechs Fokusgruppen mit insgesamt 40 Teilnehmern aus drei verschiedenen Selbsthilfegruppen, Betroffene, die keiner Selbsthilfegruppe angehören, gesunde Männer sowie als Experten die Mitglieder des Steering Commitees der PREFERE Studie und eine Fokusgruppe mit 18 Urologinnen und Urologen beteiligt. Mittels Fragebogen und ausführlicher Diskussion wurden die Verständlichkeit und Eignung von Patientenbroschüre und Video zur Präferenz- und Entscheidungsfindung zur Teilnahme an der PREFERE-Studie getestet. Die Ergebnisse dieser Laien-Bewertungen flossen in die abschließende Überarbeitung ein. Für die Ärztinnen und Ärzte wurde eine Gesprächshilfe erarbeitet, die wesentliche Aspekte der PREFERE-Patientenaufklärung enthält. Das Vorgehen bei der Aufklärung sowie die Patientenaufklärungsmaterialien sind Gegenstand einer Kurzschulung für niedergelassene Urologen und Strahlentherapeuten, die deutschlandweit durchgeführt wird. Der Beitrag beschreibt das methodische Vorgehen bei der Erstellung der beschriebenen Materialien. Inwieweit die Patientenaufklärung durch die behandelnden Ärzte und die Patientenaufklärungsmaterialien die Entscheidung zur Teilnahme an der PREFERE-Studie tatsächlich beeinflusst hat, ist Gegenstand einer Befragung im Rahmen der Lebensqualitätserhebungen nach erfolgter Behandlung bzw. Randomisation (im Fall von Active Surveillance) während der Laufzeit von PREFERE.
    Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 03/2015; DOI:10.1016/j.zefq.2015.01.014
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    ABSTRACT: We previously showed that the Wnt-signaling antagonist SFRP1 (secreted frizzled-related protein 1) is a promising marker in bladder cancer. The aim of this study was to validate the prognostic role and analyze the functional significance of SFRP1. Four bladder cancer cell lines (RT112, RT4, J82 and BFTC905) and one urothelial cell line (UROtsa) were used for functional characterization of SFRP1 expression. Effects on viability, proliferation and wound healing were investigated, and canonical Wnt-pathway activity as well as Wnt-signaling target gene expression was analyzed. Additionally, tissue micro-arrays from two different bladder tumor cohorts were evaluated for SFRP1 expression, and associations with survival and histopathological parameters were analyzed. The cell lines RT112, RT4, J82 and UROtsa showed SFRP1 expression. In BFTC905, SFRP1 expression was inhibited by promoter hypermethylation. Wnt-pathway activity was absent in all cell lines and independent from SFRP1 expression. RT112 and BFTC905 were used for further functional characterization. SFRP1 overexpression resulted in decreased viability and migration in BFTC905 cells. Knockdown of SFRP1 expression in RT112 cells resulted only in marginal effects. In bladder tumors, SFRP1 expression was associated with lower tumor grade, but not with progression in patients with papillary bladder cancer. SFRP1 expressing papillary bladder cancer tumors also demonstrated a tendency to longer overall survival. SFRP1 is reducing malignant potential of BFTC905 cells, but not by regulation of canonical Wnt-signaling pathway. Other pathways, like non-canonical Wnt or the MAPK pathway, could be activated via SFRP1-expression loss. In bladder tumors, SFRP1 has the potential to predict outcome for a subset of papillary bladder tumors.
    Journal of Cancer Research and Clinical Oncology 03/2015; 141(10). DOI:10.1007/s00432-015-1942-1 · 3.08 Impact Factor
  • Transplantation 11/2014; 98(10):e87-8. DOI:10.1097/TP.0000000000000475 · 3.83 Impact Factor
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    ABSTRACT: Objectives: To explore the views of experts about the development and validation of a robotic surgery training curriculum, and how this should be implemented. Materials and methods: An international expert panel was invited to a structured session for discussion. The study was of a mixed design, including qualitative and quantitative components based on focus group interviews during the European Association of Urology (EAU) Robotic Urology Section (ERUS) (2012), EAU (2013) and ERUS (2013) meetings. After introduction to the aims, principles and current status of the curriculum development, group responses were elicited. After content analysis of recorded interviews generated themes were discussed at the second meeting, where consensus was achieved on each theme. This discussion also underwent content analysis, and was used to draft a curriculum proposal. At the third meeting, a quantitative questionnaire about this curriculum was disseminated to attendees to assess the level of agreement with the key points. Results: In all, 150 min (19 pages) of the focus group discussion was transcribed (21 316 words). Themes were agreed by two raters (median agreement κ 0.89) and they included: need for a training curriculum (inter-rater agreement κ 0.85); identification of learning needs (κ 0.83); development of the curriculum contents (κ 0.81); an overview of available curricula (κ 0.79); settings for robotic surgery training ((κ 0.89); assessment and training of trainers (κ 0.92); requirements for certification and patient safety (κ 0.83); and need for a universally standardised curriculum (κ 0.78). A training curriculum was proposed based on the above discussions. Conclusion: This group proposes a multi-step curriculum for robotic training. Studies are in process to validate the effectiveness of the curriculum and to assess transfer of skills to the operating room.
    BJU International 11/2014; 116(1). DOI:10.1111/bju.12974 · 3.53 Impact Factor

Publication Stats

5k Citations
1,405.36 Total Impact Points


  • 2000–2015
    • Universität des Saarlandes
      • • Klinik für Urologie und Kinderurologie
      • • Klinik für Neurologie
      Saarbrücken, Saarland, Germany
  • 2005–2014
    • Universitätsklinikum des Saarlandes
      Homburg, Saarland, Germany
    • Universität Witten/Herdecke
      • Institute of Physiology and Pathophysiology
      Witten, North Rhine-Westphalia, Germany
    • Friedrich-Alexander Universität Erlangen-Nürnberg
      Erlangen, Bavaria, Germany
    • Freie Universität Berlin
      Berlín, Berlin, Germany
    • HELIOS Agnes Karll Krankenhaus Bad Schwartau
      Bad Schwartau, Schleswig-Holstein, Germany
  • 2003–2013
    • University of Bonn
      • Institute of Pathology
      Bonn, North Rhine-Westphalia, Germany
  • 2008
    • Universitätsklinikum Schleswig - Holstein
      Kiel, Schleswig-Holstein, Germany
    • Erasmus MC
      • Department of Urology
      Rotterdam, South Holland, Netherlands
  • 1987–2006
    • Johannes Gutenberg-Universität Mainz
      • • Department of Urology
      • • Klinik und Poliklinik für Allgemein- und Abdominalchirurgie
      Mayence, Rheinland-Pfalz, Germany
  • 2004
    • University of California, San Francisco
      • Department of Anatomy
      San Francisco, California, United States
  • 1999–2001
    • Christian-Albrechts-Universität zu Kiel
      • Institute of Phytopathology
      Kiel, Schleswig-Holstein, Germany
  • 1997
    • University of Bonn - Medical Center
      Bonn, North Rhine-Westphalia, Germany
    • Universität Heidelberg
      • Department of Biostatistics
      Heidelburg, Baden-Württemberg, Germany