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ABSTRACT: PURPOSE: To elucidate the reasons for conflicting results regarding the prognostic significance of tumor location in upper tract urothelial carcinoma (UTUC), we analyzed the stage-specific impact of tumor location on oncological outcomes following radical nephroureterectomy (RNU). METHODS: Data from 392 patients who underwent RNU with curative intent between 1991 and 2010 were reviewed. Prognostic impact of tumor location and various clinicopathological factors for recurrence-free survival (RFS) and cancer-specific survival (CSS) was evaluated using Kaplan-Meier and Cox regression analyses at each pathological stage. Tumor location was classified as renal pelvis or ureter, and pT3 tumors were further stratified as invading the renal parenchyma or peripelvic or periureteral fat. RESULTS: In stage-specific analysis, tumor location did not have prognostic significance in patients with ≤pT2 tumors, whereas RFS and CSS rates were significantly lower in patients with pT3 ureteral tumors than renal pelvic tumors. Subgroup analysis showed that RFS and CSS rates were significantly higher for pT3 tumors invading the renal parenchyma than the peripelvic or periureteral fat. On multivariate analysis in pT3 tumors adjusting other clinicopathological parameters, tumor location remained significant predictors for both RFS and CSS. Compared with tumors invading renal parenchyma, tumors invading peripelvic fat or periureteral fat were associated with about 3.5 times higher risk for cancer-specific mortality (p < 0.05). CONCLUSIONS: Location-dependent survival difference exists only in patients with pT3 UTUC. Conflicting institutional results regarding tumor location in UTUC may be due to difference in the proportions of parenchymal versus peripelvic fat invasion in pT3 pelvic tumors.
World Journal of Urology 04/2013; · 2.41 Impact Factor
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Seong Joon Park,
Jae-Lyun Lee,
Inkeun Park,
Kwonoh Park,
Yongcheol Ahn,
Jin-Hee Ahn,
Dae-Ho Lee,
Shin Ahn,
Cheryn Song, Jun Hyuk Hong,
Choung-Soo Kim,
Hanjong Ahn
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ABSTRACT: Background: This study investigated the efficacy and toxicity of sorafenib and sunitinib as primary treatment for patients with metastatic renal cell carcinoma (mRCC). Methods: We identified 49 and 220 patients treated with sorafenib and sunitinib, respectively, as first-line therapy in the Asan Medical Centre from April 2005 to March 2011. Results: Disease control rates of 71 and 74% were achieved with sorafenib and sunitinib, respectively (p = 0.687). After a median follow-up of 27.6 months, progression-free survival (PFS) and overall survival (OS) were not significantly different between the sorafenib and the sunitinib group (PFS 8.6 vs. 9.9 months, respectively, p = 0.948, and OS 25.7 vs. 22.6 months, p = 0.774). Patients treated with sorafenib required dose reduction due to toxicities less frequently than those treated with sunitinib (37 vs. 54%, p = 0.034). Haematological toxicity of grade 3 or 4 was more common in the sunitinib group than in the sorafenib group (45 vs. 4%, p < 0.001). Multivariate analysis showed old age, Heng's risk group, and bone and liver metastases, but not the type of vascular endothelial growth factor tyrosine kinase inhibitor, were independent prognostic factors affecting OS. Conclusion: The results of this study indicate that sorafenib has comparable efficacy to sunitinib in the treatment of mRCC patients and fewer and less severe toxicities, but the number of patients included in the study was small.
Chemotherapy 03/2013; 58(6):468-474. · 1.82 Impact Factor
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Korean journal of urology 03/2013; 54(3):204-6.
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ABSTRACT: PURPOSE: To evaluate clinical characteristics including the response to targeted therapy, the benefits of cytoreductive nephrectomy, or the prognostic factors in advanced renal cell carcinoma (RCC) with extensive sarcomatoid component (ESC), a rare but fatal disease. METHODS: Data from 37 consecutive patients with metastatic or recurrent RCC with ESC (≥25 % on resected kidney or exclusive sarcomatoid histology on needle biopsy) were analyzed. RESULTS: Of the 37 patients, 27 patients (73 %) had synchronous metastatic disease. The median percentage of sarcomatoid component (PSC) was 50 % (range 25-93 %). Twenty (74 %) of the 27 synchronous metastatic patients underwent cytoreductive nephrectomy. Of the nine patients undergoing cytokine therapy, none showed objective responses. Two (15 %) of the 13 patients undergoing targeted agent therapy had partial responses, and five patients (38 %) achieved stable disease. The median overall survival for all patients was 5.9 months [95 % confidence interval (CI) 1.0-10.9]. In multivariate analysis, age (>58 years), ECOG performance status (>1), PSC (>50 %), and time from first diagnosis to advanced disease (<6 months) remained independent prognostic factors. Neither the type of systemic therapy nor cytoreductive nephrectomy had an effect on survival. CONCLUSIONS: Patients with RCC with ESC have a dismal clinical course, and the majority of patients have rapid disease progression, especially in response to immunotherapy. Four clinical factors can be used to model survival outcomes for advanced RCC with ESC and may be helpful in selecting patients for aggressive treatment.
Journal of Cancer Research and Clinical Oncology 02/2013; · 2.56 Impact Factor
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Inkeun Park,
Kwonoh Park,
Seongjoon Park,
Yongcheol Ahn,
Jin-Hee Ahn,
Hyuck Jae Choi,
In Gab Jeong,
Cheryn Song, Jun Hyuk Hong,
Choung-Soo Kim,
Hanjong Ahn,
Jae-Lyun Lee
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ABSTRACT: BACKGROUND: We evaluated whether best overall response changes by designating primary renal lesions as either target or nontarget lesions and assessing response per Response Evaluation Criteria in Solid Tumors in mRCC patients treated with sunitinib. In addition, we evaluated whether discordance, if any, leads to a difference in predictive value of response in terms of time to progression (TTP) and overall survival (OS). PATIENTS AND METHODS: Patients with mRCC with an intact primary tumor and at least 1 extrarenal measurable lesion were included in this study. The variation of the sum of diameters (ΔSOD) of target lesions and best overall response, assessed from all target lesions and from metastasis-only target lesions, was documented separately. RESULTS: There were 41 patients included. Median ΔSOD of the primary lesion and metastatic target lesion were -6.0% (range, -34.0% to 17.6%), and -18.0% (range, -100.0% to 120.0%), respectively. For metastasis-only target lesions, the best overall response of 2 patients (4.9%) changed from stable disease to partial response. When we categorized patients into responders and nonresponders, response determination using metastasis-only target lesions resulted in significantly better discrimination of time to progression (14.9 vs. 4.3 months, P = .001) and overall survival (18.5 vs. 9.6 months, P = .036) between 2 groups. Using all target lesions, both TTP (14.9 vs. 5.4 months, P = .056) and OS (18.0 vs. 10.6 months, P = .155) were not statistically significant. CONCLUSION: When treating nonnephrectomized mRCC patients, selecting metastasis-only lesions as target lesions might be better to determine response, which might be more representative of survival end point.
Clinical Genitourinary Cancer 01/2013; · 2.61 Impact Factor
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ABSTRACT: OBJECTIVE: To present our long-term follow-up data to investigate whether cigarette smoking is associated with the prognosis of bladder cancer after radical cystectomy. Despite the close link between cigarette smoking and the development of bladder cancer, little is known about the influence of cigarette smoking on the bladder cancer prognosis after radical cystectomy. MATERIALS AND METHODS: The cigarette smoking status of 602 patients who had undergone radical cystectomy for bladder cancer was determined using questionnaires completed before surgery. The effect of cigarette smoking on recurrence-free survival, cancer-specific survival, and overall survival was determined. RESULTS: Of the 340 patients with a smoking history, 159 were current smokers. The smokers were younger (P = .001) and more likely to be male (P = .001) than were the nonsmokers. The 5-year recurrence-free survival rate of the smokers and nonsmokers was 62.1% and 56.8% (P = .182), the 5-year cancer-specific survival rate was 67.3%, 63.9% (P = .436), and the 5-year overall survival rate was 63.0% and 58.8% (P = .309), respectively. Multivariate analysis revealed that smoking was not an independent predictor of recurrence-free survival or cancer-specific survival. After adjusting for other prognostic variables, cigarette smoking status (non-, ex-, or current smoker), cumulative exposure, and years from smoking cessation were not associated with cancer-specific survival (P = .378, P = .827, and P = .876, respectively). CONCLUSION: The results of the present study found no association between cigarette smoking and the prognosis of bladder cancer after radical cystectomy.
Urology 10/2012; · 2.43 Impact Factor
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ABSTRACT: To investigate whether tumor aggressiveness in patients with prostate cancer has changed in Korea since the introduction of prostate-specific antigen (PSA) testing.
The data from 2,508 patients with pathologically confirmed prostate cancer who underwent radical prostatectomy at Asan Medical Center between 2000 and 2011 were reviewed. The patients were divided into four 3-year time series, and the changes between the groups in terms of serum PSA levels, pathological Gleason score (GS), and pathological stage were assessed. The change in GS over time in organ-confined disease and in patients whose PSA was below 10 ng/ml was also analyzed.
The mean PSA levels dropped significantly over the 12-year period (p<0.001). The frequency of organ-confined disease increased (55.7% vs. 64.7% vs. 62.9% vs. 63.5%, p=0.043). The frequency of patients with a GS of 8 or more decreased (38.9% vs. 25.7% vs. 18.2% vs. 19.7%) and the frequency of patients with a GS of 6 or less increased (15.0% vs. 18.9% vs. 26.7% vs. 18.2%, p=0.003). However, the vast majority (more than 70%) of all cases had a high GS (7 or greater) at all time points. The GS distribution did not change over time in patients whose PSA levels were below 10 ng/ml or in those who had organ-confined disease.
In 2000 to 2011, the preoperative PSA, pathological stage, and pathological GS dropped. However, the majority of the prostate cancers in Korean men were poorly differentiated, even when the patients had organ-confined disease or their PSA levels were less than 10 ng/ml.
Korean journal of urology 10/2012; 53(10):680-5.
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ABSTRACT: Study Type - Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? In patients with pRCC, the presence of venous tumour thrombus is known to be a predictor of poorer outcomes. However, a paucity of data is available regarding the prognostic significance of histology in patients with RCC and IVC thrombus. In our series, we found that patients with type II pRCC had significantly poorer outcomes when compared to those with cRCC. Although the lack of effective treatment for patients with metastatic pRCC may have contributed to these adverse outcomes, type II papillary histology was independent predictor not only of CSS but also of RFS. OBJECTIVE: • To analyze the prognostic impact of papillary histology on oncological outcomes in patients with renal cell carcinoma (RCC) and inferior vena cava (IVC) thrombus. PATIENTS AND METHODS: • We reviewed the medical records of 74 patients who underwent radical nephrectomy and IVC thrombectomy between 1990 and 2010 for clear cell or papillary RCC. • We compared the clinicopathological features and clinical outcomes of 62 patients with clear cell RCC (cRCC) and 12 with papillary RCC (pRCC). • All cases of pRCC were subdivided into type I or type II. • The prognostic role of papillary histology on recurrence-free survival (RFS) and cancer-specific survival (CSS) was estimated using Cox's regression models. RESULTS: • Upon reclassification of the pRCC subtype, all 12 patients with pRCC had type II tumours. • Patients with type II pRCC were significantly younger (P = 0.028) and were more probably women (P = 0.025) than those with cRCC • The 2- and 5-year CSS rates were 81.1% and 53.6% in cRCC patients, and 28.1% and 0% in type II pRCC patients, respectively. All eight patients with non-metastatic type II pRCC developed disease recurrence at a median interval of 6 months after surgery, whereas 25 of 44 (56.8%) patients with non-metastatic cRCC experienced such recurrence at a median interval of 10 months after surgery. • Patients with type II pRCC showed significantly lower CSS (P < 0.001) and RFS (P = 0.002) than those with cRCC. • On multivariate analysis, type II papillary histology was an independent predictor of CSS (hazard ratio, 3.73; P = 0.003) and RFS (hazard ratio, 3.15; P = 0.015). CONCLUSIONS: • Type II papillary histology appears to be predominant in cases of pRCC with IVC thrombus. • Patients with type II pRCC who presented with IVC thrombus had significantly worse outcomes than those with cRCC, and histology is an important prognostic factor in patients with RCC and IVC thrombus.
BJU International 09/2012; · 2.84 Impact Factor
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ABSTRACT: OBJECTIVES: To evaluate the risk factors and prognosis of muscle-invasive bladder cancer (MIBC) developing after nephroureterectomy for upper urinary tract urothelial cell carcinoma (UUT-UC). MATERIALS AND METHODS: We reviewed the medical records of 422 patients who underwent nephroureterectomy for UUT-UC between 1990 and 2010, and identified 173 (40.9%) with intravesical recurrence and 28 (6.6%) with MIBC. We evaluated the clinicopathologic features, risk factors, and cancer-specific survival (CSS) using the Kaplan-Meier method and the Cox proportional hazards regression models. RESULTS: The median intervals from nephroureterectomy to intravesical recurrence and the development of MIBC were 8 and 17 months, respectively. On multivariate analysis, the pathologic stage (≥pT3 vs. Ta/T1, HR 5.03, P = 0.001) and ureteral tumor location (HR 2.79, P = 0.011) were independent risk factors for the development of MIBC, whereas a history of previous or concomitant bladder tumor was the only significant risk factor for intravesical recurrence. The probability of developing MIBC 5 years after nephroureterectomy was 12.6% in patients with 1 risk factor and 20.6% in patients with both risk factors. Patients with MIBC had significantly worse CSS than those without MIBC (P = 0.004), whereas CSS rates were similar in patients with and without intravesical recurrence (P = 0.593). However, stratification analysis for matching pathology revealed that CSS rates were not significantly different in patients with pT2 or higher stage of UUT-UC. CONCLUSIONS: Approximately 5% of the patients developed MIBC after nephroureterectomy with a median interval of 17 months. Patients with advanced pathologic stage (≥pT3) and a ureteral tumor location are at increased risk of developing MIBC after nephroureterectomy.
Urologic Oncology 05/2012; · 3.22 Impact Factor
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ABSTRACT: To evaluate the impact of surgical waiting time (SWT) on outcomes of patients who underwent radical nephrectomy for stage II or higher renal cell carcinoma (RCC).
Of the 1,732 patients who underwent surgery for RCC between 1989 and 2007, medical records of 319 with clinical stage II or higher RCC without distant metastases were retrospectively reviewed. Ten patients with SWT greater than 3 months were excluded from analysis, and we compared pathological upstaging and survival rates between patients with SWT <1 month (234/319, 73.3 %) and 1-3 months (75/319, 23.5 %).
Clinicopathological characteristics between two groups were not different except the presence of symptom. The pathological upstaging was higher in patients with SWT of 1-3 months but statistically not significant. SWT of 1-3 months was not an independent predictor of pathological upstaging, recurrence-free survival (RFS; p = 0.896), or cancer-specific survival (CSS; p = 0.737). On subgroup analysis by TNM stage (cT2NxcM0 and cT3-4NxcM0), SWT of 1-3 months was not an independent predictor of pathological upstaging and was not associated with RFS or CSS. SWT, treated as a continuous variable, was also not an independent predictor of outcome in any subgroup. Similar results were found in symptomatic patients.
The outcomes of patients with prolonged SWT did not differ from those of most patients who underwent nephrectomy within 1 month. In patients with stage II or higher RCC who underwent nephrectomy within 3 months after diagnosis, prolonged SWT was not an independent predictor of pathological upstaging, RFS, or CSS.
Journal of Cancer Research and Clinical Oncology 05/2012; 138(9):1561-7. · 2.56 Impact Factor
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Kwonoh Park,
Jae-Lyun Lee,
Inkeun Park,
Seongjoon Park,
Yongcheol Ahn,
Jin-Hee Ahn,
Shin Ahn,
Cheryn Song, Jun Hyuk Hong,
Choung-Soo Kim,
Hanjong Ahn
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ABSTRACT: Sequential therapy is a standard strategy used to overcome the limitations of targeted agents in metastatic renal cell carcinoma. It remains unclear whether a mammalian target of rapamycin (mTOR) inhibitor is a more effective second-line therapy after first-line vascular endothelial growth factor tyrosine kinase inhibitor (VEGF TKI) has failed than the alternative, VEGF TKI. A clinical database was used to identify all patients with renal cell carcinoma who failed at first-line VEGF TKI and then treated with second-line VEGF TKI or mTOR inhibitors in the Asan Medical Center. Patient medical characteristics, radiological response and survival status were assessed. Of the 83 patients who met the inclusion criteria, 41 received second-line VEGF TKI [sunitinib (n = 16) and sorafenib (n = 25)] and 42 were treated with mTOR inhibitors [temsirolimus (n = 11) and everolimus (n = 31)]. After a median follow-up duration of 23.9 months (95 % CI, 17.8-30.0), progression-free survival was 3.0 months for both groups [hazard ratio (HR, VEGF TKI vs. mTOR inhibitor) = 0.97, 95 % CI 0.59-1.62, P = 0.92]. Overall survival was 10.6 months for the VEGF TKI group and 8.2 months for the mTOR inhibitor group (HR = 0.98, 95 % CI 0.57-1.68, P = 0.94). The two groups did not differ significantly in terms of disease control rate (51 % for VEGF TKI and 59 % for mTOR inhibitor, P = 0.75). Second-line VEGF TKI seems to be as effective as mTOR inhibitors and may be a viable option as a second-line agent after first-line anti-VEGF agents have failed.
Medical Oncology 03/2012; · 2.14 Impact Factor
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ABSTRACT: INTRODUCTION: Preoperative factors favoring the performance of non-orthotopic bladder substitution (OBS) after radical cystectomy for muscle-invasive bladder cancer were identified. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 730 patients who underwent radical cystectomy for urothelial carcinoma of the bladder. After excluding 75 patients who were unable to undergo OBS due to the tumor location or elevated serum creatinine level, we assessed the preoperative factors in the remaining 655 patients. Multivariate logistic regression analysis was performed to identify the independent preoperative predictors of type of urinary diversion. RESULTS: Of the 655 patients, 171 (26.1%) underwent non-OBS. Patients who underwent non-OBS were more likely to be older and females, to have a lower educational status, non-organ confined disease, more comorbid medical conditions, more impaired performance status, lower body mass index, anemia, azotemia, and hypoalbuminemia, and to be treated by less-experienced surgeons (P < 0.05 each). After adjusting for provider-based factors, multivariate analysis showed that factors independently associated with non-OBS included advanced age (odds ratio [OR] 4.10, P < 0.001), female gender (OR 2.08, P = 0.027), ECOG performance status (≥1 vs 0, OR 5.20, P < 0.001), low educational status (OR 1.59, P = 0.042), clinically node-positive disease (OR 2.36, P = 0.003), anemia (OR 1.67, P = 0.041), azotemia (OR 3.97, P < 0.001), and hypoalbuminemia (OR 1.84, P = 0.046). CONCLUSION: Several patient-based as well as provider-based factors were associated with the type of urinary diversion after radical cystectomy. Advanced age, female gender, low performance status, low education level, clinically node-positive disease, anemia, hypoalbuminemia, and azotemia were associated with non-OBS, as surgery was performed by relatively inexperienced surgeons.
World Journal of Urology 03/2012; · 2.41 Impact Factor
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Jae-Lyun Lee,
Inkeun Park,
Kwonoh Park,
Seongjoon Park,
Yongcheol Ahn,
Jin-Hee Ahn,
Tae-Won Kim,
Shin Ahn,
Cheryn Song, Jun Hyuk Hong,
Choung-Soo Kim,
Hanjong Ahn
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ABSTRACT: Temsirolimus is a standard of care in patients with metastatic renal cell carcinoma (mRCC) with poor risk factors. The role of vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKI) remains poorly defined in this setting.
Records of our center were examined to identify patients with mRCC and 3 or more poor prognosis factors, as determined in the Advanced Renal Cell Carcinoma (ARCC) trial, who had been treated with VEGFR TKIs. Their baseline characteristics, radiologic response, adverse events, and survival status were assessed.
The 88 patients who met our inclusion criteria had a median age of 56 years (range 17-83 years). We observed clear cell histology in 71 (81%) patients, and 52 (59%) underwent prior nephrectomy. Seventy-six patients (86%) were treated with sunitinib and 10 (11%) with sorafenib. Of 85 patients with measurable lesions, 19 (22%) showed objective response, with disease control achieved in 49 (56%). At a median follow-up of 29.6 months, the median time to progression was 5.0 months (95% CI, 3.5-6.5 months) and the median overall survival (OS) was 9.3 months (95% CI, 7.1-11.5 months). Neutrophil count (>ULN), bone metastasis, and lymph node metastasis were independent prognostic factors for OS, whereas prior nephrectomy was not.
VEGFR TKIs, especially sunitinib, are active and tolerated by mRCC patients with poor risk features.
Journal of Cancer Research and Clinical Oncology 01/2012; 138(4):687-93. · 2.56 Impact Factor
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ABSTRACT: Genexol-PM is a novel Cremophor® EL (CrEL)-free polymeric micelle formulation of paclitaxel. This multicenter phase II study was designed to evaluate the efficacy and safety of Genexol-PM monotherapy in patients with advanced urothelial carcinoma who developed disease progression after gemcitabine and cisplatin combination chemotherapy.
Patients received Genexol-PM 240 mg/m(2) intravenously over 3 h every 3 weeks without premedication. Intra-patient dose escalation to 300 mg/m(2) was allowed during the second and subsequent cycles if pre-specified toxicities were not observed during the first cycle. The primary endpoint was response.
Thirty-seven patients were enrolled in this study. Platinum-free interval was less than 6 months in 27 (73%) patients, and 24 (64%) were categorized as having intermediate or poor prognosis according to Bajorin's criteria. Of 34 evaluable patients, there were 7 responses (21%; 95% CI, 7-34%), including one complete response (CR), with a median response duration of 6.5 months (95% CI, 3.5-9.6 months). The median time to progression was 2.7 months (95% CI, 0.9-4.6 months) with a median overall survival of 6.5 months (95% CI, 5.0-8.0 months). The most common grade 3/4 non-hematologic toxicities were peripheral neuropathy (sensory type 5.9%; motor type 8.8%) and infection (5.9%). Grade ≥3 hematologic toxicities occurred in only one patient.
Genexol-PM was generally well tolerated and demonstrated sufficient antitumor activity to warrant further development when used as second-line chemotherapy after gemcitabine-cisplatin failure in patients with urothelial carcinoma (NCT01426126).
Investigational New Drugs 10/2011; 30(5):1984-90. · 3.36 Impact Factor
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ABSTRACT: Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? To date, studies to evaluate clinical significance of prostate cancer detected on repeat biopsy in patients who underwent radical prostatectomy have yielded inconsistent results. The present study confirms that prostate cancer diagnosed after repeat biopsies is related to better pathological outcomes after radical prostatectomy, but not predictive of biochemical recurrence. Additionally, we find that the number of cores taken at initial biopsy do not affect the association between the number of previous biopsies and the prognosis.
To determine whether repeat prostate biopsies are associated with more favourable prognoses compared with diagnosis at initial biopsy in patients who undergo radical prostatectomy for prostate cancer and to determine if this association is affected by the number of cores taken at initial biopsy.
We reviewed 1147 patients with prostate cancer from 1991 to 2008. Patients were stratified into two groups by the number of biopsies before diagnosis (initial biopsy vs repeat biopsy: at least two biopsies). The effects of several variables on pathological outcomes and biochemical recurrence-free and systemic progression-free survivals were assessed.
Of the 1147 patients, 1064 (92.8%) were diagnosed with cancer at first biopsy and 83 (7.2%) at repeat biopsy. Compared with patients diagnosed at initial biopsy, those diagnosed at repeat biopsies were more likely to have a lower clinical stage (cT1c: 79.5% vs 55.5%, P < 0.001) and organ-confined tumours (78.3% vs 61.3%, P= 0.003), but there was no significant difference in initial biopsy core number (8.3 vs 8.7, P= 0.373). Five-year biochemical recurrence-free and progression-free survival rates did not show significant differences between the two groups (88.8% vs 82.2%, P= 0.078; 100.0% vs 96.5%, P= 0.105, respectively), and these results were not affected by the number of cores taken at initial biopsy.
Although prostate cancer diagnosed after repeat biopsies was related to better pathological outcomes after radical prostatectomy, the number of previous biopsies did not predict disease recurrence. Moreover, the number of cores taken at initial biopsy did not affect these associations.
BJU International 09/2011; 109(10):1474-9. · 2.84 Impact Factor
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ABSTRACT: To assess the validity of the 2009 TNM classification for renal cell carcinoma (RCC) and compare its ability to predict survival relative to the 2002 classification.
We identified 1,691 patients who underwent radical nephrectomy or partial nephrectomy for unilateral, sporadic RCC between 1989 and 2007. Cancer-specific survival was estimated by the Kaplan-Meier method and was compared among groups by the log-rank test. Associations of the 2002 and 2009 TNM classifications with death from RCC were evaluated by Cox proportional hazards regression models. The predictive abilities of the two classifications were compared by using Harrell's concordance (c) index.
There were 234 deaths from RCC a mean of 38 months after nephrectomy. According to the 2002 primary tumor classification, 5-year cancer-specific survival was 97.6% in T1a, 92.0% in T1b, 83.3% in T2, 61.9% in T3a, 51.1% in T3b, 40.0% in T3c, and 33.6% in T4 (p for trend<0.001). According to the 2009 classification, 5-year cancer-specific survival was 83.2% in T2a, 83.8% in T2b, 62.6% in T3a, 41.1% in T3b, 50.0% in T3c, and 26.1% in T4 (p for trend<0.001). The c index for the 2002 primary tumor classification was 0.810 in the univariate analysis and increased to 0.906 in the multivariate analysis. The c index for the 2009 primary tumor classification was 0.808 in the univariate analysis and increased to 0.904 in the multivariate analysis.
Our data suggest that the predictive ability the 2009 TNM classification is not superior to that of the 2002 classification.
Korean journal of urology 08/2011; 52(8):524-30.
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ABSTRACT: OBJECTIVES: We examined whether altered protein expression for 7 potential biomarkers, including p53, pRb, PTEN, Ki-67, p27, FGFR3, and CD9, could predict tumor recurrence and progression in patients treated with bacillus Calmette-Guerin (BCG) therapy for primary stage T1 grade 3 (T1G3) bladder cancer (BC). MATERIALS AND METHODS: The study included 61 patients with primary T1G3 BC who were treated with 6 weekly intravesical BCG instillations after clinically complete transurethral resection of bladder tumor between 1990 and 2007. All patients had proper muscle tissue in their specimen. Protein expression for 7 molecular biomarkers before BCG therapy was analyzed by immunohistochemistry based on tissue microarray methodology, and the percentage of positive cells was determined quantitatively in a blind fashion. Survival analysis was performed using Kaplan-Meier curves and Cox regression to determine the effect of each marker on recurrence-free survival (RFS) and progression-free survival (PFS) after BCG therapy. RESULTS: Overall 5-year RFS and PFS rates were 56.0% and 84.5%, respectively, with a median follow-up of 60.0 months (range 6-217). The altered expression for each marker were noted in 53.3% for p53, 73.3% for pRb, 63.8% for PTEN, 40.0% for Ki-67, 66.1% for p27, 37.3% for FGFR3, and 47.5% for CD9, respectively. No significant association was found between altered marker status and clinicopathologic characteristics. While increased p53 expression was associated with progression after BCG therapy (5-year PFS rates: 90.7% in p53 < 10% vs. 78.7% in p53 ≥ 10%, P = 0.0495), no single marker was associated with RFS and PFS after BCG therapy in univariate and multivariate Cox regression analysis. Similarly, in subgroup analysis according to tumor size, multiplicity, and morphology, no single marker was associated with RFS and PFS. No difference was noted in molecular marker status between BCG responders and nonresponders. CONCLUSIONS: Our findings indicate that immunohistochemical analysis for 7 potential molecular markers has no predictive value for recurrence and progression in primary T1G3 BC treated with BCG therapy. Large prospective studies are needed to validate the prognostic molecular markers in primary T1G3 BC.
Urologic Oncology 07/2011; · 3.22 Impact Factor
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ABSTRACT: • To analyse the clinicopathological and radiological features of multilocular cystic renal cell carcinoma (MCRCC) and to determine the preoperative factors differentiating MCRCC from other cystic RCC (CRCC).
• The medical records of 53 patients with complex cystic renal masses evaluated by multiphase computed tomography (CT), surgically removed and confirmed as sporadic RCC were reviewed. • Of these 53 patients, 23 were classified as having MCRCC and 30 as other CRCCs, defined as RCCs with extensive cystic change or cystic necrosis. • Another 22 patients were treated for complex cystic renal masses presumed to be RCC and diagnosed as having benign cyst.
• Benign cysts and MCRCCs were significantly more likely to be of Bosniak classification III than other CRCCs (77% vs 61% vs 27%, P= 0.001). • The mean Hounsfield unit (HU) during the corticomedullary phase (CMP) was significantly higher in other CRCCs, with HU ≥38 having 83% sensitivity and 80% specificity for predicting other CRCCs. • In a multiple regression model, Bosniak classification and mean HU during CMP were independent factors predictive of other CRCCs. • In the 41 patients with masses >4 cm in diameter, the combination of Bosniak classification IV and HU ≥38 during CMP showed 63% sensitivity, 96% specificity, 91% positive predictive value and 80% negative predictive value, yielding 2% false-positive and 15% false-negative rates.
• The mean HU during CMP and Bosniak classification can differentiate MCRCC from other CRCCs. • This could help in selecting an appropriate surgical method, such as nephron-sparing surgery, for complex cystic renal masses >4 cm.
BJU International 07/2011; 108(9):1444-9. · 2.84 Impact Factor
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ABSTRACT: We compared the efficacy of radical cystectomy (RC) and non-RC treatment [transurethral resection of bladder tumor (TURB) only, partial cystectomy, or TURB followed by radiotherapy] in octogenarians with muscle-invasive bladder cancer (MIBC).
A total of 177 patients aged 80 years or more underwent TURB at our institute, and 41 patients had MIBC according to the histologic examination. Fourteen patients with lymph node or distant metastasis were excluded, and 27 patients were ultimately included. Patients were stratified by treatment modality (RC vs. non-RC), Charlson Comorbidity Index (low CCI vs. high CCI), and clinical tumor stage (organ-confined disease vs. extravesical disease). The effects of several variables on cancer-specific and overall survival were assessed.
Of the 27 patients, 11 (41%) underwent RC and 16 (59%) underwent non-RC treatment. Patients in the RC group were younger and more likely to have low CCI scores. There were no significant differences in overall or cancer-specific survival in the RC and non-RC groups. Patients with clinically organ-confined disease had better survival outcomes than did those with extravesical disease. Stratification of patients by CCI indicated that overall survival was better in patients with low CCI scores (p=0.013), although cancer-specific survival was similar in the two CCI groups. Univariate and multivariate analysis indicated that clinical tumor stage and CCI were independently associated with overall survival.
RC in octogenarians with MIBC does not improve overall survival compared with other treatment modalities. However, clinically organ-confined disease and low CCI score were associated with better overall survival.
Korean journal of urology 07/2011; 52(7):446-51.
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ABSTRACT: We assessed the change in unilateral renal function after laparoscopic partial nephrectomy to determine factors affecting the course and factors predicting the postoperative glomerular filtration rate decrease.
From prospectively collected data on 116 patients who underwent laparoscopic partial nephrectomy we evaluated the glomerular filtration rate of the operated kidney using diethylenetriaminepentaacetic acid scans done preoperatively, and 3 months, and 1, 2 and 3 years postoperatively. Kidney volume was measured from the arterial phase of dynamic computerized tomography of the kidney done before and 3 months postoperatively to calculate the volume reduction. We analyzed clinicopathological and operative factors with the potential to influence the perioperative glomerular filtration rate decrease.
In all patients the glomerular filtration rate was significantly decreased by 3 months postoperatively. It remained significantly lower compared to preoperative function despite the trend toward progressive recovery, which was noted until 3 years postoperatively. Recovery in individuals was significantly influenced by patient age (less than 55 vs 55 years or greater), medical comorbidities, tumor size (less than 2.5 vs 2.5 cm or greater), kidney volume reduction (less than 20% vs 20% or greater) and collecting system repair at surgery. Independent determinants of postoperative renal function were the preoperative glomerular filtration rate (β = 0.410, 95% CI 0.424-1.084; p <0.001), the percent of renal parenchymal volume reduction (β = 0.273, 95% CI 0.168-0.766; p = 0.003) and pelvicalyceal system repair (β = 0.284, 95% CI 2.960-15.788; p = 0.005).
Function of the kidney undergoing laparoscopic partial nephrectomy progressively recovers after a significant decrease immediately after surgery. Although recovery differs according to patient age, comorbidities and tumor size, factors that independently predicted the postoperative glomerular filtration rate decrease were the renal parenchymal volume reduction and pelvicalyceal system repair.
The Journal of urology 07/2011; 186(1):53-8. · 4.02 Impact Factor
