Ioannis Zachos

University of Thessaly, Iolcus, Thessaly, Greece

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Publications (16)32.65 Total impact

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    ABSTRACT: The purpose of this study was to assess the correlation of previous bladder cancer history with the recurrence and progression of patients with high-risk non-muscle-invasive bladder cancer treated with adjuvant Bacillus Calmette-Guérin (BCG) and to evaluate their natural history. Patients were divided into two groups based on the existence of previous bladder cancer (primary, non-primary). A logistic regression analysis was used to identify the possible differences in the probabilities of recurrence and progression with respect to tumor history, while potential differences due to gender, tumor size (> 3 cm, < 3 cm), stage (pTa, T1), concomitant carcinoma in situ (pTis) and number of tumors (single, multiple) were also assessed. Univariate and multivariate models were employed. In addition, Kaplan-Meier survival analysis was used to compare recurrence- and progression-free survival between the groups. A total of 192 patients were included (144 with primary and 48 with non-primary tumors). The rates of recurrence and progression for patients with primary tumors were 27.8% and 12.5%, respectively. The corresponding percentages for patients with non-primary tumors were 77.1% and 33.3%, respectively. The latter group of patients displayed significantly higher probabilities of recurrence (p=0.000; 95% confidence interval [CI], 4.067 to 18.804) and progression (p=0.002; 95% CI, 1.609 to 7.614) in a univariate logistic regression analysis. Previous bladder cancer history remained significant in the multivariate model accounting for history, age, gender, tumor size , number of tumors, stage and concomitant pTis (p=0.000; 95% CI, 4.367 to 21.924 and p=0.002; 95% CI, 1.611 to 8.182 for recurrence and progression respectively). Kaplan-Meier curves revealed that the non-primary group hadreduced progression- and recurrence-free survival. Previous non-muscle-invasive bladder cancer history correlates significantly with recurrence and progression in patients with high-risk non-muscle-invasive disease treated with adjuvant BCG.
    Cancer Research and Treatment 09/2014; DOI:10.4143/crt.2014.050 · 2.98 Impact Factor
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    ABSTRACT: The aim of this retrospective study was to evaluate the impact of stapling devices use on overweight and obese bladder cancer patients treated with radical cystectomy (RC). Fifty-two overweight and 24 obese patients underwent open RC for muscle invasive bladder cancer. Bladder removal was performed using standard suture technique (SST) or multifire autosuture articulated vascular Endo-GIA (eG). Twenty-three overweight and 11 obese patients formed the SST arms and the remaining 29 overweight and 13 obese patients formed the eG arms. Intra and postoperative parameters and early postoperative complications (30 days) using the Clavien-Dindo classification were recorded. SST and eG arms of overweight and obese patients were comparable in intra and postoperative parameters. Both overweight and obese eG arms had significantly lower estimated blood loss, lower number of transfused packed red blood cells units (PRBC) and lower cystectomy intraoperative time compared with the SST ones (p < 0.05). In obese patients, staplers use led to significantly lower total length of stay compared with SST (p = 0.041). Complications rate was significantly higher in the obese group compared with the overweight group (58.33% versus 30.77%, p = 0.042). No difference in complications was found between the SST and eG arms of the overweight and obese patients. No deaths occurred. Staplers use in RC in overweight/obese patients is accompanied by significantly shorter intraoperative time, lower blood loss and lower number of transfused PRBC units, compared with SST. In obese patients, eG use led to shorter length of stay.
    The Canadian Journal of Urology 02/2014; 21(1):7114-9. · 0.91 Impact Factor
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    ABSTRACT: We conducted a retrospective study to determine the prognostic significance of age, gender, associated carcinoma in situ, stage, number of tumors, and tumor size for patients with high-risk non-muscle-invasive bladder tumors treated with bacillus Calmette-Guérin (BCG). Data were evaluated on 144 high-risk patients with non-muscle-invasive bladder cancer treated with BCG immunotherapy after the initial treatment with transurethral resection. According to their response to BCG, patients were divided into groups, and the differences in factors, associated with recurrence and progression, were evaluated. Patients were categorized into two groups: group A, complete responders without recurrence and without progression, and group B, patients with recurrence and with progression. Furthermore, group B was divided into two subgroups: group B1, patients with recurrence, and group B2, patients with progression. Univariate analysis of group B showed that only tumor size of >3 cm diameter (hazard ratio (HR) 11.99; 95 % confidence interval (CI) range 5.69-25.3; p < 0.001) is associated with recurrence. After multivariate analysis, the same factor appeared to be prognostic for recurrence as well. In addition, group B2 was statistically correlated with group B1. Univariate analysis proved that tumor stage (Ta or T1) is the unique factor associated with progression (HR 6.4; 95 % CI 1.29-31.9; p = 0.02). Tumor stage seems to be associated with disease's progression after the multivariate analysis too. Tumor size and stage may serve as prognostic factors, because of its independent correlation with recurrence and progression for patients with high-risk non-muscle-invasive bladder tumors treated with BCG.
    Tumor Biology 12/2013; DOI:10.1007/s13277-013-1547-8 · 2.84 Impact Factor
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    ABSTRACT: Glucuronidation, mediated by the UDP-glucuronosyltransferase 1A1 (UGT1A1) enzyme, is an important metabolic process during which steroids are converted to more easily excreted compounds in steroid target tissues, such as the prostate. The aim of our study was to investigate the possible correlation between UGT1A1 promoter gene polymorphism and benign prostatic hyperplasia. 421 blood samples were obtained from 138 consecutive patients diagnosed with benign prostatic hypeplasia (BPH group) and 283 healthy volunteers (control group). A(TA)6TAA promoter polymorphism of UGT1A1 gene was studied using the Fragment Analysis Software of an automated DNA sequencer and three genotypes (homozygous 7/7, heterozygous 6/7 and normal homozygous 6/6) were identified. No significant differences were observed between the BPH group and controls regarding the genotyping distribution of the three UGT1A1 promoter genotypes (P = 0.39). Also, no association was found between overall disease risk and the presence of the polymorphic homozygous genotype (TA(7)/TA)7) vs. TA(6)/TA(7) + TA(6)/TA(6)) (P = 0.31). Our data suggest that the TA repeat polymorphism of UGT1A1 is not associated with increased BPH risk susceptibility in Caucasian men.
    Molecular Biology Reports 09/2013; DOI:10.1007/s11033-013-2781-2 · 1.96 Impact Factor
  • European Urology Supplements 10/2012; 11(4):160. DOI:10.1016/S1569-9056(13)60303-6 · 3.37 Impact Factor
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    ABSTRACT: To assess the learning curve for fluorescence cystoscopy using hexaminolevulinate hydrochloride (HAL) in patients with bladder cancer. Fifty patients underwent bladder instillation with HAL. Two senior residents inspected separately the bladder using white light cystoscopy, followed by fluorescence cystoscopy and mapped the lesions. An experienced with photodynamic diagnosis (PDD) urologist also performed both cystoscopies, mapped, resected or cold biopsied suspect lesions under the supervision of another experienced urologist. To evaluate the learning curve, patients were divided into five subgroups, including group 1 (patients 1-10), group 2 (11-20), group 3 (21-30), group 4 (31-40) and group 5 (41-50). The kappa statistics was calculated to assess interobserver agreement between the physicians and the false positive rates of urologists and residents were also compared. Histologically verified tumors were diagnosed in 103 of 142 lesions identified by PDD. The interobserver agreement between urologists and residents was moderate, moderate, good, excellent, and excellent for group 1, 2, 3, 4, and 5, respectively. Both residents had increased false positive rates compared to urologists in all subgroups of patients but this difference did not reach statistical significance. In addition, false positive rate of residents was declining as the number of procedures was increasing. Our data suggest that 20 cases of HAL PDD are required to achieve a good interobserver agreement between inexperienced and experienced operator, and excellent agreement is achieved after 30 cases. The false positive rate of inexperienced operators was comparable to the experts and showed a gradual decrease.
    The Canadian Journal of Urology 06/2012; 19(3):6269-73. · 0.91 Impact Factor
  • Journal of Obstetrics and Gynaecology 10/2011; 31(7):670-1. DOI:10.3109/01443615.2011.601360 · 0.60 Impact Factor
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    ABSTRACT: Approximately 70% to 80% of patients with urothelial carcinomas of the bladder are initially diagnosed with non-muscle invasive disease. Superficial, non-muscle invasive bladder cancers (NMIBCs) are managed with cystoscopic transurethral resection of all visible lesions followed by intravesical chemotherapy and/or immunotherapy. Despite this treatment, up to 70% of these tumors will recur within five years and 15% will ultimately progress to muscle-invasive disease, suggesting that novel therapeutic strategies are necessary. Recent studies have greatly advanced our understanding of urothelial carcinogenesis and have highlighted the distinct molecular pathogenesis of NMIBCs versus muscle-invasive bladder tumors. It is now clear that diverse genetic and epigenetic events are driving the oncogenesis of NMIBCs, thereby attesting to their potential as therapeutic targets for these tumors. This article reviews the molecular pathogenesis of NMIBCs, discusses recently completed and ongoing clinical trials and anticipates the future direction of molecular targeted agents in this disease.
    Current Molecular Medicine 09/2011; 11(8):623-32. DOI:10.2174/156652411797536697 · 3.61 Impact Factor
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    ABSTRACT: The aim of our study was to evaluate the efficacy and safety of ESWL using a modified lateral position in obese patients with renal stones. Nineteen obese patients with renal stones were enrolled (group A). The mean stone diameter was 1.3 cm (0.7-1.9 cm). The mean BMI was 35.1 kg/m² (31-41 kg/m²). Patients were placed in the lateral position, with the energy source facing their body posteriorly and the site where the stone was located in direct contact with the water cushion. Success rate (defined as the percentage of patients who were stone-free or with insignificant fragments after 3 months), mean number of ESWL sessions, mean duration of ESWL session and complications were recorded. The results were compared with those of 17 obese patients (Group B) with similar baseline characteristics treated in the standard supine position. All ESWLs were performed using the Dornier lithotripter SII. Both success rate (68.4 vs. 64.7% for groups A and B, respectively) and mean number of sessions (2.2 vs. 2.6) did not differ significantly between the two groups (p = 0.5). Interestingly, the time required to complete ESWL was significantly shorter for group A patients (56 min) compared to group B (73 min) (p = 0.001). No severe complications (including hematoma, pyelonephritis) were recorded. Our data indicate that ESWL in the modified lateral position for renal calculi in obese patients seems to be feasible and safe. In addition, it is faster than in the supine position since it overcomes technical difficulties. Further studies with a large number of patients are required to support our findings.
    Urological Research 08/2011; 40(4):355-9. DOI:10.1007/s00240-011-0416-4 · 1.31 Impact Factor
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    ABSTRACT: Platinum-based chemotherapy is considered the standard-of-care first-line therapy for metastatic bladder cancer. Despite the initial high response rate, the vast majority of patients eventually progress and succumb to their disease, urging the need for development of novel therapies. This article discusses the main signaling pathways implicated in the pathogenesis of bladder carcinomas, reviews recently completed and ongoing clinical trials, and anticipates the future direction of molecularly targeted agents. This manuscript presents the current status of conventional chemotherapy in advanced bladder cancer, and provides a comprehensive review of molecular targeted agents currently in clinical development for this disease. Improved understanding of the biology of urothelial carcinogenesis has paved the way for the development of novel molecularly targeted therapies, several of which are currently tested in clinical trials. In this regard, VEGF and EGFR pathways are emerging as important therapeutic targets for metastatic bladder cancer, either alone or in combination with conventional chemotherapeutics. Other therapies, including aurora kinase inhibitors, endothelin receptor antagonists, RAS/MAPK pathway inhibitors and novel immunologic strategies, may also prove helpful in the treatment of this disease.
    Expert Opinion on Investigational Drugs 07/2010; 19(7):875-87. DOI:10.1517/13543784.2010.496450 · 5.43 Impact Factor
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    ABSTRACT: We conducted a prospective study to determine whether expression of telomerase reverse transcriptase (hTERT) is associated with recurrence-free-survival (RFS) or development of invasive disease in patients with high risk superficial bladder cancer (SBC) that received adjuvant BCG immunotherapy. Thirty patients with high-grade T1 tumors were evaluated. Pre-BCG TURBT and post-BCG specimens were analyzed for hTERT nucleolar expression by immunohistochemistry. Post-BCG hTERT expression was statistically significantly lower than pre-BCG hTERT expression. Pre-BCG hTERT nucleolar staining in more than 75% of cells was associated with worse RFS (9 months vs. not yet reached, P = 0.05), while post-BCG hTERT nucleolar staining in more than 50% of the cells was associated with worse RFS (6 months vs. not yet reached, P = 0.001) and development of invasive disease. In multivariate analysis, post-BCG hTERT expression was independently associated with RFS and development of invasive disease. Immunohistochemical evaluation of hTERT may help define a subset of high risk SBC patients that will eventually fail BCG and may therefore benefit from early salvage cystectomy.
    Journal of Cancer Research and Clinical Oncology 03/2009; 135(9):1169-75. DOI:10.1007/s00432-009-0557-9 · 3.01 Impact Factor
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    ABSTRACT: A rare case of penile cancer presenting with total obliteration of the penis and urinary retention is presented.
    The Scientific World Journal 02/2009; 9:158-62. DOI:10.1100/tsw.2009.14 · 1.73 Impact Factor
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    ABSTRACT: Prostate leiomyosarcoma is an extremely rare and highly aggressive neoplasm that accounts for less than 0.1% of primary prostate malignancies. We present a patient with primary leiomyosarcoma of the prostate and review 54 cases reported in the literature to discuss the clinical, diagnostic and therapeutic aspects of this uncommon tumor. Median survival was estimated at 17 months (95% C.I. 20.7-43.7 months) and the 1-, 3-, and 5-year actuarial survival rates were 68%, 34%, and 26%, respectively. The only factors predictive of long-term survival were negative surgical margins and absence of metastatic disease at presentation. A multidisciplinary approach is necessary for appropriate management of this dire entity.
    Sarcoma 02/2008; 2008:458709. DOI:10.1155/2008/458709
  • Annals of Diagnostic Pathology 10/2007; 11(5):393-393. DOI:10.1016/j.anndiagpath.2007.05.013 · 1.11 Impact Factor
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    ABSTRACT: Cystic hydatid disease may be found in virtually any organ, although involvement of the urinary tract is relatively uncommon. We report a case of isolated renal hydatid disease presenting with hydatiduria. A short review of the literature regarding diagnosis and management of renal echinococcosis is also presented.
    International Journal of Urology 03/2006; 13(2):174-6. DOI:10.1111/j.1442-2042.2006.01254.x · 1.80 Impact Factor
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    ABSTRACT: Primary small cell bladder carcinoma is an extremely rare and highly aggressive tumor. Unfortunately, the optimal therapeutic strategy for the tumor is still unknown. Recently, a two-stage system for limited and extensive small cell bladder carcinoma has been suggested in analogy to the practiced staging and treatment of small cell lung carcinoma. We present a new case of small cell bladder carcinoma and discuss relevant current literature.
    Tumori 92(6):552-4. · 1.09 Impact Factor