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ABSTRACT: OBJECTIVE: To introduce the new preoperative parameter as a predictor for extracapsular extension (ECE), we defined the presence of tumor at the stump of the rectum side on prostate needle biopsy as a positive posterior margin (PPM), and speculated that PPM is related to ECE. METHODS: This retrospective study was conducted in 230 patients who underwent prostate needle biopsy and retropubic radical prostatectomy between 2001 and 2011. We analyzed the association between their clinicopathological parameters and ECE. RESULTS: Multivariate analysis showed that the Gleason score (P = .023, odds ratio [OR] 1.433), serum prostate-specific antigen (PSA, P = .013, OR 1.040), clinical stage (P = .018, OR 2.162), and PPM (P = .013, OR 2.253) were significant independent predictors for ECE. Next, using these 4 preoperative risk factors, we were able to accurately predict their ECE. Patients with 0 or 1 risk factor had a low probability of ECE (13.0% and 18.5%, respectively). In contrast, the majority of patients who had 3 or 4 risk factors were found to have ECE (80.1% and 71.4%, respectively). CONCLUSION: The data suggest that the Gleason score, serum PSA, clinical stage, and PPM may be independent predictors for the existence of ECE. This suggests that the posterior margin in biopsy specimens is a more reliable and clinically useful parameter when making decisions concerning the choice of treatments.
Urology 03/2013; · 2.43 Impact Factor
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ABSTRACT: PURPOSE: Although smoking status has a significant association with clinical features in patients with bladder cancer, there have been few reports on the impact of smoking on clinical outcome of upper tract urothelial cancer (UTUC). The aim of the present study was to investigate the possible influence of smoking status on subsequent bladder recurrence after radical nephroureterectomy (RNU). MATERIALS AND METHODS: We identified a study population of 245 consecutive patients treated surgically for UTUC at our 3 institutions between 1994 and 2010. The associations between the subsequent bladder recurrence and the clinicopathological parameters of a patient including the smoking status were analyzed. RESULTS: The 3-year bladder recurrence-free survival rates were 32.6% in current smokers, 37.6% in ex-smokers and 61.7% in non-smokers. Multivariate analysis showed that male gender (P =0.013, HR=1.90 (1.15-3.16)) and smoking status (ex-smokers; P =0.027, HR=1.77 (1.07-2.93), current smokers; P =0.035, HR=1.58 (1.03-2.42)) were independent risk factors for subsequent bladder recurrence. In addition, we focused on patients with positive smoking history: patients with a number of pack-years ≥50 showed significantly higher incidence of subsequent bladder recurrence following RNU (P =0.003, HR=2.00). CONCLUSIONS: Positive smoking history and male gender were independent risk factors for subsequent bladder recurrence following RNU, and a larger number of cigarettes smoked may increase the incidence of bladder recurrence in patients with UTUC.
The Journal of urology 01/2013; · 4.02 Impact Factor
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Nobuyuki Tanaka,
Eiji Kikuchi,
Suguru Shirotake,
Kent Kanao, Kazuhiro Matsumoto,
Hiroaki Kobayashi,
Yasumasa Miyazaki,
Hiroki Ide,
Jun Obata,
Katsura Hoshino,
Nozomi Hayakawa,
Yujiro Ito,
Takeo Kosaka,
Kiichiro Kodaira,
Masafumi Oyama,
Akira Miyajima,
Tetsuo Momma,
Ken Nakagawa,
Munehisa Ueno,
Mototsugu Oya
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ABSTRACT: BACKGROUND: Few studies have discussed the prognostic impact of serum C-reactive protein (CRP) level in upper tract urothelial carcinoma (UTUC). OBJECTIVE: To investigate whether the perioperative level of CRP provides additional prognostic information following radical nephroureterectomy (RNU). DESIGN, SETTING, AND PARTICIPANTS: A total of 564 patients with UTUC from a retrospective multi-institutional cohort were included. The median follow-up was 32 mo. INTERVENTION: All patients underwent RNU without neoadjuvant chemotherapy, while 106 patients (18.8%) received adjuvant chemotherapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Associations between perioperative CRP level and outcome were assessed using multivariate analysis. A serum CRP level >0.50mg/dl was defined as elevated. RESULTS AND LIMITATIONS: Preoperative CRP (pre-CRP) level was elevated in 136 patients (24.1%). Multivariate analysis showed that pre-CRP elevation was an independent predictor of subsequent disease recurrence (hazard ratio [HR]: 1.47 for CRP 0.51-2.00; HR: 1.89 for CRP >2.00). Five-year recurrence-free survival rates were 69.2% in patients with pre-CRP levels ≤0.50mg/dl, 54.3% in patients with pre-CRP levels between 0.51 and 2.00mg/dl, and 35.4% in patients with pre-CRP levels >2.00mg/dl (p<0.001). Similar results were found in cancer-specific mortality, showing that pre-CRP elevation was an independent predictor of worse outcome (HR: 1.74 for CRP 0.51-2.00; HR: 2.31 for CRP >2.00). In a subgroup analysis of the elevated pre-CRP group, postoperative normalisation of CRP level was an independent predictor of better outcome. This study is limited by its retrospective nature as well as its heterogeneous group of patients and variable follow-up protocols resulting from the multi-institution design. CONCLUSIONS: Serum CRP may become a possible biomarker in UTUC, suggesting that patients with an elevated pre-CRP level could be predicted to have subsequent disease recurrence and cancer-specific mortality, while postoperative normalisation of CRP level was an independent predictor for prognosis.
European urology 12/2012; · 7.67 Impact Factor
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ABSTRACT: BACKGROUND AND OBJECTIVE: Serum C-reactive protein (CRP) is one particular marker of systemic inflammation, and an elevated CRP level is associated with poor outcome in various malignancies. While the clinical value of CRP levels in upper tract urothelial carcinoma (UTUC) has not yet been fully evaluated, we investigated the impact of CRP elevation as a biomarker of patient prognosis in UTUC. MATERIALS AND METHODS: A total of 183 patients who underwent radical nephroureterectomy (RNU) for localized UTUC (pTa-4N0M0) were identified between 1993 and 2009. The associations between the levels of serum CRP and patient outcome were analyzed. RESULTS: Thirty-three patients experienced disease recurrence, and 28 died of the disease during the median follow-up period of 39 months. Using the defined cutoff level of CRP >0.5 mg/dl as elevated, preoperative CRP (pre-CRP) levels were elevated in 42 patients (23.0%). Kaplan-Meier curves revealed that subsequent tumor recurrences and worse cancer-specific survival could be significantly predicted in the elevated pre-CRP group. The 5-year recurrence-free survival rate was 63.6% in the elevated pre-CRP group and 83.4% in their counterparts (P < 0.001), and the 5-year cancer-specific survival rate was 64.7% in the elevated pre-CRP group and 84.3% in their counterparts (P = 0.001). Multivariate analysis revealed that elevated pre-CRP, in addition to pathologic T stage, was an independent risk factor for subsequent disease recurrence (P = 0.003, hazard ration (HR) = 2.83), and the decrease in cancer-specific survival (P = 0.012, HR = 2.65). In subgroup analysis using patients with pT3 tumors or greater, multivariate analysis also showed that elevated pre-CRP was an independent risk factor for a decrease in both recurrence-free and cancer-specific survival. CONCLUSIONS: Pre-CRP level was an independent predictor of patient survival in localized advanced UTUC. Patients with pre-CRP >0.5 mg/dl were strongly predicted to have worse prognostic outcomes following RNU. Due to its low cost and easy accessibility, CRP may be a useful biomarker for localized UTUC.
Urologic Oncology 11/2012; · 3.22 Impact Factor
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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? Upper tract urothelial carcinoma (UTUC) is relatively uncommon, accounting for only ∼5% of urothelial malignancies and 10% of all renal tumours. Radical nephroureterectomy (RNU) with bladder cuff excision is the surgical standard of care for treating localized UTUC, but the prognosis for patients who undergo RNU remains poor. Evidence suggests that an interactive relationship exists between haemostatic factors and tumour biology. A number of procoagulant and fibrinolytic factors have been found to be overexpressed in tumours. One of these factors is plasma fibrinogen. Recent studies have shown that elevated pre-therapeutic plasma fibrinogen levels are associated with worse outcome in various malignancies; however, the prognostic value of plasma fibrinogen levels for UTUC has not yet been reported. To the best of our knowledge, this is the first paper to evaluate the prognostic impact of preoperative plasma fibrinogen levels in patients with localized UTUC treated surgically. We believe that the present results may assist in decision-making with respect to the need for lymph node dissection and neoadjuvant chemotherapy. OBJECTIVE: • To investigate the prognostic value of plasma fibrinogen levels as a predictor of patient outcome in upper tract urothelial carcinoma (UTUC). PATIENTS AND METHODS: • A total of 218 patients who underwent radical nephroureterectomy (RNU) for localized UTUC (pTa-4N0M0) were identified between 1995 and 2009. • The association between preoperative plasma fibrinogen levels and clinicopathological variables was analysed. RESULTS: • Forty-five patients experienced tumour recurrence, and 36 died from disease during the mean follow-up of 51 months. The mean (sd) preoperative plasma fibrinogen level was 362 (103) mg/dL. • Kaplan-Meier curves showed that subsequent tumour recurrence was strongly predicted in patients with preoperative plasma fibrinogen levels ≥450 mg/dL, and similar results were observed for cancer-specific survival. • On multivariate analysis we found that a preoperative plasma fibrinogen level of ≥450 mg/dL was an independent risk factor for subsequent tumour recurrence and cancer-specific survival. • The 5-year recurrence-free survival rate was 56.9% in patients with plasma fibrinogen levels ≥450 mg/dL and 81.5% in patients with plasma fibrinogen levels <450 mg/dL (P < 0.001). The 5-year cancer-specific survival rate was 59.5% in patients with plasma fibrinogen levels of ≥450 mg/dL and 84.8% in patients with plasma fibrinogen levels <450 mg/dL (P < 0.001). • On multivariate analysis, controlling for preoperative indicators, a preoperative plasma fibrinogen level of ≥450 mg/dL predicted worse pathological features, such as ≥pT3 disease and positive lymphovascular invasion, in surgical specimens. CONCLUSIONS: • Preoperative elevated plasma fibrinogen level was an independent predictor for poor survival after RNU and for worse pathological features. • Plasma fibrinogen levels may become a useful biomarker, particularly because of its low associated cost and easy accessibility.
BJU International 07/2012; · 2.84 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? So far, few previous reports have analysed the risk factors for tumour recurrence and stage progression with a special focus on BCG-relapsing disease, defined as the recurrence after achieving a disease-free status by initial BCG instillations for 6 months. There are no guidelines outlining a specific treatment strategy for BCG-relapsing disease, although many BCG failure cases are attributable to BCG-relapsing disease. In this study, additional BCG instillation was shown to decrease the subsequent tumour recurrence rate against BCG-relapsing tumours with intermediate pathological risk features; however, a BCG-relapsing tumour with a pathologically high risk was a significant risk factor for both subsequent tumour recurrence and stage progression. This information might identify a therapeutic strategy for BCG-relapsing tumours. OBJECTIVE: • To investigate the risk of subsequent tumour recurrence and stage progression in bacillus Calmette-Guérin (BCG)-relapsing non-muscle-invasive bladder cancer, defined as recurrence after achieving a disease-free status for 6 months. PATIENTS AND METHODS: • A total of 183 patients with BCG-relapsing tumours were treated with conservative therapy between 1985 and 2008 at our three institutions. • We analysed the association between their clinicopathological parameters and subsequent tumour recurrence or stage progression. RESULTS: • Additional induction courses of BCG or anticancer drug (mitomycin C or epirubicin) instillations were performed in 119 patients and 24 patients, respectively. The remaining 40 patients did not undergo any adjuvant therapy. • Multivariate analysis showed that a relapsing tumour with a pathologically high risk (defined as tumours with G3 and/or pT1 and/or concomitant carcinoma in situ) was a significant risk factor for subsequent tumour recurrence (P= 0.002; hazard ratio [HR] 2.15). Additional BCG instillation significantly decreased the subsequent tumour recurrence rate (P < 0.001; HR 0.41). • Multivariate analysis also showed that a relapsing tumour with a pathologically high risk was also significantly associated with stage progression (P < 0.001; HR 8.05). CONCLUSIONS: • An additional course of BCG instillation might be effective in patients with BCG-relapsing tumours with pathologically intermediate risk. • Nevertheless, some patients with high-risk pathological features developed subsequent stage progression. Such patients should be followed up closely and counselled on the need for aggressive therapeutic options, such as radical cystectomy.
BJU International 05/2012; · 2.84 Impact Factor
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ABSTRACT: The KiSS-1 gene has been reported to be a metastasis suppressor gene in human melanoma. The gene product was isolated from human placenta as the ligand of GPR54, a G protein-coupled receptor, and the C-terminally amidated peptide of 54 amino acids is called metastin. The binding of metastin to GPR54 has been shown to inhibit tumor metastasis in some tumor cells; however, its function remains unclear in urothelial carcinoma. We first evaluated KiSS-1 expression and GPR54 expression in 151 patients with upper urinary tract urothelial carcinoma to determine their prognostic significance. Next, we examined the role of metastin in the invasiveness and lung metastasis of MBT-2 variant (MBT-2V), which is a highly metastatic murine bladder cancer cell. Multivariate analysis revealed that KiSS-1 expression was an independent predictor of metastasis and overall survival. However, GPR54 expression was not selected. Hematogeneous metastasis had a significantly lower level of KiSS-1 expression compared with lymph node metastasis. Metastin treatment significantly reduced the invasiveness of MBT-2V cells and inhibited the DNA-binding activity of NF-κB by blocking its nuclear translocation, leading to a reduction in the expression and activity of matrix metalloproteinase-9. Metastin treatment dramatically prevented the occurrence of lung metastatic nodules (6.3 ± 2.3, n = 15) compared with controls (30.4 ± 5.1, n = 15; P < 0.01), as well as had survival benefit. KiSS-1 plays an important role in the prognosis of upper tract urothelial carcinoma and metastin may be an effective inhibitor of metastasis in urothelial carcinoma through its blockade of NF-κB function.
Molecular Cancer Therapeutics 02/2012; 11(4):853-63. · 5.23 Impact Factor
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ABSTRACT: What's known on the subject? and What does the study add? Adjuvant intravesical BCG therapy is the most effective regimen for non-muscle-invasive bladder cancer. Previously, patients who experienced recurrences after BCG therapy tended to be lumped together as patients with 'BCG failure', but BCG failure was defined inconsistently in each study and several studies indicated that patients with a particular pattern of BCG failure had a worse prognosis. We divided patients with BCG failure into four groups, which were based mainly on the responsiveness to BCG therapy and duration until tumour recurrence. Patients in the BCG-refractory group, in particular, had a higher risk for subsequent stage progression and disease-specific death over a long duration compared with patients in the other BCG-failure groups. As the definitions of BCG failure used to date have been decidedly heterogeneous, we recommend that standardized treatment decisions, protocols and recommendations be established according to individual BCG failure patterns.
To investigate the differences in the clinical features and subsequent stage progression and disease-specific survival among patients with Bacillus Calmette-Guérin (BCG) failure, after dividing these patients into BCG-refractory, -resistant, -relapsing, and -intolerant groups.
We identified 173 patients with initial BCG failure from 521 patients who had undergone induction BCG therapy for non-muscle-invasive bladder cancer, excluding CIS, between 1987 and 2009. Patients were stratified into four BCG-failure groups, and each prognostic outcome was evaluated.
Median follow-up period from initial BCG failure was 4.7 years. A total of 42 patients (24.3%) were stratified into the BCG-refractory, three (1.7%) into the BCG-resistant, 106 (61.3%) into the BCG-relapsing, and 22 (12.7%) into the BCG-intolerant group. Twenty-four patients (13.9%) experienced stage progression during follow-up. Multivariate analysis showed that pathological G3 at BCG failure (P = 0.014; risk ratio 2.84) and BCG-refractory (P < 0.001; risk ratio 4.68) were independent predictors for stage progression. The 10-year progression-free survival rates were 53.2%, 91.1% and 93.8% in the BCG-refractory, BCG-relapsing and BCG-intolerant groups, respectively. The stage progression rate was higher in the BCG-refractory than in the BCG-relapsing (P < 0.001) and BCG-intolerant (P = 0.007) groups. Similarly, the 10-year disease-specific survival rate in the BCG-refractory group was significantly worse than those in the other BCG failure groups (P < 0.001).
Stratification of BCG failure into the above-mentioned four groups can identify patients with BCG-failure in terms of their prognosis. The potential risk for critical adverse events was higher in the BCG-refractory group than in the other BCG-failure groups, despite the fact that patients in each group all underwent induction BCG therapy, therefore, treatment decisions, protocols and recommendations should be established based on each individual BCG-failure pattern.
BJU International 02/2012; 110(6 Pt B):E216-21. · 2.84 Impact Factor
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ABSTRACT: Several studies have associated urachal carcinoma with a poor prognosis, because the disease tends to be detected later as the patient is asymptomatic, there are few therapeutic options, and it has a high local recurrence rate. We review our experience with urachal carcinoma and discuss the role of surgical management and chemotherapeutic options.
We reviewed the records of 10 cases with urachal carcinoma evaluated at Keio University Hospital from 1998 to 2009, and examine the surgical and chemotherapeutic options in the management of urachal carcinoma.
Median age was 55.0 years. Applying the TNM staging system, 1 case was in stage I, 4 cases in stage II, 4 cases in stage III, and 1 case was in stage IV. Nine cases were managed initially with surgery; 5 by partial cystectomy and 4 by total cystectomy. The median follow-up period was 3.5 years and the survival rate at 2 years was 87.5%. Six of the resected cases remain disease-free. Salvage chemotherapy was performed in 3 cases, and adjuvant chemotherapy was performed in 2 cases.
We had 10 cases with urachal carcinoma. While there is still no standard chemotherapy combination, CPT-11 plus TS-1 produced stable disease in 1 case.
Urologia Internationalis 12/2011; 88(2):209-14. · 0.99 Impact Factor
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Minoru Yamada,
Masahiro Jinzaki,
Yutaka Tanami, Kazuhiro Matsumoto,
Akihisa Ueno,
Masatake Nukui,
Yasuhiro Imai,
Yotaro Ishihara,
Akihiko Nishide,
Kosuke Sasaki,
Sachio Kuribayashi
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ABSTRACT: The purpose of this study was to evaluate whether experimental fine-cell detector computed tomography with a 0.3125 mm cell (0.3 mm cell CT) can improve the detection of coronary vessel walls compared with conventional 64-slice computed tomography with a 0.625 mm cell (0.6 mm cell CT). A coronary vessel wall phantom was scanned using 0.6 mm cell CT and 0.3 mm cell CT. The data for 0.3 mm cell CT were obtained using four protocols: a radiation dose equal, double, triple or quadruple that were used in the 0.6 mm cell CT protocol. The detectable size of the vessel wall was assessed based on the first and second derivative functions, and the minimum measurable values were compared using a paired t-test. As a result, the minimum detectable wall thickness of 0.6 mm cell CT (1.5 mm) was significantly larger than that of 0.3 mm cell CT performed using the triple- and quadruple-dose protocols (0.9 mm) and the double-dose protocol (1.1 mm). The difference in the minimum detectable vessel wall thickness measured using 0.6 mm cell CT (1.5 ± 0.1 mm) and 0.3 mm cell CT (0.9 ± 0.1 mm, 1.1 ± 0.2 mm) was significant (p < 0.01). We concluded that 0.3 mm cell CT improved the detection of coronary vessel walls when a more than double-dose protocol was used compared with 0.6 mm cell CT.
Physics in Medicine and Biology 08/2011; 56(16):5235-47. · 2.83 Impact Factor
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ABSTRACT: Downstaging by neoadjuvant chemotherapy improves the survival of patients with muscle-invasive bladder cancer. In salvage setting, gemcitabine plus cisplatin has demonstrated an efficacy similar to that of methotrexate, vinblastine, doxorubicin and cisplatin with less toxicity. Therefore, the application of neoadjuvant gemcitabine plus cisplatin is also being anticipated.
Twenty-two patients who received neoadjuvant gemcitabine plus cisplatin were evaluated. The rate of downstaging, chemotherapy delivery profile and toxicity data were assessed. As comparator group, nine patients who were administered with neoadjuvant methotrexate, vinblastine, doxorubicin and cisplatin were evaluated.
A mean of 1.9 cycles of neoadjuvant gemcitabine plus cisplatin were performed. Achieved drug intensity for gemcitabine and cisplatin was 83.8 and 95.4%. Downstaging to pT0 and <pT2 was achieved in 50.0 and 63.6%. Grade 3 or 4 neutropenia, anemia, thrombocytopenia and febrile neutropenia appeared in 14.3, 2.4, 21.4 and 2.4%, respectively. Grade 3 or 4 non-hematologic toxicity was not observed. Thrombocytosis developed in 26.2%. A mean of 2.3 cycles of neoadjuvant methotrexate, vinblastine, doxorubicin and cisplatin were performed. The achieved drug intensities for methotrexate, vinblastine, doxorubicin and cisplatin were 59.6, 69.8, 100 and 88.6%. In patients treated with neoadjuvant methotrexate, vinblastine, doxorubicin and cisplatin, downstaging to pT0 and <pT2 was achieved in 22.2 and 44.4%. Grade 3 or 4 neutropenia, anemia and thrombocytopenia was present in 19.1, 9.5 and 4.8%. Grade 3 nausea developed in 28.6%.
The rate of downstaging by neoadjuvant gemcitabine plus cisplatin was comparable with that by methotrexate, vinblastine, doxorubicin and cisplatin. Gemcitabine plus cisplatin was associated with less non-hematologic toxicity than methotrexate, vinblastine, doxorubicin and cisplatin.
Japanese Journal of Clinical Oncology 06/2011; 41(7):908-14. · 1.78 Impact Factor
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ABSTRACT: Interleukin-15 (IL-15) is known to stimulate the proliferation of CD8(+) T-cells and natural killer cells, and also to help to maintain memory CD8(+) T cells, suggesting that it may be of value in cytokine treatment of bladder cancer. In this experiment, we tested the efficiency of intravesical liposomal IL-15 gene delivery and its antitumor effect in a mouse orthotopic bladder cancer model. We established an orthotopic bladder cancer model by implanting 5×10(5) MBT-2 cells into female C3H/HeN mice through the urethra. The mice received repeated intravesical gene delivery injected with liposome-mediated plasmids (5 μg) transurethrally. On day 23, the bladder weights in the group receiving medium alone, the beta-galactosidase gene delivery control group, and the IL-15 gene therapy group were 196±36 mg, 201±35 mg, and 96±29 mg, respectively (p<0.05), demonstrating the antitumor effect of intravesical IL-15 gene therapy in this model. In the bladders treated with IL-15 gene plasmid instillation, histological analysis revealed that many inflammatory cells were induced around the tumors. Immunohistochemical analysis confirmed that there was predominant infiltration of CD8(+) T cells around the tumor nest. After the intravesical IL-15 gene therapy, the growth of rechallenged subcutaneous MBT-2 cells in surviving mice was inhibited again via tumor-specific cytotoxic T lymphocytes, although newly implanted FM3A cells in the same mice were not rejected. The present findings indicate that IL-15 gene therapy may be a promising new adjuvant therapy for bladder cancer.
Human gene therapy 05/2011; 22(11):1423-32. · 4.20 Impact Factor
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ABSTRACT: The purpose of this study was to compare the accuracy of CT urography and excretory urography for the detection and localization of upper urinary tract urothelial carcinoma.
Of 128 patients at high risk for upper tract urothelial carcinoma who were examined with both CT urography and excretory urography between 2002 and 2007, 24 were undiagnosed and excluded. CT urography and excretory urography results of the remaining 104 patients and 552 urinary tract segments were compared with histopathologic examination or follow-up imaging at 1 year. Two readers independently scored the confidence levels for the presence or absence of upper urinary tract urothelial carcinoma in each of six upper urinary tract segments on both CT urography and excretory urography; differences were resolved by consensus.
Upper urinary tract urothelial carcinoma was diagnosed in 77 (14%) segments of 46 (44%) patients. Per-patient sensitivity, specificity, overall accuracy, and area under the receiver operating characteristic curves for detecting carcinomas with CT urography (93.5% [43/46], 94.8% [55/58], 94.2% [98/104], and 0.963, respectively) were significantly greater than those for excretory urography (80.4% [37/46], 81.0% [47/58], 80.8% [84/104], and 0.831, respectively) (p = 0.041, p = 0.027, p = 0.001, and p < 0.001, respectively). Per-segment sensitivity and overall accuracy for the localization of upper urinary tract urothelial carcinoma were significantly greater with CT urography (87.0% [67/77] and 97.8% [540/552]) than with excretory urography (41.6% [32/77] and 91.5% [505/552]) (p < 0.0001).
CT urography was more accurate than excretory urography in the detection and localization of upper urinary tract urothelial carcinoma and should be considered as the initial examination for the evaluation of patients at high risk for upper urinary tract urothelial carcinoma.
American Journal of Roentgenology 05/2011; 196(5):1102-9. · 2.78 Impact Factor
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ABSTRACT: In recent years some reports have suggested without any significant evidence that mitomycin C instillation would be more effective with urinary alkalinization. We investigated the association between urinary pH and the efficiency of mitomycin C instillation.
We identified 130 patients treated with transurethral resection of a bladder tumor and adjuvant intravesical mitomycin C instillation between 1985 and 2008 at Keio University Hospital. Urinary pH was determined in 124 of the 130 patients just before mitomycin C administration during the scheduled instillation period. These 124 patients were assigned to groups according to urinary pH in increments of 0.5 and the association between urinary pH and clinicopathological characteristics was evaluated.
Mean±SD urinary pH was 5.77±0.05 (range 5.00 to 7.66) during the scheduled instillation period. Urinary pH was 5.00 to 5.49, 5.50 to 5.99, 6.00 to 6.49, 6.50 to 6.99 and 7.00 in 39, 46, 25, 7 and 7 patients, respectively. Patients were further divided into 2 groups by urinary pH using a cutoff of 5.5, including 39 with pH less than 5.5 and 85 with pH 5.5 or more. Age, gender, tumor grade, primary/recurrent disease, pathological stage and the presence or absence of concomitant carcinoma in situ were not significantly difference between the 2 groups. Multivariate analysis revealed that categorical urinary pH was an independent risk factor for tumor recurrence (HR 1.75, p=0.032). Three and 5-year recurrence-free rates were 64.2% and 52.9% in patients with pH 5.5 or greater, and 41.9% and 38.4% in those with pH less than 5.5, respectively (p=0.046). Multivariate analysis showed that the HR of urinary pH for tumor recurrence was 1.84 and 2.54 at the 5.4 and 5.2 cutoffs, respectively.
Results suggest that urinary pH more than 5.5 is associated with a decreased risk of tumor recurrence in patients treated with intravesical mitomycin C for nonmuscle invasive bladder cancer. Monitoring urinary pH during mitomycin C adjuvant treatment and modifying pH for urine alkalization may improve the therapeutic efficacy of mitomycin C instillation.
The Journal of urology 03/2011; 185(3):802-6. · 4.02 Impact Factor
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ABSTRACT: Patients with nonmuscle invasive bladder cancer usually experience multiple instances of tumor recurrence until stage progression occurs. However, it has not yet been fully evaluated whether the timing and/or pattern of tumor recurrence could affect subsequent stage progression. We examined whether the frequency of tumor recurrence provides additional predictive information concerning stage progression.
A total of 484 patients with initially diagnosed nonmuscle invasive bladder cancer were identified between 1985 and 2006 at our institution. Median followup was 7.2 years. Frequency of tumor recurrence was analyzed to determine if it affected subsequent stage progression.
Of these patients 40 (8.3%) experienced stage progression during followup. Using Kaplan-Meier analysis subsequent stage progression could be most strongly predicted in patients with a recurrence rate of 1 or more per year during the first 2 years, although similar results were observed for various cutoff periods and recurrence rates. The 10-year progression-free survival rate was 58.0% in patients with a recurrence rate of 1 or more per year and 93.3% in their counterparts (p <0.001). Multivariate analysis demonstrated that the appearance of tumor grade 3 (p = 0.027, risk ratio 2.36), carcinoma in situ (p = 0.045, risk ratio 2.44) and a recurrence rate of 1 or more per year during the first 2 years (p <0.001, risk ratio 7.40) were independent risk factors for subsequent stage progression.
Frequency of tumor recurrence is a strong predictor of subsequent stage progression in patients initially diagnosed with nonmuscle invasive bladder cancer. More appropriate followup and aggressive treatment due to a higher malignant potential for stage progression might be recommended in patients with a recurrence rate of 1 or more per year during the first 2 years.
The Journal of urology 02/2011; 185(2):450-5. · 4.02 Impact Factor
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ABSTRACT: To compare image quality obtained in phantoms with virtual monochromatic spectral (VMS) imaging with that obtained with conventional 120-kVp computed tomography (CT) for a given radiation dose.
Three syringes were filled with a diluted contrast medium (each syringe contained a contrast medium with a different iodine concentration [5, 10, or 15 mg of iodine per milliliter]), and a fourth syringe was filled with water. These syringes were placed in a torso phantom meant to simulate the standard human physique. The phantom was examined with a CT system and use of the fast kilovoltage switching (80 and 140 kVp) and conventional (120 kVp) modes. Image noise and contrast-to-noise (CNR) ratio were analyzed on VMS images and 120-kVp CT images.
Image noise on VMS images in the range of 67-72 keV was significantly lower than that on the 120-kVp CT images (P < .014). Image noise was lowest at 69 keV and was 12% lower when compared with that on 120-kVp CT images. CNR on the VMS images was highest at 68 keV. CNR on the VMS images obtained at 68 keV in the syringes filled with diluted contrast material (5, 10, and 15 mg of iodine per milliliter) was 28%, 31%, and 30% higher, respectively, compared with that on the 120-kVp CT images (P < .001).
VMS imaging at approximately 70 keV yielded lower image noise and higher CNR than did 120-kVp CT for a given radiation dose. VMS imaging has the potential to replace 120-kVp CT as the standard CT imaging modality, since optimal VMS imaging may be expected to yield improved image quality in a patient with standard body habitus.
Radiology 02/2011; 259(1):257-62. · 5.73 Impact Factor
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ABSTRACT: In this study, by comparing TVT surgery and TOT surgery for stress urinary incontinence in women, the characteristics and learning curves of both operative methods were studied.
A total of 83 women with stress urinary incontinence treated with tension-free vaginal tape (TVT) (n = 38) or transobturator tape (TOT) (n = 45) at Saiseikai Central Hospital between April 2004 and September 2009 were included. We compare the outcomes and learning curves between TVT surgery and TOT surgery. In statistical analysis, Student's t test, Fisher's exact test, and Mann-Whitney's U test were used.
The surgical durations were 37.4 ± 15.7 minutes with TVT surgery and 31.0 ± 8.3 minutes with TOT surgery. A longer period of time was required for TVT surgery (p = 0.025). The residual urine at post-operative day 1 was higher in TVT surgery (25.9 ± 44.2 ml) than in TOT surgery (10.6 ± 19.2 ml) (p = 0.0452). The surgical duration of TVT surgery was shortened after the operator had performed 15 operations (p = 0.019).
In comparison of TVT surgery and TOT surgery, the surgical duration of TVT surgery was longer and the residual urine of TVT surgery was higher at post-operative day 1. Surgical experience could shorten the duration of TVT surgery.
BMC Urology 01/2011; 11:13. · 1.45 Impact Factor
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ABSTRACT: The effect of local immunotherapy with bacille Calmette-Guérin in elderly patients with non-muscle-invasive bladder cancer has not yet been fully evaluated. The aim of the present study was to evaluate whether patients' age influences the response to bacille Calmette-Guérin treatment for the prevention of tumor recurrence and whether the side effects were tolerable.
We reviewed 1252 cases with non-muscle-invasive bladder cancer treated with transurethral bladder tumor resection, and 447 cases who underwent bacille Calmette-Guérin immunotherapy were included. The associations between patient age or pathological findings and tumor recurrence were determined. Side effects were classified as minor or major and were analyzed on the basis of their incidences in each age group.
The patients were divided into four age categories: younger than 55 (n= 86), 55-64 (n = 143), 65-74 (n = 132) and equal or older than 75 years (n = 86). The Kaplan-Meier curves of recurrence-free survival rates demonstrated that patients aged 55-64 had been continuously tumor-free than the equal or older than 75 group. The presence of previous bladder cancer and Grade 3 were independent predictors for tumor recurrence; however, patients' age was not selected. The incidence of fever was slightly higher and that of cystitis was lower in the younger group.
Age does not certainly affect recurrence in patients with bladder cancer treated with bacille Calmette-Guérin therapy. The related side effects in the elderly patients were almost equal to those in the younger. With careful monitoring, bacille Calmette-Guérin therapy is safe even in elderly patients.
Japanese Journal of Clinical Oncology 01/2011; 41(4):565-70. · 1.78 Impact Factor
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ABSTRACT: To evaluate recurrence and clinical course of bladder carcinoma in situ according to the current carcinoma in situ classification by analyzing the patients with diagnosed carcinoma in situ in our hospital.
Between January 1993 and September 2008, 93 patients were initially diagnosed with bladder carcinoma in situ in our hospital. All specimens underwent an additional review by one uro-pathologist. Primary, secondary and concurrent carcinoma in situ were found in 26, 21 and 46 patients, respectively. Sixty-nine patients (74.2%) underwent bacillus Calmette-Guérin instillation therapy.
The multivariate analysis determined that the secondary carcinoma in situ and the absence of bacillus Calmette-Guérin therapy were the independent unfavorable risk factors for tumor recurrence. The 5-year recurrence-free survival rates on primary, concurrent and secondary carcinoma in situ were 60.9, 63.2 and 25.4%, respectively, and the differences between secondary and primary carcinoma in situ, and secondary and concurrent were significant (P= 0.023 and P= 0.006, respectively). During the median follow-up period of 47 months, 19 patients had tumor recurrence in the bladder after the first bacillus Calmette-Guérin therapy, and 13 of them were treated with a second bacillus Calmette-Guérin therapy. After the second bacillus Calmette-Guérin therapy six patients eventually had distant metastasis and three had upper tract recurrence, whereas totally four had a tumor-free status after the second bacillus Calmette-Guérin therapy.
The first induction course of bacillus Calmette-Guérin therapy proved to be effective for the prevention of bladder cancer recurrence, however, the efficacy of a second bacillus Calmette-Guérin therapy on a recurrent tumor was somewhat limited.
Japanese Journal of Clinical Oncology 12/2010; 41(3):424-9. · 1.78 Impact Factor
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ABSTRACT: The diagnosis of prostate cancer is based on the results of ultrasonography-guided needle biopsy of the prostate, but cancer foci are often not visible in conventional transrectal ultrasonography. Sonazoid is a new microbubble contrast agent. The purpose of our study was to compare areas of contrast material enhancement in the prostate at ultrasonography with whole-mount radical prostatectomy specimens to determine if the use of Sonazoid improves the detection rate of prostate cancer.
Fifty patients with biopsy-proven cancer of the prostate who were scheduled to undergo radical prostatectomy were recruited for this study. The day before the operation, each patient was evaluated with ultrasonography at baseline and again during intravenous infusion of Sonazoid. A map of ultrasonography findings was created prospectively at the time of imaging. Following radical prostatectomy, independent mapping of the pathologic results was performed and the maps were compared.
Ultrasonography evaluation at baseline demonstrated that at least one focus of cancer was identified in 20 of the 50 subjects (40.0%). Meanwhile at least one cancer focus was enhanced in 31 of the 50 patients (62.0%) when Sonazoid was used. The combination of baseline grayscale imaging and contrast-enhanced imaging allowed identification of at least one focus of cancer in 40 patients (80.0%). Contrast-enhanced ultrasonography can improve sensitivity, especially for the detection of large cancer, peripheral zone cancer and highly malignant cancer.
Our study has demonstrated significantly improved detection of prostate cancer with the combination of baseline grayscale imaging and contrast-enhanced imaging compared with conventional ultrasonography techniques only, and this technique may be applicable to targeted biopsy.
Japanese Journal of Clinical Oncology 11/2010; 40(11):1099-104. · 1.78 Impact Factor
