[Show abstract][Hide abstract] ABSTRACT: Thyroid-like follicular carcinoma of the kidney is an extremely rare histological variant of renal cell carcinoma. It was described only recently and is not included in the World Health Organization classification of renal tumors. This tumor characteristically shows similar histology to thyroid follicular carcinoma but lacks typical thyroid markers. Herein, we report a new case of thyroid-like follicular carcinoma of the kidney diagnosed in a partial nephrectomy specimen in a 68-year-old-woman. We present typical histological and immunohistochemical findings, discuss differential diagnosis and provide a review of the literature. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_186.
[Show abstract][Hide abstract] ABSTRACT: To assess bacillus Calmette-Guérin maintenance treatment schedule for non-muscle invasive bladder cancer at 2 years, using one-third of the full dose and fewer instillations every 3 months or 6 months.
International journal of urology : official journal of the Japanese Urological Association. 09/2014;
[Show abstract][Hide abstract] ABSTRACT: To assess the prognostic value of clinical and biological variables in the era of targeted therapies, especially induced toxicity in patients treated for metastatic renal cell carcinoma (RCC).
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie. 07/2014; 24(9):563-71.
[Show abstract][Hide abstract] ABSTRACT: The objective of this retrospective study was to assess the usefulness of fluorescence during cystoscopy after BCG-therapy in the management of non-invasive bladder tumors.
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie. 07/2014; 24(9):551-5.
[Show abstract][Hide abstract] ABSTRACT: To analyze to what extent partial nephrectomy (PN) is superior to radical nephrectomy (RN) in preserving renal function outcome in relation to tumor size indication.
[Show abstract][Hide abstract] ABSTRACT: In the present study, we have examined the presence of orexins and their receptors in prostate cancer (CaP) and investigated their effects on the apoptosis of prostate cancer cells.
European journal of cancer (Oxford, England: 1990) 06/2014; · 4.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
To assess the incidence and age-related histopathological characteristics of incidentally diagnosed prostate cancer (PCa) from specimens obtained via radical cystoprostatectomy (RCP) for muscle-invasive bladder cancer.Patients and MethodsA retrospective review of the histopathological features of 2,424 male patients who underwent a RCP for bladder cancer was done at eight centers between January 1996 and June 2012. No patient had preoperative suspicion of PCa. Statistical analyses were performed in different age-related groups.ResultsOverall, a PCa was diagnosed in 518 men (21.4%). Incidences varied significantly according to age (5.2% in those aged <50 years to 30.5% in those aged >75 years, p<0.001). The majority of prostate cancers were considered as “non-aggressive” that is to say organ-confined (≤pT2) and well-differentiated (Gleason score <7). TNM stage and proportion with a Gleason score of ≥7 were significantly greater in older patients (p <0.001). Apart from age, there were no preoperative predictive factors for “non-aggressive” prostate-cancer status. At the end of the follow-up, only nine patients (1.7%) had biochemical recurrence of PCa, and no preoperative predictive factors were identified.Conclusion
The rate of incidentally diagnosed PCa from RCP specimens is ∼20%, most of them being organ-confined and well-differentiated. The probability of having a “non-aggressive” PCa decreases in older men.
[Show abstract][Hide abstract] ABSTRACT: To evaluate renal function and to identify factors associated with renal dysfunction in the elective indications setting of nephron-sparing surgery (NSS).
We retrospectively reviewed operative data and glomerular filtration rate (GFR) of 519 patients treated by NSS in an elective indications setting between 1984 and 2006 in eight academic institutions. A GFR decrease under the thresholds of 60 or 45 ml/min at last follow-up was considered a significant renal dysfunction. Univariate and multivariate regression models were used to assess multiple factors of renal function.
Median age, tumor size, preoperative, and final GFR were 59.5 years (27-84), 2.7 cm (0.9-11), 79 (45-137), and 69 ml/min (p < 0.0001), respectively, with a median follow-up of 23 months (1-416). Hilar clamping was performed in 375 procedures (72.3 %). Significant GFR decrease was observed in 89 patients (17.1 %). Median operating time, hilar clamping duration, and blood loss were 137 min (55-350), 22 min (0-90), and 150 ml (0-4150), respectively. At univariate analysis, age (p = 0.002), preoperative GFR (p = 0.001), pedicular clamping (p = 0.01), and ischemia time (p = 0.0001) were associated with renal dysfunction. Age (p = 0.004; HR 1.2), pedicular clamping (p = 0.04; HR 1.3), and ischemia time (p = 0.0001; HR 1.8) remained independent risk factors for renal function deterioration in multivariate analysis.
Non- or time-limited clamping techniques are associated with preservation of renal function in the elective indications setting of NSS.
World Journal of Urology 04/2014; · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Brachytherapy is a possible treatment for localized low risk prostate cancer. Although this option is minimally invasive, some side effects may occur. Acute retention of urine (ARU) has been observed in 5% to 22% of cases and can be prevented in most cases by alpha-blocker treatment. Several alternatives have been reported in the literature for the management of ARU following brachytherapy: prolonged suprapubic catheterization, transurethral resection of the prostate and also intermittent self-catheterization. The authors report an original endoscopic approach, using urethral endoprosthesis, with a satisfactory voiding status.
Progrès en Urologie 03/2014; 24(3):164-6. · 0.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
To assess the prognostic value of clinical and biological variables in the era of targeted therapies, especially induced toxicity in patients treated for metastatic renal cell carcinoma (RCC).
Patients and methods
A retrospective single-center study was performed in patients treated in our center from 2006 to 2012. The clinical and biological variables and toxicity data were retrospectively collected. Survival rates were calculated using the Kaplan-Meier method and compared by the Log-Rank test. Multivariate analysis was also performed using the Cox model.
One hundred and two patients were included, with a median follow-up of 20 months. The median overall survival (OS) was 21 months, and 6 months for the progression free survival (PFS). As expected, the variables included in the Mozter prognostic score had a significant impact on OS (P < 0.0001) and PFS (P < 0.0001). However, hypoalbuminemia (P < 0.0001), brain metastasis (P = 0.003) and the absence of nephrectomy (P < 0.0001) were found as poor prognosis factors for OS. In addition, severe toxicity (grade 3-4) was significantly associated with higher OS (P < 0.0001) and PFS (P = 0.0003) and appeared as an independent factor in multivariate analysis for OS (P = 0.02) and PFS (P = 0.01).
Severe toxicity induced by targeted therapies was found as a prognostic factor increasing significantly the survival. Further studies are needed to assess the real value of this factor in the development of sequential therapies for the treatment of RCC.
[Show abstract][Hide abstract] ABSTRACT: Introduction
The objective of this retrospective study was to assess the usefulness of fluorescence during cystoscopy after BCG-therapy in the management of non-invasive bladder tumors.
Patients and methods
Fifty-four patients were enrolled: Ta (15 cases), T1 (27 cases) carcinoma in situ (CIS) alone (12 cases) or associated (14 cases). Urine cytology was of high grade and a second look was systematically performed in case of lamina propria infiltration. Initial therapy with 6 intravesical BCG instillations (81 mg) was performed with histologic and endoscopic bladder evaluation 3 months after initial resection using hexylaminolevulinate fluorescence (Hexvix® 85 mg).
Urine cytology was negative in 27 cases, suspicious in 12 cases and positive in 15 cases. With standard endoscopy under white light, mucosal bladder was normal in 32 cases, the use of fluorescence detected 8 tumour lesions confirmed with histology (CIS). When mucosal bladder was suspect under white light (22 patients), fluorescence was positive in 16 cases with 10 matching histological analysis (CIS and/or residual tumoral lesion). Therefore, despite high false positive rate with persistent mucosal bladder inflammation (38%), fluorescence guided endoscopy has allowed the diagnosis of suspect lesions not detected with white light with negative urine cytology.
Hexvix® fluorescence after intravesical BCG instillations may improve persistent carcinoma in situ detection when performed 3 months after induction treatment. However, a multicenter prospective study will be necessary in future to confirm these preliminary results.
Level of evidence
[Show abstract][Hide abstract] ABSTRACT: Aim
In the present study, we have examined the presence of orexins and their receptors in prostate cancer (CaP) and investigated their effects on the apoptosis of prostate cancer cells.
We have localised the orexin type 1 and 2 receptors (OX1R and OX2R) and orexin A (OxA) in CaP sections of various grades and we have quantified tumour cells containing OX1R. Expression of OX1R was evaluated in the androgeno-dependent (AD) LNCaP and the androgeno-independent (AI) DU145 prostate cancer cells submitted or not to a neuroendocrine differentiation. The effects of orexins on the apoptosis and viability of DU145 cells were also investigated.
OX1R is strongly expressed in carcinomatous foci exhibiting a neuroendocrine differentiation, and the number of OX1R-stained cancer cells increases with the grade of the CaP. In contrast, OX2R is only detected in scattered malignant cells in high grade CaP. OX1R is expressed in the AI DU145 cells but is undetectable in the LNCaP cells. Acquisition of a neuroendocrine phenotype by the DU145 cells is associated with an overexpression of OX1R. Orexins induce the apoptosis of DU145 cells submitted to a neuroendocrine differentiation.
The present data indicate that OX1R-driven apoptosis is overexpressed in AI CaP exhibiting a neuroendocrine differentiation opening a gate for novel therapies for these aggressive cancers which are incurable until now.
[Show abstract][Hide abstract] ABSTRACT: Objectives
To analyze to what extent partial nephrectomy (PN) is superior to radical nephrectomy (RN) in preserving renal function outcome in relation to tumor size indication.
Methods and materials
Clinical data from 973 patients operated at 9 academic institutions were retrospectively analyzed. Glomerular filtration rate (GFR) before and after surgery was calculated with the abbreviated Modification of the Diet in Renal Disease equation. For a fair comparison between the 2 techniques, all imperative indications for PN were excluded. A shift to a less favorable GFR group following surgery was considered clinically significant.
Median age at diagnosis was 60 years (19–91). Tumor size was smaller than 4 cm in 665 (68.3%) cases and larger than 4 cm in 308 (31.7%) cases. PN and RN were performed in 663 (68.1%) and 310 (31.9%) patients, respectively. In univariate analysis, patients undergoing PN had a smaller risk for developing significant GFR change following surgery than those undergoing RN did. This was true for tumors≤4 cm (P = 0.0001) and for tumors>4 cm (P = 0.0001). In multivariate analysis, the following criteria were independent predictive factors for developing significant postoperative GFR loss: the use of RN (P = 0.0001), preoperative GFR<60 ml/min (P = 0.0001), tumor size≥4 cm (P = 0.0001), and older age at diagnosis (P = 0.0001).
The renal function benefit carried out by elective PN over RN persists even when expanding nephron-sparing surgery indications beyond the traditional 4-cm cutoff.
Urologic Oncology: Seminars and Original Investigations. 01/2014;
[Show abstract][Hide abstract] ABSTRACT: Objective: The aim of our study was to assess short and mid-term clinical efficacy of external beam radiation therapy to achieve hemostasis in patients with bladder-cancer related gross hematuria who were unfit for surgery. We also assessed hypofractionation as a possible alternative option for more severe patients. Patients and Methods: Thirty-two patients were included for hemostatic radiation therapy, with two schedules based on Eastern Cooperative Oncology Group performance status. The standard treatment was 30 Gy in 10 fractions over 2 weeks. More severe patients underwent a hypofractionated regimen, with 20 Gy in 5 fractions over a one week period. Clinical evaluation was performed at 2 weeks and 6 months. Results: At 2 weeks, 69% of patients were hematuria-free. Subgroup analysis showed that 79% of patients undergoing hypofractionated regimen were hematuria-free. A total of 54% were hematuria-free with the standard regimen. Based on tumor stage, hematuria was controlled at 2 weeks for 57% of non-muscle invasive tumors and 72% of muscle-invasive tumors. After 6 months, 69% of patients had relapsed, regardless of tumor stage or therapy schedules. Conclusions: Hemostatic radiotherapy is an effective option for palliative-care hematuria related to bladder cancer in patients unfit for surgery. Although it appears to be rapidly effective, its effect is of limited duration. Hypofractionation also seems to be an effective option; however larger cohorts and prospective trials are needed to evaluate its efficacy compared to standard schedules.
International braz j urol: official journal of the Brazilian Society of Urology 12/2013; 39(6):808-16.
[Show abstract][Hide abstract] ABSTRACT: To assess oncologic outcomes after salvage radiotherapy (SRT) without androgen deprivation therapy (ADT) in patients with persistently detectable PSA after radical prostatectomy (RT).
Two hundred and one patients who failed to achieve an undetectable PSA received SRT without ADT. The primary endpoint was failure to SRT that was defined by clinical progression or use of second-line ADT. Clinicopathological parameters, 6-week PSA level, PSAV and pre-SRT PSA levels were assessed using time-dependent analyses.
Median postoperative 6-week PSA and pre-SRT PSA levels were 0.25 and 0.48 ng/mL, respectively. Median time between surgery and SRT was 7 months. Failure to SRT was reported in 42.8 % of cases with the need for second-line ADT in 26.9 % of cases. Pre-SRT PSA was strongly correlated with postoperative 6-week PSA (p < 0.001) but not with PSAV. The risk of SRT failure was increased by threefold in case of Gleason score 8-10 (p = 0.036) or pT3b cancer (p = 0.006). Risk group classification based on these prognostic factors improved SRT failure prediction. Survival curves confirmed that 5-year ADT-free survival rates were significantly influenced by PSAV (p = 0.002) and pre-SRT PSA (p = 0.030).
In patients with persistently detectable PSA after RP and selected for local salvage treatment, SRT offers good oncologic clinical outcomes. The most powerful pathologic predictive factors of SRT failure include a pT3b stage, a Gleason score 8 or more cancer and high PSAV and pre-SRT PSA levels. Patients having a high PSAV >0.04 ng/mL/mo would be potentially better candidates for a systemic therapy due to a high SRT failure rate.
World Journal of Urology 11/2013; · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the impact of hospital volume on partial nephrectomy indications and outcomes.
Data were extracted from the National Observational Registry on the Practice and Hemostasis in Partial Nephrectomy registry. Four groups were created according to the number of partial nephrectomy (PN) performed: very high (VH, ≥19 PN), high (H, 10-18 PN), moderate (M, 4-9 PN) and low (L, <4 PN) PN activity. Indications and surgical outcomes were compared among all groups. The effect of hospital volume on postoperative complications and positive margin rate was examined by a multivariable analysis.
Fifty-three centers included a total of 570 PN. There were 9 VH, 13 H, 12 M and 19 L volume centers which performed 270 (47.4 %), 179 (31.4 %), 74 (13 %) and 47 (8.2 %) PN, respectively. Patients in higher volume centers were significantly younger (p = 0.008), had a lower BMI (p = 0.002) and decreased ASA score (p < 0.001). PN was more frequently performed in higher volume centers (p = 0.006) particularly in case of renal masses <4 cm (p = 0.005). Open surgery was the most common approach in all groups, but laparoscopic PN was more frequent in M volume hospitals (p < 0.001). Positive margin (p = 0.06) and complications (p = 0.022) rates were higher in M group. In multivariable analysis, renal chronic disease was an independent predictor of positive margin rate (p < 0.001, OR 3.91).
PN is more frequently performed in high volume institutions particularly for small renal masses. We observed increase positive margin and complication rates in moderate volume centers that might be explained by an increased use of laparoscopy.
World Journal of Urology 11/2013; · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective was to update the guidelines of the French Urological Association Cancer Committee for upper tract urothelial carcinoma (UTUC).
A Medline search was performed between 2010 and 2013, as regards diagnosis, options of treatment and follow-up of UTUC, to evaluate different references with levels of evidence.
The diagnosis of this rare pathology is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Total nephro-urectomy remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed : unifocal tumour and diameter < 1cm and low grade and absence of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscope) in compliant patients is therefore necessary.
These new guidelines will hopefully contribute not only to improve patient management, but also diagnosis and treatment for UTUC.
[Show abstract][Hide abstract] ABSTRACT: The objective was to update the guidelines of the French Urological Association Cancer Committee for non invasive (NMIBC) and invasive bladder cancer (MIBC).
A Medline search was performed between 2010 and 2013, as regards diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence.
Diagnosis of NMIBC (Ta, T1, CIS) depends on cystoscopy and complete deep resection of the tumour. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on pelvic-abdominal and thoracic CT-scan, MRI and FDGPET remain optional. Cystectomy associated with extensive lymph nodes resection is considered the gold standard for non metastatic MIBC. An orthotopic bladder substitution should be proposed to both male and female patients lacking any contraindications and in cases of negative frozen urethral samples, otherwise trans-ileal ureterostomy is recommended as urinary diversion. The interest of neoadjuvant chemotherapy is well known for advanced MIBC as T3-T4 and/or N1-3. As regards metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when status (PS<1) and renal function (creatinine clearance > 60ml/min) permits (only in 50 % of cases). In second line treatment, only chemotherapy using vinfluvine has been validated to date. Conclusion.-These new guidelines will hopefully contribute not only to improve patient management, but also diagnosis and treatment for NMIBC and MIBC.