Hwang Gyun Jeon

Samsung Medical Center, Sŏul, Seoul, South Korea

Are you Hwang Gyun Jeon?

Claim your profile

Publications (98)258.43 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To examine radiological growth patterns as an indicator of renal tumor aggressiveness, we studied about the growth kinetics of small renal mass(SRM, ≤4cm) and possible associated factors for high Fuhrman nuclear grade (≥3). Methods: From January 1999 to May 2013, 112 cases (111 patients) diagnosed as renal cell carcinoma after surgical treatment were reviewed retrospectively. Patients who had at least two preoperative contrast-enhanced computed tomography scans more than 6 months apart were included. Results: The mean age was 59 years and mean CT follow up duration was 20 months. Median tumor size and tumor volume at diagnosis were 1.45 cm, 1.80cm(3), respectively. Median linear growth rate (LGR) was 0.28 cm/year. Median volumetric growth rate (VGR) was 0.75cm(3)/year and median volume doubling time (VDT) was 1.41 years. Tumor growth rate was not different to histologic type (p=0.271). High LGR was a significant factor associated with high Fuhrman grade in multivariate analysis (OR 3.877, 95% CI 1.715-8.765).VGR (p<0.001) and VDT (p=0.004) were positive correlation with initial mass size, but not LGR (p=0.764). Conclusion: In our growth kinetics study, generally SRM grew slowly. High LGR could be a risk factor for high grade tumor (Fuhrman grade ≥3).
    No preview · Article · Jan 2016 · Urology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aims: TMPRSS2/E26 transformation-specific (ETS) family gene fusion in prostate carcinoma (PCa) can be detected by several methods including immunohistochemistry (IHC) for ETS-related gene (ERG), the diagnostic utility of which has not been clearly defined. Methods: We explored TMPRSS2-ERG gene rearrangement status in 132 patients with PCa with four detection methods including fluorescence in situ hybridisation for TMPRSS2-ERG fusion, real-time reverse transcription PCR (RT-qPCR) for ERG and TMPRSS-ERG fusion transcript mRNA and IHC for ERG. Results: Concordant results were found in 126 cases for the four detection methods and the remaining six cases showed discrepancy in one method: two cases in IHC, three cases in RT-qPCR for ERG and one case in RT-qPCR for fusion transcript. In discordant cases, the majority results were determined as final fusion status. Analysis of discrepancy cases for ERG IHC showed that weak immunoreactivity for ERG should be regarded as equivocal and that even strong immunoreactivity can be false positive. The overall incidence of TMPRSS-ERG gene fusion was 24%. Conclusions: ERG IHC is a useful surrogate test for the detection of TMPRSS2-ERG gene fusion, but it needs to be interpreted with caution and definite judgement should not be based on IHC alone. A relatively low incidence of TMPRSS2-ERG gene fusion was demonstrated in this Korean cohort.
    No preview · Article · Dec 2015 · Journal of clinical pathology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To investigate the differences in the cancer detection rate and pathological findings on a second prostate biopsy according to benign diagnosis, high-grade prostatic intraepithelial neoplasia (HGPIN), and atypical small acinar proliferation (ASAP) on first biopsy. Materials and Methods: We retrospectively reviewed the records of 1,323 patients who underwent a second prostate biopsy between March 1995 and November 2012. We divided the patients into three groups according to the pathologic findings on the first biopsy (benign diagnosis, HGPIN, and ASAP). We compared the cancer detection rate and Gleason scores on second biopsy and the unfavorable disease rate after radical prostatectomy among the three groups. Results: A total of 214 patients (16.2%) were diagnosed with prostate cancer on a second biopsy. The rate of cancer detection was 14.6% in the benign diagnosis group, 22.1% in the HGPIN group, and 32.1% in the ASAP group, respectively (p<0.001). When patients were divided into subgroups according to the number of positive cores, the rate of cancer detection was 16.7%, 30.5%, 31.0%, and 36.4% in patients with a single core of HGPIN, more than one core of HGPIN, a single core of ASAP, and more than one core of ASAP, respectively. There were no significant differences in Gleason scores on second biopsy (p=0.324) or in the unfavorable disease rate after radical prostatectomy among the three groups (benign diagnosis vs. HGPIN, p=0.857, and benign diagnosis vs. ASAP, p=0.957, respectively). Conclusions: Patients with multiple cores of HGPIN or any core number of ASAP on a first biopsy had a significantly higher cancer detection rate on a second biopsy. Repeat biopsy should be considered and not be delayed in those patients.
    Full-text · Article · Dec 2015 · Korean journal of urology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective To analyze trends in the use of partial nephrectomy, we evaluated which individual factors of renal nephrometry score (RNS) influenced the operative approach bi-annually from 2008 to 2014. Materials and Methods We performed a retrospective review of renal cell carcinoma treated by surgery in 2008, 2010, 2012, and 2014. The complexity of renal masses was measured using the R.E.N.A.L. nephrometry scoring system with CT or MRI. Group comparison in terms of operation year and surgical type (partial nephrectomy versus radical nephrectomy) was performed. We developed a nomogram to quantitate the likelihood of selecting partial nephrectomy over radical nephrectomy. Results A total of 1106 cases (237 in 2008, 225 in 2010, 292 in 2012, and 352 in 2014) were available for the study. Over the study period, the proportion of partial nephrectomies performed increased steadily from 21.5% in 2008 to 66.5% in 2014 (p < 0.05). Furthermore, use of partial nephrectomy increased steadily in all RNS complexity groups (low, moderate, and high) (p < 0.05). In the analysis of individual components of RNS, values of the R and N components increased statistically by year in the partial nephrectomy group (p < 0.05). Average AUC was 0.920. Conclusions The proportion of partial nephrectomies performed sharply increased over the study period. Additionally, over the study period, more partial nephrectomies were performed for renal masses of larger size and closer to the collecting system and main renal vessels. A nomogram developed based on this recent data set provides significant predictive value for surgical decision making.
    Full-text · Article · Nov 2015 · PLoS ONE
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Diagnostic ureterorenoscopy is powerful tool to confirm upper tract urothelial cancer (UTUC). However, URS and associated manipulation may be related to the risk of intravesical recurrence (IVR) following radical nephroureterectomy (RNU). We aimed to investigate whether preoperative ureterorenoscopy would increase IVR after RNU in patients with UTUC. We performed a retrospective analysis of 630 patients who had RNU with bladder cuff excision due to UTUC. Diagnostic URS was performed in 282 patients (44.7%). Patients were divided into two groups according to the URS. Survival analysis and multivariate Cox regression model were performed to address risk factors for the IVR. The interval from URS to RNU was measured. During URS, manipulation such as biopsy and resection was determined. The median age was 64 (IQR 56-72) years with follow-up duration of 34.3 (15.7-64.9) months. Median time from URS to RNU was 16 (0-38) days. The IVR developed in 42.5% (n = 268) patients at 8.2 (4.9-14.7) months. The five-year IVR-free survival rate was 42.6 ± 8.0% and 63.6 ± 6.9% in patients with and without preoperative URS, respectively (P < 0.001). In multivariate analysis, previous history of bladder tumour, extravesical excision of distal ureter, multifocal tumour, and URS (HR, 95% CI; 1.558, 1.204-2.016, P = 0.001) were independent predictors for higher IVR. The IVR rate in patients without manipulation during URS was not different to those with manipulation (P = 0.658). The duration from URS to RNU was not associated with IVR (P = 0.799). Diagnostic URS for UTUC increased IVR rate after RNU. However, the lessening of interval from URS to radical surgery or URS without any manipulation could not reduce the IVR rate.
    Preview · Article · Nov 2015 · PLoS ONE
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose Current clinical data support a safe warm ischemia time (WIT) limit of 30 minutes during laparoscopic partial nephrectomy (LPN) or robot-assisted partial nephrectomy (RPN). We evaluated independent factors predicting prolonged WIT (more than 30 minutes) after LPN or RPN. Materials and Methods A retrospective data review was performed for 317 consecutive patients who underwent LPN or RPN performed by the same surgeon from October 2007 to May 2013. Patients were divided into two groups: group A was defined as prolonged WIT (≥30 minutes) and group B as short WIT (<30 minutes). We compared clinical factors between the two groups to evaluate predictors of prolonged WIT. Results Among 317 consecutive patients, 80 were in the prolonged WIT group. Baseline characteristics were not significantly different between the groups. In the univariable analysis, PADUA (preoperative aspects and dimensions used for an anatomical) score (p=0.001), approach method (transperitoneal or retroperitoneal approach; p<0.001), and surgeon experience (p<0.001) were significantly associated with prolonged WIT. In the multivariable analysis, PADUA score (p=0.032), tumor size (≥25 mm; odds ratio, 2.98; 95% confidence interval, 1.48-5.96; p=0.002), and surgeon experience (p<0.001) were independent predictors of prolonged WIT. Conclusions Surgeon experience, tumor size, and PADUA score predicted prolonged WIT after RPN or LPN. Among these factors, increasing surgical experience with LPN or RPN is the most important factor for preventing prolonged WIT.
    Full-text · Article · Nov 2015 · Korean journal of urology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To evaluate the oncological outcome and to assess prognostic factors of salvage radiotherapy alone in patients with biochemical recurrence after radical prostatectomy. Methods: We reviewed our single institution, prospectively maintained database of 2043 patients who underwent radical prostatectomy between September 1995 and December 2011. In this cohort, 149 patients who developed biochemical recurrence after radical prostatectomy and received salvage radiotherapy alone after pelvic magnetic resonance imaging were included. Three-dimensional conformal radiotherapy or intensity-modulated radiotherapy was delivered with a median dose of 70.0 Gy (66.0-78.0 Gy) or 67.2 Gy (64.8-70.0 Gy). Kaplan-Meier and Cox regression analyses were carried out. Results: With a median follow up of 82 months (range 20-153 months), 55 patients (36.9%) failed salvage radiotherapy. The 5-year salvage radiotherapy failure-free probability was 53.6%. On multivariate analysis, pre-salvage radiotherapy prostate-specific- antigen ≥1.0 ng/mL (P = 0.003, hazard ratio 3.592, 95% confidence interval 1.522-8.579), pathological stage ≥T3a (P = 0.004, hazard ratio 2.261, 95% confidence interval 1.290-3.833), pathological Gleason score ≥7 (P = 0.018, hazard ratio 5.501, 95% confidence interval 1.577-21.221), prostate-specific antigen doubling time <12 months (P = 0.014, hazard ratio 2.243, 95% confidence interval 1.177-4.275) and no visible lesion on pelvic magnetic resonance imaging (P = 0.016, hazard ratio 2.068, 95% confidence interval 1.268-3.501) were independent prognostic factors of salvage radiotherapy failure after radical prostatectomy. Conclusions: Pre-salvage radiotherapy prostate-specific antigen ≥1.0 ng/mL, pathological stage ≥T3a, pathological Gleason score ≥7, prostate-specific antigen doubling time <12 months and no visible lesion on pelvic magnetic resonance imaging are prognostic factors of salvage radiotherapy failure after radical prostatectomy. We should consider additional treatment in patients with these factors for favorable outcomes.
    No preview · Article · Oct 2015 · International Journal of Urology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to investigate a single-institution experience with radical perineal prostatectomy (RPP), radical retropubic prostatectomy (RRP) and minimally invasive radical prostatectomy (MIRP) with respect to onco-surgical outcomes in patients with intermediate-risk (IR; PSA 10-20 ng/mL, biopsy Gleason score bGS 7 or cT2b-2c) and high-risk (HR; PSA >20 ng/mL, bGS ≥8, or ≥cT3) prostate cancer (PCa). We retrospectively reviewed data from 2,581 men who underwent radical prostatectomy for IR and HR PCa (RPP, n = 689; RRP, n = 402; MIRP, n = 1,490 [laparoscopic, n = 206; robot-assisted laparoscopic, n = 1,284]). The proportion of HR PCa was 40.3%, 46.8%, and 49.5% in RPP, RRP, and MIRP (P < 0.001), respectively. The positive surgical margin rate was 23.8%, 26.1%, and 18.7% (P = 0.002) overall, 17.5%, 17.8%, and 8.8% (P < 0.001) for pT2 disease and 41.9%, 44.4%, and 40.0% (P = 0.55) for pT3 disease in men undergoing RPP, RRP, and MIRP, respectively. Biochemical recurrence-free survival rates among RPP, RRP, and MIRP were 73.0%, 70.1%, and 76.8%, respectively, at 5 yr (RPP vs. RPP, P = 0.02; RPP vs. MIRP, P = 0.23). Furthermore, comparable 5-yr metastases-free survival rates were demonstrated for specific surgical approaches (RPP vs. RPP, P = 0.26; RPP vs. MIRP, P = 0.06). RPP achieved acceptable oncological control for IR and HR PCa.
    Preview · Article · Oct 2015 · Journal of Korean Medical Science
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To report the diagnostic accuracy of renal mass biopsy (RMB) for a small (≤4 cm) renal mass (SRM) and to identify the predictors of a successful RMB in a contemporary cohort of patients from two large tertiary referral centers. Materials and methods: A total of 442 biopsies of renal tumors ≤4 cm in two tertiary centers between 2008 and 2015 were included. Biopsy outcomes (malignant, benign, or non-diagnostic) and concordance rates between RMB and final surgical pathology were presented. Univariate and multivariate logistic regression analyses were performed to identify factors indicative of a non-diagnostic biopsy. Results: The initial biopsy was diagnostic in 393 cases (88.9%) and non-diagnostic in 49 cases (11.1%). Of the diagnostic biopsies, 76% were renal cell carcinomas (RCCs), and 24% were benign. Histological subtyping and grading in RCC was possible in 90.2% and 31.3% of cases, respectively. A second biopsy was performed in 11 of the 49 non-diagnostic cases, and a diagnosis was possible for 100% (10 RCCs and one oncocytoma). Small tumor size, cystic nature of tumors and a biopsy during the initial years of the study were independent predictors of a non-diagnostic biopsy. Accuracy in identifying malignancies, histotyping, and grading between the RMB and surgical pathology were 97.1%, 95.1%, and 68.8% (2-tier), respectively. Conclusions: An RMB for an SRM can be performed accurately. A non-diagnostic RMB is common in smaller masses, cystic masses and during the initial years of the study. A second biopsy should be considered in non-diagnostic biopsy cases.
    No preview · Article · Sep 2015 · The Journal of urology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to evaluate the diagnostic and prognostic value of clinical-positive nodes at preoperative imaging (cN1) in patients with non-metastatic renal cell carcinoma (RCC) treated with lymph node dissection (LND). We retrospectively reviewed data for a cohort of 440 consecutive patients (cN0, 76.8%; cN1, 23.2%) with cTanyNanyM0 RCC who underwent nephrectomy and LND from 1994 to 2013. Metastasis-free survival (MFS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Multivariate Cox regression analysis was performed to determine significant predictors of MFS and CSS. The mean number of lymph nodes (LNs) examined for all patients was 8.3, and pN1 disease was identified in 31 (7.0%). LN staging by preoperative imaging had a sensitivity of 65%, a specificity of 80%, and an accuracy of 77%. During a median follow-up of 69 months, 5-yr MFS and CSS were 83.6% and 91.3% in patients with cN0 and 49.2% and 70.1% in patients with cN1, demonstrating a trend toward worse prognosis with radiologic lymphadenopathy (all P < 0.001). Furthermore, differences in MFS and CSS between the cN0pN0 and cN1pN0 groups were significant (all P < 0.001). Clinical nodal involvement is an important determinant of adverse prognosis in patients with non-metastatic RCC who undergo LND. Graphical Abstract
    Full-text · Article · Sep 2015 · Journal of Korean medical science
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We investigated trends in perioperative chemotherapy use, and determined factors associated with neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) use in Korean patients with muscle-invasive bladder cancer (MIBC). We recruited 1,324 patients who had MIBC without nodal invasion or metastases and had undergone radical cystectomies (RC) between 2003 and 2013. The study's cut-off time for AC was three months after surgery, and the study's timespan was divided into three periods based on NAC use, namely, 2003-2005, 2006-2009, and 2010-2013. Complete remission was defined as histologically confirmed T0N0M0 after RC. NAC and AC were administered to 7.3% and 18.1% of the patients, respectively. The median time interval between completing NAC and undergoing RC was 32 days and the mean number of cycles was 3.2. The median time interval between RC and AC was 43 days and the mean number of cycles was 4.1. Gemcitabine and cisplatin were most frequently used in combination for NAC (49.0%) and AC (74.9%). NAC use increased significantly from 4.6% between 2003 and 2005 to 8.4% between 2010 and 2013 (P < 0.05), but AC use did not increase. Only 1.9% of patients received NAC and AC. Complete remission after NAC was achieved in 12 patients (12.5%). Multivariable modeling revealed that an advanced age, the earliest time period analyzed, and clinical tumor stage ≤ cT2 bladder cancer were negatively associated with NAC use (P < 0.05). While NAC use has slowly increased over time, it remains an underutilized therapeutic approach in Korean clinical practice.
    Full-text · Article · Aug 2015 · Journal of Korean medical science
  • [Show abstract] [Hide abstract]
    ABSTRACT: Preoperative assessment of patients' immunologic and nutritional conditions is required to predict the outcome of patients with malignant tumors. The aim of the current study was to clarify the significance of the prognostic nutritional index (PNI), which simply accounts for immunological and nutritional conditions, in patients with renal cell carcinoma (RCC). We included 1437 patients who underwent nephrectomy for RCC between 1994 and 2008. PNI was calculated using the following formula: 10 × serum albumin concentration (g/dL) + 0.005 × lymphocyte counts (number/mm(2)) in peripheral blood. We examined the correlation of the preoperative PNI value with clinicopathological features. A Cox regression model and the Harrell concordance index with variables only or combined PNI data were used to evaluate the prognostic significance in the T1-4NallMall and T1-4N0M0 groups. The mean preoperative PNI value was 52.7 ± 6.3 (range 27.7-85.3). The mean PNI values were significantly lower in patients with more advanced tumor T stage, regional lymph node metastasis, distant metastases, higher Fuhrman grade, and sarcomatoid differentiation than in patients without such factors (p < 0.001). Patients with low PNI (<51) had poor survival rates compared to those with high PNI in univariate analysis (>51, p < 0.001). Multivariate analysis showed that low PNI was significantly associated with cancer-specific survival (p = 0.026 and p = 0.009) and overall survival (p = 0.013 and p = 0.011) in the T1-4NallMall and T1-4N0M0 groups, respectively, after correcting for other clinicopathological factors. PNI is an independent prognostic factor for predicting survival after nephrectomy in patients with RCC.
    No preview · Article · Jun 2015 · Annals of Surgical Oncology
  • Source
    Wan Song · Hwang Gyun Jeon
    [Show abstract] [Hide abstract]
    ABSTRACT: The incidence of cancer is sharply increasing. Cancer is a leading cause of death as well as a significant burden on society. The incidence of urological cancer has shown a higher than average increase and will become an important concern in the future. Therefore, an overall and accurate understanding of the incidence of urological cancer is essential. In this study, which was based on the Korea National Cancer Incidence Database, annual incident cases, age-standardized incidence rates, annual percentage change (APC), and distribution by age group were examined in kidney, bladder, and prostate cancers, respectively. From 1999 to 2011, the total number of each type of urological cancer was as follows: kidney cancer (32,600 cases, 25.5%), bladder cancer (37,950 cases, 29.7%), and prostate cancer (57,332 cases, 44.8%). The age-standardized incidence rates of prostate cancer showed a significant increase with an APC of 12.3% in males. Kidney cancer gradually increased with an APC of 6.0% for both sexes and became the second most frequent urological cancer after 2008. Bladder cancer showed no significant change with an APC of -0.2% for both sexes and has decreased slightly since 2007. The distribution of kidney cancer according to age showed two peaks in the 50- to 54-year-old and 65- to 69-year-old age groups. Bladder and prostate cancers occurred mostly in the 70- to 74-year-old age group. The proportions of male to female were 2.5:1 in kidney cancer and 5.6:1 in bladder cancer. We have summarized the incidence trends of kidney, bladder, and prostate cancers and have provided useful information for screening and management of these cancers in the future.
    Preview · Article · Jun 2015 · Korean journal of urology
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the impact of three-dimensional tumor volume on cancer-specific survival for patients with pT1 clear-cell renal cell carcinoma (ccRCC). We reviewed a prospectively maintained database of 917 patients who underwent radical nephrectomy or nephron-sparing surgery for unilateral, pT1 ccRCC, including 654 pT1a and 263 pT1b patients, between April 1997 and December 2010. Three-dimensional tumor volume was measured using specialized volumetric software on cross-sectional computed tomography images of a preoperative venous phase. Kaplan-Meier and Cox regression analyses were carried out. The median age was 54 years with a follow-up of 60.8 months. Median tumor size and volume were 3.2 cm and 17.4 cm(3), respectively. Of 917 patients, 54 (5.9 %) had died, including 32 patients with ccRCC (9 patients in pT1a and 23 patients in pT1b). On multivariate analysis, tumor size >3.2 cm and tumor volume >17.4 cm(3) were associated with cancer-specific death in pT1 ccRCC patients. When stratified by pT1a/pT1b status and analyzed on median splits, tumor size >2.5 cm was associated with cancer-specific death but not tumor volume >9.5 cm(3) in pT1a patients. However, in pT1b patients, tumor volume >62.1 cm(3) (P = 0.036, HR 2.91, 95 % CI 1.02-7.77) was highly associated with cancer-specific death but not tumor size >5.0 cm (P = 0.159, HR 1.91, 95 % CI 0.78-4.70). In addition to tumor size, tumor volume is associated with cancer-specific death in pT1 ccRCC patients, particularly in pT1b ccRCC but not in pT1a ccRCC.
    No preview · Article · May 2015 · World Journal of Urology
  • [Show abstract] [Hide abstract]
    ABSTRACT: We aimed to evaluate the performance of various GFR estimates compared with direct measurement of GFR (dGFR). We also sought to create a new formula for volume-based GFR (new-vGFR) using kidney volume determined by CT. GFR was measured using creatinine-based methods (MDRD, the Cockcroft-Gault equation, CKD-EPI formula, and the Mayo clinic formula) and the Herts method, which is volume-based (vGFR). We compared performance between GFR estimates and created a new vGFR model by multiple linear regression analysis. Among the creatinine-based GFR estimates, the MDRD and C-G equations were similarly associated with dGFR (correlation and concordance coefficients of 0.359 and 0.369 and 0.354 and 0.318, respectively). We developed the following new kidney volume-based GFR formula: 217.48-0.39XA + 0.25XW-0.46XH-54.01XsCr + 0.02XV-19.89 (if female) (A = age, W = weight, H = height, sCr = serum creatinine level, V = total kidney volume). The MDRD and CKD-EPI had relatively better accuracy than the other creatinine-based methods (30.7 % vs. 32.3 % within 10 % and 78.0 % vs. 73.0 % within 30 %, respectively). However, the new-vGFR formula had the most accurate results among all of the analyzed methods (37.4 % within 10 % and 84.6 % within 30 %). The new-vGFR can replace dGFR or creatinine-based GFR for assessing kidney function in donors and healthy individuals. • Accurate prediction of GFR is crucial in kidney donors. • DTPA is accurate but costly, invasive, and clinically difficult to apply. • Volume-based GFR estimation performs as well as the Cr-based method. • New volume-based GFR estimation performs better among GFR estimation formulas.
    No preview · Article · May 2015 · European Radiology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate structural hypertrophy and functional hyperfiltration as compensatory adaptations following radical nephrectomy (RN) in patients with renal cell carcinoma (RCC) according to the preoperative stage of chronic kidney disease (CKD). We retrospectively identified 543 patients who underwent RN for RCC between 1997 and 2012. Patients were classified according to preoperative GFR [No CKD:GFR≥90 mL/min/1.73m(2) (n=230, 42.4%), CKD stage II: 60≤GFR<90mL/min/1.73m(2) (n=227, 41.8%), CKD stage III: 30≤GFR<60 mL/min/1.73m(2) (n=86, 15.8%)]. CT images taken within 2 months prior to surgery and 1 year after surgery were used to assess functional renal volume (FRV) for measuring the degree of hypertrophy of the remnant kidney, and the pre- and postoperative GFR per unit volume of FRV (GFR/FRV) was used to calculate the degree of hyperfiltration. Among all patients (mean age: 56.0 years), the mean preoperative GFR, FRV, and GFR/FRV were 83.2mL/min/1.73m(2), 340.6cm(3), and 0.25ml/min/1.73m(2)/cm(3), respectively. The percent reduction in GFR was statistically significant according to CKD stage (no CKD:-31.2% vs. II:-26.5%vs. III:-12.8%; p<0.001); however, The degree of hypertrophic FRV in the remnant kidney was not statistically significant (no CKD:18.5% vs. II:17.3% vs. III:16.5%; p=0.250). The change in GFR/FRV was statistically significant (no CKD:18.5% vs. II:20.1% vs. III:45.9%; p<0.001). Factors that increased GFR/FRV above the mean value were Body mass index (p=0.012), diabetes mellitus (p=0.023), hypertension (p=0.015), and CKD stage (p<0.001). Patients with lower preoperative GFR had less of a reduction in postoperative renal function than patients with higher preoperative GFR due to greater degrees of functional hyperfiltration. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Apr 2015 · The Journal of urology
  • [Show abstract] [Hide abstract]
    ABSTRACT: We evaluated the association between tumor size and preoperative volumetric kidney parameters measured with CT in patients with renal cell carcinoma (RCC). We prospectively identified 1118 patients who underwent radical or partial nephrectomy for RCC between 2011 and 2014. Contrast-enhanced CT was performed within three months before surgery. Kidney volume was measured using a tissue segmentation tool program from CT images. We classified patients into three groups depending on tumor size (A: ≤4 cm, B: 4-7 cm, C: >7 cm). The preoperative volumetric kidney parameters were compared and multivariable linear regression was used to analyze potential factors associated with compensatory hypertrophy of the contralateral normal kidney before surgery. Patients in group C had a significantly larger contralateral normal kidney volume than patients in A and B (A: 170.0 mL, B: 171.7 mL, C: 187.2 mL, p < 0.001). The contralateral kidney volume was not significantly different between groups A and B (p > 0.05). However, tumor-side real kidney volume in group C was significantly smaller than that of groups A and B (A: 168.8 mL, B: 164.9 mL, C: 150.9 mL, p < 0.001). On multivariable analysis, increased contralateral kidney volume was positively associated with male gender, higher BMI, DM, higher preoperative GFR, and tumor size (>7 cm), and negatively associated with older age (p < 0.05). Tumor size had the strongest positive association with contralateral kidney volume (>7 cm, partial regression coefficient = 30.2). Tumor size (>7 cm) is the strongest factor associated with compensatory hypertrophy in the contralateral normal kidney before surgery.
    No preview · Article · Apr 2015 · World Journal of Urology
  • Source

    Full-text · Article · Apr 2015 · The Journal of Urology

  • No preview · Article · Apr 2015 · European Urology Supplements
  • Source

    Full-text · Article · Apr 2015 · The Journal of Urology

Publication Stats

745 Citations
258.43 Total Impact Points

Institutions

  • 2013-2016
    • Samsung Medical Center
      • Department of Urology
      Sŏul, Seoul, South Korea
  • 2012-2015
    • Sungkyunkwan University
      • Department of Urology
      Sŏul, Seoul, South Korea
  • 2010-2012
    • CHA University
      Sŏul, Seoul, South Korea
    • Yonsei University
      Sŏul, Seoul, South Korea
    • Yonsei University Hospital
      • Department of Internal Medicine
      Sŏul, Seoul, South Korea
  • 2004-2009
    • Seoul National University Hospital
      • Department of Urology
      Sŏul, Seoul, South Korea
  • 2005-2006
    • Seoul National University
      • Department of Urology
      Sŏul, Seoul, South Korea