A preoperative prognostic model predicting recurrence-free survival for patients with kidney cancer.

OBJECTIVE: To develop a preoperative prognostic model in order to predict recurrence-free survival in patients with nonmetastatic kidney cancer. METHODS: A multi-institutional data base of 1889 patients who underwent surgical resection between 1987 and 2007 for kidney cancer was retrospectively analyzed. Preoperative variables were defined as age, gender, presentation, size, presence of radiological lymph nodes and clinical stage. Univariate and multivariate analyses of the variables were performed using the Cox proportional hazards regression model. A model was developed with preoperative variables as predictors of recurrence after nephrectomy. Internal validation was performed by Harrell's concordance index. RESULTS: The median follow-up was 23.6 months (1-222 months). During the follow-up, 258 patients (13.7%) developed cancer recurrence. The median follow-up for patients who did not develop recurrence was 25 months. The median time from surgery to recurrence was 13 months. The 5-year freedom from recurrence probability was 78.6%. All variables except age were associated with freedom from recurrence in multivariate analyses (P < 0.05). Age was marginally significant in the univariate analysis. All variables were included in the predictive model. The calculated c-index was 0.747. CONCLUSIONS: This preoperative model utilizes easy to obtain clinical variables and predicts the likelihood of development of recurrent disease in patients with kidney tumors.

Does cisplatin-based chemotherapy effect on blood lipid levels of patients with germ cell testicular tumor in long-term follow-up?

PURPOSE: Cisplatin-based chemotherapy is widely used in the treatment for germ cell testicular tumors. However, long-term complications of this treatment have gained importance, and hypercholesterolemia is one of these. In some studies, hypercholesterolemia is reported following the cisplatin-based chemotherapy. In this study, we evaluated the relationship of cisplatin-based chemotherapy and blood lipid levels in long-term survivors of patients with germ cell testicular tumors. PATIENTS AND METHODS: A total of 89 testicular cancer patients were evaluated between December 1989 and December 2001. Of these, while 39 received cisplatin-based chemotherapy (Group 1), the remaining control group of 50 testicular cancer patients (Group 2) had no adjuvant treatment. The patients in both groups had at least 5-year follow-up and had no known cardiovascular disease. Fasting lipid profiles were obtained including total cholesterol, triglyceride, low- and high-density lipoprotein and very low-density lipoprotein. These values were compared with the normal range, and the statistical difference between the two groups was evaluated. Student's t test was used for continuous variables, and P < 0.05 was accepted as significant. RESULTS: Groups 1 and 2 had 39 and 50 cases, respectively. Mean follow-up period for Group 1 was 110 months (60-187) and 107 months (60-282) for Group 2. Mean total cholesterol in Groups 1 and 2 was 199.5 ± 44.1 mg/dl and 210.3 ± 41 mg/dl (P = 0.398), mean triglyceride 189.9 ± 131.0 mg/dl and 156.6 ± 105.5 mg/dl (P = 0.334), mean high-density lipoprotein cholesterol 38.3 ± 7.3 and 41.6 ± 10.9 mg/dl (P = 0.242), respectively, while very low density lipoprotein cholesterol was 38.2 ± 22.1 and 34.6 ± 26.7 mg/dl (P = 0.621). The only difference between the two groups was the low-density lipoprotein levels. The mean low-density lipoprotein cholesterol was 116.6 ± 51.7 and 141.9 ± 28.1 mg/dl (P = 0.036), respectively. CONCLUSION: Cisplatin-based chemotherapy in germ cell testicular tumors did not have long-term negative effect on blood lipid levels.

Is a second transurethral resection necessary for newly diagnosed pT1 bladder cancer?

PURPOSE: We evaluated the potential benefit of a second transurethral resection in patients with newly diagnosed pT1 transitional cell carcinoma of the bladder. MATERIALS AND METHODS: Between January 2001 and May 2003, 80 patients with stage T1 bladder cancer were included in this protocol in which all patients prospectively received second TUR within 2 to 6 weeks following the initial resection. Patients with incomplete resections were excluded from study. The pathological findings of the second TUR were reviewed. RESULTS: Of the 80 patients who underwent second resection, 18 (22.5%) had macroscopic tumors before resection. However, with the addition of microscopic tumors, overall residual disease was determined in 27 (33.8%) patients. Of the 27 patients 7 had pTa, 14 had pT1, 3 had pT1+pTis and 3 had pT2 disease. Residual cancers were detected in 5.8%, 38.2% and 62.5% in G1, G2 and G3 tumors, respectively. The risk of residual tumor directly correlated with the grade of the initial tumor (p = 0.009). CONCLUSIONS: Although second TUR dramatically changed the treatment strategy in a small percentage of cases, we strongly recommend performing second TUR in all cases of primary pT1 disease, especially in high grade cases.