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1.
Prostate ; 84(7): 636-643, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38413843

RESUMO

BACKGROUND: To clarify the clinical roles of changes in testosterone (T) levels with a cut-off level of 20 ng/dL as predictive factors for prostate cancer patients treated with degarelix acetate. METHODS: A total of 120 prostate cancer patients who received hormone therapies with gonadotropin-releasing hormone antagonist degarelix acetate were retrospectively analyzed. The predictive values of nadir T levels, max T levels, T bounce, and other clinical factors were evaluated for overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). T bounce was defined as satisfying both nadir serum T levels of <20 ng/dL and max serum T levels of ≥20 ng/dL during hormone therapies. RESULTS: In 120 prostate cancer patients, 16 (13%) patients did not achieve nadir T < 20 ng/dL, and 76 (63%) patients had max T ≥ 20 ng/dL. The median times to nadir T and max T are 108 and 312 days, respectively. T bounce was shown in 60 (50%) patients and is associated with favorable prognoses both for OS (p = 0.0019) and CSS (p = 0.0013) but not for PFS (p = 0.92). While in the subgroup analyses of the patients with the progression of the first-line hormone therapies, T bounce predicts favorable OS (p = 0.0015) and CSS (p = 0.0013) after biochemical recurrence. CONCLUSIONS: The present study revealed that T bounce with cut-off levels of 20 ng/dL is a promising biomarker that predicts OS and CSS for prostate cancer patients treated with degarelix acetate.


Assuntos
Oligopeptídeos , Neoplasias da Próstata , Testosterona , Masculino , Humanos , Estudos Retrospectivos , Neoplasias da Próstata/tratamento farmacológico , Prognóstico , Antígeno Prostático Específico , Hormônio Liberador de Gonadotropina
2.
Int J Urol ; 29(5): 406-412, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35102612

RESUMO

OBJECTIVES: This study was carried out to identify biomarkers that distinguish Hunner-type interstitial cystitis from non-Hunner-type interstitial cystitis patients. METHODS: Total ribonucleic acid was purified from 212 punch biopsy specimens of 89 individuals who were diagnosed as interstitial cystitis/bladder pain syndrome. To examine the expression profile of patients' bladder specimens, 68 urothelial master transcription factors and nine known markers (E-cadherin, cytokeratins, uroplakins and sonic hedgehog) were selected. To classify the biopsy samples, principal component analysis was carried out. A decision tree algorithm was adopted to identify critical determinants, in which 102 and 116 bladder specimens were used for learning and validation, respectively. RESULTS: Principal component analysis segregated tissues from Hunner-type and non-Hunner-type interstitial cystitis specimens in principal component axes 2 and 4. Principal components 2 and 4 contained urothelial stem/progenitor transcription factors and cytokeratins, respectively. A decision tree identified KRT20, BATF and TP63 to classify non-Hunner-type and Hunner-type interstitial cystitis specimens. KRT20 was lower in tissues from Hunner-type compared with non-Hunner-type interstitial cystitis specimens (P < 0.001). TP63 was lower in Hunner's lesions compared with adjacent mucosa from Hunner-type interstitial cystitis patients (P < 0.001). Blinded validation using additional biopsy specimens verified that the decision tree showed fairly precise concordance with cystoscopic diagnosis. CONCLUSION: KRT20, BATF and TP63 were identified as biologically relevant biomarkers to classify tissues from interstitial cystitis/bladder pain syndrome specimens. The biologically explainable determinants could contribute to defining the elusive interstitial cystitis/bladder pain syndrome pathogenesis.


Assuntos
Cistite Intersticial , Fatores de Transcrição de Zíper de Leucina Básica/metabolismo , Biomarcadores/metabolismo , Biópsia , Cistite Intersticial/patologia , Feminino , Proteínas Hedgehog/metabolismo , Humanos , Queratina-20 , Masculino , Aprendizado de Máquina Supervisionado , Fatores de Transcrição/metabolismo , Proteínas Supressoras de Tumor/metabolismo , Bexiga Urinária/patologia
3.
Int J Urol ; 27(10): 899-904, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32767525

RESUMO

OBJECTIVE: To examine the urodynamic effects of fesoterodine on neurogenic detrusor overactivity and/or low compliance bladder. METHODS: A total of 77 patients (52 men, 25 women; aged 61.6 ± 20.3 years) were given fesoterodine 4-8 mg/day and prospectively followed for 12 weeks. The primary end-point variable was change in the maximum cystometric capacity on urodynamic study. The secondary end-point was to assess the number of patients whose neurogenic detrusor overactivity disappeared, and the changes in the urodynamic parameters, lower urinary tract symptoms questionnaires and the 3-day frequency volume chart parameters after the treatment. RESULTS: A total of 13 patients (16.9%) withdrew because of adverse events (dry mouth or blurred vision), and four patients dropped out for unknown reasons. Finally, 60 patients completed the study. Bladder capacity at first desire to void, maximum cystometric capacity and bladder compliance increased by 29.2 mL, 79.9 mL and 22.2 mL/cm H2 O, respectively, showed statistical significance (P = 0.026, P < 0.001 and P < 0.001). Neurogenic detrusor overactivity disappeared in 12 of 51 patients (23.5%), and a significant increase was observed in bladder capacity at first involuntary contraction (P < 0.001), and a significant decrease was observed in maximum detrusor contraction (P < 0.001). In patients with low compliance bladder (with detrusor underactivity without neurogenic detrusor overactivity; n = 9), maximum cystometric capacity and bladder compliance increased significantly (P = 0.003 and P = 0.006, respectively). Overactive bladder symptom score, International Consultation on Incontinence Questionnaire-Short Form, most items of King's Health Questionnaire, and the number of urgency episodes and leaks in a day decreased significantly after treatment. CONCLUSIONS: Fesoterodine seems to be a valid treatment option for neurogenic detrusor overactivity and/or low compliance bladder in neurogenic bladder patients.


Assuntos
Bexiga Urinaria Neurogênica , Bexiga Urinária Hiperativa , Adulto , Idoso , Idoso de 80 Anos ou mais , Compostos Benzidrílicos/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bexiga Urinaria Neurogênica/tratamento farmacológico , Bexiga Urinária Hiperativa/tratamento farmacológico , Urodinâmica
4.
Int J Clin Oncol ; 24(10): 1231-1237, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31134469

RESUMO

BACKGROUND: Patients with brain metastasis from renal cell carcinoma have poor outcomes despite recent advances in diagnosis and treatment. Moreover, factors affecting such poor outcomes are unclear. This study aimed to evaluate the prognostic factors associated with overall survival in renal cell carcinoma patients with brain metastasis. METHODS: We retrospectively reviewed the data of 50 consecutive patients with brain metastasis from renal cell carcinoma at our institution between 1988 and 2017. The evaluated prognostic factors for overall survival included clinicopathological factors at diagnosis, treatment for brain metastasis, and the Graded Prognostic Assessment score of renal cell carcinoma. The associations between preoperative clinicopathological factors and overall survival were assessed using the log-rank test and Cox proportional hazards models for univariate and multivariate analyses, respectively. RESULTS: Forty-five patients were included, among whom 39 died during follow-up. The median follow-up was 8.2 months. The median survival time was 8.2 months (95% confidence interval 5.5-13.7). A Graded Prognostic Assessment score ≤ 2 (hazard ratio 1.967; 95% confidence interval 1.024-3.892; P = 0.042), the presence of sarcomatoid components (hazard ratio 3.299; 95% confidence interval 1.424-7.193; P = 0.007), and no treatment for brain metastasis (hazard ratio 2.594; 95% confidence interval 1.033-5.858; P = 0.043) were independently associated with poor prognosis in the multivariate analysis. CONCLUSIONS: Patients with renal cell carcinoma who develop brain metastasis have poor overall survival. The Graded Prognostic Assessment score, sarcomatoid components, and treatment for brain metastasis from renal cell carcinoma were independent factors associated with prognosis.


Assuntos
Neoplasias Encefálicas/mortalidade , Carcinoma de Células Renais/mortalidade , Neoplasias Renais/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/terapia , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/terapia , Criança , Terapia Combinada , Feminino , Humanos , Japão , Neoplasias Renais/patologia , Neoplasias Renais/terapia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Adulto Jovem
5.
Int J Urol ; 25(10): 871-878, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30103271

RESUMO

OBJECTIVES: To elucidate the effects of the preoperative albumin : globulin ratio on the survival of patients with upper tract urothelial carcinoma after radical nephroureterectomy. METHODS: We retrospectively reviewed 124 consecutive patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy at Chiba Cancer Center, Chiba, Japan between 2002 and 2015. The albumin : globulin ratio was defined: albumin / (total protein - albumin). Associations between preoperative clinicopathological factors, including the albumin : globulin ratio, and recurrence-free survival, cancer-specific survival and overall survival were assessed. The log-rank test and Cox proportional hazards models were used for univariate and multivariable analyses, respectively. The study cohort was separated into two groups based on the optimal albumin : globulin ratio cut-off value determined using receiver operating characteristic curve analysis. RESULTS: The median survival time was 55 months (interquartile range 28-76 months), and 31 patients died during follow up. A low preoperative albumin : globulin ratio <1.40 was associated with tumor grade and surgical margin status. Kaplan-Meier analyses showed that a low albumin : globulin ratio was more significantly correlated with worse recurrence-free survival, cancer-specific survival and overall survival. Multivariate analyses showed that a low albumin : globulin ratio was an independent predictive factor associated with poor recurrence-free survival (hazard ratio 3.758; P = 0.0028), cancer-specific survival (hazard ratio 5.687; P = 0.0044) and overall survival (hazard ratio 3.124; P = 0.0030). CONCLUSIONS: A low albumin : globulin ratio is an independent predictive factor associated with poor prognosis in upper tract urothelial carcinoma patients treated with radical nephroureterectomy.


Assuntos
Carcinoma de Células de Transição/cirurgia , Neoplasias Renais/cirurgia , Nefroureterectomia , Albumina Sérica Humana/análise , Soroglobulinas/análise , Neoplasias Ureterais/cirurgia , Idoso , Carcinoma de Células de Transição/sangue , Carcinoma de Células de Transição/mortalidade , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Neoplasias Renais/sangue , Neoplasias Renais/mortalidade , Masculino , Valor Preditivo dos Testes , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Neoplasias Ureterais/sangue , Neoplasias Ureterais/mortalidade
6.
Jpn J Clin Oncol ; 48(8): 760-764, 2018 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-29931182

RESUMO

BACKGROUND: The effectiveness of cancer control is unclear after radical prostatectomy for patients with clinical T3 prostate cancer. METHODS: We retrospectively reviewed 1409 patients who underwent radical prostatectomy between April 2007 and December 2014, including 210 patients with cT3 prostate cancer. Nine patients who received neoadjuvant hormonal therapy and three patients who were lost to follow-up were excluded from the analysis. Clinical staging was performed by an experienced radiologist using preoperative magnetic resonance imaging findings. We analyzed the predictors of biochemical recurrence using Cox proportional hazard analyses. RESULTS: A total of 113 patients (57%) underwent radical retropubic prostatectomy and 85 patients (43%) underwent robot-assisted radical prostatectomy. The median follow-up period was 36 months. Downstaging occurred for 60 patients (30%), positive surgical margins were identified in 117 patients (59%), and biochemical recurrence was observed for 89 patients (45%). In the multivariate analyses, the independent preoperative predictors of biochemical recurrence were ≥50% proportion of positive biopsy cores [hazard ratio (HR): 2.858, P < 0.0001] and a biopsy Gleason score of ≥8 (HR: 1.800, P = 0.0093). The independent post-operative predictors of biochemical recurrence were positive surgical margins (HR: 2.490, P = 0.0018) and seminal vesicle invasion (HR: 2.750, P < 0.0001). CONCLUSIONS: Among patients with cT3 prostate cancer, the percentage of positive biopsy cores and the biopsy Gleason score should be considered to select treatment. Compared with radical retropubic prostatectomy, robot-assisted radical prostatectomy may be a feasible treatment option in this setting.


Assuntos
Recidiva Local de Neoplasia/patologia , Prostatectomia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Idoso , Intervalo Livre de Doença , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Cuidados Pré-Operatórios , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco
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