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PURPOSE: To evaluate the impact of modifications to anatomical apical dissection including a puboprostatic open-collar technique, which visualizes the lateral aspect of the apex and dorsal vein complex (DVC) covering the rhabdosphincter while preserving the puboprostatic collar, on positive surgical margin (PSM) and continence recovery. METHODS: One-hundred-and-sixty-seven patients underwent gasless single-port retroperitoneoscopic radical prostatectomy using a three-dimensional head-mounted display system. Sequentially modified surgical techniques comprised puboprostatic open-collar technique, sutureless transection of the DVC, retrograde urethral dissection, and anterior reconstruction. The associations of these modifications with PSM and continence recovery were assessed. RESULTS: The puboprostatic open-collar technique, sutureless DVC transection, and retrograde urethral dissection were significantly associated with lower apical PSM (P = 0.003, 0.003, and 0.010, respectively). The former two also showed similar associations in 84 patients with anterior apical tumor (P = 0.021 and 0.030, respectively). Among 92 patients undergoing all of these three procedures, overall and apical PSM rates were 13.0% and 3.3%, respectively. Retrograde urethral dissection (odds ratio [OR] 2.73, P = 0.004) together with nerve sparing (OR 2.77, P = 0.003) and anterior apical tumor (OR 0.45, P = 0.017) were independently associated with immediate continence recovery. A multivariable model for 3-month continence recovery included anterior apical tumor (OR 0.28, P = 0.003) and puboprostatic open-collar technique (OR 3.42, P = 0.062). Immediate and 3-month continence recovery rates were 56.3% and 85.4%, respectively, in 103 patients undergoing both the puboprostatic open-collar technique and retrograde urethral dissection. CONCLUSION: Novel anatomical apical dissection utilizing a puboprostatic open-collar technique may favorably impact on both apical surgical margin and continence recovery.
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Próstata/cirugía , Prostatectomía/métodos , Anciano , Humanos , Laparoscopía , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Oportunidad Relativa , Próstata/anatomía & histología , Antígeno Prostático Específico/análisis , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Recuperación de la Función , Factores de Tiempo , Uretra/anatomía & histología , Uretra/cirugíaRESUMEN
OBJECTIVES: To assess whether biopsy of multiparametric magnetic resonance imaging (MRI)-negative lobes can be avoided without compromising significant cancer (SC) detection among men with unilateral MRI-positive lobes. METHODS: From April 2013 to April 2019, 322 men with elevated prostate-specific antigen (PSA <20 ng/mL) and unilateral MRI-positive lobes underwent targeted 4-core and systematic 14-core biopsy. MRI findings were prospectively collected and evaluated according to the Prostate Imaging-Reporting and Data System (PI-RADS) version 2, and scores ≥3 were considered positive. SC was defined as Gleason score ≥3 + 4 or maximal cancer length ≥5 mm. We developed predictive models of overall cancer and SC in MRI-negative lobes and evaluated the performance of these models. RESULTS: Detection rates of overall cancer/SC were 69%/61% for the overall cohort, 58%/48% for MRI-positive lobes, and 36%/20% for MRI-negative lobes. Age ≥75 years, PSA density ≥0.3, and PI-RADS ≥4 were independently predictive of both overall cancer and SC in MRI-negative lobes; 1 point was assigned for each risk factor, and the predictive score was defined as the sum of points (0-3) for both overall cancer and SC. Areas under the curve of the model for overall cancer/SC were 0.67/0.71. In the decision curve analysis, the model was of value above the threshold probability of 13%/6% for detecting overall cancer/SC in MRI-negative lobes. Of 40 men with score 0, overall cancer/SC was detected in the MRI-negative lobe in 4 (10%)/1 (2.5%). CONCLUSION: Biopsies of MRI-negative lobes may be avoided without compromising SC detection using our predictive model.
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Biopsia con Aguja Gruesa , Imágenes de Resonancia Magnética Multiparamétrica , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patología , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
A 38-year-old female developing pelvic lymph node recurrence (cN2) of bladder cancer was referred to our hospital. Eighteen months earlier, she had received complete transurethral resection of bladder tumor and pathological diagnosis of muscle-invasive urothelial carcinoma with micropapillary variant had been made. She had declined radical cystectomy or chemoradiation because of a strong desire to spare the bladder and fertility. She received induction gemcitabine/cisplatin therapy. After three cycles, she achieved a clinically complete response. Then, she underwent transumbilical gasless retroperitoneoscopic super-extended pelvic lymph node dissection up to the inferior mesenteric artery trunk using the three-dimensional head-mounted display system. Pathologically, one of 42 resected lymph nodes was positive for metastasis. She is alive with no evidence of disease 5 years after lymph node dissection, retaining functional bladder and normal ovarian functions.
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INTRODUCTION & OBJECTIVES: The controlling nutritional status (CONUT) score, consisting of serum albumin, total lymphocyte count, and total cholesterol, is a validated and objective tool for nutritional assessment. Cancer-bearing patients often suffer from malnutrition in association with cachexia. We explored the prognostic role of malnutrition evaluated by the CONUT score in advanced urothelial carcinoma (aUC) patients. MATERIALS & METHODS: Between 2003 and 2018, 201 aUC patients with cT4 and/or metastases to lymph nodes/distant organs were treated at a single cancer center. Of these, 185 were subjects of this retrospective study, with 16 excluded due to missing data. Clinical variables examined included age, sex, performance status (PS), body mass index (BMI), primary tumor site, lymph node/visceral metastasis, treatments before and after the diagnosis of aUC, hemoglobin, lactate dehydrogenase, alkaline phosphatase (ALP), C-reactive protein (CRP) and the CONUT score. Associations between clinical variables and overall survival (OS) were examined using the Cox proportional hazards model. RESULTS: The median (range) CONUT score was 2 (0-8). A higher CONUT score was associated with poorer PS (P < 0.001), lower BMI (Pâ¯=â¯0.007), lower hemoglobin (P < 0.001), higher ALP (Pâ¯=â¯0.005), and higher CRP (P < 0.001). During follow-up (median 12.3 months), 133 (72%) patients died. The median OS periods for patients with CONUT scores of 0 to 1, 2 to 3 and ≥4 were 19.3, 13.3, and 7.7 months, respectively (P < 0.001). Multivariate analysis revealed a higher CONUT score to be an independent and significant adverse prognostic factor (2-3 vs. 0-1, hazard ratio [HR] 1.57, Pâ¯=â¯0.024; ≥4 vs 0-1, HR 2.94, P < 0.001), along with greater age (Pâ¯=â¯0.003), poorer PS (Pâ¯=â¯0.006), lower BMI (Pâ¯=â¯0.008), primary tumor site in the upper tract (Pâ¯=â¯0.004), higher CRP (P < 0.001), no usage of pembrolizumab (Pâ¯=â¯0.005), and no curative treatment after the diagnosis of aUC (Pâ¯=â¯0.035). CONCLUSION: This study showed the prognostic significance of the CONUT score in aUC patients. The CONUT score indicates a patient's general condition from the aspect of nutritional status, and appears to be independent of PS as a prognosticator.
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Carcinoma de Células Transicionales/complicaciones , Desnutrición/etiología , Evaluación Nutricional , Estado Nutricional , Neoplasias Urológicas/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Transicionales/mortalidad , Carcinoma de Células Transicionales/patología , Femenino , Humanos , Masculino , Desnutrición/mortalidad , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Neoplasias Urológicas/mortalidad , Neoplasias Urológicas/patologíaRESUMEN
BACKGROUND: No standard therapy has been established for localised prostate cancer patients with prostate-specific antigen (PSA) failure after radical prostatectomy (RP). OBJECTIVE: To determine whether radiotherapy ± hormone therapy is superior to hormone therapy alone in such patients. DESIGN, SETTING, AND PARTICIPANTS: This study is a multicentre, randomised, open-label, phase 3 trial. Patients with localised prostate cancer whose PSA concentrations had decreased to <0.1 ng/ml after RP, and then increased to 0.4-1.0 ng/ml, were randomised to the salvage hormone therapy (SHT) group (80 mg bicalutamide [BCL] followed by luteinising hormone-releasing hormone agonist in case of BCL failure) or the salvage radiation therapy (SRT) ± SHT group (64.8 Gy of SRT followed by the same regimen as in the SHT group in case of SRT failure). From May 2004 to May 2011, 210 patients (105 in each arm) were registered, with the median follow-up being 5.5 yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was time to treatment failure (TTF) of BCL. RESULTS AND LIMITATIONS: TTF of BCL was significantly longer in the SRT ± SHT group (8.6 yr) than in the SHT group (5.6 yr; hazard ratio 0.56, 90% confidence interval [0.40-0.77]; one-sided p = 0.001). Thirty-two of 102 patients (31%) in the SRT ± SHT group did not have SRT treatment failure. However, clinical relapse-free survival and overall survival did not differ between the arms. The most frequent grade 3-4 adverse event was erectile dysfunction (83 patients [80%] in the SHT group vs. 76 [74%] in the SRT ± SHT group). Limitations include the short follow-up periods and surrogate endpoint setting to allow definitive conclusions. CONCLUSIONS: Initial SRT prolongs TTF of BCL in patients with post-RP PSA failure, indicating that SRT ± SHT is more beneficial than SHT alone. PATIENT SUMMARY: Patients who have prostate-specific antigen failure after radical prostatectomy benefit from salvage radiation therapy prior to salvage hormone therapy.
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Anilidas/uso terapéutico , Antineoplásicos/uso terapéutico , Hormona Liberadora de Gonadotropina/agonistas , Nitrilos/uso terapéutico , Neoplasias de la Próstata/tratamiento farmacológico , Neoplasias de la Próstata/radioterapia , Compuestos de Tosilo/uso terapéutico , Anciano , Humanos , Masculino , Antígeno Prostático Específico/sangre , Prostatectomía/métodos , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/cirugía , Terapia Recuperativa , Insuficiencia del TratamientoRESUMEN
BACKGROUND/AIM: Serum γ-glutamyltransferase (GGT) is reportedly associated with survival and therapeutic response in various malignancies; however, as far as we are aware its impact on metastatic castration-resistant prostate cancer (mCRPC) has never been assessed. PATIENTS AND METHODS: Fifty consecutive men with mCRPC receiving enzalutamide at a single cancer center were retrospectively evaluated. The primary endpoint was overall survival (OS) and the secondary endpoints were prostate-specific antigen (PSA) response, maximal PSA change, and PSA progression-free survival (PSA-PFS). RESULTS: Multivariable analysis demonstrated that elevation of GGT (≥40 U/l) was significantly and independently associated with shorter OS (hazard ratio(HR)=3.61; p=0.004), as were lower hemoglobin (HR=6.04; p<0.001) and higher PSA (HR=4.38; p=0.009). Elevated GGT was also associated with poorer PSA response, maximal PSA change, and shorter PSA-PFS. CONCLUSION: Elevated GGT was an adverse prognostic indicator in men with mCRPC receiving enzalutamide. External validations would improve the generality of our findings.
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Antineoplásicos/uso terapéutico , Biomarcadores de Tumor/sangre , Feniltiohidantoína/análogos & derivados , Neoplasias de la Próstata Resistentes a la Castración/sangre , Neoplasias de la Próstata Resistentes a la Castración/tratamiento farmacológico , gamma-Glutamiltransferasa/sangre , Anciano , Anciano de 80 o más Años , Benzamidas , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Humanos , Masculino , Neoplasias Primarias Secundarias/sangre , Neoplasias Primarias Secundarias/tratamiento farmacológico , Nitrilos , Feniltiohidantoína/uso terapéutico , Pronóstico , Antígeno Prostático Específico/sangre , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: The objective of the study was to identify a subset of men who can avoid systematic multisite biopsy (SyB) among those undergoing magnetic resonance imaging (MRI)-targeted transperineal 4-core biopsy (TgB) without missing clinically significant cancer (SC). PATIENTS AND METHODS: From April 2013 to December 2017, 304 men with elevated prostate-specific antigen levels (< 20 ng/mL) or abnormal digital rectal examination and positive MRI findings underwent transrecta ultrasound and MRI-targeted transperineal 4-core with 14-core systematic biopsy. MRI findings were prospectively collected and evaluated using Prostate Imaging-Reporting and Data System version 2 (PI-RADS), and scores ≥3 were considered positive. SC was defined as Gleason score ≥3 + 4 or maximum cancer length ≥5 mm. We evaluated the diagnostic performance of TgB and SyB to detect SC and characterized men who could avoid SyB without missing SC. RESULTS: Detection rates of any cancer and SC for TgB/SyB/their combination were 59%/63%/68% and 51%/52%/61%, respectively. TgB alone missed 14% (29/207) of any cancer and 16% (29/184) of SC detected using TgB with SyB. In uni- and multivariable analyses, PI-RADS scores of 3 to 4 were independent predictors for missing SC using TgB alone. When restricted to 81 men with PI-RADS scores of 5 (27%), SC was missed using TgB alone only in 3 (4.6% vs. 22% for the remaining 223 men; P = .007). CONCLUSION: SC was missed using TgB alone in a non-negligible proportion of men who underwent TgB and SyB. SyB might be safely avoided in men with PI-RADS score 5 lesions with reduced risks of missing SC.
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Imagen por Resonancia Magnética Intervencional/métodos , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patología , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Gruesa , Humanos , Biopsia Guiada por Imagen , Masculino , Persona de Mediana Edad , Imagen Multimodal , Clasificación del Tumor , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
Carcinosarcoma of the upper urinary tract is very rare. In this article, we report a case of upper urinary tract carcinosarcoma with rhabdomyoblastic differentiation showing distinct transition between the epithelial and mesenchymal components confirmed by morphology and immunohistochemistry. An 81-year-old female underwent radical nephroureterectomy under the diagnosis of left ureteral urothelial carcinoma (UC). Multiple invasive tumors showed combined histology with UC and rhabdomyosarcomatous elements (pT2-ureter and pT3-renal pelvis, pN0, u-lt0, ly0, v0, RM0). Each element demonstrated typical epithelial or mesenchymal staining patterns (positive for AE1/AE3 in the former and positive for vimentin and myogenin in the latter). Notably, immunohistochemical transition patterns of GATA-3, p63, SOX2, and myogenin between UC and rhabdomyosarcomatous elements were observed, implying possible involvement of neoplastic stem cells in the process of carcinosarcoma formation. The patient did not receive any adjuvant therapy and eventually succumbed to multiple visceral metastases (lungs and liver) at 11 months postoperatively. No autopsy was performed.
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Carcinoma de Células Transicionales/diagnóstico , Carcinosarcoma/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico , Rabdomiosarcoma/diagnóstico , Neoplasias Urológicas/diagnóstico , Anciano de 80 o más Años , Carcinoma de Células Transicionales/patología , Carcinoma de Células Transicionales/cirugía , Carcinosarcoma/patología , Carcinosarcoma/cirugía , Resultado Fatal , Femenino , Humanos , Riñón/patología , Riñón/cirugía , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/cirugía , Nefroureterectomía , Rabdomiosarcoma/patología , Rabdomiosarcoma/cirugía , Uréter/patología , Uréter/cirugía , Vejiga Urinaria/patología , Vejiga Urinaria/cirugía , Neoplasias Urológicas/patología , Neoplasias Urológicas/cirugíaRESUMEN
OBJECTIVES: Serum γ-glutamyltransferase (GGT) is reportedly associated with prognosis in patients with various malignancies. However, the prognostic role of GGT is unknown among patients with advanced urothelial carcinoma (aUC). This study was designed to examine the prognostic role of serum GGT in patients with aUC. MATERIALS AND METHODS: Charts of 125 consecutive aUC patients (inoperable cT4 and/or metastasis to lymph nodes/distant organs) managed at a single cancer center between 2004 and 2016 were retrospectively reviewed. Variables collected included age, sex, body mass index, Karnofsky performance status, primary site, clinical tumor stage, lymph node/visceral metastasis, hepatic comorbidities, the presence of curative treatment before the diagnosis of aUC, white blood cell count, neutrophil-to-lymphocyte ratio, hemoglobin, albumin, lactate dehydrogenase, alkaline phosphatase, GGT, C-reactive protein, and treatments given after the diagnosis of aUC. Associations of variables with overall survival (OS) were analyzed using the Cox proportional hazard model. RESULTS: Serum GGT was elevated (≥60 U/l) at the diagnosis of aUC in 16 patients (13%). During follow-up period (median 12.1 months), 101 patients died (2-year OS rate, 32%). Patients with elevated GGT at the diagnosis of aUC had a significantly poorer prognosis than those with normal GGT with respective 2-year OS rates of 0% and 37% (P < 0.001). On multivariate analysis, elevated GGT was a significant and independent risk factor for shorter OS (hazard ratio, HRâ¯=â¯2.97; P < 0.001) as were poorer Karnofsky performance status (HRâ¯=â¯3.47; P < 0.001), elevated lactate dehydrogenase (HRâ¯=â¯1.86; Pâ¯=â¯0.033), advanced age (HRâ¯=â¯1.82; Pâ¯=â¯0.013), elevated neutrophil-to-lymphocyte ratio (HRâ¯=â¯1.80; Pâ¯=â¯0.015), elevated C-reactive protein (HRâ¯=â¯1.73; Pâ¯=â¯0.018), the absence of systemic chemotherapy (HRâ¯=â¯1.71; Pâ¯=â¯0.035), and primary site of upper urinary tract (HRâ¯=â¯1.71; Pâ¯=â¯0.014) in descending order by HR. The prognostic significance of elevated GGT was also observed in a subset of 101 patients who had been diagnosed with aUC at their first presentation. CONCLUSION: The present study for the first time demonstrated that elevated serum GGT was an independent adverse prognostic factor in aUC patients.
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Biomarcadores de Tumor/sangre , Carcinoma de Células Transicionales/secundario , Neoplasias Urológicas/patología , gamma-Glutamiltransferasa/sangre , Anciano , Anciano de 80 o más Años , Carcinoma de Células Transicionales/sangre , Carcinoma de Células Transicionales/enzimología , Carcinoma de Células Transicionales/terapia , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Tasa de Supervivencia , Neoplasias Urológicas/sangre , Neoplasias Urológicas/enzimología , Neoplasias Urológicas/terapiaRESUMEN
A 78-year-old man who had a horseshoe kidney (HSK) visited us because of gross hematuria and suspicious urine cytology. CT and MRI revealed a right renal pelvic tumor of 28 mm in diameter. He underwent gasless single-port retroperitoneoscopic nephroureterectomy with division of the isthmus via the right pararectal small incision using the RoboSurgeon system. Pathological diagnosis was invasive urothelial carcinoma, grade 3, pT3, pN0, LVI0, RM0. He was discharged from hospital on the 6th postoperative day without any perioperative complication. He has no evidence of disease clinically and radiologically 19 months after the operation. Only a few cases of upper tract urothelial carcinoma complicated by HSK treated with minimally invasive surgery have been reported in English literature. This is the first case successfully managed with RoboSurgeon gasless single-port retroperitoneoscopic nephroureterectomy.
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OBJECTIVES: Sarcopenia, decreased skeletal muscle mass (SMM), is an adverse prognostic factor in patients with advanced urothelial carcinoma (aUC). Given that SMM is variable depending on disease and patient conditions, changes in SMM over the course of treatments may be also prognostic. We investigated the prognostic role of posttherapeutic SMM recovery (PSR) in patients with aUC receiving first-line platinum-based chemotherapy. MATERIALS AND METHODS: This retrospective study included 72 consecutive patients with aUC receiving first-line platinum-based chemotherapy. Skeletal muscle index (SMI) was measured on computed tomography images taken before the initiation of and immediately after 2 cycles of chemotherapy. ΔSMI was calculated as [(posttherapeutic SMI - pretherapeutic SMI)/pretherapeutic SMI] × 100, and PSR was defined as ΔSMI >0. Variables associated with progression-free survival (PFS) and overall survival (OS) were evaluated. RESULTS: During the follow-up (median, 18mo for survivors), 60 (83%) patients progressed (2-year PFS, 17%) and 55 (76%) died (2-year OS, 24%). ΔSMI was significantly associated with chemotherapy response (P = 0.012), and was an independent predictor for both PFS (hazard ratio [HR] = 0.94, P<0.001) and OS (HR = 0.93, P<0.001). A total of 15 (21%) patients with PSR demonstrated significantly longer PFS and OS than those without PSR (both P<0.001). On multivariate analysis, PSR was an independent favorable predictor for both PFS (HR = 0.24, P<0.001) and OS (HR = 0.21, P<0.001). Incorporation of PSR into the Bajorin's and Galsky's models improved their c-indices (0.611-0.650, and 0.690-0.708, respectively). CONCLUSIONS: PSR is a novel prognostic factor in patients with aUC receiving first-line platinum-based chemotherapy.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Transicionales/tratamiento farmacológico , Músculo Esquelético/patología , Sarcopenia/patología , Neoplasias Urológicas/tratamiento farmacológico , Anciano , Carcinoma de Células Transicionales/complicaciones , Carcinoma de Células Transicionales/mortalidad , Cisplatino/uso terapéutico , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Músculo Esquelético/diagnóstico por imagen , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Sarcopenia/diagnóstico por imagen , Sarcopenia/etiología , Tomografía Computarizada por Rayos X , Neoplasias Urológicas/complicaciones , Neoplasias Urológicas/mortalidadRESUMEN
BACKGROUND: Sarcopenia, or the degenerative loss of skeletal muscle mass, develops as a consequence of cancer-host interactions, including systemic inflammation and poor nutritional status, and is associated with a poor prognosis in patients with metastatic renal cell carcinoma (mRCC). We explored whether postoperative changes in skeletal muscle mass after cytoreductive nephrectomy (CN) can predict the prognosis of patients with mRCC. PATIENTS AND METHODS: The present retrospective study included 37 mRCC patients undergoing CN at a single cancer center. The skeletal muscle index (SMI) was calculated by measuring the skeletal muscle areas at the third lumbar vertebra level on computed tomography images taken ≤ 1 month before and 5 to 6 months after CN. The percentage of change in the SMI (ΔSMI) was calculated as [(postoperative SMI - preoperative SMI)/preoperative SMI] × 100, and the association with overall survival (OS) was analyzed. RESULTS: During the follow-up period (median, 61 months for survivors), 16 patients (43%) died for a 3-year OS rate of 63%. The ΔSMI was significantly associated with OS (hazard ratio, 0.92; P < .001). When the patients were categorized into 3 groups according to the ΔSMI (decreased, 12 patients with ΔSMI ≤ -5; stabilized, 15 patients with ΔSMI < 5; and increased, 10 patients with ΔSMI ≥ 5), the OS curves were distinctly separate, with a 3-year OS rate of 19%, 76%, and 100%, respectively (P < .001). CONCLUSION: Postoperative changes in the SMI after CN predict OS for patients with mRCC. SMI kinetics is a novel biomarker that can serve as a useful surrogate for the prognosis of patients with mRCC undergoing CN.
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Carcinoma de Células Renales/cirugía , Procedimientos Quirúrgicos de Citorreducción/efectos adversos , Neoplasias Renales/cirugía , Músculo Esquelético/diagnóstico por imagen , Nefrectomía/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
We report a 32-year-old female case of a right adrenal gland mass detected on CT scan at medical checkup. CT and MRI showed a mass of 5.1 cm made of fat and calcification in the right adrenal gland, leading to the clinical diagnosis of adrenal myelolipoma. Because of its relatively large size and the patient's desire, the patient underwent gasless single-port retroperitoneoscopic adrenalectomy using the RoboSurgeon system. Histopathological examination revealed that the cystic tumor is composed of keratinized epidermis, mature fat, nerve, cartilage, bone, and sebaceous glands compressing the normal adrenal gland, leading to the diagnosis of retroperitoneal mature cystic teratoma. The patient remains free of recurrence 29 months after surgery. Retroperitoneal teratoma is relatively rare but clinically important because of high possibility of malignancy. In a case of an adrenal mass difficult to clinically distinguish retroperitoneal teratoma from adrenal myelolipoma, surgical resection via a minimally invasive approach would be the best therapeutic option.
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We evaluated the prognostic roles of local therapy to bone metastasis (BM) in metastatic renal cell carcinoma (mRCC) patients with BM. This retrospective study included 71 mRCC patients with BM. Local therapy to BM included en bloc resection, curettage, and radiotherapy (RT). RT was classified into RT with biological effective dose (BED) ≥85 Gy and <85 Gy by its therapeutic intensity. Local therapy to BM was given for 64 patients (90 %): en bloc resection, curettage, and RT for 16, 10, and 38 patients, respectively. Fifteen patients received RT with BED ≥85 Gy. The median overall survival (OS) was 25 months (median follow-up 16 months). For 46 patients with solitary BM, patients treated with en bloc resection, curettage, and RT with BED ≥85 Gy showed significantly better OS than those treated with RT with BED <85 Gy or no local therapy (P = 0.006). Because OS was comparable among patients treated with en bloc resection, curettage, and RT with BED ≥85 Gy, these three treatment modalities were defined as "intensive local therapy". Intensive local therapy to BM was also associated with favorable OS with marginal significance (P = 0.052) in a cohort of 25 patients with multiple BM. A multivariate analysis in the whole cohort revealed that intensive local therapy to BM was independently associated with favorable OS (hazard ratio 0.23, P < 0.001) along with Memorial-Sloan Kettering Cancer Center risk category (P < 0.001). Thus, intensive local therapy to BM might improve OS in mRCC patients with BM including multiple BM.
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Neoplasias Óseas/tratamiento farmacológico , Carcinoma de Células Renales/tratamiento farmacológico , Pronóstico , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias Óseas/patología , Neoplasias Óseas/secundario , Carcinoma de Células Renales/patología , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
We investigated the prognostic significance of sarcopenia in upper tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy (RNU). The skeletal muscle index (SMI) was calculated from computed tomography images. Sarcopenia was defined as SMI <43 cm(2) /m(2) for males with body mass index <25 kg/m(2) , <53 cm(2) /m(2) for males with BMI ≥25 kg/m(2) , and <41 cm(2) /m(2) for females. Associations of sarcopenia with cancer-specific survival (CSS) and overall survival (OS) were evaluated in 81 consecutive UTUC patients who underwent RNU. Forty-seven (58%) out of 81 patients had sarcopenia. Multivariate analyses identified sarcopenia as a significant and independent poor prognostic factor for both CSS (hazard ratio [HR] 8.58, 95% confidence interval [CI]: 1.63-158.1, P = 0.008) and OS (HR 6.05, 95%CI 2.00-26.21, P < 0.001). In patients with locally advanced disease (pT3/4 or pN+), those with sarcopenia showed significantly worse CSS and OS than those without (5-year CSS rate 55% vs. 100%, P = 0.014; 5-year OS rate 40% vs. 86%, P = 0.007). In contrast, no prognostic difference was observed between patients with and without sarcopenia in those with organ-confined disease (pTa-2pN0/x). Sarcopenia is an independent poor prognostic factor for UTUC patients treated with RNU, particularly for those with locally advanced disease.
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Nefrectomía , Sarcopenia/patología , Uréter/patología , Uréter/cirugía , Neoplasias Urológicas/diagnóstico , Neoplasias Urológicas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Nefrectomía/métodos , Pronóstico , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Neoplasias Urológicas/mortalidad , Neoplasias Urológicas/terapiaRESUMEN
PURPOSE: Sarcopenia, a novel concept reflecting the degenerative loss of skeletal muscle mass, is a critical physiological change during the development of cancer cachexia. We retrospectively investigated the prognostic role of sarcopenia in patients with metastatic renal cell carcinoma. MATERIALS AND METHODS: Skeletal muscle index was calculated using computerized tomography performed at the diagnosis of metastatic renal cell carcinoma. Sarcopenia was defined as skeletal muscle index less than 43 cm(2)/m(2) for males with a body mass index less than 25 kg/m(2), less than 53 cm(2)/m(2) for males with a body mass index 25 kg/m(2) or greater, and less than 41 cm(2)/m(2) for females. The relationship between sarcopenia and overall survival was assessed in 92 patients with metastatic renal cell carcinoma using Cox proportional hazards models. The predictive accuracy of these models was evaluated using the c-index. RESULTS: A total of 63 (68%) patients were classified as having sarcopenia and 52 (57%) died (median overall survival 27 months) during followup (median 19 months). A multivariate analysis identified sarcopenia as a significant and independent predictor of overall survival (HR 2.58, p = 0.015), along with prior nephrectomy (p <0.001), number of metastatic sites (p = 0.017), corrected calcium (p = 0.026) and lactate dehydrogenase (p = 0.006). The 3-year overall survival rates were 31% and 73% for sarcopenic and nonsarcopenic cases, respectively (p <0.001). The integration of sarcopenia into the Memorial Sloan Kettering Cancer Center risk model improved the c-index from 0.726 to 0.758 (addition of sarcopenia to the original model) and 0.755 (substitution of sarcopenia for Karnofsky performance status). CONCLUSIONS: Sarcopenia is a significant prognostic factor in metastatic renal cell carcinoma.
Asunto(s)
Carcinoma de Células Renales/complicaciones , Carcinoma de Células Renales/mortalidad , Neoplasias Renales/complicaciones , Neoplasias Renales/mortalidad , Sarcopenia/etiología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Renales/secundario , Femenino , Humanos , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
OBJECTIVES: Sarcopenia, a novel concept reflecting the degenerative loss of skeletal muscle mass, is an objective indicator of cancer cachexia. We investigated its role as a prognostic biomarker in advanced urothelial carcinoma (UC) patients. METHODS: This retrospective study consisted of 88 UC patients with cT4 and/or metastases to lymph nodes/distant organs. Skeletal muscle index (SMI), an indicator of whole-body muscle mass, was measured from computed tomography (CT) images at the diagnosis. Sarcopenia was defined as SMIs of <43 cm(2)/m(2) for males with body mass index (BMI) <25 cm(2)/m(2), <53 cm(2)/m(2) for males with BMI ≥ 25 cm(2)/m(2), and <41 cm(2)/m(2) for females. Predictors of overall survival (OS) were examined using Cox proportional hazard models. RESULTS: Sixty-seven patients (76%) died during the median follow-up of 13 months. The median OS rate was 13 months. Multivariate analysis revealed that SMI was a significant and independent predictor of shorter OS (hazard ratio (HR) 0.90, P <0.001). In the present cohort, 53 (60%) were diagnosed with sarcopenia. The median OS rates were 11 and 31 months for sarcopenic and non-sarcopenic patients, respectively (P <0.001). On multivariate analysis, sarcopenia was a significant and independent predictor of shorter OS (HR 3.36, P <0.001), along with higher C-reactive protein (CRP) (P = 0.001), upper urinary tract cancer (P = 0.007), higher lactate dehydrogenase (LDH) (P = 0.047), and higher alkaline phosphatase (ALP) (P = 0.048). CONCLUSION: Sarcopenia, which is readily evaluated on routine CT scans, is a useful prognostic biomarker of advanced UC. Non-sarcopenic patients can expect long-term survival. Evaluating sarcopenia can be helpful for decision-making processes in the management of advanced UC patients.
Asunto(s)
Caquexia , Supervivencia sin Enfermedad , Modelos Biológicos , Sarcopenia , Neoplasias Urológicas , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor , Caquexia/diagnóstico por imagen , Caquexia/etiología , Caquexia/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sarcopenia/diagnóstico por imagen , Sarcopenia/etiología , Sarcopenia/mortalidad , Tasa de Supervivencia , Tomografía Computarizada por Rayos X , Neoplasias Urológicas/diagnóstico por imagen , Neoplasias Urológicas/mortalidadRESUMEN
A 55-year-old man who presented himself with gross hematuria and right back pain was found to have a right renal mass with evidence of metastasis to the lymph nodes, bone and lung (cT1bN1M1). He underwent a transperitoneal right nephrectomy. Tumor expressed markers of CD10, P504S and CK19 immunohistochemically, so histopathological examination revealed tubulocystic carcinoma of the right kidney (pT3a). After the patient received sunitinib therapy, computed tomography revealed reduction in the size of the metastatic lung nodule and lymph nodes, indicating a partial response. He is alive without disease progression at 12 months after nephrectomy. Tubulocystic carcinoma has been referred to by Amin et al as low-grade collecting duct carcinoma and is not yet included in the World Health Organization (WHO) 2004 classification of renal tumors. The cells lining the tumor range from cuboidal to columnar and have large nuclei with low-grade changes and abundant eosinophilic or amphophilic cytoplasm. Hobnail cells are commonly seen. Immunohistochemically, tubulocystic carcinomas are strongly positive for markers of the proximal nephron (CD10, P504S) and the distal nephron (parvalbumin, CK19). Despite a low nuclear grade, tubulocystic carcinomas occasionally show progressive behavior clinically. Although there is no established salvage therapy, sunitinib was found to be effective for this patient.
Asunto(s)
Carcinoma de Células Renales/patología , Biomarcadores de Tumor/análisis , Carcinoma de Células Renales/cirugía , Humanos , Inmunohistoquímica , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: Selection criteria for active surveillance (AS) program of localized prostate cancer remain to be standardized. The purpose was to evaluate the validity of selection criteria and investigate the feasibility of this AS program. METHODS: Patients meeting the criteria (i) stage T1cN0M0, (ii) age 50-80, (iii) serum prostate-specific antigen (PSA) =20 ng/ml, (iv) one or two positive cores per 6-12 systematic biopsy cores, (v) Gleason score =6, and (vi) cancer involvement in positive core =50% were enrolled and encouraged to start AS for at least 6 months during the period between January 2002 and December 2003. PSA was measured bimonthly for 6 months and every 3 months thereafter. Trigger of treatment recommendation was PSA-doubling time (PSADT) of =2 years or pathological progression at re-biopsy. Primary endpoint was '%PSADT > 2y', which was defined as the proportion of patients who showed PSADT assessed at 6 months >2 years out of all the patients who chose AS. Point estimate of '%PSADT > 2y' was expected to be >80%. RESULTS: One hundred and eighteen patients opted for AS and 16 chose immediate treatment at enrollment. PSADT for the initial 6 months based on four measurements could be assessed in 106 patients. Intent-to-treat analysis of '%PSADT > 2y' was 71.2% (84/118, 95% CI: 62.1-79.2). Pathological progression rate at 1-year re-biopsy was 33%. Fifty-four (46%) patients remained on AS for maximal observation of 54 months. General health-related QOL in patients undergoing AS was not impaired. CONCLUSIONS: The primary endpoint, '%PSADT > 2y', did not meet the pre-specified decision criteria. Further prospective study with revised program and endpoint is needed.
Asunto(s)
Selección de Paciente , Vigilancia de la Población/métodos , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/prevención & control , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Estado de Salud , Humanos , Japón , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Prospectivos , Neoplasias de la Próstata/inmunología , Calidad de VidaRESUMEN
OBJECTIVE: To evaluate the clinical outcome of radical prostatectomy (RP) in Japan, by retrospectively analysing the clinicopathological data in patients with clinical T1-T2 prostate cancer treated by RP, as there can be prostate-specific antigen (PSA) recurrence after RP in substantially many patients, and its character can differ according to ethnic group and/or country. PATIENTS AND METHODS: We reviewed 1192 patients who had a RP from 1993 to 2002 with no neoadjuvant/adjuvant therapy and whose PSA level after RP decreased at least once to undetectable levels (<0.2 ng/mL). PSA recurrence was defined as > or = 0.20 ng/mL. The patient data were collected from the Urological Oncology Study Group, a subgroup of Japan Clinical Oncology Group. RESULTS: The patients' median (range) age was 67 (47-83) years and their PSA level before RP was 8.7 (1.0-153) ng/mL. During the median follow-up of 45.6 months, 302 of the 1192 patients (25.3%) developed PSA recurrence. The median time to recurrence was 369 (61-2128) days after RP. A log-rank test showed that five significant clinicopathological factors were associated with PSA recurrence after RP: the percentage of prostate needle-biopsy cores with cancer, the biopsy Gleason score, PSA level before RP, pathological stage, and the Gleason score of the RP specimen (P < 0.001 for all). In multivariate analyses, the percentage of positive biopsy cores, PSA level before RP, pT and the Gleason score of the RP specimen were all independent significant predictors of PSA recurrence after RP in Japanese men. CONCLUSIONS: The frequency of PSA recurrence after RP was 25.3% in Japan and the percentage of positive biopsy cores, PSA level before RP, pT and the Gleason score of the RP specimen were independent significant factors for PSA recurrence.