ABSTRACT
BACKGROUND: The association of diabetes mellitus and bladder cancer recurrence following radical nephroureterectomies (RNUs) in patients with upper urinary tract urothelial carcinoma (UTUC) was investigated. METHODS: Between January 1996 and March 2009, 538 patients with UTUC who received RNU and had no previous bladder cancer histories were enrolled. The clinicopathological characteristics were obtained and used for the analysis of metachronous bladder recurrence by using Cox proportional hazard model. RESULTS: The diabetic patients (N = 104, 19.3%) were elderly (72 vs 67 years, p < 0.001) and had more hypertension (56.7 vs 34.5%, p < 0.001) as compared with non-diabetic patients. There was no significant difference in the rest of clinicopathological characteristics between patient groups. During the median follow-up duration of 51 months, bladder recurrences were discovered in 47.1 and 33.1% of diabetic and non-diabetic patients with UTUC, respectively. Poorly controlled diabetic patients (HbA1c ≥ 7.0%) exhibited a shorter duration of bladder cancer recurrence-free survival as compared with those with good glycemic controlled diabetes mellitus and without diabetes mellitus (log-rank test, p < 0.001 and <0.001, respectively). In the multivariate analysis, male gender [hazard ratio (HR) = 1.67, p = 0.017], ureteral tumour (HR = 1.61, p = 0.020), end-stage renal disease (HR = 2.09, p = 0.030) and diabetes mellitus with poor glycemic control (HR = 2.10, p < 0.018) independently predicted bladder recurrence after RNU. CONCLUSIONS: Diabetes mellitus with poor glycemic control (HbA1c ≥ 7.0%) increases the risk of subsequent bladder cancer recurrence. These results underscore the need for intensive glycemic control and close follow-up for diabetic patients.
Subject(s)
Diabetes Mellitus/physiopathology , Hyperglycemia/diagnosis , Hypoglycemia/diagnosis , Neoplasm Recurrence, Local/diagnosis , Postoperative Complications , Urinary Bladder Neoplasms/complications , Urologic Neoplasms/complications , Aged , Case-Control Studies , Cohort Studies , Female , Follow-Up Studies , Humans , Hyperglycemia/etiology , Hyperglycemia/mortality , Hypoglycemia/etiology , Hypoglycemia/mortality , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Recurrence, Local/etiology , Neoplasm Recurrence, Local/mortality , Neoplasm Staging , Nephrectomy/adverse effects , Prognosis , Survival Rate , Urinary Bladder Neoplasms/mortality , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/surgery , Urologic Neoplasms/mortality , Urologic Neoplasms/pathology , Urologic Neoplasms/surgeryABSTRACT
OBJECTIVES: The aim of this study was to investigate the effect of tumor location on oncologic outcomes in patients with upper urinary tract urothelial carcinoma (UTUC) stratified according to pathologic stage. MATERIAL AND METHODS: Between January 1996 and March 2009, 503 patients with UTUC were enrolled who had undergone radical nephroureterectomies and had no nodal or distal metastases. Preoperative chemotherapy or radiation therapy was not administered to any study patient. Clinicopathologic patient characteristics were obtained and used to analyze recurrence-free survival (RFS), cancer-specific survival, and overall survival with the Cox proportional hazards model. RESULTS: During the median follow-up of 52 months, patients with pathologic tumor (pT) stage 3 ureteral tumors had a shorter duration of RFS compared with those with pT3 renal pelvis tumors (5-y RFS: 50% and 71%, P = 0.047). There was no prognostic relevance to the tumor location in pTa/Tis/T1 and pT2 diseases. RFS and cancer-specific survival were significantly shorter in duration in pT3 ureteral disease compared with pT2 diseases (P<0.001 and P = 0.028). No differences were found in oncologic outcomes between pT3 renal pelvic and pT2 diseases. The presence of pT3 ureteral tumors actually increased the risks of disease recurrence (hazard ratio [HR] = 7.82, P<0.001), cancer-specific death (HR = 5.08, P<0.001), and overall mortality (HR = 3.25, P = 0.031). CONCLUSIONS: Patients with UTUC and pT3 ureteral tumors had an increased risk of disease recurrence and cancer-specific death. These results underscore the need for close follow-up and the consideration of adjuvant chemotherapy for patients with pT3 ureteral cancer.
Subject(s)
Nephrectomy , Pelvic Neoplasms/pathology , Ureteral Neoplasms/pathology , Urologic Neoplasms/pathology , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasm Grading , Neoplasm Staging , Pelvic Neoplasms/surgery , Prognosis , Survival Rate , Ureteral Neoplasms/surgery , Urologic Neoplasms/surgeryABSTRACT
A 55-year-old man started to suffer from severe penile pain 2 days after engaging in sexual intercourse in the woman-on-top position. A fixed, 2-cm long, cord-like lesion was found on the dorsal midline of his penis which was in a partially tumescent state. Ultrasonography showed part of the deep dorsal vein was obstructed by a hyperechoic mass. Laboratory tests revealed elevated plasma factor VIII coagulant activity. The patient received thrombophlebectomy of the deep dorsal penile vein. Pathology reported venous thrombosis with eosinophilic and lymphocytic infiltration of the venous wall. At the outpatient follow up, painful thrombophlebitic veins at the previous i.v. accesses were noted on his left arm. He has received long-term warfarin control as suggested by hematologists. This patient represents the first reported case of deep dorsal penile thrombophlebitis associated with elevated plasma factor VIII coagulant activity, which is an independent risk factor of recurrent venous thromboembolism and superficial thrombophlebitis.