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1.
Urol J ; 2019 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-30636274

RESUMO

INTRODUCTION: To investigate the prognostic role of time to castration resistance(TTCR) in patients who have received solely Docetaxel chemotherapy regimen(DCR) for castration resistant prostate cancer(CRPC). Methods: Between Jan 2004 and Dec 2015, data of 162 patients who have received DCR for CRPC are detected. Patients were divided into three groups according to TTCR: Group 1(?12 months), group 2(13-24 months), and group 3(>24 months). Data of age, clinical stage, Gleason grade(GG), previous treatments, site of metastases, Prostate-specific antigen (PSA) values, TTCR, overall survival, biochemical progression free survival(PFS) and PSA response to docetaxel were recorded. RESULT: The mean age of the 162 patients was 74.4±8.5. Data on mean age, type of castration, adding estramustine to docetaxel, secondary hormonal manipulation, Gleason grade, clinical T stage at initial diagnosis and site of metastases were comparable between three groups. All PSA values were statistically significant higher in group 1 than other groups. PSA response to docetaxel was 59.2% in all patient and it was worse in group 1 than other groups(P=.009). Two years OS rates were 7.6%, 25% and 32.3% in group 1, 2 and 3, respectively. Median survival rates were 7, 14 and 23 months in group 1, 2 and 3, respectively, and this difference was statistically significant (P=.016). On multivariate analysis, TTCR was found to be independent prognostic factor for overall survival and response to docetaxel treatment. CONCLUSION: TTCR appears to be an independent prognostic factor for patients who are candidates for DCR.

2.
Urol J ; 2018 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-30345496

RESUMO

PURPOSE: To compare of changes in glomerular filtration rate (GFR) in patients who underwent radical cystectomy(RC) and multimodal treatment(MMT). MATERIALS AND METHODS: We identified 472 consecutive patients who underwent RC or treated with MMT for muscle invasive bladder cancer(MIBC) at our institution, between January 1995 and December 2010. After excluding the patients who died within 5 years or without 5 years of follow-up, 175 and 59 patients who were treated with RC and MMT, respectively were included to the study. GFR was measured before treatment and every 6 months after treatment till the end of 60th months. RESULTS: The mean age and mean baseline GFR were 66.5±5.7 and 85.1±18.2 mL/min/1.73m2, respectively for all patients. We detected statistically significant higher decrease rates for GFRs in MMT group compared to RC group at every follow up period till 42nd months. Renal function decreasing was found to be more prominent during first year of follow-up (79.1 to 65.9 mL/min/1.73m2) in MMT group. However, GFR decreased more regularly in RC group (~4 mL/min/1.73m2 per year). MMT, lower baseline GFR, Diabetes Mellitus, hypertension, and ureteroenteric anastomotic stricture development were associated with low GFR under 60 and 45 ml/min at the end of five years. CONCLUSION: Decreased renal function is noted in many MIBC patients after RC or MMT in the long-term follow-up. Renal function deterioration is more prominent within the first year after MMT.

3.
Can Urol Assoc J ; 12(11): E475-E479, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29989888

RESUMO

INTRODUCTION: Kidney displacement may alter the quality of renal puncture during percutaneous nephrolithotomy (PCNL). The aim of this study was to identify the rate of kidney displacement and parameters associated with kidney displacement in patients who underwent supine mini-PCNL. METHODS: Data of 98 consecutive patients who underwent mini-PCNL was collected prospectively. The patients were grouped as displacement-positive vs. -negative. The parameters collected were age, gender, body mass index, side of the kidney, punctured calyx, fluoroscopy time to successful puncture and tract dilation, stone-free and complication rates, stone diameter, length of the renal artery, and quantity of peri-renal and abdominal fat. Groups were compared for the above listed parameters and logistic regression analysis was performed to identify factors associated with kidney displacement. RESULTS: There were 34 and 64 patients in the displacement-positive and -negative groups, respectively. Groups were similar for stone-free and complication rates. Fluoroscopy time to puncture and tract dilation were longer in the displacement-positive group. Groups were different for renal artery length and peri-renal fat measurements. In multivariate analysis, lower pole puncture, renal artery length, and peri-renal fat measurement were found to be independent predictors of kidney displacement. CONCLUSIONS: Kidney displacement does not alter the success and complication rates, but is associated with longer fluoroscopy times during supine PCNL. In the current study, parameters in preoperative non-contrast computerized tomography (NCCT) associated with kidney displacement were identified. We recommend surgeons evaluate and take into account these parameters during preoperative planning to establish better outcomes and diminish fluoroscopy times.

4.
World J Urol ; 36(8): 1263-1266, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29572727

RESUMO

PURPOSE: Colour Doppler ultrasound (CDUS) is the main radiologic tool to evaluate scrotal masses and intratesticular-vascularised solid lesions are mostly considered malign lesions. Objective of this trial is determine ratio of benign lesions in patients with hypervascularised solid intratesticular lesions. MATERIAL AND METHOD: Patients who underwent radical orchiectomy due to hypervascularised intratesticular solid lesions detected in CDUS are evaluated retrospectively. Those with previous testicular cancer history and inguinal/scrotal surgeries were excluded from the study. All patients are evaluated for age, preoperative testicular atrophy, multicentricity, echotexture and size of solid lesions, preoperative tumor markers (AFP, bHCG and LDH), and postoperative pathology results. Two tailed p value test was used to evaluate numeric parameters and Fisher's exact test was used to evaluate non-numeric parameters. RESULTS: A total of 117 patients with a mean age of 35.9 (5-86) were included to the study. Mean size of solid lesions was 4.39 cm. Seven patients had subcentimeter (subcm) lesions. 101 patients had hypoechoic, ten patients had isoechoic and six patients hyperechoic solid lesions. Preoperatively 60 patients (51.2%) had at least one tumor marker elevated. Postoperative pathology examination resulted to; 21 patients (17.9%) had benign lesions. Elevation of tumor markers, palpability, hypoechoic texture and larger size of the solid lesion were found to be parameters that predict malignancy. CONCLUSION: Benign incidence of vascular testicular solid lesions detected with scrotal ultrasound with colour Doppler is greater than expected. In patients with smaller, non-palpable lesions without elevated tumor markers, treatment options other than radical orchiectomy such as testicular sparing surgery should be considered.

5.
Minerva Urol Nefrol ; 69(4): 342-348, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27733750

RESUMO

BACKGROUND: Primary treatment of choice for advanced germ cell tumors is 3 to 4 cycles of combination bleomycin-etoposide-cisplatin (BEP) chemotherapy. Although most patients treated for advanced germ cell tumors (GCT) will be cured, approximately 30% will fail to achieve a durable complete response (CR). Thrombocytosis has been found to be related with significantly shorter survival in many cancers. However, its role in testicular cancer patients has not been studied previously. The objective of this study was to investigate the relationship between thrombocytosis and chemotherapy response in patients with metastatic testicular cancer. METHODS: Records of 113 patients with advanced stage testicular cancer were reviewed. Treatment outcomes were classified as complete clinical response (cCR), partial clinical response (pCR), complete pathological response (cPR) and treatment failure and the relationship with thrombocytosis was investigated. Logistic regression analysis was performed to identify factors associated with treatment failure. RESULTS: Totally 103 patients met the eligibility criteria. Thrombocytosis was detected in 26 (25.2%) patients. Treatment failure was observed in 14 (53.8%) and 28 (36.4%) of the patients in the thrombocytosis and non-thrombocytosis groups respectively (P=0.037). Thrombocytosis and IGCCCG high-risk group are found as independent prognostic factors for treatment failure in multivariate analysis. CONCLUSIONS: Thrombocytosis is seen in 25% of patients with testicular GCT and it is found to be associated with poorer chemotherapy response in metastatic patients. It can be used to predict the response to chemotherapy.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/patologia , Trombocitose , Adulto , Biomarcadores , Feminino , Humanos , Masculino , Metástase Neoplásica , Valor Preditivo dos Testes , Prognóstico , Resultado do Tratamento , Adulto Jovem
6.
Indian J Pathol Microbiol ; 59(1): 35-40, 2016 Jan-Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26960632

RESUMO

INTRODUCTION: The aim of this study was to assess whether epidermal growth factor receptor (EGFR) overexpression was a significant prognostic factor in clear cell renal cell carcinoma (CRCC) and whether its prognostic significance was affected by immunohistochemical expression patterns. MATERIALS AND METHODS: Immunohistochemistry was performed on 100 cases of CRCC using an antibody against EGFR. Tumors were grouped by nuclear grade (NG) as low-NG (NG1, 2) or high NG (NG3, 4), and by pathological stage as localized (pT1, 2), or locally invasive (pT3, 4). Clinical disease was grouped by clinical stage as early stage (stage I, II), or late stage (stage III, IV). Evaluation of the EGFR overexpression was based on cytoplasmic (EGFR Cyt), and membranous (EGFR Mem) staining. RESULTS: EGFR Cyt correlated with high NG (P = 0.001), lymphovascular invasion (P = 0.028), regional lymph node involvement (P = 0.027), metastasis (P = 0.001), late stage (P = 0.003), cancer-specific death (P = 0.036), and was a predictor for disease-specific survival (P = 0.012) whereas EGFR Mem correlated with only local invasion (P = 0.021) and perirenal invasion (P = 0.009) and did not show any correlation with cancer-specific death or disease specific survival. CONCLUSION: Our findings suggest that EGFR overexpression is an important prognostic factor in CRCC, and its prognostic value differs significantly with respect to the location of EGFR immunostaining. This prognostic difference may give direction on the management and treatment of CRCC patients.


Assuntos
Biomarcadores/análise , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/patologia , Receptores ErbB/análise , Perfilação da Expressão Gênica , Adulto , Idoso , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Prognóstico , Índice de Gravidade de Doença , Análise de Sobrevida
7.
World J Urol ; 34(6): 847-51, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26462931

RESUMO

PURPOSE: Although the role of second transurethral resection of bladder tumor (TURB) is well established in high-risk non-muscle-invasive bladder cancer, to the best of our knowledge, there is no study regarding the role of a second transurethral resection (TUR) after a complete first TURB in multimodal therapy (MMT). The aim of this study was to evaluate the role of a second TUR on disease-specific survival (DSS) and overall survival (OS) rates in muscle-invasive bladder cancer (MIBC) patients who were treated with MMT. METHODS: We assessed the data of 90 patients (stage T2-4, N0-1, M0 urothelial cancer) who were treated with MMT at our clinic between January 2000 and June 2014. Patients with incomplete initial TURB were excluded. A total of 43 patients had a second TUR before starting radiochemotherapy of MMT (group 1), and 47 patients (group 2) were treated with MMT without having a second TUR. The impact of second TUR on DSS and OS rates was the primary outcome measure of the study. RESULTS: Mean (SD, range) age and mean follow-up of the patients were 65.1 (7.1, 52-81) years and 60.3 (38.3, 6-159) months, respectively. The two groups were similar with regard to sex, age, presence of hydronephrosis, lymph node involvement and stage. The 5-year DSS rate was better in group 1 compared to group 2 (68 vs. 41 %) (p = 0.046). The 5-year OS rates of the patients were 63.7 and 40.1 % in groups 1 and 2, respectively (p = 0.054). Multivariate analysis revealed that second TUR, lymph node involvement, presence of hydronephrosis and tumor stage were independent prognostic factors for DSS. CONCLUSIONS: Second TUR should be performed in patients with MIBC who are going to be treated with bladder-preserving MMT protocols.


Assuntos
Cistectomia/métodos , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Liso , Invasividade Neoplásica , Tratamentos com Preservação do Órgão , Reoperação , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Uretra , Neoplasias da Bexiga Urinária/mortalidade
8.
Can Urol Assoc J ; 9(11-12): E789-94, 2015 Nov-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26600886

RESUMO

INTRODUCTION: We evaluated the prognostic effects of hematologic parameters of preoperative leukocytosis and neutrophil-to-lymphocyte ratio (NLR) in patients who underwent radical cystectomy for bladder cancer. METHODS: We retrospectively reviewed the medical records of 363 patients who underwent radical cystectomy for bladder cancer between January 1990 and June 2013. In total, 286 patients were included in the study. Age, gender, pathologic stage, lymph node involvement, preoperative hydronephrosis, histologic sub-type, surgical margin status, and lymphovascular invasion were recorded for each patient. Univariate and multivariate analysis were performed to determine the prognostic value of the preoperative clinical and laboratory parameters on disease-specific survival (DSS). Additionally, the correlation between leukocytosis and other factors were evaluated. RESULTS: According to the univariate analysis preoperative leukocytosis and NLR were detected as negative prognostic factors on DSS. Preoperative leukocytosis, NLR, stage, lymph node involvement, histologic subtype, grade and age were independent prognostic factors for DSS, on multivariate analysis. Patients with leukocytosis had higher stage, grade and lymphovascular invasion. CONCLUSIONS: Inexpensive, reproducible, and readily available peripheral blood count components of white blood cell count and NLR were independent prognostic factors, which can stratify DSS risks in bladder cancer patients who underwent radical cystectomy.

9.
Urology ; 86(3): e13-5, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26166674

RESUMO

Renal angiomyolipoma (AML) is the most common benign renal mesenchymal tumors. AMLs are usually asymptomatic and frequently affect women. Only epithelioid variant has malignant potential. Although life-threatening complications related to retroperitoneal bleeding and massive hematuria are possible, it is often detected incidentally. Pulmonary embolism as the first symptom is extremely rare. Herein, we present a case of renal AML who admitted with pulmonary embolism symptoms.


Assuntos
Angiomiolipoma/diagnóstico , Embolia Gordurosa/diagnóstico , Embolia Gordurosa/etiologia , Neoplasias Renais/diagnóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Adulto , Angiomiolipoma/complicações , Angiomiolipoma/cirurgia , Embolia Gordurosa/cirurgia , Feminino , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/cirurgia , Embolia Pulmonar/cirurgia
10.
Korean J Urol ; 56(5): 357-64, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25964836

RESUMO

PURPOSE: To investigate the effects of lymph node metastasis, skip metastasis, and other factors related to lymph node status on survival in patients who underwent radical cystectomy (RC) and extended lymph node dissection (eLND). MATERIALS AND METHODS: RC and eLND were performed in 85 patients with a diagnosis of bladder cancer. Disease-free survival (DFS) and overall survival (OS) were determined by using a Cox proportional hazards model that included the number of excised lymph nodes, the presence of pathological lymph node metastasis, the anatomical level of positive nodes, the number of positive lymph nodes, lymph node density, and the presence of skip metastasis. RESULTS: The mean number of lymph nodes removed per patient was 29.4±9.3. Lymph node positivity was detected in 85 patients (34.1%). The mean follow-up duration was 44.9±27.4 months (2-93 months). Five-year estimated OS and DFS for the 85 patients were 62.6% and 57%, respectively. Three of 29 lymph node-positive patients (10.3%) had skip metastasis. Only lymph node positivity had a significant effect on 5-year OS and DFS (p<0.001). No difference in OS and DFS was found between the three patients with skip metastasis and other lymph node-positive patients. Other factors related to lymph node status had no significant effect on 5-year OS and DFS. CONCLUSIONS: No factors related to lymph node status predict DFS and OS, except for lymph node positivity. OS and DFS were comparable between patients with skip metastasis and other lymph node-positive patients.


Assuntos
Linfonodos/patologia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia , Bexiga Urinária/patologia , Adulto , Idoso , Cistectomia , Feminino , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Prognóstico , Análise de Sobrevida , Resultado do Tratamento
11.
Pathol Res Pract ; 211(7): 505-12, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25908108

RESUMO

OBJECTIVES: To examine the prognostic significance of Gelsolin, NF-κB, and p53 in clear cell renal cell carcinoma (CRCC), which has an unpredictable behavior and tendency for recurrence and metastasis. MATERIALS AND METHODS: Immunohistochemistry was performed on 100 consecutive cases of CRCC using antibodies against Gelsolin, NF-κB, and p53. Tumors were grouped by nuclear grade (NG) as low NG (NG1, 2) or high NG (NG3, 4), and by pathological stage as localized (pT1, 2) or locally invasive (pT3, 4). Clinical stage was grouped as early stage (stage I, II) or late stage (stage III, IV). Evaluation was based on cytoplasmic (NF-κB(Cyt)) and nuclear (NF-κB(Nuc)) expression for NF-κB, nuclear expression for p53, membranous and cytoplasmic expression for Gelsolin. RESULTS: Gelsolin expression correlated with high NG (p = 0.001), metastasis (p = 0.003), late stage (p = 0.008), and cancer death (p = 0.001). NF-κB(Cyt) expression correlated with high NG (p = 0.002), perirenal invasion (p = 0.010), local invasion (p = 0.020), and late stage (p= 0.003). NF-κB(Nuc) expression failed to predict the prognosis of CRCC. p53 expression correlated with high NG (p = 0.045), lymphovascular invasion (p = 0.05), metastasis (p = 0.001), late stage (p = 0.028), and cancer death (p = 0.034). However, only Gelsolin was found to correlate with disease-specific survival, (p = 0.006), and neither NF-κB nor p53 showed such relation. CONCLUSION: Expressions of Gelsolin, NF-κB(Cyt), and p53 associated with aggressive behavior of CRCC, while Gelsolin expression specifically indicated poor disease-specific survival. The results of the present study served to determine biomarkers for predicting high-risk patients with CRCC, expected to show aggressive phenotype.


Assuntos
Carcinoma de Células Renais/patologia , Gelsolina/biossíntese , Neoplasias Renais/patologia , NF-kappa B/biossíntese , Proteína Supressora de Tumor p53/biossíntese , Adulto , Idoso , Biomarcadores Tumorais/análise , Carcinoma de Células Renais/mortalidade , Intervalo Livre de Doença , Feminino , Gelsolina/análise , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Neoplasias Renais/mortalidade , Masculino , Pessoa de Meia-Idade , NF-kappa B/análise , Modelos de Riscos Proporcionais , Proteína Supressora de Tumor p53/análise
12.
Clin Nephrol ; 83(4): 225-30, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25707457

RESUMO

OBJECTIVES: To evaluate the relationship between preoperative high sensitive C-reactive protein (hs-CRP) and procalcitonin (PCT) levels with the two important prognostic factors, tumor stage and tumor grade, in patients with clear cell renal cell carcinoma (RCC). METHODS: We evaluated 116 clear cell RCC patients who had undergone either radical or partial nephrectomy at Ankara University, Department of Urology between November 2011 and June 2014. Comparison of hs-CRP and PCT levels between the subgroups of pathological stage and nuclear grade were evaluated. The cut off value for hs-CRP and PCT was determined by receiver- operating characteristic (ROC) analysis. RESULTS: Median levels of hs-CRP and PCT levels of the patients were 0.818 mg/L and 0.0825 ng/mL, respectively. Hs-CRP levels of pT1 stage patients was found to be lower compared to the pT3-4 group (p = 0.016). Median hs-CRP levels of the grade 1 - 2 group was found to be significantly lower compared to the grade 3 - 4 group (p = 0.0001). The difference of median PCT levels between stage pT1 vs. pT2 (p = 0.003) and stage pT1 vs. pT3-4 (p = 0.0001) were statistically significant. Regarding Fuhrman grade, median PCT levels of Fuhrman grade 1 - 2 patients were significantly lower compared to grade 3 - 4 patients (p = 0.001). To predict higher Fuhrman grade of the tumor (grade 3 - 4), ROC analysis was performed and cut off values of 0.645 mg/L and 0.087 ng/mL were detected for hs-CRP and PCT, respectively. CONCLUSION: High preoperative serum hs-CRP and PCT values may play a role in the prognostic stratification of localized clear cell RCC patients. Further prospective validation is required prior to recommendation regarding suitability as biomarkers for RCC clinical prediction.


Assuntos
Proteína C-Reativa/análise , Calcitonina/sangue , Carcinoma de Células Renais/sangue , Neoplasias Renais/sangue , Precursores de Proteínas/sangue , Idoso , Peptídeo Relacionado com Gene de Calcitonina , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Curva ROC
13.
BJU Int ; 116(5): 721-6, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25715815

RESUMO

OBJECTIVES: To evaluate the effect of the interval between the initial and second transurethral resection (TUR) on the outcome of patients with high-risk non-muscle-invasive bladder cancer (NMIBC) treated with maintenance intravesical Bacillus Calmette-Guérin (BCG) therapy. PATIENTS AND METHODS: We reviewed the data of patients from 10 centres treated for high-risk NMIBC between 2005 and 2012. Patients without a diagnosis of muscle-invasive cancer on second TUR performed ≤90 days after a complete first TUR, and received at least 1 year of maintenance BCG were included in this study. The interval between first and second TUR in addition to other parameters were recorded. Multivariate logistic regression analysis was used to identify predictors of recurrence and progression. RESULTS: In all, 242 patients were included. The mean (sd, range) follow-up was 29.4 (22.2, 12-96) months. The 3-year recurrence- and progression-free survival rates of patients who underwent second TUR between 14 and 42 days and 43-90 days were 73.6% vs 46.2% (P < 0.001) and 89.1% vs 79.1% (P = 0.006), respectively. On multivariate analysis, the interval to second TUR was found to be a predictor of both recurrence [odds ratio (OR) 3.598, 95% confidence interval (CI) 1.885-8.137; P = 0.001] and progression (OR 2.144, 95% CI 1.447-5.137; P = 0.003). CONCLUSIONS: The interval between first and second TUR should be ≤42 days in order to attain lower recurrence and progression rates. To our knowledge, this is the first study demonstrating the effect of the interval between first and second TUR on patient outcomes.


Assuntos
Adjuvantes Imunológicos/administração & dosagem , Vacina BCG/administração & dosagem , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias da Bexiga Urinária/prevenção & controle , Neoplasias da Bexiga Urinária/cirurgia , Administração Intravesical , Progressão da Doença , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Prevenção Secundária/métodos , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/patologia
14.
Asian Pac J Cancer Prev ; 15(15): 6283-6, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25124612

RESUMO

In patients with microscopic hematuria there is a need for better identification of those who are at greater risk of harbouring bladder tumors. The RisikoCheck® questionnaire has a strong correlation with the presence of urothelial carcinoma (UC) of the bladder and in combination with other available tests may help identify patients who require detailed clinical investigations due to increased risk of presence of bladder tumors. This study aimed to evaluate the efficacy of RisikoCheck® questionnaire together with NMP-22® (BladderChek®) as a point-of-care urine test in predicting the presence of bladder tumors in patients presenting with microscopic hematuria as the sole finding. In this multi-institutional prospective evaluation of 303 consecutive patients without a history of urothelial carcinoma (UC), RisikoCheck® risk group assessment, urinary tract imaging and cystourethroscopy as well as urine cytology and Nuclear Matrix Protein-22 (NMP-22 BladderChek) testing were performed where available. The sensitivity, specificity, negative predictive value (NPV), and positive predictive values (PPV) for the risk adapted approach were calculated. All patients underwent cystoscopy, and tumors were detected in 18 (5.9%). Urine cytology and NMP-22 was positive for malignancy in 9 (3.2%) and 12 (7.5%) of patients, respectively. A total of 43 (14%) patients were in the high risk group according to the RisikoCheck® questionnaire. The sensitivity and specificity of the questionnaire in detecting a bladder tumor was 61.5 % and 84.0 % in the high risk group. In patients with either a positive NMP-22 test or high risk category RisikoCheck®, 23.6% had bladder tumors with a corresponding sensitivity of 54.2% and specificity of 88.6%. If both tests were negative only 3.3% of the patients had bladder tumors. The results of our study suggest that the efficacy of diagnostic evaluation of patients with microscopic hematuria may be further enhanced by combining RisikoCheck® questionnaire with NMP-22.


Assuntos
Citodiagnóstico , Hematúria/complicações , Hematúria/patologia , Sistemas Automatizados de Assistência Junto ao Leito/normas , Urinálise/métodos , Neoplasias da Bexiga Urinária/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Curva ROC , Medição de Risco , Inquéritos e Questionários , Turquia , Neoplasias da Bexiga Urinária/etiologia , Neoplasias da Bexiga Urinária/urina
15.
Int Urol Nephrol ; 46(8): 1521-6, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24677002

RESUMO

PURPOSE: The purpose of the study was to investigate the effect of ABO blood groups and Rhesus (Rh) factor on prognosis of patients undergoing radical cystectomy. MATERIALS AND METHODS: In this study, total number of 290 patients who underwent radical cystectomy between January 1990 and September 2012 were evaluated retrospectively. Patients were grouped as O and non-O according to ABO antigens; also positive and negative according to Rh factor. Parameters such as age, sex, stage, lymph node involvement and positive surgical margins were investigated. Disease-free and overall survival rates have been compared. Multivariate analysis were performed to determine independent prognostic factors. RESULTS: A total of 260 (89.7 %) male and 30 (10.3 %) female patients participated in the study. Mean follow-up was 37.7 ± 18.9 months. A total of 180 patients were non-O (62.1 %),while the 110 patients had the blood group O (37.9 %). The number of Rh positive and negative patients were 247 (85.2 %) and 43 (14.8 %), respectively. According to the univariate and multivariate analyses, ABO blood groups and Rh factor did not exhibit any significant impact on overall and disease-specific survival. CONCLUSION: ABO blood group and Rh factor were not associated with the prognosis of bladder cancer patients who underwent radical cystectomy. However, prospective studies are needed in larger patient series for further evaluations.


Assuntos
Sistema do Grupo Sanguíneo ABO/sangue , Carcinoma/sangue , Carcinoma/cirurgia , Sistema do Grupo Sanguíneo Rh-Hr/sangue , Neoplasias da Bexiga Urinária/sangue , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Carcinoma/secundário , Cistectomia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/patologia
16.
Scand J Urol ; 48(2): 177-82, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23941315

RESUMO

OBJECTIVE: This study aimed to assess the oncological outcomes of patients experiencing an upgrade from their initial biopsy pathology, and to determine whether these tumours have characteristics resembling their initial biopsy Gleason score (GS) or final radical prostatectomy (RP) GS. MATERIAL AND METHODS: Data on 632 patients undergoing open retropubic RP between January 1994 and May 2011 at Ankara University were investigated retrospectively. Data included age, preoperative prostate-specific antigen (PSA), clinical stage, biopsy GS, prostate volume, RP specimen GS, surgical margin positivity, pathological T stage and biochemical recurrence. Biochemical recurrence of GS concordant and upgraded tumours was compared. RESULTS: GS concordance was found in 378 cases (59.8%) and GS upgrading was observed in 183 patients (28.9%). GS upgraded tumours were found to have higher biochemical recurrence rates than their corresponding concomitant GS group. Multivariate analysis revealed that serum PSA level, pathological T stage and GS upgrading were independent prognostic factors for biochemical recurrence. Age and prostate volume were not found to be independent prognostic factors. CONCLUSION: Upgrade in biopsy GS is a predictor for aggressive tumours with a higher risk for biochemical recurrence than concordant tumours. It may be observed in about a quarter of patients. As it was not possible to identify correctly those patients who may experience an upgrade in GS, patients who are candidates for less invasive treatment options must be informed about the risk of upgrading and the possibility of a worse clinical course.


Assuntos
Próstata/patologia , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Biópsia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estudos Retrospectivos
17.
Korean J Urol ; 54(8): 499-503, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23956823

RESUMO

PURPOSE: We evaluated the prognostic value of type 2 diabetes mellitus (DM) in patients treated surgically for localized renal cell carcinoma (RCC). MATERIALS AND METHODS: Between 1995 and 2011, 588 patients with renal tumor diagnoses were treated surgically and 492 patients with pathologically confirmed nonmetastatic RCC diagnoses were included in the study. The associations of clinical and pathologic parameters with a type 2 DM diagnosis were evaluated. Kaplan-Meier estimations for disease-specific survival (DSS) and overall survival (OS) were generated according to type 2 DM diagnosis, and the log-rank test was used to compare survival according to the variables. RESULTS: The mean age of the patients was 56.7±12 years (range, 15 to 84 years; median, 58 years) and the mean length of follow-up was 35.9±28 months (range, 1 to 145 months; median, 34.3 months). Of the 492 patients, 62 (12.6%) had a diagnosis of DM at the time of surgery (group I) and 430 did not have DM (group II). The mean age and the incidence of clear cell RCC histological subtype were significantly higher in group I than in group II (p<0.001 and p=0.036, respectively). Although DSS and OS were lower in group I, this difference was not significant. Type 2 DM was not detected as an independent prognostic factor for DSS and OS. CONCLUSIONS: This study investigated the role and effect of DM on the prognosis of localized RCC that was treated surgically. The present study did not detect DM as an independent prognostic factor for RCC.

18.
Urol Int ; 91(2): 182-6, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23751593

RESUMO

PURPOSE: We evaluated the risk factors for residual tumor detection after transurethral resection of bladder tumors (TURBT) in patients with newly diagnosed high-grade T1 transitional cell carcinoma of the bladder. PATIENTS AND METHODS: Overall 132 patients underwent TURBT for primary bladder tumors and were diagnosed as high-grade T1 bladder cancer. Patients with incomplete resections were excluded from the study. Clinical and pathologic characteristics of the patients were compared and multivariate analysis was performed to determine independent prognostic factors. RESULTS: Residual tumor was demonstrated in 57 (43.1%) of the patients. The residual tumor rate was significantly lower in patients with solitary tumors, tumors <3 cm in diameter, muscle presence in the initial TURBT pathologic sample and treated by an expert surgeon. In patients with solitary bladder tumors, tumors at the dome and posterior wall of the bladder exhibited higher rates of residual tumor (p < 0.0001). The time elapsed between first and second TURBT was significantly shorter in patients without residual tumor compared to patients with residual tumor at second TURBT (32.6 ± 9.1 vs. 39.3 ± 10.9 days, respectively, p = 0.001). Multivariate analysis demonstrated that time elapsed between first and second TURBT is the most important parameter for residual tumor detection. CONCLUSION: Our study revealed that multiple tumors, tumors >3 cm in size, absence of detrusor muscle in the initial TURBT specimen, TURBT performed by trainees and finally, as a new finding, prolonged interval between first and second TURBT are independent predictors for residual tumor detection in patients with high-grade T1 tumors.


Assuntos
Carcinoma de Células de Transição/cirurgia , Recidiva Local de Neoplasia/cirurgia , Reoperação/métodos , Neoplasias da Bexiga Urinária/cirurgia , Adulto , Idoso , Carcinoma de Células de Transição/patologia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Recidiva Local de Neoplasia/patologia , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologia
19.
J Urol ; 190(6): 2081-5, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23764076

RESUMO

PURPOSE: We assessed the effects of the number of cisplatin, etoposide and bleomycin cycles on long-term renal function. MATERIALS AND METHODS: A total of 157 patients with primary testicular germ cell tumors were treated between 1995 and 2013, of whom 113 (72%) received chemotherapy as the primary intervention. Data were collected retrospectively. The estimated glomerular filtration rate was determined using the Modification of Diet in Renal Disease (MDRD) formula based on pretreatment and last followup visit serum creatinine measurements. Patients who did not receive chemotherapy were compared to those who received cisplatin based chemotherapy. The chemotherapy group was also divided into 3 subgroups according to the number of chemotherapy cycles (2, 3, or 4 or more). RESULTS: At the last followup visit serum creatinine and the estimated glomerular filtration rate significantly differed between the chemotherapy and nonchemotherapy groups. The decrease in the median estimated glomerular filtration rate was significantly greater in the chemotherapy than the nonchemotherapy group (p<0.001). New onset stage 3 chronic kidney disease was observed in 19 patients (12.1%) in the chemotherapy group, including 0%, 5.9%, 13.8% and 20.9% who received 0, 2, 3, or 4 or more chemotherapy cycles, respectively. Except for the difference between the nonchemotherapy group and the 2-cycle chemotherapy group the differences between the groups in new onset chronic stage 3 kidney disease were statistically significant. CONCLUSIONS: Patients with testicular tumors who received cisplatin based chemotherapy showed a significant decrease in the estimated glomerular filtration rate and a significant increase in new onset stage 3 chronic kidney disease compared to patients who received no cycle. However, in patients at high risk with stage I nonseminomatous germ cell tumor who elected 2 cycles of cisplatin, etoposide and bleomycin the chemotherapy had no statistically significant effect on these parameters compared to those in patients who received no chemotherapy.


Assuntos
Antineoplásicos/administração & dosagem , Bleomicina/administração & dosagem , Cisplatino/administração & dosagem , Etoposídeo/administração & dosagem , Rim/efeitos dos fármacos , Rim/fisiopatologia , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/fisiopatologia , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/fisiopatologia , Adulto , Antineoplásicos/farmacologia , Bleomicina/farmacologia , Cisplatino/farmacologia , Creatinina/sangue , Etoposídeo/farmacologia , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
20.
Urol J ; 10(1): 774-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23504681

RESUMO

PURPOSE: To evaluate the influence of perinephric fat infiltration and tumor size on survival of patients with renal cell carcinoma (RCC). MATERIALS AND METHODS: We have retrospectively reviewed the records of 338 consecutive patients with pT1-3aN0M0 RCC, including 275 pT1-2 and 63 pT3a tumors, who underwent open partial or radical nephrectomy between 1995 and 2008. Univariate and multivariate analyses were performed in order to evaluate the prognostic factors. RESULTS: Median follow-up period was 36.07 months. Receiver Operating Characteristic curve analysis determined the optimal tumor size cutoff value as 7 cm (Area Under the Curve: 0.65 ± 0.047; 95% Confidence Interval: 0.558 to 0.741). Perinephric fat invasion and Fuhrman grade were independent prognostic factors for disease-specific survival (DSS). In patients with tumor size >7 cm, perinephric fat invasion affected DSS significantly. Tumor size (according to the cutoff value of 7 cm) significantly affected DSS in patients with pT3a disease. According to the TNM 2002 staging system, perinephric fat invasion did not have any significant effect on DSS in patients with tumor size smaller than 4 cm, unlike tumor size of 4 to 7 cm and >7 cm. pT3a tumors larger than 7 cm demonstrated the worst prognosis compared to other groups. CONCLUSION: Perinephric fat invasion was demonstrated as a significant prognostic factor for RCC patients with tumor size >4 cm. Consequently, evaluation of pT3a patients should take tumor size into consideration for better prognostic analysis.


Assuntos
Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/patologia , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Carga Tumoral , Tecido Adiposo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Taxa de Sobrevida
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