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1.
J Surg Oncol ; 121(4): 688-696, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31930511

RESUMO

BACKGROUND: To investigate the effect of frailty on short-term postoperative outcomes and total hospital charges (THCs) in patients with non-metastatic upper urinary tract carcinoma, treated with radical nephroureterectomy (RNU). METHODS: Within the National Inpatient Sample (NIS) database we identified 11 258 RNU patients (2000-2015). We used the Johns Hopkins frailty-indicator to stratify patients according to frailty status. Time trends and multivariable logistic, Poisson and linear regression models were applied. RESULTS: Overall, 1801 (16.0%) patients were frail, 4664 (41.4%) were older than 75 years and 1530 (13.6%) had Charlson comorbidity index ≥2. Rates of frail patients increased over time, from 7.3% to 24.9% (P < .001). Frail patients exhibited higher rates (all P < .05) of overall complications (62.6% vs 50.9%), in-hospital mortality (1.6% vs 1.0%), non-home-based discharge (22.7% vs 12.1%), longer length of stay (LOS) (6 vs 1 day) and higher THCs ($49 539 vs $39 644). Moreover, frailty independently predicted (all P < .05) overall complications (OR, 1.46), in-hospital mortality (OR, 1.52), non-home-based discharge (OR, 1.36), longer LOS (RR, 1.30) and higher THCs (RR, +$11 806). CONCLUSION: Preoperative frailty is important in RNU patients. One of four RNU patients is frail. Moreover, frailty predicts short-term postoperative complications, as well as longer LOS and higher THCs after RNU.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Nefroureterectomia/estatística & dados numéricos , Neoplasias Urológicas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nefroureterectomia/efeitos adversos , Nefroureterectomia/mortalidade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Período Pré-Operatório , Neoplasias Urológicas/epidemiologia
2.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(6): 1056-1061, 2019 Dec 18.
Artigo em Chinês | MEDLINE | ID: mdl-31848504

RESUMO

OBJECTIVE: To identify the effect of preoperative anemia on the prognosis of patients with upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy. METHODS: Clinicopathological and prognosis data on 686 patients with UTUC who underwent RNU at Peking University First Hospital between January 2000 and December 2013 were retrospectively analyzed. Preoperative anemia was defined as hemoglobin <130 g/L in men and <120 g/L in women based on the World Health Organization classification. The Kaplan-Meier method with log-rank test was applied to estimate the effect of anemia on survival. The associations of clinicopathologic features with overall survival and cancer-specific survival were evaluated using univariate and multivariate Cox regression models. RESULTS: There were 303(44.2%, 303/686) male and 383(55.8%, 383/686) female patients, and the median age was 68 years (interquartile range: 60-74 years). In all, 320 (46.6%, 320/686) patients were anemic before surgery. The median follow-up duration was 47 months. In all, 160 (23.3%) patients died, 141 (20.6%) died of cancer and 19 (2.7%) died of other disease or accidents. Preoperative anemia was associated with gender (P=0.002), age (P<0.001), lymph node positive (P=0.026), increased tumor grade (P=0.018), concomitant carcinoma in situ (P=0.038), tumor necrosis (P=0.007) and poor renal function (P<0.001). In univariate analysis, overall mortality was correlated with pre-operative anemia (P<0.001), gender (P=0.009), hydronephrosis (P=0.024), tumor stage (P<0.001), lymph node positive (P<0.001), tumor grade (P<0.001), tumor architecture(P<0.001), sarcomatoid differentiation (P=0.013), history of ureteroscope (P=0.033) and tumor hemorrhage (P<0.001); cancer-specific mortality was correlated with preoperative anemia (P=0.001), gender (P=0.001), hydronephrosis (P=0.043), tumor stage (P<0.001), lymph node positive (P<0.001), tumor grade (P<0.001), tumor architecture (P<0.001), sarcomatoid differentiation (P=0.016), history of ureteroscope (P=0.028) and tumor hemorrhage (P=0.003). A multivariate Cox proportional hazards model indicated that preoperative anemia was an independent prognositic predictor for overall mortality (P<0.001, HR=1.861) and cancer-specific mortality (P=0.003, HR=1.688). CONCLUSION: The preoperative anemia is an independent risk factor for cancer-specific survival and overall survival. Hemoglobin levels should be considered during patient counseling and in decision-making for further therapy.


Assuntos
Anemia , Carcinoma de Células de Transição , Neoplasias Urológicas , Idoso , Carcinoma de Células de Transição/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrectomia , Nefroureterectomia , Prognóstico , Estudos Retrospectivos , Neoplasias Urológicas/cirurgia
4.
J Cancer Res Clin Oncol ; 145(11): 2863-2870, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31501983

RESUMO

PURPOSE: To determine the association between lymphovascular invasion (LVI) and upper tract urothelial carcinoma (UTUC) among patients who underwent radical nephroureterectomy (RNU). MATERIALS AND METHODS: From 2003 and 2018, retrospective data of 453 patients treated for UTUC with open, laparoscopic, or robotic RNU were collected. Pathological specimens were assessed for LVI through hematoxylin and eosin staining. According to presence of LVI, patients were stratified into two groups and compared for perioperative characteristics. Kaplan-Meier analysis was used to assess progression-free (PFS), cancer-specific (CSS), and overall survival (OS). Uni- and multivariate Cox regression models were used to find significance of LVI to survival. RESULTS: LVI was present in 132 (29.1%) of patients and was associated with higher age and lower preoperative GFR. Pathological outcomes included significantly higher tumor grade, higher rates of lymph node invasion and more positive surgical margins. During median 23.2 months follow-up (mean 37.1 months), 59.2% (n = 268) of total patients had tumor recurrence, with highest incidences in lymph nodes (51.5%). 5-year PFS, CSS, and OS were estimated at 35.4%, 94.6%, and 91.1% in LVI-negative patients and 17.2%, 75.1%, and 70.8% in LVI-positive patients, respectively (all p < 0.001). Multivariate analysis showed LVI to be an independent predictor of PFS (HR = 1.480; p = 0.018). CONCLUSION: LVI is an independent predictor of adverse PFS and is associated with poor CSS and OS in patients undergoing RNU for UTUC. These results may guide clinicians in selecting patients for adjuvant chemotherapy. Future prospective trials are necessary to further validate our results.


Assuntos
Linfonodos/patologia , Vasos Linfáticos/patologia , Recidiva Local de Neoplasia/mortalidade , Nefroureterectomia/mortalidade , Neoplasias Urológicas/mortalidade , Idoso , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias Urológicas/patologia , Neoplasias Urológicas/cirurgia
5.
Ann Surg Oncol ; 26(11): 3774-3781, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31313043

RESUMO

BACKGROUND: This study aimed to investigate the long-term oncologic outcomes of laparoscopic radical nephroureterectomy (LRNU) and open radical nephroureterectomy (ORNU) for patients with clinical and pathologic T3N0M0 upper tract urothelial carcinoma (UTUC). METHODS: Among 375 UTUC patients who underwent radical nephroureterectomy, this study identified 144 pT3N0M0 patients as cohort 1 after propensity score (PS) matching. Among 399 UTUC patients, the study identified 110 cT3N0M0 patients as cohort 2 after PS matching. Oncologic outcomes such as intravesical recurrence-free survival (IVRFS) and cancer-specific survival (CSS) were assessed by multivariate Cox's regression analysis. RESULTS: Cohort 1 of pT3N0M0 UTUC had 3-year CSS and IVRFS rates of 67.9 and 52.7%, respectively, in the LRNU group, which were significantly lower than in the ORNU group (81.4%, p = 0.039 and 71.6%, p = 0.046). The multivariate Cox's regression analysis identified the type of surgical approach (LRNU vs. ORNU) as one of the independent prognostic factors for CSS (hazard rate [HR], 1.88, p = 0.043) and IVRFS (HR, 1.75, p = 0.049). Cohort 2 of cT3N0M0 UTUC had 3-year CSS and IVRFS rates of 48.5 and 41.4%, respectively, in the LRNU group, which were significantly lower than in the ORNU group (65.8%, p = 0.049 and 67.2%, p = 0.047), and the type of surgical approach (LRNU vs. ORNU) remained as one of the independent prognostic factors for CSS and IVRFS. CONCLUSIONS: Based on clinical and pathologic T3N0M0 UTUC populations after PS adjustments, LRNU resulted in poorer CSS and IVRFS than ORNU.


Assuntos
Laparoscopia/mortalidade , Nefroureterectomia/mortalidade , Neoplasias Urológicas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias Urológicas/patologia
6.
Int J Clin Oncol ; 24(9): 1089-1098, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31218529

RESUMO

BACKGROUND: Nivolumab has demonstrated antitumor activity and manageable safety in the single-arm, phase II CheckMate 275 study in patients with unresectable locally advanced or metastatic platinum-resistant urothelial carcinoma. We report updated results of the global population and a subanalysis of Japanese patients from this study. METHODS: Patients received nivolumab 3 mg/kg intravenously every 2 weeks until progression or unacceptable toxicity. The primary endpoint was objective response rate (ORR) confirmed by blinded independent review committee (BIRC) per Response Evaluation Criteria in Solid Tumors v1.1. Secondary endpoints included progression-free survival (PFS) by BIRC and overall survival (OS). Safety was also reported. The minimum follow-up was 21 months. RESULTS: Overall, 270 patients were treated with nivolumab globally; 23 patients were Japanese. In the global and Japanese populations, respectively, ORR per BIRC was 20.4% and 21.7%; median PFS was 1.9 (95% confidence interval [CI] 1.9-2.3) and 3.8 months (95% CI 1.9-7.2); and median OS was 8.6 (95% CI 6.1-11.3) and 21.0 months (95% CI 7.2-not reached). The most common any grade treatment-related adverse events were fatigue (18.1%) and diarrhea (12.2%) in the global population; the most common in the Japanese population were diarrhea (26.1%) and pyrexia (13.0%). Grade 3 or 4 treatment-related adverse events occurred in 61 (22.6%) and seven (30.4%) of the global and Japanese patients, respectively. CONCLUSIONS: Nivolumab continues to show antitumor activity and survival in the global population of CheckMate 275. Meaningful clinical benefit was also observed in Japanese patients. No new safety signals were identified.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/uso terapêutico , Nivolumabe/efeitos adversos , Nivolumabe/uso terapêutico , Neoplasias Urológicas/tratamento farmacológico , Idoso , Grupo com Ancestrais do Continente Asiático , Diarreia/induzido quimicamente , Resistencia a Medicamentos Antineoplásicos , Fadiga/induzido quimicamente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Qualidade de Vida , Critérios de Avaliação de Resposta em Tumores Sólidos , Resultado do Tratamento , Neoplasias Urológicas/mortalidade , Neoplasias Urológicas/patologia , Neoplasias Urológicas/cirurgia
7.
Prog Urol ; 29(6): 318-325, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31153857

RESUMO

INTRODUCTION: The incidence of cancer increases with age, especially for urological cancers. The frailty of the elderly persons may expose them to more postoperative complications resulting in prolonged hospitalization, increased morbidity or even increased mortality, and delayed or impossible return to normal life. In such cases, the benefit of surgery and therefore its realization can be questioned. PATIENTS AND METHOD: This article reports the experience of a pre-operative risk assessment in a population of elderly patients treated for urologic cancer. This retrospective study aims to report the feasibility and the main results of this systematic preoperative multi-professional evaluation. RESULTS: Between April 2016 and February 2017, 31 elderly patients were evaluated. The evaluation revealed: moderate to severe malnutrition in 59 % of cases, a patient judged from a geriatric point of view fit, intermediate or fragile in respectively 25 %, 35 % and 40 % of cases. This evaluation led to propose a modification of an element of care for 66 % of patients and to propose therapeutic abstention for only 3 patients. CONCLUSION: An evaluation whose purpose is to adapt to the physiological age of patients and their overall state of health, surgical treatment and postoperative management is feasible and seems to help unmask elements of fragility usually not detected. LEVEL OF EVIDENCE: 4.


Assuntos
Avaliação Geriátrica , Equipe de Assistência ao Paciente , Cuidados Pré-Operatórios/métodos , Medição de Risco , Neoplasias Urológicas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos/métodos
8.
Int J Clin Oncol ; 24(11): 1412-1418, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31197556

RESUMO

BACKGROUND: No definitive evidence exists regarding the clinical significance of histologic variants (HV) in upper urinary tract cancer. We investigated the impact of HV on prognosis in patients with upper urinary tract cancer following radical surgery. PATIENTS AND METHODS: We retrospectively analyzed 451 patients with upper urinary tract cancer who underwent radical nephroureterectomy at six affiliated hospitals from 1990 to 2015. Patients with distant metastatic disease prior to surgery and those who received neoadjuvant chemotherapy were excluded, leaving 441 eligible patients. Patients were classified into two groups: pure urothelial carcinoma (UC) and HV. The clinicopathological variables of each group were examined using Kaplan-Meier plots and proportional Cox hazard ratios (HR) to compare the oncological outcomes between the two groups. RESULTS: HV included 37 patients (8%). Compared with the pure UC patients, HV patients had significantly worse recurrence-free survival (RFS) and cancer-specific survival (CSS; RFS p = 0.0002, CSS p = 0.0001). Multivariate analysis for RFS revealed HV were independent predictors (HR 1.92; p = 0.026), but the association did not remain significant for CSS. There was no significant difference in CSS between the adjuvant chemotherapy (AC) group and the non-AC group for all HV patients, except in patients with ≥ pT3 tumor or positive lymph node status where the AC group had significantly favorable CSS. CONCLUSIONS: HV in upper urinary tract cancer are independent predictors for RFS, but not for CSS. AC improved CSS for HV patients with ≥ pT3 tumor or positive lymph node status.


Assuntos
Nefroureterectomia/métodos , Neoplasias Urológicas/patologia , Neoplasias Urológicas/cirurgia , Idoso , Carcinoma de Células de Transição/tratamento farmacológico , Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Quimioterapia Adjuvante , Feminino , Humanos , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias Ureterais/tratamento farmacológico , Neoplasias Ureterais/mortalidade , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia , Neoplasias Urológicas/tratamento farmacológico , Neoplasias Urológicas/mortalidade
9.
Cancer Biomark ; 25(2): 151-160, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31045512

RESUMO

BACKGROUND: Amplified in breast cancer 1 (AIB1) is a candidate oncogene in human breast cancer, which has been identified to be amplified and overexpressed in several types of other human cancers. Abnormalities of AIB1 and its clinical/prognostic significance, however, in upper tract urothelial carcinoma (UTUC) remain unclear. OBJECTIVE: To explore what role AIB1 plays in upper tract urothelial carcinoma. METHODS: The expression of AIB1 was analyzed using immunohistochemical staining in 133 UTUC patients. Overall, cancer specific and recurrence-free survival rates (OS, CSS, and RFS) were estimated using the Kaplan-Meier method. Multivariable COX regression models containing relevant clinicopathological variables addressed the prediction of postoperative outcome. RESULTS: High AIB1 expression was observed to be associated with increased hazard ratios for 5-year CSS (80.6% vs. 55.8%, p= 0.008) and OS (78.1% vs. 54.8%, p= 0.006). Multivariable analysis revealed that elevated AIB1 expression was an independent prognostic predictor of OS, CSS and RFS. Additionally, pT, pN and hydronephrosis were independently associated with oncologic outcome of UTUC. Three proposed nomograms were proposed to provide an individualized risk estimate of postoperative outcome in patients with UTUC. CONCLUSIONS: AIB1 can be used as an independent molecular marker for the prognosis of clinical outcomes of UTUC.


Assuntos
Biomarcadores Tumorais , Expressão Gênica , Coativador 3 de Receptor Nuclear/genética , Neoplasias Urológicas/genética , Neoplasias Urológicas/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Nefroureterectomia/métodos , Coativador 3 de Receptor Nuclear/metabolismo , Modelos de Riscos Proporcionais , Curva ROC , Resultado do Tratamento , Carga Tumoral , Neoplasias Urológicas/patologia , Neoplasias Urológicas/cirurgia
10.
Medicine (Baltimore) ; 98(22): e15930, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145361

RESUMO

The stagnant mortality rates for metastatic urothelial cancer (UC) have provoked efforts to find novel treatments. To test the utility of the extirpative surgery for primary tumor as an option for these patients, we investigated the perioperative and oncologic outcomes of surgery for primary tumors in metastatic UC patients.We reviewed the medical records of 130 metastatic UC patients (bladder: 88, upper tract UC: 42) at diagnosis from November 2005 to November 2016. A total of 56 patients (surgery group) underwent chemotherapy with extirpative surgery for the primary tumor, and 74 patients (non-surgery group) received chemotherapy. We evaluated perioperative outcomes, cancer-specific survival (CSS), and overall survival (OS) using Kaplan-Meier methods and factors related to OS and CSS using Cox regression models.Surgery group showed similar perioperative outcome and postoperative complications to those previously reported in UC patients without metastasis, and fewer urinary complications than non-surgery group. Surgery group showed better oncological outcomes than non-surgery group for median CSS (16.0 vs 10.0 months, P = 0.014) and median OS (14.0 vs 9.0 months, P = 0.043). Multivariate analysis showed Eastern Cooperative Oncology Group performance status and metastasis to liver as significant predictors of CSS and OS. Surgery was not related with OS, but a significant predictor of CSS.Extirpative surgery for primary tumor in metastatic UC can be feasible and it might have survival benefits, especially those patients with a tolerable general condition and no liver metastasis. In addition, LT reduces the possibility of a surgical procedure towing to urinary complications.


Assuntos
Tempo para o Tratamento/estatística & dados numéricos , Neoplasias Urológicas/mortalidade , Neoplasias Urológicas/cirurgia , Urotélio/cirurgia , Idoso , Estudos de Viabilidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/terapia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Neoplasias Urológicas/patologia , Urotélio/patologia
11.
Urology ; 132: 10-17, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31129192

RESUMO

Indocyanine green (ICG) is a dye used for fluorescent-guided surgery. This review article addresses the recent surge in reported uses of ICG in various surgical fields and provides a comprehensive and up to date review of the uses of ICG in urologic surgery.


Assuntos
Corantes , Verde de Indocianina , Cirurgia Assistida por Computador , Neoplasias Urológicas/diagnóstico por imagem , Neoplasias Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Humanos , Imagem Óptica
12.
Int J Surg ; 66: 12-17, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31018160

RESUMO

OBJECTIVE: We investigated the impact of cisplatin-based adjuvant chemotherapy (AC) on oncologic outcomes including recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) after radical nephroureterectomy (RNU) for patients with pT3NanyM0 upper tract urothelial carcinoma (UTUC). METHODS: We retrospectively reviewed 293 patients who underwent RNU for UTUC between 1995 and 2017. Clinicopathologic characteristics of patients were examined and compared according to the use of AC. Kaplan-Meier survival analysis was used to illustrate RFS, CSS and OS. Cox proportional hazard models were applied to identify factors predicting oncologic outcomes. RESULTS: Among the 293 total patients, 127 (43.3%) patients received AC. During a mean follow-up of 59.7 months, recurrence and/or distant metastasis were identified in 124 (42.3%) patients, and 106 (36.2%) patients died overall, of which 93 (31.7%) died from UTUC. The 5-year RFS, CSS and OS rates of overall patients were 51.3%, 68.0% and 64.7%, respectively. In multivariate analysis, AC was inversely associated with tumor recurrence (HR = 0.74, P = 0.028) but not significantly associated with death from UTUC (P = 0.237) and death from all-cause (P = 0.433). The 5-year RFS of patients who had received AC was 58.0%, while 44.0% for patients who had only been observed after RNU. CONCLUSION: AC improved RFS, but did not have a significant effect on CSS and OS in patients with pT3NanyM0 UTUCs following RNU. Further efforts are needed to identify reliable criteria in the clinic for patients that would benefit from AC.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células de Transição/tratamento farmacológico , Neoplasias Urológicas/tratamento farmacológico , Idoso , Carcinoma de Células de Transição/secundário , Carcinoma de Células de Transição/cirurgia , Quimioterapia Adjuvante/métodos , Cisplatino/administração & dosagem , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Recidiva Local de Neoplasia , Nefroureterectomia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Neoplasias Urológicas/cirurgia
13.
World J Surg Oncol ; 17(1): 65, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975161

RESUMO

BACKGROUND: To assess the feasibility and effectiveness of total laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma (UUTUC) under a single surgical position. METHODS: The medical data of 89 UUTUC patients were collected, who were treated in our institution from Jan 2016 to Jun 2018. The 45 cases that underwent total laparoscopic nephroureterectomy with a single position were allocated in the test group, while the 44 patients who received retroperitoneal laparoscopy combined with hypogastric oblique incision were assigned in the control group. We compared the two groups in perioperative indicators and tumor recurrence rate and analyzed the clinical effect of the new surgical treatment of UUTUC. RESULTS: All 89 operations for UUTUC were successful and had no conversion to open surgery. No obvious complications occurred during the perioperative period. The test group had significantly shorter average operation time (96.58 ± 8.56 min versus 147.45 ± 9.16 min), less blood loss (39.58 ± 4.15 ml versus 46.50 ± 4.58 ml), earlier ambulation (7.47 ± 1.01 h versus 11.39 ± 1.82 h), and shorter length of stay in hospital (6.98 ± 1.14 days versus 9.89 ± 1.51 days) (P < 0.05). The visual analogue scale (VAS) scores of the test group at 1 h, 12 h, and 24 h after operation were lower compared with those of the control group (P < 0.05). No significant difference was found in the tumor stage, tumor grade, postoperative gastrointestinal function recovery time, follow-up time, and tumor recurrence rate between the two groups. CONCLUSIONS: Compared with the traditional surgical methods, the total laparoscopic treatment of UUTUC under a single surgical position had advantages of shorter operation time, less blood loss, and early postoperative ambulation. The new operative method could shorten the length of stay and accelerate recovery of patients, and it is a viable surgical procedure which deserved clinical application and promotion. TRIAL REGISTRATION: Our trial was approved and has been registered in the ethics committee of the Yantai Yuhuangding Hospital (Approval NO.[2015]171) .


Assuntos
Laparoscopia/métodos , Nefroureterectomia/métodos , Sistema Urinário/cirurgia , Neoplasias Urológicas/cirurgia , Idoso , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Sistema Urinário/patologia , Neoplasias Urológicas/patologia
14.
Int J Surg ; 65: 88-93, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30951871

RESUMO

PURPOSE: To retrospectively evaluate the prognostic value of preoperative plasma fibrinogen to predict oncological outcome and intravesical recurrence in upper urinary tract urothelial carcinoma. METHODS: This retrospective study comprised 130 patients with non-metastatic upper urinary tract urothelial carcinoma who underwent surgery between June 2009 and June 2017 at a single center. Patients were categorized base on an optimal value of preoperative plasma fibrinogen. Progression-free and cancer-specific survival were assessed using Kaplan-Meier method. The associations between plasma fibrinogen and clinical outcomes were assessed with univariate and Multivariate analysis. RESULTS: Elevated plasma fibrinogen was associated with advance tumor stage, high tumor grade and tumor size. No significant association was found between plasma fibrinogen and intravesical recurrence. Multivariate analysis revealed that plasma fibrinogen ≥3.602 g/L was an independent prognostic indicator for progression-free survival (HR = 2.18; 95% CI: 1.17-4.06; p = 0.01) and cancer-specific survival (HR = 2.2; 95% CI: 1.13-4.28; p = 0.02), as well as pathological T stage and tumor grade. CONCLUSIONS: Elevated preoperative plasma fibrinogen is an independent unfavorable prognostic factor for oncological outcomes in patients with upper urinary tract urothelial carcinoma. However, there is no association between preoperative plasma fibrinogen and intravesical recurrence. As an effective and easily accessible biomarker, this parameter can be applied in pre-intervention risk stratification of upper urinary tract urothelial carcinoma.


Assuntos
Fibrinogênio/metabolismo , Recidiva Local de Neoplasia/sangue , Neoplasias Urológicas/sangue , Neoplasias Urológicas/patologia , Adulto , Idoso , Biomarcadores Tumorais/sangue , Testes de Coagulação Sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Gradação de Tumores , Nefroureterectomia , Prognóstico , Estudos Retrospectivos , Neoplasias Urológicas/cirurgia , Urotélio
15.
Eur J Surg Oncol ; 45(5): 747-754, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30871883

RESUMO

OBJECTIVE: Sarcopenia is associated with unfavorable prognosis in patients undergoing surgical treatments of the respiratory tract, gastrointestinal tract and urinary tracts. We summarized all available evidence to investigate the prognostic value of sarcopenia in patients with surgically treated urothelial carcinoma (UC). METHODS: We conducted a comprehensive study search up to January 2019, searching the online database Embase, PubMed and Cochrane Library. The hazard ratio (HR) and 95% confidence interval (CI) were extracted from the studies. RESULTS: A total of 12 research consisting of 2075 patients were enrolled in the quantitative synthesis. We observed that UC patients with sarcopenia had a worse OS (HR = 1.87; 95%CI 1.43-2.45; P < 0.001) and CSS (HR = 1.98; 95%CI 1.43-2.75; P < 0.001). Stratified by tumor, sarcopenia is also an unfavorable factor for OS and CSS in patients with upper tract urothelial carcinoma (UTUC) or urothelial carcinoma of bladder (UCB). CONCLUSION: Sarcopenia is an unfavorable factor for OS and CSS in patients with surgically treated UC. Besides, stratified by tumor, the results of patients with UTUC or UCB are consistent with previous results. More prospective studies are required to validate our findings.


Assuntos
Sarcopenia/complicações , Neoplasias Urológicas/cirurgia , Humanos , Prognóstico , Fatores de Risco , Taxa de Sobrevida
16.
Crit Rev Oncol Hematol ; 135: 59-65, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30819447

RESUMO

BACKGROUND: The role of neoadjuvant chemotherapy (NAC) for the management of upper tract urothelial carcinoma (UTUC) remains controversial. The aim of present study was to evaluate the contemporary role of NAC for patients with locally advanced UTUC through systematic review and meta-analysis of the literature. METHODS: Systematic literature searches were conducted in PubMed/Medline and Embase for all studies that examined the role of chemotherapy for UTUC. We performed this study according to the Preferred Reported Items for Systematic Reviews and Meta-analysis guidelines. Endpoints were overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). RESULTS: A total of four trials on 318 patients were included in this study. Each of the included studies was retrospective. Compared to controls, NAC improved OS, CSS, and PFS by 57% (95% confidence interval [CI], 0.25-0.73; p = 0.002), 59% (95% CI, 0.27-0.57; p < 0.00001), and 45% (95% CI, 0.50-0.60; p < 0.00001), respectively. The absolute increases in OS, CSS, and PFS were 11%, 18%, and 13%, respectively, and these increases are equivalent to numbers-needed-to-treat of 9, 5.5, and 7.6, respectively. Pooled odds ratio for the effect of NAC on downstaging was 0.21 (95% CI, 0.09-0.60; p = 0.004), which indicates that NAC group had a 4.76-fold higher probability of having pathologic N stage 0 than control group. CONCLUSIONS: NAC treatment before radical nephroureterectomy might provide better survival outcomes in patients with locally advanced UTUC. Prospective randomized studies are needed to confirm the benefits of NAC in locally advanced UTUC patients.


Assuntos
Carcinoma de Células de Transição/tratamento farmacológico , Quimioterapia Adjuvante/métodos , Terapia Neoadjuvante/métodos , Neoplasias Ureterais/tratamento farmacológico , Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/cirurgia , Quimioterapia Adjuvante/mortalidade , Terapia Combinada/mortalidade , Humanos , Terapia Neoadjuvante/mortalidade , Nefroureterectomia/mortalidade , Neoplasias Ureterais/mortalidade , Neoplasias Ureterais/cirurgia , Neoplasias Urológicas/tratamento farmacológico , Neoplasias Urológicas/mortalidade , Neoplasias Urológicas/cirurgia
17.
Urologe A ; 58(4): 373-380, 2019 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-30830292

RESUMO

For the estimation of perioperative risks and mortality in the context of radical urological tumor surgery in elderly patients, the guidelines meanwhile require the use of geriatric assessments. The aim of this work is therefore to explain frequently used geriatric assessments and to give an overview of their predictive significance in radical urological tumor surgery. Comprehensive geriatric assessments provide a good description of the patient's state of health, but are hardly feasible in clinical routine due to their complexity. It is more reasonable to use screening tools with subsequent targeted examination of high-risk patients. Special tools allow the standardized assessment of functional status, mobility, cognition, mood, nutrition, frailty, comorbidities and polypharmacy and have different prognostic significance. Evidence on the predictive value of assessments prior to radical urological tumor surgery is mainly described for the systematic classification of comorbidities. In cystectomy, the Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologists (ASA) score allow an estimation of the risk of complications and mortality. The focus of assessments prior to prostatectomy is to identify patients with sufficient life expectancy to benefit from radical surgery. CCI and ASA scores as well as the Eastern Co-operative Oncology Group (ECOG) score can help to assess the risk of perioperative complications in kidney tumor surgery.


Assuntos
Cistectomia , Prostatectomia , Neoplasias da Próstata , Neoplasias Urológicas , Idoso , Comorbidade , Avaliação Geriátrica , Humanos , Masculino , Prognóstico , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Neoplasias Urológicas/cirurgia
18.
Int Urol Nephrol ; 51(5): 765-771, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30903392

RESUMO

PURPOSE: With the availability of near-infrared fluorescence (NIRF) imaging using indocyanine green dye (ICG) to the robotic platform, utility of this imaging technology has evolved significantly across the board for ablative and reconstructive procedures. Herein, we describe the potential indications of indocyanine green for both oncologic and non-oncologic applications in robot-assisted laparoscopic urologic surgery. METHODS: A narrative mini-review was performed in November 2018 using PubMed, Scopus, EMBASE, and Web of Science databases utilizing the following search phrase: "indocyanine green fluorescence robotic surgery" resulting in 104 articles of which 30 articles had urologic-pertinent applications. All 30 articles, and the references within, were reviewed and judged for scientific integrity and merit. Articles with non-novel findings or similar conclusions to original papers were omitted. RESULTS: ICG does not have a urologic FDA indication, though it has been used off-label for urologic surgery since 2006. Fluorescence-augmented surgery with ICG can facilitate oncologic surgery in the adrenal gland, kidney, bladder, prostate, and retroperitoneum, in addition to lymph node dissection for various malignant pathologies. ICG-NIRF can enhance non-oncologic surgery including ureterolysis, ureteroureterostomy, ureteral re-implantation, pyeloplasty, and urinary diversion in both the adult and pediatric populations. CONCLUSIONS: Although it is not necessary to utilize fluorescence-enhanced surgery in all cases, the authors find the utilization of ICG-NIRF in complex and highly technical surgeries useful.


Assuntos
Corantes , Verde de Indocianina , Monitorização Intraoperatória/métodos , Procedimentos Cirúrgicos Robóticos , Doenças Urológicas/diagnóstico por imagem , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Humanos , Imagem Óptica , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Urológicas/diagnóstico por imagem , Neoplasias Urológicas/cirurgia
19.
Cancer Treat Res Commun ; 19: 100124, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30851645

RESUMO

Urothelial cancer is one of the most common malignancies; after relapse or disease progression available therapeutic options are limited. We analyze efficacy and toxicity of local treatment on metastases using stereotactic body radiation therapy (SBRT) in selected patients with oligometastatic disease from urothelial cancer. A significant percentage of treated lesions achieved local control, with a promising overall response rate. OBJECTIVES: to analyze efficacy and toxicity of local treatment on metastases using stereotactic body radiation therapy (SBRT) in selected patients with oligometastatic disease from urothelial cancer. MATERIALS AND METHODS: Data from clinical records of 19 patients treated in our institution since May 2011 to October 2017 with SBRT for oligometastatic/oligoprogressive urothelial carcinoma were retrospectively collected. Clinical outcomes in terms of local control (LC), response rate, symptoms control, progression free and overall survival (PFS and OS), and adverse events were analyzed and reported. RESULTS: Nineteen patients were treated on 25 metastatic lesions; 5 of them received treatment on multiple sites. After an average follow up of 11.5 months, LC was achieved in 17 lesions (68%) and there was no local recurrence in lesions with complete or partial response. OS was 13.8 months. Adverse events were reported only in 3 patients (5 overall events). No late toxicity was reported. CONCLUSIONS: An approach consisting in SBRT for local treatment of oligometastatic or persistent disease can be effective and safe in selected patients. Prospective studies are needed, to find correct selection criteria and optimal dose and fractionation.


Assuntos
Neoplasias Ósseas/cirurgia , Neoplasias Encefálicas/cirurgia , Neoplasias Hepáticas/cirurgia , Neoplasias Pulmonares/cirurgia , Recidiva Local de Neoplasia/cirurgia , Radiocirurgia/métodos , Neoplasias Urológicas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/secundário , Neoplasias Encefálicas/secundário , Progressão da Doença , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/secundário , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Prognóstico , Estudos Retrospectivos , Neoplasias Urológicas/patologia
20.
Surg Oncol Clin N Am ; 28(2): 327-332, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30851832

RESUMO

Urologists were early adopters of minimally invasive, specifically robotic, techniques for cancer surgery. The current trends show increasing adoption of robotic surgery for renal, bladder, and prostate cancer. Several randomized controlled trials show that robotic urologic surgery has outcomes that are at least as good as, if not superior to, open surgery.


Assuntos
Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Humanos
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