Prevalence and impact on survival of positive surgical margins in partial nephrectomy for renal cell carcinoma: a population-based study.

OBJECTIVES: To determine the prevalence of positive surgical margins (PSMs) on a population level. To identify the predictors of PSMs and assess their impact on survival. PATIENTS AND METHODS: Using the Ontario Cancer Registry, we reviewed pathology reports on 664 patients after partial nephrectomy for renal cell carcinoma between 1995 and 2004. Demographic information and pathological characteristics were obtained and multivariable logistic regression analysis was performed to determine the predictors of PSMs. Kaplan-Meier analysis was used to examine disease-specific (DSS) and overall survival (OS) by margin status. A multivariable Cox proportional hazards model was used to determine the independent association between PSMs and survival. RESULTS: The mean patient age was 57.7 years and 61.6% were men. Tumour size was <2.0 cm in 25%, 2.0-3.9 cm in 59%, 4.0-6.9 cm in 13%, and ≥7.0 cm in 3% of patients. Seventy-one patients (10.7%) had PSMs on final pathology. Only stage (P = 0.02) and fat invasion (P = 0.04) were significantly associated with PSMs. At a median follow-up of 7.9 years, the unadjusted 5-year DSS and OS rates were 91.8 and 88.3%, respectively. Survival rates did not differ by surgical margin status, with 90.9 and 84.4% 5-year DSS and OS rates for patients with PSMs compared with 91.9 and 88.6% for those with a negative surgical margin (P = 0.58, log rank test). Using a Cox proportional hazards model, surgical margin status was not associated with time to all-cause death (P = 0.67). CONCLUSION: Our population-level data suggest that, although PSMs are fairly prevalent, they appear to have little to no impact on 5-year survival rates.

Changes in insulin sensitivity in response to troglitazone do not differ between subjects with and without the common, functional Pro12Ala peroxisome proliferator-activated receptor-gamma2 gene variant: results from the Troglitazone in Prevention of Diabetes (TRIPOD) study.

OBJECTIVE: We have tested whether the Pro12Ala variant of the peroxisome proliferator-activated receptor (PPAR)-gamma nuclear receptor involved in thiazolidinedione (TZD) action accounted for the failure of troglitazone to increase insulin sensitivity in nondiabetic Hispanic women with previous gestational diabetes treated in the Troglitazone in Prevention of Diabetes (TRIPOD) study. RESEARCH DESIGN AND METHODS: Ninety-three women assigned to troglitazone had intravenous glucose tolerance tests at randomization and after 3 months of treatment with troglitazone, 400 mg/day, and were genotyped for the Pro12Ala variant of the PPAR-gamma gene. Subjects were divided into tertiles based on their change in minimal model insulin sensitivity (S(i)) during the first 3 months of troglitazone treatment. RESULTS: The mean changes in S(i) in the bottom, middle, and top tertiles of S(i) response were -0.21 +/- 0.57, 0.91 +/- 0.26, and 2.58 +/- 1.32 min(-1) per microU/ml. 10(-4), respectively. Frequencies of the Ala/- genotype were 30, 22, and 26% in the same three tertiles (P = 0.77). Analysis of phenotypes by genotype revealed only small differences between the Pro/Pro and Ala/- groups, respectively, in baseline S(i) (2.76 +/- 0.19 vs. 2.33 +/- 0.33 x 10(-4) min(-1) per microU/ml; P = 0.27), the change in S(i) after 3 months of troglitazone treatment (1.19 +/- 0.17 vs. 0.93 +/- 0.30; P = 0.46), and the cumulative incidence of diabetes during a median follow-up of 30 months (13 vs. 17%; P = 0.66). CONCLUSIONS: Among young Hispanic women at high risk for type 2 diabetes, the Pro12Ala variant of the PPAR-gamma receptor gene did not explain the failure of approximately 1/3 of subjects to increase their insulin sensitivity when placed on troglitazone at a dose of 400 mg/day.

Metastatic prostate cancer with malignant ascites: A case report and literature review.

Malignant ascites from advanced prostate cancer is rare and has a poor prognosis. We report a case of a 57-year-old African American male presenting with weight loss, lower urinary tract symptoms and voiding dysfunction. He also had renal failure with metabolic abnormalities associated with significant abdominal distention and pain. Computed tomography showed ascites, which was pathologically confirmed by immunostaining and cytological identification of malignant cells. Prostate biopsy identified high-grade prostate cancer which responded to hormonal therapy with a significant decrease in serum prostatic-specific antigen. Ascites was managed with paracentesis and renal failure with hemodialysis as needed.