Factors predicting incisional surgical site infection in patients undergoing open radical cystectomy for bladder cancer.

BACKGROUND: The risk factors of incisional surgical site infection (iSSI) after open radical cystectomy (ORC) have not been fully investigated. The aim of the present study is to examine factors correlated with iSSI development after ORC with intestinal urinary diversion. METHODS: A total of 178 patients who had undergone ORC with intestinal urinary diversion between 2003 and 2012 at our institution were included in this retrospective study. Correlations between different perioperative factors and iSSI development were determined using univariate and multivariate logistic regression analyses. RESULTS: iSSI was observed in 53 patients (29.8 %). In the univariate analysis, age, diabetes mellitus, thickness of subcutaneous fat (TSF), and allogeneic transfusion were significant predictors of iSSI development. Although subcutaneous closed-suction drainage (SCSD) was not a significant factor in univariate analysis, SCSD, age, and TSF were all finally identified as independent predictors of iSSI development (P = 0.020, P < 0.001, and P = 0.022, respectively). Further analyses demonstrated that SCSD was frequently used in patients with relatively thick subcutaneous fat tissue and that SCSD significantly decreased iSSI development in these patients. CONCLUSIONS: Advanced patient age, thick subcutaneous fat tissue, and the absence of SCSD were significantly associated with iSSI development in bladder cancer patients who underwent ORC with intestinal urinary diversion. SCSD may be a useful procedure for iSSI prevention, especially in patients with relatively thick subcutaneous fat tissue.

Preoperative prediction of malignant involvement of resected ureters in patients undergoing radical cystectomy for bladder cancer.

OBJECTIVE: To investigate preoperative predictors of ureteral involvement of bladder malignancy and to develop a novel preoperative model for the prediction of ureteral involvement in bladder cancer patients undergoing radical cystectomy. METHODS: This study included 197 consecutive bladder cancer patients treated with radical cystectomy. The correlations of preoperative factors with ureteral involvement were analyzed by univariate analysis with Pearson's χ(2-) test and multivariate logistic regression analysis with a stepwise selection procedure. RESULTS: Positive ureteral involvement was observed in 38 (19.3%) patients. Tumor location (involvement of the vesical trigone), clinical T stage (≥ cT3) and the number of tumors (≥ 3), but not sex, tumor grade and histological features determined by transurethral resection of bladder tumor, tumor size, shape of tumor, concomitant presence of carcinoma in situ, preoperative intravesical therapy, number of transurethral resection of bladder tumor procedures or the presence of hydronephrosis were significantly associated with ureteral involvement in the univariate analysis. Multivariate logistic regression analysis confirmed that the aforementioned three significant factors identified in the univariate analysis were significant independent predictors of ureteral involvement. The probability of ureteral involvement estimated by a combination of these three parameters was well correlated with the real incidence (R = 0.904, P = 0.0021). CONCLUSIONS: Tumor location (involvement of vesical trigone), clinical T stage (≥ cT3) and the number of tumors (≥ 3) are significant independent preoperative predictors of ureteral involvement of malignancy in bladder cancer patients undergoing radical cystectomy. Our predictive model might be useful for preoperative prediction of ureteral tumor involvement.

Development of a Nomogram for Predicting Severe Neutropenia Associated With Docetaxel-Based Chemotherapy in Patients With Castration-Resistant Prostate Cancer.

BACKGROUND: Neutropenia is a major adverse event of docetaxel-based chemotherapy. The present study was undertaken to evaluate the incidence of neutropenia and to develop a nomogram for predicting Grade 4 neutropenia during the first cycle of docetaxel-based chemotherapy in patients with castration-resistant prostate cancer (CRPC). PATIENTS AND METHODS: This study included 112 patients with CRPC treated with docetaxel-based systemic chemotherapy. We evaluated the incidence and risk factors for Grade 4 neutropenia in the first cycle of chemotherapy. RESULTS: Sixty-two of 112 patients (55.4%) developed Grade 4 neutropenia in the first cycle of docetaxel-based chemotherapy. There were significant differences in age, baseline white blood cell count, and baseline neutrophil count between patients with non-Grade 4 neutropenia and those with Grade 4 neutropenia in univariate analyses. The serum prostate-specific antigen level, hemoglobin level, creatinine, albumin, Eastern Cooperative Oncology Group performance status, metastatic sites, extent of disease, and history of external beam radiotherapy to the prostate were not significantly different between the 2 groups. Multivariate logistic regression analysis showed that age (odds ratio [OR], 1.08; P = .019) and baseline neutrophil counts (OR, 0.79; P = .045) were significant independent risk factors for severe neutropenia. A nomogram and a calibration plot on the basis of these results were developed from a multivariate logistic regression analysis to predict the probability of Grade 4 neutropenia. CONCLUSION: Age and baseline neutrophil counts were significant independent risk factors for Grade 4 neutropenia. The nomogram to predict it provides useful information for the management of patients with CRPC treated with docetaxel chemotherapy.

Granulomatosis with Polyangiitis (Wegener's Granulomatosis) Accompanied by Dysuria.

A 65-year-old male visited us with complaints of retarded urination, dysuria, gross hematuria, and fever. Urinalysis showed pyuria. Prostatic tumor with lung metastasis was suspected from computed tomography and magnetic resonance imaging. Transurethral prostatic biopsy and bronchoscopic biopsy only revealed fibrinoid necrosis and inflammatory infiltration. Right lateral maxillary sinusitis was also found by MRI. ANCA testing was positive with specificity for anti-PR3 (PR3-ANCA). On the basis of these results, Granulomatosis with polyangiitis (GPA) was diagnosed. GPA involving the prostate gland is unusual, and only a few cases have previously been reported.

Associations between ABO blood groups and biochemical recurrence after radical prostatectomy.

BACKGROUND: Recent studies have demonstrated associations between ABO blood groups and prognosis in various types of cancers. The aim of this study was to investigate the association between ABO blood groups and biochemical recurrence (BCR) after radical prostatectomy (RP). METHODS: A total of 555 patients with prostate cancer who underwent RP were included in the study. No patients received neoadjuvant and/or adjuvant therapy. The effect of ABO blood groups on BCR was examined using univariate and multivariate analyses. RESULTS: During the follow-up period (mean, 52.0 months), 166 patients (29.9%) experienced BCR, with a 5-year BCR-free rate of 67.3%. Although the ABO blood group was not a significantly associated with BCR in the univariate analysis, it was an independent predictor of BCR in the multivariate analysis: blood type O patients had a significantly lower risk of BCR compared to type A patients (Hazard ratio, 0.608; 95% confidence interval, 0.410-0.902; P = 0.014). Further analyses revealed that surgical margin status confounded the assessment of the association between the ABO blood group and BCR. In the analyses of patients with a negative surgical margin, the 5-year BCR-free rate in blood type O patients was a significantly higher than that in type A patients (91.2% vs. 71.0%; P = 0.026). CONCLUSION: Blood type O is significantly associated with a decreased risk of biochemical recurrence after radical prostatectomy. Further studies are needed to clarify the nature of this association.

Primary large cell neuroendocrine carcinoma of the ureter.

Large cell neuroendocrine carcinoma (LCNEC) is the rarest type of urinary tract malignancy. Herein, we report a case of LCNEC that arose in the ureter of a 78-year-old Japanese man with a history of ascending colon cancer that had been excised by a right hemicolectomy. Left-sided hydronephrosis associated with the ureteral tumor was discovered during follow-up. A left nephroureterectomy combined with a partial resection of the urinary bladder was performed because atypical cells were detected using voided urine cytology. A histopathological examination revealed that the ureteral tumor contained large atypical epithelial cells of neuroendocrine morphology without a urothelial carcinomatous component. The neoplastic cells were immunohistochemically positive for synaptophysin, chromogranin A, CD56, and cytokeratins, but they were negative for uroplakin III and thyroid transcription factor-1. The Ki-67 labeling index of the neoplastic cells was 50%. Transmission electron microscopy demonstrated the presence of numerous dense granules in the cytoplasm of the neoplastic cells. The ureteral lesion was finally classified as stage III, pT3 cN0 cM0. The patient's postoperative course was uneventful without chemoradiotherapy, and LCNEC did not recur in the subsequent nine months. This case demonstrates that LCNEC can occur in the ureter, which normally does not contain neuroendocrine cells in the urothelium.