Characterization of mild and severe post-radical nephrectomy renal functional deterioration utilizing histopathological evaluation of non-neoplastic nephrectomized renal parenchyma.

BACKGROUND: We investigated factors affecting mild (MRFD) and severe renal functional deterioration (SRFD) after radical nephrectomy with a special focus on the histopathology of nephrectomized non-neoplastic renal parenchyma. METHODS: MRFD was defined as a postoperative decline of percent estimated glomerular filtration rate (eGFR) lower than the value of the mean minus standard deviation (SD). SRFD was defined as a rate greater than the value of the mean plus SD. The histopathological factors of global glomerulosclerosis (GS) and arteriosclerosis in non-neoplastic renal parenchyma and multiple clinical factors were analyzed to determine whether they affected postoperative renal functional deterioration in 100 renal cell carcinoma cases. The prognoses, including non-cancer mortality, were collected from long-term follow-up data. RESULTS: A higher preoperative eGFR and a higher global GS extent in non-neoplastic renal parenchyma were independently associated with MRFD and SRFD, respectively. The cardiovascular disease-specific survival rates of the SRFD group and the group with global GS extent >14 % were significantly worse than those of their counterparts. CONCLUSIONS: This is the first report to identify global GS extent in nephrectomized non-neoplastic renal parenchyma as a factor affecting the development of life-threatening post-nephrectomy renal functional deterioration. Moreover, we are the first to advocate the importance of the characterization of favorable post-nephrectomy renal functional deterioration. The identification of MRFD and SRFD by histopathological evaluation of nephrectomized non-neoplastic renal parenchyma will contribute to personalized postoperative follow-up. It may improve follow-up of individual patients with SRFD by permitting collaboration with other clinical departments such as cardiology.

Robot-assisted radical cystectomy is a promising alternative to open surgery in the Japanese population with a high rate of octogenarians.

BACKGROUND: Japanese patients who undergo radical cystectomy have a unique feature, i.e., the ratio of octogenarians is higher than in Western patients because of the aging Japanese population. The purpose of this study was to compare perioperative outcomes, complications, and oncologic outcomes between robot-assisted radical cystectomy and open radical cystectomy. METHODS: From 2010-2015, 20 (of which 8 were octogenarians) and 40 (of which 11 were octogenarians) patients underwent robot-assisted radical cystectomy and open radical cystectomy, respectively. RESULTS: There was no significant difference in terms of patient demographics between the two surgical cohorts, regardless of patient age. In the octogenarian patient cohort, the rates of previous abdominal surgery and the median age-adjusted Charlson comorbidity index were higher. The median estimated blood loss, transfusion rate and the days to resumption of a regular diet were significantly lower in the robot-assisted radical cystectomy cohort, regardless of patient age. Robot-assisted radical cystectomy significantly decreased grade II or higher complications, but there were no significant differences in terms of decreasing grade III or higher complications, regardless of patient age. Positive surgical margin and the mean number of lymph nodes removed were similar between the two surgical cohorts, regardless of patient age. CONCLUSION: Although robot-assisted radical cystectomy has a short history in Japan, the outcomes were generally comparable to those of previous studies. In a country that is aging rapidly like Japan, robot-assisted radical cystectomy could be a valid option for the management of muscle-invasive and high-risk superficial bladder cancer.

Robot-assisted radical prostatectomy in an initial Japanese series: the impact of prior abdominal surgery on surgical outcomes.

OBJECTIVES: To evaluate the influence of prior abdominal surgery on surgical outcomes of robot-assisted radical prostatectomy in an early single center experience in Japan. METHODS: We reviewed medical records of patients with localized prostate cancer who underwent robot-assisted radical prostatectomy from October 2010 to September 2013 at Tottori University Faculty of Medicine, Yonago, Tottori, Japan. Patients with prior abdominal surgery were compared with those with no prior surgery with respect to total operative time, port-insertion time, console time, positive surgical margin and perioperative complication rate. Furthermore, the number of patients requiring minimal adhesion lysis was compared between the two groups. RESULTS: Of 150 patients who underwent robot-assisted radical prostatectomy, 94 (63%) had no prior abdominal surgery, whereas 56 patients (37%) did. The mean total operative time was 329 and 333 min (P = 0.340), mean port insertion time was 40 and 34.5 min (P = 0.003), mean console time was 255 and 238 min (P = 0.145), a positive surgical margin was observed in 17.9% and 17.0% patients (P = 0.896), and the incidence of perioperative complications was 25% and 23.4% (P = 0.825), respectively, in those with and without prior abdominal surgery. In the prior abdominal surgery group, 48 patients (80.4%) required adhesion lysis at the time of trocar placement or while operating the robotic console. CONCLUSION: Robot-assisted radical prostatectomy appears to be a safe approach for patients with prior abdominal surgery without increasing total operative time, robotic console time, positive surgical margin or the incidence of perioperative complications.

Anatomical dimensions using preoperative magnetic resonance imaging: impact on the learning curve of robot-assisted laparoscopic prostatectomy.

OBJECTIVE: To evaluate the impact of anatomical dimensions as measured using preoperative magnetic resonance imaging on the outcomes of robot-assisted laparoscopic prostatectomy. METHODS: We retrospectively reviewed 100 consecutive robot-assisted laparoscopic prostatectomy procedures that were carried out by a single surgeon at the Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan. Preoperative clinical data and anatomical measurements, including the calculated prostate volume pelvic cavity index, were determined based on preoperative magnetic resonance imaging, and their effects on console time, estimated blood loss and surgical margin status were compared. RESULTS: Body mass index, the prostate anteroposterior diameter, and the prostate volume-to-pelvic cavity index ratio were all significantly correlated with console time and estimated blood loss, based on a univariate analysis (P < 0.05). The prostate craniocaudal diameter, prostate transverse diameter and prostate volume also correlated with console time. However, based on the multiple linear regression analysis, only the prostate volume-to-pelvic cavity index ratio was found to be a significant predictor of console time and estimated blood loss. Furthermore, when the 100 total cases were divided into 50 early cases and 50 late cases, the prostate volume-to-pelvic cavity index ratio correlated with console time and estimated blood loss only in the early group, and not in the late group. In contrast, anatomical measurements had no significant effect on surgical margin status. CONCLUSION: Magnetic resonance imaging can be a valuable adjunct to robot-assisted laparoscopic prostatectomy. Our data show that patients with larger prostates and narrow, deep pelvises might present more difficulty in robot-assisted laparoscopic prostatectomy procedures. However, the present data also show that this problem can be overcome by an experienced operator with improved surgical techniques.

High neutrophil-to-lymphocyte ratio predicts poor clinical outcome in patients with castration-resistant prostate cancer treated with docetaxel chemotherapy.

OBJECTIVE: To evaluate the prognostic significance of the neutrophil-to-lymphocyte ratio in patients receiving chemotherapy with docetaxel for castration-resistant prostate cancer. METHODS: A total of 57 castration-resistant prostate cancer patients treated between 2009 and 2014 were included in the present retrospective study. All patient data, including clinicopathological factors, were assessed. Univariate and multivariate Cox regression models were used to predict overall survival and progression-free survival after chemotherapy initiation. RESULTS: The median overall survival and progression-free survival were determined as 19.0 months (range 1-61 months) and 10.0 months (range 1-56 months), respectively. The cut-off level of the neutrophil-to-lymphocyte ratio was set as the median value of 3.5 among all patients in this study. In Kaplan-Meier analysis, the median overall survival and progression-free survival were shorter in patients with a high neutrophil-to-lymphocyte ratio compared with those with a low neutrophil-to-lymphocyte ratio (15 vs 20 months, P = 0.0125; and 9.5 vs 15 months, P = 0.0132, respectively). The overall survival and progression-free survival periods in patients with a high neutrophil-to-lymphocyte ratio were significantly shorter than those of patients with a low neutrophil-to-lymphocyte ratio (P = 0.0178 and 0.0176, respectively). In the multivariate analysis, a high neutrophil-to-lymphocyte ratio was an independent predictor of overall survival and progression-free survival (hazard ratio 2.728, 95% confidence interval 1.05-7.09, P = 0.039; and hazard ratio 2.376, 95% confidence interval 1.12-5.06, P=0.024, respectively). CONCLUSION: The present study results suggest that the neutrophil-to-lymphocyte ratio is a useful prognostic factor in patients with castration-resistant prostate cancer treated by docetaxel chemotherapy. These findings might be useful in determining treatment strategies in the future.

The role of staging MRI in predicting apical margin positivity for robot-assisted laparoscopic radical prostatectomy.

PURPOSE: To investigate the association between apical margin positivity and preoperative magnetic resonance imaging (MRI) in patients who have undergone robot-assisted laparoscopic radical prostatectomy (RARP). PATIENTS AND METHODS: From September 2010 through November 2012, we treated 84 Japanese men with clinically localized prostate cancer with RARP. The excised specimens, which were divided into right and left fragments, were evaluated for the presence of positive surgical margins (PSMs) and preoperative MRI findings. RESULTS: The overall PSM rate was 21.4% (18 of 84 patients), 83.3% (15 of 18 cases) of which were situated in the apex. Evaluating the prostate divided into right and left fragments, the PSM rate was 10.7% at the apex (18 of 168 fragments). Cancer was suspected via preoperative MRI in 39 fragments (23.2%) and detected in the prostatic apex by prostate biopsy in 67 fragments (39.9%). Multiple regression analysis revealed that MRI and nerve-sparing procedures significantly indicate apical margin positivity (p = 0.005). CONCLUSIONS: The prostatic apex is the most common location of PSMs after RARP. Our results demonstrate that preoperative MRI for cancer of the prostatic apex may provide substantial information and enable complete cancer clearance.

Oncological and functional outcomes after radical nephrectomy for renal cell carcinoma: a comprehensive analysis of prognostic factors.

OBJECTIVES: To investigate mortality rates and to comprehensively analyze prognostic indicators after radical nephrectomy for renal cell carcinoma. METHODS: Data were collected from 147 patients who underwent potentially curative radical nephrectomy for renal cell carcinoma. The following data were analyzed: tumor pathology, patient demographics and clinical parameters, such as pre- and postoperative estimated glomerular filtration rate, as well as the cause of death. Cause-specific survival rates were calculated including deaths caused by renal cell carcinoma and cardiovascular disease. A Cox proportional hazard model was used for statistical analysis. RESULTS: A univariate analysis showed that age at surgery (≥70 years), postoperative estimated glomerular filtration rate (<45 mL/min/1.73 m(2)), pathological high T stage, grade and venous invasion were significant poor prognostic indicators. The multivariate analysis provided evidence that pathological venous invasion was a significant poor prognostic indicator, whereas age at surgery (≥70 years), pre- (<65 mL/min/1.73 m(2)) or postoperative (<45 mL/min/1.73 m(2)) estimated glomerular filtration rate and pathological high grade were significant poor prognostic indicators in T1 tumor cases. CONCLUSIONS: Post-radical nephrectomy renal function insufficiency can lead to a poor prognostic outcome, especially in patients with T1 renal cell carcinoma. Physicians should consider a comprehensive follow up focusing on possible causes of death, including those related to both renal cell carcinoma and cardiovascular disease events after radical nephrectomy.

Comprehensive Investigations of Multiple Factors That Are Related to Refractory Outcome in Urosepsis Patients.

Background: Urosepsis is an acute life-threating disease, and some cases show refractory outcome to therapy. In an aging society of developed countries, characteristics of urosepsis are becoming complicated. We performed a comprehensive investigation regarding the clinical and social aspects that are related to refractory outcomes in urosepsis patients. Methods: The patient cohort consisted of 66 patients with urosepsis. Multiple factors from clinical and social aspects were reviewed retrospectively. Two categories of refractory outcomes were defined. One was afebrile resistance (AR); fever continued more than 7 days from the initiation of therapy. Another was discharge resistance (DR); hospitalization continued for more than 30 days. Logistic regression analyses were performed to identify significant factors that are related to the AR or DR. Results: Univariate analysis demonstrated that high score of Eastern Cooperative Oncology Group Performance Status (ECOG PS) (≥ 2) and Age-adjusted Charlson comorbidity index (CCI) (≥ 4), high serum C-reactive protein (CRP) level (≥ 14.9 mg/dL), and low serum albumin level (≤ 2.26 g/dL) were significantly related to AR. Univariate analysis results also revealed that high score of ECOG PS (≥ 2), high serum creatinine level (≥ 1.54 mg/dL) and vasopressor administration were significantly related to DR. Multivariate analyses demonstrated that low serum albumin level (≤ 2.26g/dL) was the only significant factor that was related to AR. In contrast, high score of ECOG PS (≥ 2) and high serum creatinine level (≥ 1.54 mg/dL) were significant factors that were related to DR. Conclusion: It is suggested that evaluating serum albumin levels is essential for the therapeutic first step because hypoalbuminemia was the significant factor that was related to obstruction to antipyresis. It is also suggested that the deterioration of patients' activities of daily living and renal dysfunction might be the refractory factors for discharge from the hospital, which was the ultimate therapeutic goal.

Interstitial pneumonitis induced by bicalutamide given for prostate cancer.

We describe interstitial pneumonitis induced by bicalutamide prescribed to treat prostate cancer. A 78-year-old man with severe lower paralysis and a bladder/rectal disorder was referred to our hospital. Prostate-specific antigen was elevated to 1418 ng/mL at that time and magnetic resonance imaging revealed multiple bone metastases. A rectal examination revealed hard nodules in the bilateral lobes of the prostate. We diagnosed prostate cancer without a biopsy, and then maximally blockaded androgens by castration and bicalutamide administration. Eight months later, he was admitted to a local hospital with breathing difficulties, and a computed tomography scan revealed interstitial pneumonitis. A physician concluded that the cause of the interstitial pneumonitis was bicalutamide, which was immediately withdrawn and replaced with prednisolone. The patient recovered over a period of 3 months. Bicalutamide-induced interstitial pneumonitis is quite rare. However, adverse reactions to maximal androgen blockade therapy should be considered and appropriate treatment for interstitial pneumonitis should be promptly initiated, as this condition is reversible.

[Small renal cell carcinoma with pancreas metastasis: a case report].

A 53-year-old-man was treated in the Department of Surgery for a pancreatic tumor because asymptomatic, nodular masses, 4 cm-in diameter were discovered in the tail of the pancreas on computed tomography (CT). The pancreatic masses were metastases of renal cell carcinoma on pathological examination. Contrast-enhanced CT and abdominal magnetic resonance imaging showed a small, 1.3 cmdiameter mass in the right kidney. The size of the renal tumor was small, but it appeared to have high malignancy because of spread to the pancreas. We chose radical nephrectomy in consideration of intrarenal spread of carcinoma. The resected specimen was diagnosed pathologically as clear cell carcinoma, G2＞ G1, pT1apN0M0, exp, INFα, v (-), ly (-). At follow-up one year after surgery, there was no evidence of recurrence.

Pathological eradication of recurrent metastatic renal cell carcinoma with sarcomatoid component by nivolumab plus ipilimumab combination therapy.

Although immuno-oncology combination therapy with nivolumab plus ipilimumab has recently shown a notable antitumor effect for first-line metastatic renal cell carcinoma, the eradication of the disease is extremely rare. Moreover, conventional treatments for renal cell carcinoma show little efficacy in the case of a poor prognostic pathological feature of sarcomatoid dedifferentiation. We report a case of pathological eradication of recurrent metastatic renal cell carcinoma with sarcomatoid component after laparoscopic radical nephrectomy by nivolumab plus ipilimumab combination therapy. A 57-year-old male patient received four cycles of nivolumab plus ipilimumab and thirty cycles of nivolumab for local recurrence and liver metastasis after laparoscopic radical nephrectomy for T3a renal cell carcinoma with sarcomatoid component. He underwent partial hepatectomy for the remaining small hepatic lesion after immuno-oncology therapy. Pathology of the surgical specimen showed no viable cancer cells. The patient was alive with no evidence of disease a year after partial hepatectomy. Our case encourages clinicians to achieve a second cure for patients with recurrent metastatic renal cell carcinoma after radical nephrectomy even though the resected kidney pathology showed sarcomatoid component.

Apoptotic action of botulinum toxin on detrusor muscle in rats.

AIMS: To examine botulinum toxin A (BTX-A)-induced apoptosis in the detrusor muscle in male rats. METHODS: The bladder wall and prostate in adult male Sprague-Dawley rats were injected with BTX-A (10 U at each site). Tissues were harvested after 2 weeks, then the effects of BTX-A on proliferative and apoptotic indices were determined using proliferative cell nuclear antigen and TUNEL staining, respectively. In addition, real-time polymerase chain reaction was used to measure mRNA expressions of the apoptosis-related gene, bcl-2, and BAX in detrusor muscle. RESULTS: Although bladder weight was significantly increased in the BTX-A group compared to controls, no significant changes in prostate weight were identified. While significant increases in proliferative cells were apparent in the vesical mucosa after staining, no significant changes were noted in apoptotic or proliferative cells in detrusor muscle or prostate. In addition, no significant changes between the BTX-A group and controls were seen for mRNA expressions of bcl-2/beta-actin or BAX/beta-actin in detrusor muscle. CONCLUSIONS: The lack of significant changes in cellular dynamics of the detrusor muscle in the current study suggests that BTX-A injection into detrusor muscle for overactive bladder may not induce bladder atrophy.

Xp11.2 translocation renal cell carcinoma with TFE3 gene fusion in the elderly: case report and literature review.

A 68-year-old man was followed up with chronic kidney disease. Follow-up CT incidentally detected a tumor at the left kidney and multiple small nodular shadows in the lungs bilaterally. The patient underwent needle biopsy and was diagnosed with Xp11.2 translocation renal cell carcinoma (RCC) pathologically. Hence, laparoscopic nephrectomy was performed. Fluorescence in situ hybridization analysis revealed a break-apart of the transcription factor E3 (TFE3) genes in the left tumor. After 2 months postoperatively, nivolumab and ipilimumab were administered thrice intravenously, considering the intermediate risk by the IMDC risk classification. However, pleural effusion occurred but was removed adequately. Lung metastasis decreased, but new metastasis occurred at the left iliopsoas muscle. Target therapy was performed with axitinib. Unfortunately, he died 6 months later postoperatively. These tumors commonly occur in children than in adults, and very rare in elderly patients. Xp11.2 translocation RCC in the elderly has a poorer prognosis than that in children. To date, no effective treatment for Xp11.2 translocation RCC has been established.

Effect of the rho-kinase inhibitor hydroxyfasudil on bladder overactivity: an experimental rat model.

OBJECTIVES: To investigate the effects of the rho-kinase inhibitor hydroxyfasudil on bladder overactivity in cyclophosphamide (CYP)-induced cystitis. METHODS: Female Sprague-Dawley rats received a single intraperitoneal injection of CYP (200 mg/kg). Four days later, bladder function was evaluated by: (i) monitoring micturition behavior in metabolic cages between hydroxyfasudil- and vehicle-treated animals; (ii) measuring changes in continuous cystometrograms in response to intravenous hydroxyfasudil under anesthesia; and (iii) conducting a functional study examining the effect of hydroxyfasudil on the concentration-response curves to carbachol in bladder tissue strips. RESULTS: Intraperitoneal injection of hydroxyfasudil (10 mg/kg) significantly increased both the average and maximal voided volumes. Hydroxyfasudil significantly decreased the maximal detrusor pressure, whereas the intercontraction interval was not significantly affected. After administration of 0.1, 0.3, 1, and 3 microM hydroxyfasudil, the maximal contraction of the concentration-response curves to carbachol was significantly reduced to 74.5 +/- 4.2%, 55.2 +/- 5.6%, 29.4 +/- 5.6%, and 21.6 +/- 8.2% of the control values, respectively. CONCLUSIONS: The present findings indicate that hydroxyfasudil might be a new treatment option for CYP-induced detrusor overactivity.

Primary tumor of the ureteral stump after a radical nephrectomy for renal cell carcinoma: case report and literature review.

We report a case of ureteral stump carcinoma following a radical nephrectomy for renal cell carcinoma. A 76-year-old man was diagnosed as having ascending colon cancer and a right renal carcinoma. He was treated with partial colon resection and radical nephrectomy without lymphadenectomy. The histology was renal cell carcinoma. Three years after that surgery, he complained of intermittent macrohematuria. Abdominal computed tomography (CT) suggested a solid mass in the pelvis. We then performed a biopsy with CT guidance. An epithelial tumor was suspected by immunohistochemistry. A total excision of ureter was then performed. The histology showed the features of urothelial carcinoma, G3, v(+), pT3. He received adjuvant chemotherapy with gemcitabine and cisplatin. He was free of disease for the following 11 months.

Extramammary Paget's disease of the glans penis secondary to urethral recurrence of bladder carcinoma after radical cystectomy: A case report.

INTRODUCTION: Extramammary Paget's disease of the vulva secondary to urothelial carcinoma is rare. It is important to determine whether extramammary Paget's disease is primary or secondary, because the appropriate treatment strategies differ. We report a case of penile extramammary Paget's disease secondary to urothelial carcinoma recurrence. CASE PRESENTATION: A 75-year-old man who was diagnosed with bladder carcinoma and received urethra-sparing radical cystectomy 5 years ago presented with erythema and red spots in the glans penis. Immunostaining (cytokeratin 7 and cytokeratin 20) of skin biopsy specimens suggested a secondary extramammary Paget's disease that originated from the urothelial carcinoma. Under urethroscopy, urethral recurrence was also suspected. A total penectomy was performed, and a final diagnosis of urothelial carcinoma recurrence and secondary extramammary Paget's disease of the glans penis were established. CONCLUSION: Using immunostaining, the differential diagnosis between primary and secondary extramammary Paget's disease is more accurate. Secondary extramammary Paget's disease should be considered when a skin lesion is present on the penis of patients with urothelial carcinoma.

Cross-Sectional Investigations of Pre- and Post-Operative Renal Global Function and Renal Parenchymal Volumetry in Both Partial and Radical Nephrectomy Utilizing Film-Based Technology.

OBJECTIVES: To investigate pre- and post-operative renal global function and renal parenchymal volume (RPV) in both partial nephrectomy (PN) and radical nephrectomy (RN) utilizing film-based technology. PATIENTS AND METHODS: The patient cohort consisted of 81 and 82 cases with T1 tumors (≤ 7 cm) treated by PN and RN, respectively. Renal global function was assessed using the estimated glomerular filtration rate (eGFR), and RPV was measured using a Synapse Vincent volumetric analyzer which creates a reconstructed image from a computed tomography scan. Renal global function and RPV were evaluated pre-operatively and 6 months post-operatively. RESULTS: The percent eGFR decline of PN cases was significantly reduced compared with RN cases (p < 0.0001). Post-operative RPV of the contralateral side was significantly increased compared with pre-operative RPV (p < 0.0001) in RN cases. The percent change of the contralat-eral side RPV was slightly increased in RN compared with PN cases (p = 0.1881). A strong positive correlation was noted between post-operative eGFR and post-operative total RPV (r = 0.69, p < 0.0001), and a strong negative correlation was noted between percent eGFR decline and post-operative total RPV (r = -0.63, p < 0.0001). CONCLUSIONS: Prominent compensatory renal hypertrophy occurred within 6 months after RN. Post-operative renal functional outcome was closely correlated with the post-operative total RPV. In addition to RPV, further studies to unravel post-operative renal function from multifactorial aspects including surgical factors and intrinsic medical disease should be performed in the future.

The significance of predictable traumatic area by renorrhaphy in the prediction of postoperative ipsilateral renal function.

INTRODUCTION: To determine the relationship between the actual renal function loss and volume loss in robot-assisted partial nephrectomy (RAPN) using a novel three-dimensional volume analyzer. MATERIAL AND METHODS: We respectively evaluated the medical records of 23 consecutive patients who underwent RAPN between January 2012 and March 2016 and the data on their kidney function and parenchymal mass specific to the operated kidney. Parenchymal volume was measured by computerized tomography and reconstructed with a Synapse Vincent volumetric analyzer. Using this system, we predicted the renal vascular territory and other trauma areas involved in renorrhaphy. All measurements were taken within 3 and 6 months pre- and postoperatively, respectively. RESULTS: The actual postoperative renal parenchymal volume was significantly correlated with the virtual predicted residual renal volume excluding the tumor and resected margin (r = 0.435, p <0.05). The ratio of split estimated glomerular filtration rate (eGFR) postoperative/preoperative) was significantly correlated with the virtual predicted residual renal volume excluding the resected margin and the traumatic area by renorrhaphy (r = 0.401, p <0.05). CONCLUSIONS: When predicting the reduction of renal function of the diseased side following partial nephrectomy, adding the extent of the area traumatized by renorrhaphy might be useful for predicting the postoperative split renal function of the affected kidney.

Comprehensive Analysis of Factors Affecting Post-partial Nephrectomy Renal Global Function.

BACKGROUND: To explore new factors that are predictive of post-partial nephrectomy (PN) renal global function, we analyzed various clinico-pathological factors with a special focus on renal volume measured via three-dimensional imaging technology and histopathological parameters in non-neoplastic parenchyma. METHODS: Estimated glomerular filtration rate (eGFR) and computed tomography (CT) scan were examined pre- and 6 months. post-operatively in 52 patients treated by PN. The post-operative percent eGFR decline was employed as the measure of global renal functional deterioration. The novel factors analyzed included the percent renal parenchymal volume decline of the diseased side, contralateral and bilateral sides and the global glomerulosclerosis (GS) extent in non-neoplastic parenchyma. Renal parenchymal volumetry by CT scan was performed using SYNAPSE VINCENT (Fujifilm). Additional factors analyzed included patient demographics and comorbidities, surgical factors and tumor pathology. All factors demonstrating significant tendencies (P < 0.1) in univariate analyses were subjected to multivariate logistic regression analysis. RESULTS: Two groups were categorized according to the degree of eGFR decline. Groups A and B were categorized as less than 15% and greater than 15% decline, respectively. Pre-operative eGFR was significantly lower in group B than in group A. Greater than 10% global GS extent in non-neoplastic parenchyma, male gender and proteinuria were significantly more frequent in in group B than in group A. The renal volume change was not statistically significant. In multivariate logistic regression analysis, greater than 10% global GS extent in non-neoplastic parenchyma was the sole independent affecting factor for Group B. CONCLUSION: Our study suggested that host factors rather than surgical factors may be useful for the prediction of post-PN renal global function. The evaluation of the global GS extent in non-neoplastic parenchyma is a promising biomarker of post-PN renal global function.

Biochemical Recurrence Prediction in High-Risk Prostate Cancer Patients, Following Robot-Assisted Radical Prostatectomy.

BACKGROUND: High-risk prostate cancer treatment has been controversial. Some high-risk prostate cancer patients fail to respond to radical prostatectomy only. Thus, we aimed to investigate the predictive factors for biochemical recurrence (BCR) and identify patients who could achieve sufficient therapeutic effect by radical prostatectomy only. METHODS: Of 264 medical records reviewed, 141 low-intermediate-risk and 100 high-risk prostate cancer patients, excluding those who had received neoadjuvant hormone therapy, were analyzed. BCR was defined as the first increase in prostate-specific antigen levels (≥ 0.2 ng/mL), with levels not decreasing to undetectable limits, after radical prostatectomy. Log-rank test and Cox proportional hazards regression analyses were performed to determine the prognostic factors. We investigated the perioperative predictive factors for BCR and BCR-free survival rates, with the number of National Comprehensive Cancer Network (NCCN) high-risk factors for high-risk prostate cancer patients who underwent robot-assisted radical prostatectomy. RESULTS: Multivariate analyses showed that clinical T3 was significantly associated with BCR [hazard ratio (HR) = 4.052; 95% confidence interval (CI), 1.26-12.99; P = 0.019]. Of the 100 patients, 77 had 1 high-risk factor and 23 had ≥ 2 high-risk factors; the 1-year BCR-free survival rate of patients with 1 high-risk factor and those with ≥ 2 high-risk factors was 94.8% and 69.6%, respectively. Patients with ≥ 2 high-risk factors were significantly associated with BCR (P = 0.002). No difference in BCR rate between patients with 1 high-risk factor and those with low- and intermediate-risk was found. CONCLUSION: High-risk prostate cancer patients with 1 NCCN high-risk factor can be considered for robot-assisted radical prostatectomy treatment only.