Evaluation of PostNeoadjuvant Chemotherapy Pathologic Complete Response and Residual Tumor Size of Breast Cancer: Analysis on Accuracy of MRI and Affecting Factors

Purpose@#To evaluate the accuracy of MRI in predicting the pathological complete response (pCR) and the residual tumor size of breast cancer after neoadjucant chemotherapy (NAC), and to determine the factors affecting the accuarcy. @*Materials and Methods@#Eighty-eight breast cancer patients who underwent surgery after NAC at our center between 2010 and 2017 were included in this study. pCR was defined as the absence of invasive cancer on pathological evaluation. The maximum diameter of the residual tumor on post-NAC MRI was compared with the tumor size of the surgical specimen measured pathologically. Statistical analysis was performed to elucidate the factors affecting pCR and the residual tumor size-discrepancy between the MRI and the pathological measurements. @*Results@#The pCR rate was 10%. The diagnostic accuracy of MRI and the area under the curve for predicting pCR were 90.91% and 0.8017, respectively. The residual tumor sizes obtained using MRI and pathological measurements showed a strong correlation (r = 0.9, p < 0.001), especially in patients with a single mass lesion (p = 0.047). The size discrepancy between MRI and the pathological measurements was significantly greater in patients with the luminal type (p = 0.023) and multifocal tumorson-mass enhancement on pre-NAC MRI (p = 0.047). @*Conclusion@#MRI is an accurate tool for evaluating pCR and residual tumor size in breast cancer patients who receive NAC. Tumor subtype and initial MRI features affect the accuracy of MRI.

Evaluation of PostNeoadjuvant Chemotherapy Pathologic Complete Response and Residual Tumor Size of Breast Cancer: Analysis on Accuracy of MRI and Affecting Factors

Purpose@#To evaluate the accuracy of MRI in predicting the pathological complete response (pCR) and the residual tumor size of breast cancer after neoadjucant chemotherapy (NAC), and to determine the factors affecting the accuarcy. @*Materials and Methods@#Eighty-eight breast cancer patients who underwent surgery after NAC at our center between 2010 and 2017 were included in this study. pCR was defined as the absence of invasive cancer on pathological evaluation. The maximum diameter of the residual tumor on post-NAC MRI was compared with the tumor size of the surgical specimen measured pathologically. Statistical analysis was performed to elucidate the factors affecting pCR and the residual tumor size-discrepancy between the MRI and the pathological measurements. @*Results@#The pCR rate was 10%. The diagnostic accuracy of MRI and the area under the curve for predicting pCR were 90.91% and 0.8017, respectively. The residual tumor sizes obtained using MRI and pathological measurements showed a strong correlation (r = 0.9, p < 0.001), especially in patients with a single mass lesion (p = 0.047). The size discrepancy between MRI and the pathological measurements was significantly greater in patients with the luminal type (p = 0.023) and multifocal tumorson-mass enhancement on pre-NAC MRI (p = 0.047). @*Conclusion@#MRI is an accurate tool for evaluating pCR and residual tumor size in breast cancer patients who receive NAC. Tumor subtype and initial MRI features affect the accuracy of MRI.

Effect of in vitro testicular spermatozoa culture on pregnancy outcomes: an experience at a single university hospital / 영남의대학술지

Background@#There are no guidelines for the optimal incubation time or temperature to improve pregnancy outcomes in testicular sperm extraction-intracytoplasmic sperm injection (TESE-ICSI) cycles. We aimed to evaluate whether a 24-hour in vitro culture of testicular spermatozoa affects pregnancy outcomes in TESE-ICSI cycles. @*Methods@#This was a retrospective study of 83 TESE-ICSI cycles using testicular spermatozoa in 46 couples with male partners suffering from nonobstructive or obstructive azoospermia. Sperm retrieval was performed either on the oocyte retrieval (OR) day (65 cycles in 33 couples; group A) or on the day before OR (18 cycles in 13 couples; group B) followed by in vitro culture for 24 hours. The clinical characteristics and pregnancy outcomes, including the number of retrieved oocytes, fertilization rates, embryo transfer rates, implantation and clinical pregnancy rates, were compared between the two groups. @*Results@#There were no differences in terms of clinical characteristics except for the levels of luteinizing hormone (LH) in males. Group B had higher LH levels than group A (4.56±1.24 IU/L vs. 3.67±1.07 IU/L, p=0.017). Group B showed higher fertilization rate (72.4±32.1% vs. 59.2±21.7%, p=0.045), implantation rate (35.0±34.1% vs. 14.0±21.5%, p=010), pregnancy rate per cycle (80% vs. 39%, p=0.033), and clinical pregnancy rate per cycle (80% vs. 37.5%, p=0.024) than those of group A. @*Conclusion@#Testicular sperm retrieval performed on the day before OR followed by in vitro culture can potentially improve pregnancy outcomes.

The comparison of QTc interval change on the ECG during laparoscopic cholecystectomy under inhalation and total intravenous anesthesia

BACKGROUND: There can be changes in the cardiac function during laparoscopic cholecystectomy. In this study, QTc interval changes were compared between total intravenous anesthesia (TIVA) group and inhalation anesthesia group during laparoscopic cholecystectomy. METHODS: The study was conducted on adult patients, ages ranging from 20 to 65 years old, and classified as the American Society of Anesthesiologists physical status I or II. At random, the patients were divided into group 1 (TIVA, n = 20) and group 2 (inhalation anesthesia, n = 19). Group 1 patients were induced and maintained with continuous infusion of remifentanil and propofol using a target controlled infusion device. Patients in group 2 were induced with sevoflurane and N2O using mask ventilation, and then anesthesia was maintained with sevoflurane and N2O. The QTc interval, heart rate and mean arterial pressure were measured prior to induction, immediately following intubation, 10 minutes following intubation, following CO2 inflation, immediately following head-up position, 10 minutes following head-up position, following CO2 deflation-supine position respectively. RESULTS: In group 1, the ECG sampling showed no prolongation in the QTc intervals at all measured points. In group 2, QTc interval was significantly longer at all other measured points compared to prior to induction (P < 0.05). Except prior to induction, QTc intervals were significantly longer at all other measure points in group 2 compared to those in group 1 (P < 0.05). CONCLUSIONS: There was no QTc interval prolongation under the TIVA using propofol and remifentanil during laparoscopic cholecystectomy.

Newly Developed Urinary Retention and Motor Weakness of Lower Extremities in a Postherpetic Neuralgia Patient

During the early stage of postherpetic neuralgia, an epidural block on the affected segment is helpful in controlling pain and preventing progression to a chronic state. The main neurologic complication following an epidural block is cord compression symptom due to an epidural hematoma. When neurologic complications arise from an epidural block for the treatment of postherpetic neuralgia, it is important to determine whether the complications are due to the procedure or due to the herpes zoster itself. We report a case of a patient who was diagnosed with herpes zoster myelitis during treatment for postherpetic neuralgia. The patient complained of motor weakness in the lower extremities after receiving a thoracic epidural block six times. Although initially, we believed that the complications were due to the epidural block, it was ultimately determined to be from the herpes zoster myelitis.

Hospitalization Decreases Serum Prostate-Specific Antigen Values Compared With Outpatient Values in Patients With Benign Prostatic Diseases

PURPOSE: To investigate whether hospitalization influences serum prostate-specific antigen (PSA) values. MATERIALS AND METHODS: Transrectal ultrasound-guided prostate biopsies were performed for detecting prostate cancer in 2,017 patients between February 2001 and April 2011 at Ajou University Hospital. Of those patients, 416 patients who were hospitalized for prostate biopsies, whose serum PSA values were measured at the outpatient department within 1 month of admission and also just after admission, and who had negative prostate biopsy results were included in the present study. We retrospectively reviewed the data of the 416 patients and compared the serum PSA values measured in the outpatient department with those measured during hospitalization. RESULTS: Among all 416 patients, the interval between the two PSA measurements was 22.2 days (range, 3 to 30 days) and the prostate size measured by transrectal ultrasonography was 53.63 mL (range, 12.8 to 197.9 mL). Among all patients, mean serum PSA levels measured during hospitalization were significantly lower than those measured in the outpatient department (6.69 ng/mL vs. 8.01 ng/mL, p<0.001). When stratified according to age, the presence or absence of chronic prostatitis in the biopsy pathology, serum PSA levels, and prostate size, the serum PSA levels measured during hospitalization were significantly lower than those measured in the outpatient department in all subgroups, except in cases aged 20 to 39 years and those with PSA <4 ng/mL, in whom no significant differences were shown. CONCLUSIONS: Hospitalization decreases serum PSA values compared with those measured on an outpatient basis in patients with benign prostatic diseases. Therefore, serum PSA values should be checked on an outpatient basis for serial monitoring.

Complete obstruction of an endotracheal tube due to an unexpected blood clot in a patient with a hemo-pneumothorax after repositioning of the patient for lumbar spine surgery / 대한마취과학회지

No abstract available.

Clinical experience of one lung ventilation using an endobronchial blocker in a patient with permanent tracheostomy after total laryngectomy / 대한마취과학회지

No abstract available.

Prognostic Significance of Substaging according to the Depth of Lamina Propria Invasion in Primary T1 Transitional Cell Carcinoma of the Bladder

PURPOSE: To evaluate the prognostic significance of the depth of lamina propria invasion in primary T1 transitional cell carcinoma (TCC) of the bladder. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 183 patients with primary T1 TCC of the bladder who had undergone transurethral resection (TUR) at our institution. Substaging was defined according to the depth of lamina propria invasion as follows: T1a, superficial invasion of lamina propria; T1b, invasion into the muscularis mucosa (MM); T1c, invasion beyond the MM but not to the muscularis propria. The prognostic significance of various clinicopathological variables for recurrence and progression was analyzed. RESULTS: Of the 183 patients, substaging was T1a in 119, T1b in 57, and T1c in 7 patients. The recurrence rate was 32.8% for T1a and 40.6% for T1b/c, but there was no significant difference between the two groups. The progression rate was significantly different between the two groups: 5.8% in T1a and 21.9% in T1b/c (p=0.003). The cancer-specific mortality rate was also significantly different: 4.2% in T1a and 14.0% in T1b/c (p=0.036). In the univariate analysis, microscopic tumor architecture was the only significant prognostic factor for recurrence. In the univariate and multivariate analysis concerning progression, depth of lamina propria invasion and concomitant carcinoma in situ were significant prognostic factors. CONCLUSIONS: Substaging according to the depth of lamina propria invasion in primary T1 TCC of the bladder was an independent prognostic factor for progression. This suggests that substaging would be helpful for guiding decisions about adjuvant therapies and follow-up strategies.

Prostate-Specific Antigen Nadir and Time to Prostate-Specific Antigen Nadir Following Maximal Androgen Blockade Independently Predict Prognosis in Patients with Metastatic Prostate Cancer

PURPOSE: To evaluate the influence of prostate-specific antigen (PSA) kinetics following maximal androgen blockade (MAB) on disease progression and cancer-specific survival in patients with metastatic, hormone-sensitive prostate cancer. MATERIALS AND METHODS: One hundred thirty-one patients with metastatic, hormone-sensitive prostate cancer treated with MAB at our institution were included in this study. Patients' characteristics, PSA at MAB initiation, PSA nadir, time to PSA nadir (TTN), and PSA decline were analyzed by using univariate and multivariate analysis. RESULTS: At a median follow-up of 30 months, 97 patients (74.0%) showed disease progression and 65 patients (49.6%) died. Fifty-nine patients (45.0%) died from prostate cancer. In the univariate analysis, PSA at MAB initiation, PSA nadir, TTN, and PSA decline were significant predictors of progression-free survival. Also, PSA nadir, TTN, and PSA decline were significant predictors of cancer-specific survival. In the multivariate analysis, higher PSA nadir (> or =0.2 ng/ml) and shorter TTN (<8 months) were independent predictors of shorter progression-free and cancer-specific survival. In the combined analysis of PSA nadir and TTN, patients with higher PSA nadir and shorter TTN had the worst progression-free survival (hazard ratio [HR], 14.098; p<0.001) and cancer-specific survival (HR, 14.050; p<0.001) compared with those with lower PSA nadir and longer TTN. CONCLUSIONS: Our results suggest that higher PSA nadir level and shorter TTN following MAB are associated with higher risk of disease progression and poorer survival in patients with metastatic, hormone-sensitive prostate cancer. Furthermore, these two variables have a synergistic effect on the outcome.

Prognostic Significance of Preoperative C-Reactive Protein Elevation and Thrombocytosis in Patients with Non-Metastatic Renal Cell Carcinoma

PURPOSE: The aim of this study was to investigate the association of preoperative C-reactive protein (CRP) elevation and thrombocytosis with the prognosis of patients with non-metastatic renal cell carcinoma (RCC). MATERIALS AND METHODS: This was a retrospective review of the medical records of 177 patients (130 men and 47 women) with non-metastatic RCC who underwent a radical nephrectomy between March 2000 and May 2008 and for whom preoperative CRP and platelet data were available for analysis. Preoperative CRP elevation and thrombocytosis were compared with clinical and pathological variables. RESULTS: There were 38 patients with CRP elevation and 11 patients with thrombocytosis. The mean follow-up time was 48.3 months (median, 48.0; range, 13-111 months). Twenty-three patients (13.0%) developed metastases and six patients died during the follow-up period. CRP elevation was significantly correlated with anemia (p=0.001), T stage (p=0.004), grade (p=0.025), and metastasis (p<0.001). Thrombocytosis was significantly correlated with anemia (p=0.003), T stage (p=0.002), and metastasis (p=0.001). The univariate analysis identified anemia, CRP elevation, thrombocytosis, tumor histology subtype, tumor size, T stage, and grade as significant prognostic factors associated with recurrence-free survival, whereas the multivariate analyses showed that CRP elevation (p=0.033) and tumor size (p=0.007) were independent prognostic factors. CONCLUSIONS: Preoperative CRP elevation and thrombocytosis were associated with a poorer prognosis and a higher recurrence rate in patients with non-metastatic RCC. Moreover, preoperative CRP elevation appeared to be an independent predictor of tumor recurrence and prognosis. Preoperative thrombocytosis, however, was not an independent prognostic factor for tumor recurrence and prognosis.

Testicular Microlithiasis: Prevalence and Clinical Significance in a Population Referred for Scrotal Ultrasonography

PURPOSE: Testicular microlithiasis (TM) is an uncommon pathologic condition that is commonly diagnosed by scrotal ultrasonography. Indirect evidence suggests that this syndrome may be associated with an increased risk of testicular malignancy and infertility. MATERIALS AND METHODS: A total of 1,439 patients undergoing scrotal ultrasound during a 6-year, 5-month period (January 2003 to May 2009) were retrospectively reviewed. Any possible association of TM with pathologic findings was assessed. Among patients with TM, further grading of TM with testicular cancer and semen analysis of the infertile group with TM were also performed. RESULTS: TM was diagnosed in 87 patients (6.0%) out of a total of 1,439. Of all established pathologic entities, only testicular malignancy and infertility were meaningfully associated with TM. There was no significant difference in the prevalence of testicular cancer between each grade. Seminal profiles (sperm count, motility, morphology, and white blood cell count) were not found to be statistically different between infertile men with and without TM. CONCLUSIONS: The prevalence of TM in symptomatic men was found to be 6.0% with significant co-occurrence of TM, testicular cancer, and infertility. Further grading of TM does not seem to be essential with regard to the detection of patients with testicular cancer and TM. TM showed no significant effect on the seminal profiles of infertile men.

Extensive Systemic Sarcoidosis with Testicular Involvement Mimicking Metastatic Testicular Cancer

Sarcoidosis is an idiopathic, multisystem disease that rarely involves the genitourinary tract. Here we present an unusual case of testicular sarcoidosis with extensive lymphadenopathy that mimicked a metastatic testicular tumor. A 27-year-old male presented with a palpable right testicular mass accompanied by multiple palpable inguinal lymph nodes. The scrotal ultrasound showed a hypoechoic lesion at the inferior portion of the right testis. Extensive enlarged lymph nodes were noted in multiple areas on the abdominal computed tomography. Preoperative testicular tumor markers were within the normal range. Exploration of the right testis with a frozen section analysis of the right testicular mass and of a palpable right inguinal lymph node showed granulomatous inflammation. The testis was salvaged and the final pathological diagnosis was sarcoidosis. Treatment with high-dose corticosteroids resulted in complete resolution of the intratesticular mass and a significant decrease in the extent of the lymphadenopathy.

Risk Factors for Acute Prostatitis after Transrectal Biopsy of the Prostate

PURPOSE: To investigate the incidence, clinical features, pathogenic bacteria, and risk factors associated with acute prostatitis after transrectal prostate biopsy. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 923 transrectal ultrasound-guided needle biopsies of the prostate in 878 patients performed at our institution from June 2004 to May 2009. The indications for biopsy were generally serum prostate-specific antigen (PSA) elevation, abnormal findings on a digital rectal examination, or both. All biopsies were performed with the patient hospitalized except for 10 patients who refused to be hospitalized, and ciprofloxacin was administered as an antibiotic prophylaxis. The incidence, clinical features, pathogenic bacteria, and potential risk factors associated with acute prostatitis after prostate biopsy were evaluated. RESULTS: Acute prostatitis developed in 18 (2.0%) cases after prostate biopsy. Among them, 9 (1.0%) had bacteremia and 2 (0.2%) showed clinical features of sepsis. Of the total 50 urine or blood specimens sent for culture study, 27 (54.0%) specimens showed positive cultures, including E. coli in 25. Among the 27 culture-positive specimens, 26 (96.3%) were resistant to ciprofloxacin. Among the potential risk factors for acute prostatitis after prostate biopsy, biopsy performed as an outpatient procedure without a cleansing enema (p=0.001) and past history of cerebrovascular accident (p=0.048) were statistically significant. CONCLUSIONS: Fluoroquinolone is effective as an antibiotic prophylaxis for transrectal prostate biopsy in most cases. The incidence of acute prostatitis after transrectal prostate biopsy was 2.0%, and almost all cases were caused by fluoroquinolone-resistant E. coli. A cleansing enema is recommended before transrectal prostate biopsy.

Bioelectrical Impedance May Predict Cell Viability During Ischemia and Reperfusion in Rat Liver

Ischemia and reperfusion (I/R) injury is a major cause of hepatic failure after liver surgery, but no method could monitor or predict it real-time during surgery. We measured bioelectrical impedance (BEI) and cell viability to assess the usefulness of BEI during I/R in rat liver. A 70% partial liver ischemia model was used. BEI was measured at various frequencies. Adenosine triphosphate (ATP) content, and palmitic acid oxidation rate were measured, and histological changes were observed in order to quantify liver cell viability. BEI changed significantly during ischemia at low frequency. In the ischemia group, BEI increased gradually during 60 min of ischemia and had a tendency to plateau thereafter. The ATP content decreased below 20% of the baseline level. In the I/R group, BEI recovered to near baseline level. After 24 hr of reperfusion, the ATP contents decreased to below 50% in 30, 60 and 120 min of ischemia and the palmitic acid metabolic rates decreased to 91%, 78%, and 74%, respectively, compared with normal liver. BEI may be a good tool for monitoring I/R during liver surgery. The liver is relatively tolerant to ischemia, however after reperfusion, liver cells may be damaged depending upon the duration of ischemia.

Impaired Cation Transport May Lead to Bioelectrical Impedance Changes during Hepatic Ischemia

PURPOSE: Ischemia and reperfusion (I/R) injury is a major cause of hepatic failure after liver surgery, but there is no direct method to monitor it in real-time (like an electrocardiogram in heart disease) during surgery. Recently we found the possible role of bioelectrical impedance (BEI) to monitor I/R injury in liver. But the mechanism responsible for ischemia-related BEI changes has not been clearly determined. METHODS: The authors used an LCR meter to quantify BEI changes at 0.12 KHz. Livers were subjected to 70% partial ischemia for 120 minutes, and ATP contents, cation changes in extracellular fluid (ECF; determined using an in vivo intracellular microdialysis technique), hepatocyte sizes, and histological changes were then examined. RESULTS: Liver tissue BEI was found to increase gradually during the first 60 minutes of ischemia and then tended to plateau. During the same period, intracellular ATP contents decreased to below 20% of the baseline level, [Na+] in ECF decreased from 150.4+/-3.8 to 97.8+/-10.6 mmol/L, and [K+] in ECF increased from 7.5+/-0.3 to 34.3+/-5.5 mmol/L during the first 60 minutes of ischemia. Hepatocyte diameter increased by ~20% during the first 60 minutes of ischemia. CONCLUSION: This study suggests that BEI changes during hepatic ischemia are probably caused by sodium and potassium concentration changes in the ECF due to reduced intracellular ATP contents.

Short-term Prostate-Specific Antigen Velocity Measurement before Prostate Biopsy

PURPOSE: We investigated whether a short-term follow-up prostate-specific antigen (PSA) measurement before prostate biopsy is useful in predicting the presence of prostate cancer. MATERIALS AND METHODS: From January 2004 to May 2008, 670 patients underwent transrectal ultrasound-guided prostate biopsy. The initial PSA (PSA1) was measured at the first outpatient visit. The second PSA (PSA2) was measured the evening before prostate biopsy. Only the patients with a PSA1 between 2.5 and 20 ng/ml and an interval between PSA1 and PSA2 of between 7 and 90 days were included in this study. The short-term PSA velocity (PSAVm) was defined as {(PSA2-PSA1/interval (days)}x30. Prostate volume (PV), PSA1, PSA2, and PSAVm were compared between the patients with prostate cancer and those with benign histology. RESULTS: Of the 362 patients who fulfilled the entry criteria, 365 prostate biopsies were performed. The PSAVm differed significantly between patients with prostate cancer and those with benign histology (p=0.021). In patients with a PSA1 of 10-20 ng/ml, age, PV, PSA1, PSA2, and PSAVm were significantly different between patients with prostate cancer and those with benign histology, whereas in patients with a PSA1 of 2.5-10 ng/ml, only PV was significantly different. In multivariate logistic regression analysis excluding PSA1 and PSA2, PSAVm was a significant predictor of prostate cancer overall and in patients with a PSA1 of 10-20 ng/ml, but not in patients with a PSA1 of 2.5-10 ng/ml. CONCLUSIONS: PSAVm was significantly different between the benign group and the prostate cancer group. But, this difference was mainly the result of a falsely elevated PSA, and PSAVm was not a significant predictor of prostate cancer when the PSA1 was 2.5-10 ng/ml.

Impact of Caveolin-1 Expression on the Prognosis of Transitional Cell Carcinoma of the Upper Urinary Tract

This study aimed to investigate the relationship of caveolin-1 expression with prognosis in patients with transitional cell carcinoma of the upper urinary tract (TCCUUT). Formalin-fixed, paraffin-embedded tissue sections of TCC-UUT from 98 patients, who had undergone radical nephroureterectomy, were stained immunohistochemically using antibodies against caveolin-1. The expression pattern of caveolin- 1 was compared with the clinicopathological variables. The caveolin-1 expression was significantly correlated with T stage (p<0.001) and grade (p=0.036). The survival rate of patients with caveolin-1 positive tumors was significantly lower than that of patients with caveolin-1 negative tumors (p<0.0001). The univariate analyses identified T stage, grade, and caveolin-1 expression as significant prognostic factors for cancer-specific survival, whereas the multivariate analyses indicated that T stage and caveolin-1 expression were independent prognostic factors. These results show that the increased expression of caveolin-1 is associated with tumor progression and poor prognosis in TCC-UUT, suggesting that caveolin-1 may play an important role in the progression of TCC-UUT.

Clinical Studies on Postcoital Hematuria / 대한비뇨기과학회지

PURPOSE: A study was conducted to evaluate the clinical characteristics of patients with postcoital hematuria without bloody ejaculate. MATERIALS AND METHODS: The records of 21 men(mean age 48.6 years, range 27-64 years) with isolated postcoital hematuria without bloody ejaculate were retrospectively reviewed. Patients underwent routine laboratory testing including coagulation studies and urological evaluation which included urinalysis, urine cytology, abdominal and transrectal ultrasonography, and cystourethroscopy. RESULTS: Among total 21 patients, there were no detectable abnormalities in 11(52.4%) patients. Lesions were found in 10(47.6%) patients, which included 1 pathologically proven prostatic urethral hemangioma, 5 benign prostatic hyperplasia, 1 bladder neck obstruction, and 3 ultrasonographically identified seminal vesicle dilatation. In 19(90.5%) patients, symptom subsided after treatment or simple observation without recurrences. In the remaining two patients, postcoital hematuria has still persisted intermittently. CONCLUSIONS: Thorough evaluations are necessary in the case of postcoital hematuria as treatable lesions could be identified. In cases without identifiable causes, the patients could be reassured that the condition is benign and self-limiting.

Correlation of Cyclooxygenase-2 Expression and Microvessel Density with Prognosis in Transitional Cell Carcinoma of the Upper Urinary Tract / 대한비뇨기과학회지

PURPOSE: The aim of this study was to investigate the relationship of cyclooxygenase (COX)-2 expression and microvessel density (MVD), a reflection of angiogenesis, with prognosis in patients with transitional cell carcinoma of the upper urinary tract (TCC-UUT). MATERIALS AND METHODS: Formalin-fixed, paraffin-embedded tissue sections of TCC-UUT from 91 patients, who had undergone radical nephroureterectomy, were examined immunohistochemically using antibodies against COX-2 and CD34. MVD was determined with CD34-stained slides. The expression patterns of COX-2 and MVD were compared with the clinicopathological variables. RESULTS: The COX-2 expression was significantly correlated with T stage (p=0.002), N stage (p=0.010), and grade (p=0.027). MVD was also significantly correlated with T stage (p<0.001), N stage (p=0.002), and grade (p=0.001). The COX-2 expression was significantly correlated with MVD (p=0.001). The survival rate of patients with COX-2 positive tumors or high MVD was significantly lower than that of patients with COX-2 negative tumors or low MVD, respectively (p=0.0013, p=0.0312). Univariate analyses identified T stage, N stage, grade, COX-2 expression, and MVD as significant prognostic factors for cancer-specific survival; multivariate analyses indicated that T stage was the only independent prognostic factor. CONCLUSIONS: The increased expression of COX-2 and MVD is associated with a worse prognosis in TCC-UUT. The COX-2 expression is correlated with MVD. These results suggest that COX-2 may play an important role in the progression of TCC-UUT and angiogenesis may be affected by COX-2 during the progression of TCC-UUT.