Clinical Prognostic Factors for Radical Cystectomy in Bladder Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We investigated the effects of radical cystectomy and the prognostic factors that affect the survival of bladder cancer patients. MATERIALS AND METHODS: From 1979 to 2002, 59 patients with long-term follow up results of at least 2 years were enrolled in this study. Indications for surgery included muscle invasive bladder cancer and high-risk superficial bladder cancer. The cancer specific and recurrence free survival rates with respect to the possible prognostic factors were determined using Kaplan-Meier statistics. RESULTS: The mean patient age was 62.8 years (M: 48, F: 11), and the estimated 5- and 10-year survival rates were 62% and 39.4%, respectively. The median time to local or systemic recurrence was 16 months (range: 5~100), and the average survival durations after local and systemic recurrence were 14.4 months and 12.7 months, respectively. Pathologic stage, tumor grade, mean nuclear area, sex and lymphatic invasion were significant factors by univariate analysis (p<0.05). The disease related survival rate in patients having progression from an initial superficial tumor was lower than for those patients who displayed muscle invasive disease at the initial treatment. Multivariate analysis identified pathologic stage and lymphatic invasion as independent prognostic factors. CONCLUSIONS: Radical cystectomy for organ-confined cancer showed favorable 5- and 10-year survival rates. The survival rate for patients with progression from an initial superficial tumor was worse than for those patients with invasive tumor at the initial presentation. The most significant independent prognostic factors were the pathologic stage and the presence of lymphatic invasion, which were highly correlated with all the investigated disease endpoints.

Effect of GM-CSF on Neutropenia Induced by Chemotherapy or Immunotherapy in Patients with Urologic Malignancy / 대한비뇨기과학회지

Purpose: Neutropenia is a major factor contributing to morbidity and mortality in patients undergoing chemotherapy for cancer. The efficacy and complications of GM- CSF (Granulocyte-Macrophage colony stimulating factor) on the neutropenia induced by chemotherapy or immunotherapy were evaluated in patients with a urologic malignancy. Material and Methods: Twenty-nine patients with a histologically confirmed urologic malignancy, who presented with neutropenia during either chemotherapy or immunotherapy, were given a fixed dose (400microgram) of GM-CSF subcutaneously for three to fifteen days. Twenty-nine patients with neutropenia were given GM-CSF for 50 cycles. The patients were evaluated by means of a complete blood cell count, white cell and differential counts. The mean time to response was 2.3 days. The statistical significance of the differences was calculated using a paired t test. RESULTS: GM-CSF treatment in patients with neutropenia resulted in an increase in the mean neutrophil count, the eosinophil count, and the monocyte count. Complications of GM-CSF included fever (76%), GI problems (19%), headache (14%), bone pain (14%), arthralgia (10%), and urticaria (5%). CONCLUSIONS: GM-CSF may be useful in reducing the toxicity of chemotherapy. Therefore, GM-CSF can be used to increase the effect of chemotherapy without delaying or stopping treatment as a result of neutropenia.

Testis Tumor: A Review of 42 Cases / 대한암학회지

PURPOSE: This study was performed in order to evaluate the clinical characteristics, effect of treatment and prognosis in patients with testicular tumors. MATERIALS AND METHODS: We retrospectively reviewed 42 patients with testicular tumor treated at our hospital. We analyzed the pathologic classification, clinical stage, preoperative tumor markers, treatment methods, clinical characteristics, and prognosis. RESULTS: The histologic type was seminoma in 11, teratoma in 10, yolk sac tumor in 5, embryonal cell carcinoma in 4, mixed type in 8 and secondary neoplasm in 4. Clinically, 31 patients were stage I, 2 stage IIa, 2 stage IIb, 1 stage IIc, 6 stage IV. Following orchiectomy, 22 patients underwent surveillance, 12 chemotherapy, 4 radiation therapy, 1 retroperitoneal lymph node dissection (RPLND), 2 radiation plus chemotherapy, and 1 radiation plus chemotherapy and RPLND. The 10-year survival rate was 90.9% in the cases of seminoma. Similarly, the 10-year survival rate was 96.0% in the cases of non-seminomatous germ cell tumors (NSGCT). CONCLUSION: In our study, patients with testicular tumor revealed an excellent survival rate. Testicular tumors are solid tumors that have a possibility of complete remission by additional chemotherapy or radiation following radical surgery. Therefore, early detection and aggressive treatment were mandatory.

Role of Color Doppler Sonography in Transrectal Ultrasound Guided Biopsy of Prostate / 대한비뇨기과학회지

PURPOSE: The aim of this study is to correlate the findings at prostate CDS (Color doppler sonography) with those of site specific transrectal ultrasound (TRUS) guided biopsy for determining the role of CDS in detection of prostate cancer. MATERIALS AND METHODS: Forty-nine patients underwent TRUS guided biopsy because of palpable hard nodule of prostate, abnormal prostate specific antigen, or hypoechoic lesion of TRUS. CDS was performed at all biopsy sites before TRUS guided biopsy. Color flow at CDS was prospectively graded on a scale of 0, I, II (0=no or minimal, I=moderate, II=markedly increased color flow at peripheral zone). CDS results were correlated with histologic findings from 491 separate biopsy sites of 49 patients. RESULTS: Cancer was found on biopsy in 153 sites, prostatitis was found in 95 sites, and benign prostatic hyperplasia (BPH) was found in 243 sites. CDS had a sensitivity of 30.1%, specificity of 98.2%, positive predictive value of 88.5%, and negative predictive value of 75.6%. Of 52 grade II color flow biopsy sites, 46 were prostate cancer, prostatitis and BPH were 3 each other. Of 153 biopsy sites in prostate cancer, 46 sites were grade II, 62 sites were grade I, 45 sites were grade 0 color flow. CDS depicted cancer in 43 sites of 5 patients without gray scale abnormality. Of 16 patients with hypoechoic lesion, eight patients had cancer, but CDS did not assist to differentiate the cancer from benign lesion. CONCLUSIONS: Grade II color flow in peripheral zone is highly associated with prostate cancer. In case of no gray scale abnormality, CDS may help identify appropriate sites for biopsy. But, negative CDS do not exclude biopsy because of low sensitivity.