ABSTRACT
The aims of this study were to determine the prognostic value of primary tumor surgery and identify optimal candidates for such surgery among patients with seminoma and distant metastasis at diagnosis. We identified 521 patients with seminoma and distant metastasis at diagnosis between 2004 and 2014 from the Surveillance, Epidemiology, and End Results database. Among these patients, 434 had undergone surgery, whereas 87 had not. The prognostic value of primary tumor surgery was assessed by Kaplan-Meier methods, log-rank analyses, and multivariate Cox's proportional hazards model. Survival curves and forest plots were also plotted. Survival analysis indicated that patients who underwent surgery had a better 5-year overall survival and cancer-specific survival than those who did not. Multivariate analyses demonstrated that primary tumor surgery is an independent prognostic factor for overall survival and cancer-specific survival, along with age at diagnosis, M stage, and marital status. In addition, primary tumor surgery still had considerable prognostic value in the subgroup of patients with lymph node metastasis. Further, forest plots demonstrated that patients with M1a stage, N1 or N2-3 stage, and a younger age at diagnosis (<60 years) may benefit from primary tumor surgery. In conclusion, our findings indicate that primary tumor surgery is correlated with improved survival in patients with seminoma and distant metastasis. Furthermore, primary tumor surgery is an independent prognostic indicator for patients with seminoma and distant metastasis.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the influence of anthropometric measures of obesity, including body mass index (BMI), abdominal subcutaneous adipose tissue and visceral adipose tissue, on pathological characteristics in patients with clinically localized prostate cancer.</p><p><b>METHODS</b>From January 2006 to March 2013, the 413 patients of prostate cancer who received radical prostatectomy (RP) and their clinical and pathological data had been collected. The median age for the entire cohort was 68 years, which ranged from 48 to 78 years. All patients were diagnosed with prostate cancer before surgery and the Gleason score ranged from 4 to 10 (median 7). Anthropometric measures of abdominal adiposity including anterior abdominal fat, posterior abdominal fat and anteroposterior diameter were measured from the T2 weighted sagittal localization images of MRI scans and subcutaneous adipose tissue and the percentage of visceral adipose tissue were calculated. The patients' clinical and pathologic characteristics across BMI groups were compared used Student's t test for continuous variables or chi-squared test for categorical variables. Moreover, univariable and multivariable logistic regression models were used to address the influence of anthropometric measures of obesity on pathological outcomes.</p><p><b>RESULTS</b>The BMI ranged from 14.2 to 34.0 kg/m(2) and the median value was 23.8 kg/m(2). The abdominal subcutaneous adipose tissue ranged from 12.6 to 60.3 mm and the median value was 31.4 mm. The percentage of visceral adipose tissue ranged from 71.1% to 92.1% and the median value was 83.8%. In RP specimens, Gleason score ≥ 8 was observed in 141 patients (34.1%), pathological tumor stage was T3a in 69 patients (16.7%) and pathological tumor stage was T3b in 78 patients (18.9%). Positive surgical margin and lymph node involvement were observed in 71(17.2%) and 38(9.2%) patients, respectively. Although univariate analysis showed that BMI ≥ 25 kg/m(2) was associated with pathological Gleason score ≥ 8 (OR = 1.413, P = 0.035), this positive correlation disappeared in multivariate analysis(P = 0.095). In multivariate analysis, the percentage of visceral adipose tissue was significantly associated with pathological Gleason score (OR = 9.618, P = 0.000), extracapsular extension (OR = 6.750, P = 0.002) and seminal vesicle invasion (OR = 4.419, P = 0.007) after adjusting for patient age, PSA level, clinical stage and biopsy Gleason score.</p><p><b>CONCLUSIONS</b>Anthropometric measures of abdominal adiposity was more sophisticated than simple BMI to evaluate the risk of obesity with regard to the aggressiveness of prostate cancer. The percentage of visceral adipose tissue was an independent factor for pathological Gleason score, extracapsular extension and seminal vesicle invasion in RP specimens.</p>
Subject(s)
Aged , Humans , Male , Middle Aged , Adiposity , Anthropometry , Body Mass Index , Intra-Abdominal Fat , Logistic Models , Obesity , Prostate , Pathology , Prostatectomy , Prostatic Neoplasms , Pathology , Risk FactorsABSTRACT
<p><b>OBJECTIVE</b>To evaluate the incidence and severity of perioperative complications in elderly patients with radical prostatectomy (RP).</p><p><b>METHODS</b>A total of 242 patents underwent RP for prostate cancer were retrospectively assessed, whose clinicopathologic factors and perioperative complications were retrieved from the medical records. The mean age in the elderly group (n = 163) and control group (n = 79) were (73.2 ± 2.4) and (63.2 ± 4.8) years, respectively. The clinicopathologic factors including Charlson comorbidity index and preoperative prostate specific antigen were statistically significant different. The difference of clinicopathologic factors and perioperative complications between the elderly group (≥ 70 years old) and control group were statistically analyzed using the SPSS 17.0.</p><p><b>RESULTS</b>The incidence of perioperative complications was 23.5% in the elderly group and 22.7% in the control group. Except for gross hematuria (there were 12 cases in elderly group and 1 case in control group, respectively, χ(2) = 3.89, P < 0.05) and perioperative transfusion (there were 36 cases in elderly group and 7 cases in control group, respectively, χ(2) = 6.37, P < 0.05), there was no significant difference in each kind or total of perioperative complications.</p><p><b>CONCLUSION</b>The elderly patients underwent RP in experienced center are not associated with higher or more serious perioperative complications.</p>