Efficacy of Bladder-Preserving Therapy for Patients with T3b, T4a, and T4b Transitional Cell Carcinoma of the Bladder

PURPOSE: Radical cystectomy has been the most widely used method in the treatment of bladder cancer, but it is limited by major problems. Therefore, we investigated the results of bladder-preserving treatment in patients with T3b, T4a, and T4b transitional carcinoma of the bladder who underwent transurethral resection of bladder cancer and subsequent administration of chemotherapy. MATERIALS AND METHODS: Of all patients who were diagnosed with bladder cancer and underwent bladder-preserving treatment between January 2001 and August 2008, 78 patients with at least 12 months of follow-up data were enrolled in this study. All patients received gemcitabine (1,000 mg/m2) and cisplatin (70 mg/m2) once per month postoperatively for a total of 6 months and completed a follow-up visit every 3 months. The patient survival rate and prognostic factors (age, tumor size, differentiation, number of lesions, stage, and presence of hydronephrosis) were assessed. The Kaplan-Meier method was used to analyze survival rate, and Cox multiple regression analysis was used for prognostic factors. RESULTS: The mean patient age was 68.32+/-8.6 years, the mean duration of follow-up was 54.70+/-32.8 months, and the median duration of follow-up was 49.0 months. The 5-year survival rate was 66.2%. Single lesions were found in 28 cases (35.9%), and multiple lesions were found in 50 cases (64.1%). Stage T3b lesions were identified in 56 cases (71.8%), stage T4a lesions were identified in 16 cases (20.5%), and stage T4b lesions were identified in 6 cases (7.7%). Tumor size was less than 4 cm in 4 cases (59.0%) and greater than 4 cm in 32 (41.0%). Hydronephrosis was present in 21 cases (26.9%). In the 5-year survival analysis, prognostic factors significantly influencing survival rate were T-stage of the tumor and absence of hydronephrosis and complete regression after treatment (p<0.05). Multivariate analysis revealed that tumor stage and the absence of hydronephrosis were statistically significant prognostic indicators. CONCLUSIONS: In patients with T3b, T4a, and T4b transitional carcinoma of the bladder, bladder preservation may prevent a decrease in quality of life. Also, our findings suggest that this approach could be considered a primary treatment option for patients with T3b stage tumors without evidence of hydronephrosis.

Translation and Validation of the Korean Version of MUDI and MUSIQ with Urinary Incontinent Older Men

PURPOSE: The purpose of this study was to evaluate the psychometric properties of the Korean version of the Male Urinary Distress Inventory (MUDI) and Male Urinary Symptom Impact Questionnaire (MUSIQ). PATIENTS AND METHODS: A convenient sample of community-dwelling older men with urinary incontinence participated. A cross-sectional survey design was used for this study. A panel of experts completed the initial translation into Korean and back-translated the MUDI and MUSIQ. Upon establishment of the content and translation equivalence between English and Korean versions of the MUDI and MUSIQ, psychometric properties were evaluated for reliability, concurrent, and construct validity with a sample of 143 older men. RESULTS: The internal consistencies of both instruments were found to be acceptable, and Cronbach's coefficients were 0.88 for the MUDI-K and 0.92 for the MUSIQ-K. A significant moderate correlation between MUDI-K and MUSIQ-K was found in this study, indicating modest concurrent validity between these 2 instruments (r = 0.56, p < 0.001). For construct validity, the mean scores of the MUDI-K were significantly different for age, marital status, prostate surgery, erectile dysfunction, and depression (p < 0.05). The means scores of MUSIQ-K were significantly different for depression (p < 0.05) only. For both the MUDI-K and MUSIQ-K, 7 factors were extracted, accounting for 68.1% and 72.1% of the variance. CONCLUSION: Results of this study suggest that the MUDI-K and MUSIQ-K can be used as a reliable and valid measure of health-related quality of life in community- dwelling Korean older men with urinary incontinence.

Vascular Endothelial Growth Factor - Its Relation to Neovascular ization and Their Significance as Prognostic Factors in Renal Cell Carcinoma

Angiogenesis is a series of processes that include endothelial proliferation, migration and tube formation. Vascular endothelial growth factor (VEGF) is regarded as a potent mediator of angiogenesis, vascular permeability and tumor cell growth in renal cell carcinoma. This study was designed to evaluate the expression of VEGF and the microvessel count (MVC) and to determine their prediction efficacies for prognosis in renal cell carcinoma. The relationship between the expression of VEGF and MVC were evaluated immunohistochemically in 50 patients with renal cell carcinoma who received a radical nephrectomy at Wonju Christian Hospital between 1989 and 1997. Microvessels were identified by immunostaining endothelial cells for CD-31 antigen. The mean follow-up was 96 months (3 - 133 months). Overall 5-year survival rate was 71.5%. VEGF was expressed in the tumor cell cytoplasm. Of the 50 tumors, 23 (46%) were weak to strongly positive for VEGF but 27 (54%) were unreactive. The respective 5-year survival rates for patients with positive and negative expressions of VEGF were 70% and 73% (p > 0.05). The overall mean MVC was 13.4 in a 400x field. Mean MVCs were significantly higher in VEGF-positive tumors (17.6 +/- 12.1) than in VEGF-negative tumors (9.9 +/- 5.4), and the MVCs of the high vascular density group and the low ascular density groups were significantly different. The 5-year survival rates of patients with high vascular density and low vascular density were 59% and 86%. The median survival period for patients with MVCs higher than or equal to 10 vessels/field was 85 months, whereas for those with MVCs lower than 10 vessels/field the median survival time was 102 months. These results suggest that MVC may be a better prognostic factor in renal cell carcinoma than the expression of VEGF.

The Prognostic Factor Analysis and Effect of Adjuvant M-VAC Chemotherapy on Advanced Transitional Cell Carcinoma of the Upper Urinary Tract / 대한비뇨기과학회지

PURPOSE: We evaluated the prognostic factors affecting the patients' survival and analyzed the effect of the adjuvant M-VAC chemotherapy after nephroureterectomy for patients with advanced (T3, T4) transitional cell carcinoma (TCC) of the upper urinary tract (UUT) with compared to surgery only group. MATERIALS AND METHODS: Of 33 patients diagnosed with upper urinary tract transitional cell carcinoma at our institution from 1988 to 1999, 20 patients with advanced transitional cell carcinoma of the renal pelvis and ureter underwent nephroureterectomy and follow-up. 5 patinets were treated nephroureterectomy only, and 15 patients were treated with nephroureterectomy plus adjuvant M-VAC chemotherapy. Prognostic factors such as age, bladder invasion, IVP finding, tumor stage, tumor grade, and tumor multiplicity were investigated. RESULTS: The mean age was 61 years old (38-75). The tumor stage (T3; 10 cases, T4; 10 cases) was not of benefit in predicting survival. Other prognostic factor such as bladder invasion, IVP finding, tumor multiplicity were not correlated with survival rate. The treatment method (nephroureterectomy only group-13.2 months vs. adjuvant M-VAC group-115 months), and tumor grade (GII; 12 cases, 39.2 months vs. GIII; 8 cases, 16.3 months) has significant prognostic value in survival rate. CONCLUSIONS: Many prognostic factors such as age, bladder invasion, IVP finding, stage and tumor multiplicity have no influence on the survival of patients with UUT TCC while tumor grade seems to be correlated with the survival. Survival rate of studied M-VAC group is superior to that of control surgery-only group. So adjuvant M-VAC chemotherapy is the valuable and tolerable treatment moldality in order to prolong the survival time for the patients with high stage UUT TCC.

The Study of Expression of p53 Protein and Its Clinical Significance in Transitional Cell Carcinoma of the Urinary Bladder / 대한비뇨기과학회지

To evaluate the prevalence of p53 gene expression and its role as a prognostic indicator in bladder carcinoma, we examined the paraffin-embedded tissue specimens from 43 patients with superficial and 31 patients with invasive bladder cancers. Nuclear expression of p53 proteins was detected by immunohistochemical analysis with microwave retrieve method, using the monoclonal antibody DO7 (Novocastra, UK). The p53 gene expression were divided into 4 categories (category 1: negative, category 2: 20%, diffuse, heterogeneous, weak intensity, category 4: >20%, diffuse, homogeneous, strong intensity). In total 74 cases, 67 (90.5%) showed positive (category 3 and 4) nuclear staining. Difference of nuclear expression between superficial and invasive cancer was not seen (96%, 84% respectively). But category 4 was more frequently seen in cases with invasive carcinoma compared to in superficial cancers (65% vs. 35%), and it was highly found in cases with grade 3 than grade 1 and 2 (79% vs. 27.5%) (p<0.005). Recurrence, progression, and survival in patients with superficial and invasive carcinoma between negative and weak intensity group (category 1,2,3) and strong intensity group (category 4) were not statistically significant. Our results showed higher positive rates than other studies may be due to using microwave retrieve method. These suggest that most bladder tumors have p53 mutations not only invasive but also superficial tumors and immunohistochemical stain using microwave retrieve method of bladder tumor specimens could be a good screening method for the presence of mutant p53 protein. The nuclear expression of p53 protein showed the trend of a stronger intensity in patients with invasive tumors and high histologic grade than in patients with superficial tumors and low histologic grade. These results also suggest that the degree of mutant p53 expression may be more useful for aggressive biological natures than the presence of mutant p53 protein.