Comparison of radical prostatectomy and external beam radiotherapy in high-risk prostate cancer

Purpose@#We evaluated clinical outcomes of high-risk prostate cancer patients receiving external beam radiotherapy (EBRT) or radical prostatectomy (RP). @*Materials and Methods@#Patients were classified as high-risk prostate cancer and received definitive treatment between 2005 and 2015. Patients with previous pelvic radiotherapy, positive lymph node or distant metastasis were excluded. The primary outcomes were prostate cancer-specific survival (PCSS) and distant metastasis-free survival (DMFS). @*Results@#Of 583 patients met the inclusion criteria (77 EBRT and 506 RP). The estimated 10-year PCSS was 97.0% in the RP and 95.9% in the EBRT (p = 0.770). No significant difference was seen in the DMFS (p = 0.540), whereas there was a trend in favor of RP over EBRT in overall survival (OS) (p = 0.068). Propensity score matching analysis with confounding variables was done, with 183 patients (66 EBRT and 117 RP) were included. No significant difference in DMFS, PCSS or OS was found. @*Conclusion@#Our data demonstrated similar oncologic PCSS, OS, and DMFS outcomes between EBRT and RP patients.

Comparison of radical prostatectomy and external beam radiotherapy in high-risk prostate cancer

Purpose@#We evaluated clinical outcomes of high-risk prostate cancer patients receiving external beam radiotherapy (EBRT) or radical prostatectomy (RP). @*Materials and Methods@#Patients were classified as high-risk prostate cancer and received definitive treatment between 2005 and 2015. Patients with previous pelvic radiotherapy, positive lymph node or distant metastasis were excluded. The primary outcomes were prostate cancer-specific survival (PCSS) and distant metastasis-free survival (DMFS). @*Results@#Of 583 patients met the inclusion criteria (77 EBRT and 506 RP). The estimated 10-year PCSS was 97.0% in the RP and 95.9% in the EBRT (p = 0.770). No significant difference was seen in the DMFS (p = 0.540), whereas there was a trend in favor of RP over EBRT in overall survival (OS) (p = 0.068). Propensity score matching analysis with confounding variables was done, with 183 patients (66 EBRT and 117 RP) were included. No significant difference in DMFS, PCSS or OS was found. @*Conclusion@#Our data demonstrated similar oncologic PCSS, OS, and DMFS outcomes between EBRT and RP patients.

Association of Serum Vitamin D Status with Prediabetes and Prehypertension in Korean Adults: An Analysis of the 2013–2015 Korea National Health and Nutrition Examination Survey Data

Background@#Recent studies have indicated that vitamin D deficiency is associated with diabetes and hypertension in adults. However, this association has not been sufficiently studied in cases of prediabetes and prehypertension. Thus, this study aimed to clarify the relationship between vitamin D levels and prediabetes and prehypertension in Korean adults. @*Methods@#Data from 1,808 adults aged ≥19 years who participated in the 2013–2015 Korea National Health and Nutrition Examination Survey were included in this study. The odds ratio of prediabetes and prehypertension according to the 25-hydroxyvitamin D (25[OH]D) status was calculated using multivariable logistic regression analysis. @*Results@#Mean serum 25(OH)D levels were significantly different among females with normal glucose levels, prediabetes, and diabetes mellitus. Further, the mean levels were not significantly different in both males and females of all ages with normal blood pressure, prehypertension, and hypertension. In addition, logistic regression analysis showed that serum 25(OH)D levels were not significantly associated with the odds ratio of prediabetes and prehypertension after adjusting for age, sex, smoking, alcohol consumption, physical activity, calcium supplement intake, income, body mass index, systolic blood pressure, and fasting glucose. @*Conclusion@#Serum vitamin D status was not independently associated with the risks of prediabetes and prehypertension in Korean adults.

A Study of Relationship of Atheroembolic Risk Factors with Postoperative Recovery in Renal Function after Partial Nephrectomy in Patients Staged T1-2 Renal Cell Carcinoma during Median 4-Year Follow-up / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The objective of this study is to evaluate the relationship of atheroembolic risk factors with postoperative recovery of renal function after on-clamp partial nephrectomy (PN) with warm ischemia in patients with staged T1-2 renal cell carcinoma (RCC). MATERIALS AND METHODS: A total of 234 patients from 2004 to 2012 were included, and their clinicopathologic and operative parameters, including atheroembolic risk factors were reviewed retrospectively. Renal function, as determined by estimated glomerular filtration rate (eGFR) and measurement of serum creatinine level (Cr) at each scheduled follow-up for a median four years, was compared between the high-risk (HR) group (n=49, > or = five risk factors) and the low-risk (LR) group (n=185, < five risk factors). RESULTS: Except for baseline renal function and number of risk factors for atheroembolism, differences in characteristics between groups were comparatively insignificant. At 3 months after the operation, Cr and eGFR differed significantly between the two groups (p < 0.05), but no differences were observed afterward. Significant deterioration from baseline in Cr and eGFR was observed in both groups at 1 month after the operation, with a greater change in the HR group (p < 0.05). From measurement to measurement, significantly faster deterioration in Cr and eGFR was observed in the HR group than in the LR group until 6 months after the operation (Cr: LR, 0.02 mg/dL and HR, 0.13 mg/dL; eGFR: LR, 1.50 mL/min/1.73 m2 and HR, 6.38 mL/min/1.73 m2; p < 0.05). CONCLUSION: The presence of atheroembolic risk factors may negatively influence postoperative recovery of renal function after PN in patients with localized RCC.

Is High-Dose Leuprorelin Acetate Effective and Safe in Asian Men with Prostate Cancer? An Open-Label, Non-Comparative, Multi-Center Clinical Trial

PURPOSE: Leuprorelin is a well known luteinizing hormone releasing hormone agonist. However, there are insufficient data on the efficacy and safety of high dose leuprorelin acetate, especially in Asian patients with prostate cancer. We aimed to investigate the safety and efficacy of leuprorelin acetate 22.5 mg administered at three-month intervals in patients with prostate cancer. MATERIALS AND METHODS: In an open, prospective clinical trial enrolling 47 patients, we aimed to assess the efficacy and safety of leuprorelin acetate 22.5 mg in treating patients with histologically confirmed prostate cancer. The primary objective of this study was to evaluate the efficacy of the leuprorelin acetate 22.5 mg in producing and maintaining castration levels of testosterone over a 6-month follow-up period and to determine its safety profile. RESULTS: All 42 patients achieved serum testosterone levels within the castration range by 4 weeks. A breakthrough response was observed in one of 36 patients by 8 weeks. However, this patient was medically castrated by 12 weeks. There were no significant prostate-specific antigen (PSA) or testosterone changes according to clinical stage or body mass index. Twenty adverse events (AEs) in 15 of 42 patients (35.7%) were observed during this study. The most common AEs were hot flushes (n=4, 20.0%) with mild intensity, pain (n=2, 10.0%), and infection (n=2, 10.0%). No patient withdrew from the study due to AEs. CONCLUSION: Leuprorelin acetate 22.5 mg was shown to be effective and safe in Asian patients with prostate cancer, even though sexual function decreased.

Nomogram to Predict Insignificant Prostate Cancer at Radical Prostatectomy in Korean Men: A Multi-Center Study

PURPOSE: Due to the availability of serum prostate specific antigen (PSA) testing, the detection rate of insignificant prostate cancer (IPC) is increasing. To ensure better treatment decisions, we developed a nomogram to predict the probability of IPC. MATERIALS AND METHODS: The study population consisted of 1,471 patients who were treated at multiple institutions by radical prostatectomy without neoadjuvant therapy from 1995 to 2008. We obtained nonrandom samples of n = 1,031 for nomogram development, leaving n = 440 for nomogram validation. IPC was defined as pathologic organ-confined disease and a tumor volume of 0.5 cc or less without Gleason grade 4 or 5. Multivariate logistic regression model (MLRM) coefficients were used to construct a nomogram to predict IPC from five variables, including serum prostate specific antigen, clinical stage, biopsy Gleason score, positive cores ratio and maximum % of tumor in any core. The performance characteristics were internally validated from 200 bootstrap resamples to reduce overfit bias. External validation was also performed in another cohort. RESULTS: Overall, 67 (6.5%) patients had a so-called "insignificant" tumor in nomogram development cohort. PSA, clinical stage, biopsy Gleason score, positive core ratio and maximum % of biopsy tumor represented significant predictors of the presence of IPC. The resulting nomogram had excellent discrimination accuracy, with a bootstrapped concordance index of 0.827. CONCLUSION: Our current nomogram provides sufficiently accurate information in clinical practice that may be useful to patients and clinicians when various treatment options for screen-detected prostate cancer are considered.

Clinical Significance of a Large Difference (> or = 2 points) between Biopsy and Post-prostatectomy Pathological Gleason Scores in Patients with Prostate Cancer

We investigated the clinical significance of large difference (> or = 2 points) between biopsy-derived (bGS) and post-prostatectomy Gleason scores (pGS). At 14 medical centers in Korea, 1,582 men who underwent radical prostatectomy for prostate cancer were included. According to the difference between bGS and pGS, the patients were divided into three groups: A (decreased in pGS > or = 2, n = 30), B (changed in pGS or = 2, n = 55). We evaluated various clinicopathological factors of prostate cancer and hazards for biochemical failure. Group A showed significantly higher mean maximal percentage of cancer in the positive cores (max%) and pathological T stage than control. In group C, the number of biopsy core was significantly smaller, however, tumor volume and max% were significantly higher and more positive biopsy cores were presented than control. Worse pathological stage and more margin-positive were observed in group A and C than in control. Hazard ratio for biochemical failure was also higher in group A and C (P = 0.001). However, the groups were not independent factors in multivariate analysis. In conclusion, large difference between bGS and pGS shows poor prognosis even in the decreased group. However it is not an independent prognostic factor for biochemical failure.

Preoperative Nomograms for Predicting Extracapsular Extension in Korean Men with Localized Prostate Cancer: A Multi-institutional Clinicopathologic Study

We developed a nomogram to predict the probability of extracapsular extension (ECE) in localized prostate cancer and to determine when the neurovascular bundle (NVB) may be spared. Total 1,471 Korean men who underwent radical prostatectomy for prostate cancer between 1995 and 2008 were included. We drew nonrandom samples of 1,031 for nomogram development, leaving 440 samples for nomogram validation. With multivariate logistic regression analyses, we made a nomogram to predicts the ECE probability at radical prostatectomy. Receiver operating characteristic (ROC) analyses were also performed to assess the predictive value of each variable alone and in combination. The internal validation was performed from 200 bootstrap re-samples and the external validation was also performed from the another cohort. Overall, 314 patients (30.5%) had ECE. Age, Prostate specific antigen (PSA), biopsy Gleason score, positive core ratio, and maximum percentage of biopsy tumor were independent predictors of the presence of ECE (all P values <0.05). The nomogram predicted ECE with good discrimination (an area under the ROC curve of 0.777). Our nomogram allows for the preoperative identification of patients with an ECE and may prove useful in selecting patients to receive nerve sparing radical prostatectomy.

Plasma Insulin-Like Growth Factor-1 (IGF-1), IGF-Binding Protein-3, and the Risk of Prostate Cancer: A Matched Case-Control Study in a Korean Population

PURPOSE: Conflicting results have been reported for western populations on associations of serum insulin-like growth factor I (IGF-I) and major IGF-binding protein-3 (IGFBP-3) with the risk of prostate cancer. However, few data have been available for oriental populations. We undertook a matched case-control study in a low-risk Korean population to extend our knowledge about potential associations. MATERIALS AND METHODS: Serum IGF-I and IGFBP-3 levels were determined for 330 men (165 cases and 165 healthy age-matched controls). Conditional logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for the association between plasma IGF levels and prostate cancer. We also investigated the potential influence of the associations according to clinical risk for advanced disease at diagnosis. RESULTS: We noted that the risks of prostate cancer were unrelated to the IGF-1 level and IGF-I/IGFBP-3 molar ratio. In contrast, a strong inverse association was observed between IGFBP-3 levels and the risk for prostate cancer. Men in the highest quartile of IGFBP-3 levels had a 71% reduced risk of prostate cancer compared with men in the lowest quartile (OR=0.29, 95% CI: 0.11-0.64, P(trend)<0.001). Subgroup analysis revealed a significant inverse association between plasma IGFBP-3 and the likelihood of a high risk prostate cancer. CONCLUSIONS: Plasma IGFBP-3 levels were inversely associated with the risk of prostate cancer and the likelihood for high-risk disease, suggesting that IGFBP-3 plays a protective role against prostate cancer in the Korean population.

Safety and Efficacy of Intravesical Keyhole-Limpet Hemocyanin Therapy for Superficial Transitional Cell Carcinoma: A Prospective, Multicenter Study / 대한비뇨기과학회지

PURPOSE: We wanted to determine the safety and efficacy 1 year after intravesical keyhole-limpet hemocyanin (KLH) therapy for the patients suffering with superficial transitional cell carcinoma. MATERIALS AND METHODS: A total of 60 patients with bladder cancer who had undergone transurethral resection were treated with a one-year protocol (once a week for 6 weeks and 12 further treatments every 4 weeks) of KLH 20mg. The local and systemic safety and efficacy were evaluated. RESULTS: In terms of the safety of KLH, 4 patients (6.7%) reported dizziness and slight fever, and 2 (3.3%) experienced urgency. The remaining 54 patients (90.0%) did not report any local side effects during the treatment period. In terms of efficacy, recurrence developed in 32 patients (53.3%) at a mean of 4.5 months after transurethral resection; 28 patients (46.7%) were disease free after 14 months. The univariate analysis showed a greater level of efficacy in the patients suffering with bacille Calmette-Gu rin (BCG)-refractory disease (p=0.0150). No significant differences were found between the low, the intermediate-risk and the high-risk patients in terms of efficacy. CONCLUSIONS: The results of this study have confirmed the good tolerability of intravesical KLH and better efficacy in the BCG-refractory patients. However, in terms of overall efficacy, intravesical KLH therapy had no superiority over that of other intravesical treatments in terms of the overall efficacy.

Emotional and Behavioral Problems Related with Internet Addiction in Adolescence / 신경정신의학

OBJECTIVES: As internet users increase rapidly, internet addiction is a rising addictive behavior associated with psychiatric problems of adolescence in Korea. The objectives of this study were to investigate the prevalences of internet use and the relations of internet addiction to emotional and behavioral problems of adolecence in Korea. METHODS: We assessed 1.555 middle and high school students in Koyang city, Korea using Young Internet Addiction Scale (YIAS), Center for Epidemiological Study for Depression (CES-D), Revised Children's Manifest Anxiety Scale (RCMAS), Youth Self Report (YSR), and Psychological Self (PS)-1 of Offer's Self Image Questionnaire (OSIQ). RESULTS: Ninty eight subjects (6.3%) were Internet Addicted Group ('Addicted Group'):51 (6.2%) were middle school students, and 47 (6.5%) were high school students. Compared to girls, boys showed higher prevalences of internet addiction and higher mean score of YIAS. But there were no significant differences of prevalences and YIAS scores between middle and high school students. Addicted Group had significantly higher mean scores of all scales (subscales) than Non-Addicted Group. CONCLUSION: Adolescents with internet addiction showed more psychiatric problems compared to adolescents without internet addiction, thus require therapeutic approaches to multiple psychopathologies in addition to the addictive behaviors.

Metastasis of Transitional Cell Carcinoma to the Lower Abdominal Wall 20 Years after Cystectomy

Iatrogenic implantation has been the main cause in the majority of cases of transitional call carcinoma (TCC) with metastasis to the abdominal wall. A 66-year-old woman had undergone radical cystectomy 20 years prior to presenting. Radiological investigations revealed one mass in the left lower abdominal wall and one mass in the right inguinal area. She underwent wide excision of the lesions that revealed metastasis of TCC. This report describes this case of a woman with bladder carcinoma who developed a metastasis in the anterior abdominal wall following an apparent disease-free interval of 20 years.

Effect of Periprostatic Nerve Blockade for Transrectal Ultrasound Guided Biopsy of the Prostate / 대한비뇨기과학회지

PURPOSE: The analgesic efficacy of the periprostatic nerve blockade during transrectal ultrasound guided prostatic biopsies was evaluated. MATERIALS AND METHODS: A transrectal ultrasound guided prostate biopsy was performed in 90 men due to abnormal digital rectal examinations or elevated prostate specific antigens. During the biopsy, two groups of 45 patients were randomly assigned to receive either an injection of 1% lidocaine or no prior analgesia. Immediately after the biopsy the pain score was independently recorded by the patients using a 10-point linear scale. RESULTS: The mean intraoperative pain scores were 2.7+/-1.7 and 4.9+/-2.6 in the lidocaine and control groups, respectively, and were significantly different (p<0.001). The mean immediate postoperative pain scores were 0.7+/-0.7 and 1.5+/-1.3 in the lidocaine and control groups, respectively, and were not significantly different (p=0.057). There were no differences in the complication rates between the two groups. CONCLUSIONS: Our results show a significant benefit of periprostatic anesthesia over that in the controls (no anesthesia applied) in our randomized trial. This safe, simple and rapid technique should be applied before a transrectal ultrasound guided prostatic biopsy to reduce undue patient discomfort.

Apoptosis of Prostate Cancer by Inhibition of Bcl-xL Expression / 대한비뇨기과학회지

PURPOSE: In this study, we evaluated in vitro whether the anti-sense transfection that was targeted against Bcl-xL would induce cytotoxicity via apoptosis in prostate cancer cells. MATERIALS AND METHODS: cDNA of the human Bcl-xL gene was obtained by RT-PCR amplification, and the anti-sense Bcl-xL mRNA plasmid was generated using the pCR 3.1 TOPO plasmid vector. The function of the cloned anti-sense Bcl-xL plasmid vector (pCR3.1-AS-Bcl-xL) was evaluated by the Western blot analysis. Using the MTT assay, the efficacy of growth inhibition by transfection with pCR3.1-AS-Bcl-xL was tested in vitro on PC-3 and DU145 human prostate cancer cell lines. Immunoblot analyses of Bax and caspase-9 were also performed. To evaluate the apoptosis, DNA fragmentation and caspase-3 assay were performed. RESULTS: Bcl-xL expression after transfection with pCR3.1-AS-Bcl-xL was gradually decreased in PC-3 cells and was continuously decreased in DU145 cells, compared to the parent cells. Bax protein was not expressed in DU145 cells, and the levels of Bax protein expression was not altered in the transfected PC-3 cells compared to the parent cells. The cytotoxicity of pCR3.1-AS-Bcl-xL on PC-3 and DU145 cells increased significantly compared to the empty vector, pCR3.1. This increased cytotoxicity was associated with enhanced apoptosis as assessed by the DNA fragmentation assay and the caspase-3 assay. The expression of the active caspase-9 was increased in the PC-3 cells but not in the DU145 cells after transfection with pCR3.1-AS-Bcl-xL. CONCLUSIONS: Our results showed that the suppression of Bcl-xL by anti-sense transfection efficiently inhibited the growth of PC-3 and DU145 human prostate cancer cell lines. The inhibition of Bcl-xL expression can possibly be a novel therapeutic alternative in the treatment of hormone refractory prostate carcinoma.

Analysis of Risk Factors for Ileus Following Radical Cystectomy: Is the Prolonged Use of a Nasogastric Tube Necessary? / 대한비뇨기과학회지

PURPOSE: We examined the risk factors for postoperative ileus, and we investigated whether the duration of postoperative nasogastric tube (NGT) use affects the rate of postoperative ileus in patients undergoing radical cystectomy with urinary diversion. MATERIALS AND METHODS: A total of 101 patients underwent radical cystectomy with urinary diversion from 1999 to 2003. We examined the demographic and perioperative variables of patients who developed postoperative ileus and those who did not. We divided the patients into two groups; a group of patients who had the NGT removed within 24 hours and a group of patients who had the NGT removed at first flatus. We compared the two groups for the incidence of ileus and for the clinical variables. RESULTS: Postoperative ileus was observed in 23 patients (23%). The demographic data for both groups were not different in terms of age and the American Society of Anesthesiology (ASA) score. Also, the operative time, estimated blood loss, the type of diversion and the postoperative complication rates were not significantly different for the two groups (p>0.05). However, the risk of postoperative ileus was significantly higher for those patients who took a polyethylene glycol bowel preparation than for those who took a sodium phosphate bowel preparation (40%:18%, p=0.02). No significant difference in the prevalence of ileus was found between the patients whose NGT were removed within 1 days and those patients whose NGT was removed beyond 2 days (25%:22%, p>0.05). CONCLUSIONS: The results of our study suggest that the use of sodium phosphate for bowel preparation may reduce postoperative ileus and that early NGT removal after cystectomy is not correlated with ileus.

Short-term Morphological and Growth Factor Changes in Rat Bladders Augmented with a Porcine Small Intestinal Submucosa / 대한비뇨기과학회지

PURPOSE: This study was performed to investigate the short-term changes in the morphology and growth factors after the augment of rat bladders with a porcine small intestinal submucosa (SIS). MATERIALS AND METHODS: The experiments were performed in 39 female Sprague- Dawley rats, comprised of 3 controls, 18 sham-operated and 18 SIS-augmented rats. The sham-operated group underwent a primary closure after a longitudinal incision of the bladder. The augmentation cystoplasty was performed using a porcine SIS after a hemi-cystectomy. The rats were postoperatively sacrificed at periods ranging between 12 hours and 14 days, and their bladders procured for histological examination. Reverse transcription-polymerase chain reactions (RT-PCR) were performed to evaluate the expressions of the keratinocyte growth factor (KGF) and the transforming growth factor-alpha (TGF-alpha). RESULTS: Both groups showed an acute inflammatory reaction during the immediate postoperative period, and chronic inflammatory cells appeared 48 hours postoperatively, with new capillaries and fibroblasts appearing 4 days postoperatively. The disrupted urothelial barrier was restored on the 7th postoperative day in the sham group, and epithelialization began to appear on day 4 in the augmented group. New granulation tissue covered the small intestinal submucosa, like a sheet of membrane, by the 4th postoperative day, and its thickness and cellularity increased with time. The mRNA expressions of the KGF and TGF-alpha increased during the initial postoperative period, but tended to derease with time. Their expressions coincided with acute inflammatory reactions. CONCLUSIONS: In conclusion, the short-term morphological changes after the augmentation cystoplasty, with a porcine small intestinal submucosa, were initially composed of acute inflammation, chronic inflammation, fibroblast aggregation, neoangiogenesis, epithelialization and formation of granulation tissue. The mRNA expressions of the KGF and TGF-alpha coincided with acute inflammatory reactions.

Apoptosis of Prostate Cancer by Bax Gene Expression / 대한비뇨기과학회지

PURPOSE: To evaluate the antitumor effect of the proapoptotic Bax gene in prostate cancer cells, in vitro, using a plasmid vector expressing the human Bax gene. MATERIALS AND METHODS: cDNA of the human Bax gene, amplified by RT-PCR, was cloned to pCR@3.1. The expression of the cloned Bax (pCR3.1-Bax) was observed by RT-PCR and Western blot analyses. The efficacy of growth inhibition by the cloned Bax gene was tested, in vitro, on PC-3 and DU145 human prostate cancer cell lines using the MTT assay. Immunoblot analysis for the expressions of Bcl-2 and Bcl-xL were performed. Assays were also performed to evaluate the apoptosis, DNA fragmentation and CPP32. RESULTS: The Bax protein was expressed in the parental PC-3 cells, but not in the DU-145 cells. The expressions of Bax mRNA in the transfected PC-3 and DU-145 cells had increased by 24 hr, and those of Bax protein in the transfected PC-3 and DU-145 cells had increased by 48 and 24 hr, respectively, compared with the control cell lines. The cytotoxicity of pCR3.1-Bax on PC-3 and DU-145 cells increased significantly compared with an empty vector, pCR3.1 (p<0.05, respectively). An increased cytotoxicity of the Bax-transfected cell lines was associated with enhanced apoptosis. The Bcl-2 protein was not expressed in the transfected cells, and the levels of Bcl-xL protein expression in transfected cells were no different to those in the parenteral cells. The Bax/Bcl-xL ratio was increased by the transfection of the Bax expression vector. CONCLUSIONS: Our results show that the cloned Bax-expression plasmid vector efficiently inhibits the growth of PC-3 and DU145 human prostate cancer cell lines. These data suggest that exogenous Bax expression may have therapeutic applications in prostate cancer.

Postoperative Adjuvant Systemic Chemotherapy for Locally Advanced Transitional Cell Carcinoma of the Upper Urinary Tract / 대한비뇨기과학회지

PURPOSE: The outcome of adjuvant systemic chemotherapy, in patients with a locally advanced transitional cell carcinoma of the upper urinary tract, was analyzed. MATERIALS AND METHODS: Between January 1990 and June 2001, a total of 97 patients underwent surgery for a transitional cell carcinoma of the upper urinary tract at our institute. Forty-five had a locally advanced disease (T3, N1, N2, lymphovascular invasion). Of these, 33 patients (chemotherapy group) underwent a median of four courses of cisplatin-based adjuvant systemic chemotherapy (M-VAC in 23, gemcitabine plus cisplatin in seven, CISCA in three), whereas 12 (Observation group) refused chemotherapy. To define possible prognostic factors in these patients, various factors, including age, sex, location, surgical method, pT stage and number of involved lymph nodes, were analyzed using the Cox's regression model. RESULTS: The mean follow-up was 39 months, ranging from 8 to 98 months; the median survival time in the chemotherapy and observation groups were 65 and 31 months, respectively. Five-year disease-specific survival rates in the chemotherapy and control groups were 71.1 and 40.9%, respectively. Of the several factors, adjuvant chemotherapy (p=0.016) and lymph node metastasis (p=0.017) both had prognostic significance. In the chemotherapy group, 21 (63.6%) were given a reduced dose for at least one cycle due to a reduced renal function. However, there was no fatal febrile neutropenia, while cellulitis or grade 3 neutropenia occurred in six patients during the chemotherapy. CONCLUSIONS: Our findings suggest that adjuvant systemic chemotherapy, for a locally advanced transitional cell carcinoma of the upper urinary tract, may lead to a significant prolongation in the survival time.

Carcinoma of the Upper Urinary Tract: Clinical Analysis on Patients during Recent 10 Years / 대한비뇨기과학회지

PURPOSE: We reviewed our experiences, at a single-center, of patients with upper tract urothelial cancer in order to assess treatment outcomes and to determine the prognostic factors of the condition. MATERIALS AND METHODS: We retrospectively reviewed 115 patients, with urothelial tumors of the renal pelvis and ureter, treated at Seoul National University Hospital. The mean age of the patients was 61.1 years, with a mean follow-up of 35.5 months. Traditional prognostic factors, including age, sex, and tumor stage, grade, location, and type of surgical treatment, were analyzed with respect to disease recurrence and survival. RESULTS: Ninety six patients (83.4%) were treated surgically. A nephroureterectomy was performed in 88 patients (91.8%); 74 with bladder cuffing and 14 without. Actuarial 5-year survival rates, by tumor stage, were 100% for Ta, 90% for T1, 76.3% for T2 and 55.6% for T3. From the multivariate analysis, the T (p=0.008), N (p=0.017) and M (p=0.002) stages were significant prognostic factors for survival. A recurrence occurred in 46 (47.9%) patients at a mean of 13.1 months. Recurrent bladder tumors developed in 36.5 and 33.3% of patients treated with conventional nephroureterectomy, with bladder cuffing and other treatments, respectively. CONCLUSIONS: Tumor stage was a unique significant prognostic factor for survival on multivariate analysis and there is no significant difference in recurrence rate of bladder tumor regardless of surgical method. Bladder tumor surveillance should be carefully performed due to the high rates of recurrence in the bladder within 2 years postoperatively.

Carcinoma of the Upper Urinary Tract: Clinical Analysis on Patients during Recent 10 Years / 대한비뇨기과학회지

PURPOSE: We reviewed our experiences, at a single-center, of patients with upper tract urothelial cancer in order to assess treatment outcomes and to determine the prognostic factors of the condition. MATERIALS AND METHODS: We retrospectively reviewed 115 patients, with urothelial tumors of the renal pelvis and ureter, treated at Seoul National University Hospital. The mean age of the patients was 61.1 years, with a mean follow-up of 35.5 months. Traditional prognostic factors, including age, sex, and tumor stage, grade, location, and type of surgical treatment, were analyzed with respect to disease recurrence and survival. RESULTS: Ninety six patients (83.4%) were treated surgically. A nephroureterectomy was performed in 88 patients (91.8%); 74 with bladder cuffing and 14 without. Actuarial 5-year survival rates, by tumor stage, were 100% for Ta, 90% for T1, 76.3% for T2 and 55.6% for T3. From the multivariate analysis, the T (p=0.008), N (p=0.017) and M (p=0.002) stages were significant prognostic factors for survival. A recurrence occurred in 46 (47.9%) patients at a mean of 13.1 months. Recurrent bladder tumors developed in 36.5 and 33.3% of patients treated with conventional nephroureterectomy, with bladder cuffing and other treatments, respectively. CONCLUSIONS: Tumor stage was a unique significant prognostic factor for survival on multivariate analysis and there is no significant difference in recurrence rate of bladder tumor regardless of surgical method. Bladder tumor surveillance should be carefully performed due to the high rates of recurrence in the bladder within 2 years postoperatively.