27 research outputs found
Diagnostic Ureteroscopy for Upper Tract Urothelial Carcinoma is Independently Associated with Intravesical Recurrence after Radical Nephroureterectomy
High expression of KPNA2 defines poor prognosis in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy
Synthesis of new tetrahydropyridinylidene ammonium salts and their antiprotozoal potency
Long-term follow-up of conservatively managed incidental carcinoma of the prostate A multivariate analysis of prognostic factors
Comparison of predictive accuracy of four prognostic models fr non-metastatic renal cell carcinoma after nephrectomy. A multicentre European study
Multiinstitutional European validation of the 2002 TNM staging system in conventional and papillary localized renal cell carcinoma.
BACKGROUND: The current study validated the 2002 edition of the TNM staging
system in a multicenter, multinational European series of localized renal cell
carcinoma (RCC).
METHODS: The authors analyzed the clinical data of 2217 patients who had
undergone radical or partial nephrectomy for localized RCC in 7 urologic centers.
RESULTS: In the current study, 1065 patients (48%) were classified as having pT1a
disease, 771 (34.8%) were classified as having pT1b disease, and 381 (17.2%) were
classified as having pT2 disease. Tumor histotype was conventional RCC in 1886
patients (85%), papillary in 182 (8.2%) patients, chromophobe in 64 (2.9%)
patients, and unclassified in 85 (3.8%) patients. The mean follow-up time was
65.36 +/- 52.09 months. The 5 and 10-year disease-specific survival probabilities
were 95.3% and 91.4% in patients with pT1a disease, 91.4% and 83.4% in patients
with pT1b disease, and 81.6% and 75.2% in patients with pT2 disease (log-rank
test P value = 0.0000). The disease-specific survival rates of patients with pT1a
RCC were significantly higher than those recorded in patients with pT1b and pT2
RCC. Similarly, the disease-specific survival probabilities of patients with pT1b
RCC were significantly better than those of patients with pT2 RCC. Analyzing the
seven series individually, the 2002 TNM staging system provided appropriate
stratification for only one series. The 2002 TNM staging system allowed
significant stratification of the cancer-related outcomes in the subgroup of
patients with conventional RCC but not in those with papillary carcinomas.
CONCLUSIONS: The application of the 2002 TNM staging system in the current
multicenter series enabled the authors to demonstrate optimal stratification of
patients with localized RCC. Stratifying by tumor histotype, the data coming from
the whole group analysis were reconfirmed for clear cell RCC only
Comparaison de la précision predictive de quatre modèles pronostiques dans le cancer du rein localisé
Comparison of predictive accuracy of four prognostic models for nonmetastatic renal cell carcinoma after nephrectomy: a multicenter European study.
BACKGROUND: The objective of the current study was to compare, in a large
multicenter study, the discriminating accuracy of four prognostic models
developed to predict the survival of patients undergoing nephrectomy for
nonmetastatic renal cell carcinoma (RCC).
METHODS: A total of 2404 records of patients from 6 European centers were
retrospectively reviewed. For each patient, prognostic scores were calculated
according to four models: the Kattan model, the University of California at Los
Angeles integrated staging system (UISS) model, the Yaycioglu model, and the
Cindolo model. Survival curves were estimated by the Kaplan-Meier method and
compared by the log-rank test. Discriminating ability was assessed by the Harrell
c-index for censored data. The primary end point was overall survival (OS), and
the secondary end points were cancer-specific survival (CSS) and disease
recurrence-free survival (RFS).
RESULTS: At last follow-up, 541 subjects had died of any causes, with a 5-year OS
rate of 80%. The 5-year CSS and RFS rates were 85% and 78%, respectively. All
models discriminated well (P < 0.0001). The c-indexes for OS were 0.706 for the
Kattan nomogram, 0.683 for the UISS model, and 0.589 and 0.615 for the Yaycioglu
and Cindolo models, respectively. The Kattan nomogram was found to improve
discrimination substantially in the UISS intermediate-risk patients.
CONCLUSIONS: The current study appears to better define the general applicability
of prognostic models for predicting survival in patients with nonmetastatic RCC
treated with nephrectomy. The results suggest that postoperative models
discriminate substantially better than preoperative ones. The Kattan model was
consistently found to be the most accurate, although the UISS model was only
slightly less well performing. The Kattan model can be useful in the UISS
intermediate-risk patients
Comparazione dell’efficacia predittiva di quattro modelli prognostici per il carcinoma renale non metastatico dopo nefrectomia: studio multicentrico europeo
Risk of Cancer-specific Mortality following Recurrence After Radical Nephroureterectomy
PURPOSE: To describe the natural history and identify predictors of cancer-specific survival in patients who experience disease recurrence after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). METHODS: Of 2,494 UTUC patients treated with RNU without neoadjuvant chemotherapy, 597 patients experienced disease recurrence. 148 patients (25%) received adjuvant chemotherapy before disease recurrence. Multivariable Cox regression model addressed time to cancer-specific mortality after disease recurrence. RESULTS: The median time from RNU to disease recurrence was 12 months (IQR 5–22). 491 of 597 (82%) patients died from UTUC and 8 patients (1.3%) died from other causes. The median time from disease recurrence to death of UTUC was 10 months. Actuarial cancer-specific survival estimate at 12 months after disease recurrence was 35%. On multivariable analysis that adjusted for the effects of standard clinico-pathologic characteristics, higher tumor stages (HR pT3 vs. pT0-T1: 1.66, p=0.001; HR pT4 vs. pT0-T1: 1.90, p=0.002), absence of lymph node dissection (HR 1.28, p=0.041), ureteral tumor location (HR 1.44, p<0.0005) and a shorter interval from surgery to disease recurrence (p<0.0005) were significantly associated with cancer-specific mortality. The adjusted 6, 12 and 24 months post-recurrence cancer-specific mortality was 73%, 60% and 57%, respectively. CONCLUSION: Approximately 80% of patients who experience disease recurrence after RNU die within two years post-recurrence. Patients with non-organ-confined stage, absence of lymph node dissection, ureteral tumor location and/or shorter time to disease recurrence died of their tumor faster than their counterparts. These factors should be considered in patient counseling and risk-stratification for salvage treatment decision-making