Chad Wotkowicz

Identification and Prognostic Significance of an Epithelial-Mesenchymal Transition Expression Profile in Human Bladder Tumors

Purpose: Epithelial to mesenchymal transition (EMT) is reportedly an important transition in cancer progression in which the underlying cellular changes have been identified mainly using in vitro models. In this study, we examined the expression pattern of EMT markers in vivo and determined the occurrence and clinical significance of these events in a series of bladder carcinomas. Experimental Design: Eight hundred and twenty-five tumor samples from 572 bladder cancer patients were assembled in 10 tissue microarrays. Paraffin sections from each tissue microarray were subjected to antigen retrieval and processed by immunohistochemistry for the expression of E-cadherin, plakoglobin, β-catenin, N-cadherin, and vimentin. Results: Pathologic expression of E-cadherin, β-catenin, plakoglobin, and vimentin were associated with the clinicopathologic variables of grade and stage with only the cytoplasmic localization of plakoglobin found associated with lymph node status. Associations between the aforementioned markers were found significant as determined by the Spearman correlation coefficient with N-cadherin showing no associations in this analysis. In univariate survival analysis involving patients who underwent cystectomy, the reduction or loss of plakoglobin significantly influenced overall survival (P = 0.02) in which the median time to death was 2 years compared with 4 years when a normal level of plakoglobin was recorded. When the analysis was done for cancer-specific survival, low levels of both plakoglobin (P = 0.02) and β-catenin (P = 0.02) significantly influenced survival. Conclusion: The putative markers of EMT defined within a panel of bladder carcinoma cell lines were recorded in vivo, frequently associated with tumors of high grade and stage. Although multivariate analysis showed no significant influence of the EMT biomarkers on survival, alterations associated with plakoglobin were identified as significant prognostic features in these tumors.

Management of renal cell carcinoma with vena cava and atrial thrombus: minimal access vs median sternotomy with circulatory arrest

The topics covered in this section include renal, prostate, bladder and testicular cancer. As can be seen, these contributions come from all over the world and are of interest for several reasons. For example, the first paper, from the USA, describes the management of RCC with vena caval and atrial extension, using minimal access as against median sternotomy with circulatory arrest. Other more unusual subjects include RCC of native kidneys in renal‐transplant recipients and radical prostatectomy in patients with HIV.

Prognostic significance of altered p120ctn expression in bladder cancer

To identify the frequency of change in the expression and localization of p120ctn in bladder tumours and its association with clinical outcomes, and to investigate the potential role of p120ctn in the migratory and invasive behaviour of bladder carcinoma cells.

Renal cell cancer: radical nephrectomy

regional lymphadenectomy) originate from this paper. Additional contributions by urologists in treating RCC are noted in Table 1 [6].These basic principles in urological surgery have come under scrutiny, as tumour extension and location are better defined via superb imaging techniques, thus promoting minimally invasive surgery with respectable survival outcomes. Current reports question the need for all components of the original surgery (adrenalectomy, complete kidney removal, extensive lymph node dissection.) Preservation of renal parenchyma via limited extirpative techniques can be seen as ‘reno-protective’ in the setting of an ageing population with increased rates of chronic renal failure.

Surgery for Renal Cell Carcinoma with Thrombus Extension into the Vena Cava

The incidence of renal cell carcinoma continues to rise secondary to increased imaging utilization with the majority of new cases being lower stages based on size criteria. The incidence of larger renal tumors with known propensities for venous thrombus formation is still present and remains a challenge for the urological community in terms of surgical treatment with acceptable oncological outcomes and limited complications. Proper staging and preoperative imaging are crucial to determine the best approach with limited morbidity.

Open Salvage Surgery

There are limited reports of open salvage procedures in the urological literature. Surgical outcome reports from institutions across the world are readily available; however, in-depth discussion about associated complications is sparse. Many reports simply list complications in table format. This stems from the reluctance to discuss complications and associated failures. Although failed operations due to technical error may be difficult to accept, the documentation and recognition of predisposing factors will limit further mishaps. Some outcomes are unavoidable due to the condition of the patient and these cases should serve as reminders that surgery cannot cure every ailment. Being open to sharing our failures and heeding the warnings of others will allow surgeons and patients to gain something positive from these complicated situations.