Ho Seok Chung

Novel immunotherapy in metastatic renal cell carcinoma

Despite the rapid development of therapeutic modalities for metastatic renal cell carcinoma (mRCC) over the past decade to include a number of targeted antiangiogenic therapies and traditional immunotherapy, such as high-dose interleukin-2 and interferon-α, mRCC continues to be associated with poor prognosis. Currently, several novel immunotherapy agents, such as cancer vaccines, adoptive cell therapy, and checkpoint inhibitors, such as programmed cell death-1 (PD-1 present on T cells), one of its ligands (PD-L1 present on antigen-presenting cells and tumor cells), and cytotoxic T-lymphocyte-associated protein-4 pathways, are being studied in mRCC and are showing promise as important steps in the management of this disease. This review summarizes the current landscape of standard and emerging immune therapeutics and other modalities for mRCC.

The Effect of Korean Red Ginseng on Sexual Function in Premenopausal Women: Placebo-Controlled, Double-Blind, Crossover Clinical Trial.

This study investigated whether Korean red ginseng (KRG) extracts could improve sexual function in premenopausal women. Forty-one premenopausal women participated in this placebo-controlled, double-blind, and crossover clinical study with administration of either three ginseng capsules (1 g per capsule) or placebo daily. After 8 weeks of medication of KRG or placebo, medication was changed for the subjects to placebo or KRG after 2 weeks of washout period. The efficacy of KRG extracts was measured by using Female Sexual Function Index (FSFI). Results. Twenty-three women completed the study. Total FSFI scores increased after KRG treatment (from 20.13 ± 2.87 to 23.98 ± 4.10, p = 0.015) and placebo treatment (from 20.06 ± 2.64 to 23.78 ± 3.28, p = 0.003). However, this change was not significantly different between the two groups (p = 0.702). KRG treatment significantly improved sexual desire, arousal, orgasm, and satisfaction domains; however, there was no treatment effect compared with placebo. There was a case of gastric discomfort after taking KRG extracts. Oral administration of KRG extracts improved sexual function in premenopausal women; however, there were no statistical significant changes compared to placebo. It implies that KRG extracts have a substantial placebo effect in premenopausal women with sexual dysfunction.

Is preoperative chronic kidney disease status associated with oncologic outcomes in upper urinary tract urothelial carcinoma? A multicenter propensity score-matched analysis

Purpose The aim of this study was to determine the effect of preoperative chronic kidney disease (CKD) on the prognosis of patients with upper urinary tract urothelial carcinoma (UTUC) who had undergone radical nephroureterectomy (RNU). Results The median follow-up period was 31.1 months (interquartile range: 16.2-55.7 months). Among the study patients, 224 patients in the non-CKD group were selected via propensity score matching. The median recurrence-free, cancer-specific, and overall survival were significantly shorter for patients with preoperative CKD than for non-CKD patients (p = 0.001, p = 0.001, and p = 0.001, respectively). According to multivariable Cox regression analysis, preoperative CKD was related to worse recurrence-free (hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.15-2.86, p = 0.011), cancer-specific (HR: 2.44, 95% CI: 1.44-4.14, p = 0.001), and overall survival (HR: 1.66, 95% CI: 1.15-2.40, p = 0.007). Methods A total of 566 patients who underwent RNU at 6 institutions from 2004 to 2014 were retrospectively reviewed. Of these patients, 342 had an estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2 (non-CKD group) and 224 patients had an eGFR <60 ml/min/1.73 m2 (CKD group). To adjust for potential baseline confounders, 224 patients in the non-CKD group were selected by propensity matching. Clinicopathological variables and survival rates were compared between the 2 groups. Conclusions Preoperative CKD appears to be an important independent prognostic factor for oncologic outcomes in patients with UTUC.PURPOSE The aim of this study was to determine the effect of preoperative chronic kidney disease (CKD) on the prognosis of patients with upper urinary tract urothelial carcinoma (UTUC) who had undergone radical nephroureterectomy (RNU). RESULTS The median follow-up period was 31.1 months (interquartile range: 16.2-55.7 months). Among the study patients, 224 patients in the non-CKD group were selected via propensity score matching. The median recurrence-free, cancer-specific, and overall survival were significantly shorter for patients with preoperative CKD than for non-CKD patients (p = 0.001, p = 0.001, and p = 0.001, respectively). According to multivariable Cox regression analysis, preoperative CKD was related to worse recurrence-free (hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.15-2.86, p = 0.011), cancer-specific (HR: 2.44, 95% CI: 1.44-4.14, p = 0.001), and overall survival (HR: 1.66, 95% CI: 1.15-2.40, p = 0.007). METHODS A total of 566 patients who underwent RNU at 6 institutions from 2004 to 2014 were retrospectively reviewed. Of these patients, 342 had an estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2 (non-CKD group) and 224 patients had an eGFR <60 ml/min/1.73 m2 (CKD group). To adjust for potential baseline confounders, 224 patients in the non-CKD group were selected by propensity matching. Clinicopathological variables and survival rates were compared between the 2 groups. CONCLUSIONS Preoperative CKD appears to be an important independent prognostic factor for oncologic outcomes in patients with UTUC.

Laparoscopic adrenalectomy using the lateral retroperitoneal approach: Is it a safe and feasible treatment option for pheochromocytomas larger than 6 cm?

To evaluate the surgical feasibility of laparoscopic adrenalectomy using the lateral retroperitoneal approach for the treatment of large pheochromocytomas, and to identify the preoperative risk factors for intraoperative hypertension.

Abiraterone or Enzalutamide in Chemotherapy-Naïve Metastatic CRPC

The current standard of care for metastatic prostate cancer is androgen deprivation therapy (ADT); however, after 5 years, significant patients undergo disease progression despite hormonal manipulation and castrate testosterone levels [1, 2]. Multiple new treatment agents have been developed for men with metastatic castration-resistant prostate cancer (mCRPC) including chemotherapeutic agents, such as docetaxel and cabazitaxel [3–5]. Docetaxel and cabazitaxel are the only US Food and Drug Administration (FDA)-approved chemotherapeutic agents for the mCRPC treatment, decrease PSA levels, and palliate symptoms, but survival benefits are limited. Also, use of systemic chemotherapy generally be reserved for men with symptomatic mCRPC and may be limited by the presence of pre-existing medical conditions and the risk of developing adverse effects [6]. Because the androgen receptor (AR) activates PSA gene expression, more understanding of the role of the AR in prostate cancer progression has led to the improvement of treatment strategies to further suppress AR signaling in mCRPC [7]. Both abiraterone acetate and enzalutamide have been studied and shown to prolong overall survival in large phase III trials in the chemotherapy-naive mCRPC settings.

Urethral mobility and Point Aa of the Pelvic Organ Prolapse Quantification (POP-Q) system before and after midurethral sling operation

Objective: The aim of the present study was to verify the usefulness of Point Aa as a substitute marker of the Q‐tip angle and urethral mobility before and after midurethral sling operation for the treatment of stress urinary incontinence (SUI) in women.

Trial Comparing a Combined Regimen of Amikacin and Ciprofloxacin to Ciprofloxacin Alone as Transrectal Prostate Biopsy Prophylaxis in the Era of High Fluoroquinolone-Resistant Rectal Flora

Background To investigate whether addition of amikacin to fluoroquinolone (FQ) antimicrobial prophylaxis reduces infections after transrectal ultrasound-guided prostate biopsy (TRUSPB). Methods A total of 503 patients undergoing rectal swab were divided into three groups. Patients with FQ-sensitive rectal flora (group 1, n = 248) were administered ciprofloxacin before TRUSPB, and patients with FQ-resistant rectal flora were either administered ciprofloxacin (group 2, n = 97) or amikacin and ciprofloxacin (group 3, n = 158) before TRUSPB. Results Based on the rectal swab, FQ resistance was 54.9%, and extended-spectrum β-lactamase (ESBL) positivity was 17.2%. The incidence of infectious complication in group 1 was 1.6%. Groups 2 and 3, with FQ-resistant rectal flora, tended to have increased infectious complications (5.2% and 4.4%, respectively) but the difference between those results is not statistically significant. The most common pathogens of infectious complications in patients with FQ-resistant rectal flora were FQ-resistant and ESBL-producing Escherichia coli. E. coli pathogens isolated in Group 3 were amikacin-susceptible species. The operation history and ESBL positivity of rectal flora increased the incidence of infectious complications (odds ratio [OR] = 3.68; P = 0.035 and OR = 4.02; P = 0.008, respectively). DM and antibiotics exposure were risk factors for FQ resistance (OR = 2.19; P = 0.002) and ESBL positivity of rectal flora (OR = 2.96; P = 0.005), respectively. Conclusion Addition of amikacin to ciprofloxacin prophylaxis could not reduce infectious complications in patients with FQ-resistant rectal flora. Despite the amikacin sensitivity of infectious complications, single-dose amikacin addition to ciprofloxacin prophylaxis has limitations.

Prevalence of fluoroquinolone-resistant rectal flora in patients undergoing transrectal ultrasound-guided prostate needle biopsy: A prospective multicenter study

To estimate the prevalence of fluoroquinolone‐resistant rectal flora in patients undergoing transrectal ultrasound‐guided prostate needle biopsy and to identify the high‐risk groups.

MP67-08 PREOPERATIVE SYSTEMIC INFLAMMATORY MARKERS IN UPPER TRACT UROTHELIAL CELL CARCINOMA: WHICH IS BETTER AS A PROGNOSTIC FACTOR?

Eu Chang Hwang*, Yang Hyun Cho, Ho Seok Chung, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Gwangju, Korea, Republic of; Myung Ki Kim, Jeonju, Korea, Republic of; Sung Gu Kang, Seok Ho Kang, Jun Cheon, Seoul, Korea, Republic of; Ja Yoon Ku, Hong Koo Ha, Busan, Korea, Republic of; Chang Wook Jeong, Ja Hyeon Ku, Cheol Kwak, Seoul, Korea, Republic of; Tae Gyun Kwon, Tae-Hwan Kim, Seock Hwan Choi, Daegu, Korea, Republic of; Ill Young Seo, Iksan, Korea, Republic of

MP67-04 EVALUATION OF THE DE RITIS (ASPARTATE TRANSAMINASE/ALANINE TRANSAMINASE) RATIO AS A PREDICTOR OF ONCOLOGICAL OUTCOMES IN PATIENTS WITH UPPER URINARY TRACT UROTHELIAL CARCINOMA AFTER SURGERY

Eu Chang Hwang*, Yang Hyun Cho, Ho Seok Chung, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Gwangju, Korea, Republic of; Myung Ki Kim, Jeonju, Korea, Republic of; Sung Gu Kang, Jun Cheon, Seoul, Korea, Republic of; Ja Yoon Ku, Hong Koo Ha, Busan, Korea, Republic of; Chang Wook Jeong, Ja Hyeon Ku, Cheol Kwak, Seoul, Korea, Republic of; Tae Gyun Kwon, Tae-Hwan Kim, Seock Hwan Choi, Daegu, Korea, Republic of