Hyun Hwan Sung

Comparison of percutaneous radiofrequency ablation and open partial nephrectomy for the treatment of size- and location-matched renal masses

Purpose: To compare percutaneous radiofrequency ablation (RFA) and open partial nephrectomy (OPN) for the treatment of renal cell carcinoma (RCC) with respect to renal function and mid-term oncological outcome. Materials and methods: From January 2006 to December 2008, 40 (RFA group) and 110 (OPN group) patients underwent RFA and OPN for sporadic RCC, respectively. The sizes and locations of RCCs were matched between the two groups. To determine the lesion size, the maximum transverse diameter was measured. Estimated glomerular filtration rates (eGFR) before and after treatment and overall three-year recurrence-free survival rates were calculated and compared. Results: Tumours in the RFA and OPN groups ranged from 9–76u2009mm (24.4u2009±u200913.1u2009mm) and from 6–60u2009mm (22.3u2009±u200910.2u2009mm), respectively (pu2009=u20090.962). The locations of RCCs were not significantly different (pu2009=u20090.101–0.508). The mean reductions of eGFR in the RFA and OPN groups were 2.3u2009±u20098.6u2009mL/min/1.73u2009m2 (range, −23 to +17.5u2009mL/min/1.73u2009m2) and 7.4u2009±u200910.9u2009mL/min/1.73u2009m2 (−23.6 to +42.8u2009mL/min/1.73u2009m2, respectively (pu2009=u20090.013). Overall three-year recurrence-free survival rates in the RFA and OPN groups were 94.7% and 98.9%, respectively (pu2009=u20090.266). Conclusion: For treating size- and location-matched RCCs, RFA is superior to OPN with respect to the preservation of renal function. Furthermore, RFA can achieve excellent mid-term outcomes that are equivalent to those of OPN.

Prevalence of urinary incontinence in Korean women: results of a National Health Interview Survey

ObjectivesWe determined the prevalence and types of urinary incontinence (UI) in Korean women and analyzed their attitude toward treatment.MethodsThis national survey was conducted as part of the Korean National Health Interview Survey to evaluate the prevalence of UI in Korean women between April and June 2005. In 13,345 Korean households, 13,484 women aged 19 years or older were interviewed by census takers. The subjects were asked about the type of UI that they had experienced and their treatment. UI was classified as “stress,” “urge,” “mixed” (stress and urge), or “other.”ResultsThe overall prevalence of UI in the subjects was 24.4%. Of those women, 48.8% reported stress UI only; 7.7%, urge UI only; 41.6%, mixed UI; and 1.9%, other type of UI. The prevalence of UI increased with age. Only 12.6% of the women with UI had sought medical care, and only 0.8% had undergone surgery for UI. Self-reported depression was higher in women with UI than in those without that disorder, and UI was more prevalent in women who were married, unemployed, and undereducated. According to national population data estimated by weighted UI numbers, about 4.2 million Korean women aged 19 years or older have experienced UI.ConclusionsThe prevalence of UI among women aged 19 years or older in Korea was 24.4%, and stress UI was the most prevalent type. Many women with UI did not seek medical treatment for that condition.

Diffusion-weighted magnetic resonance imaging for prediction of insignificant prostate cancer in potential candidates for active surveillance

AbstractObjectivesTo investigate whether the apparent diffusion coefficient (ADC) from diffusion-weighted magnetic resonance imaging (DW-MRI) could help improve the prediction of insignificant prostate cancer in candidates for active surveillance (AS).MethodsEnrolled in this retrospective study were 287 AS candidates who underwent DW-MRI before radical prostatectomy. Patients were stratified into two groups; Group A consisted of patients with no visible tumour or a suspected tumour ADC valueu2009>u20090.830u2009×u200910-3xa0mm2/sec and Group B consisted of patients with a suspected tumour ADC valueu2009<u20090.830u2009×u200910-3xa0mm2/sec. We compared pathological outcomes in each group.ResultsGroup A had 243 (84.7xa0%) patients and Group B had 44 (15.3xa0%) patients. The proportion of organ-confined Gleasonu2009≤u20096 disease and insignificant prostate cancer was significantly higher in Group A than Group B (61.3xa0% vs. 38.6xa0%, pu2009=u20090.005 and 47.7xa0% vs. 25.0xa0%, pu2009=u20090.005, respectively). On multivariate analysis, a high ADC value was the independent predictor of organ-confined Gleasonu2009≤u20096 disease and insignificant prostate cancer (odds ratiou2009=u20092.43, pu2009=u20090.011 and odds ratiou2009=u20092.74, pu2009=u20090.009, respectively).ConclusionTumour ADC values may be a useful marker for predicting insignificant prostate cancer in candidates for AS.Key points• ADC from DW-MRI can help assess prostate cancer aggressiveness in potential AS candidates.n • There was a closed correlation between higher ADC values and insignificant prostate cancer.n • The absence of lesions on DWI/DWI can help select potential AS candidates.

Preoperative Prognostic Nutritional Index is a Significant Predictor of Survival in Renal Cell Carcinoma Patients Undergoing Nephrectomy

BackgroundPreoperative assessment of patients’ immunologic and nutritional conditions is required to predict the outcome of patients with malignant tumors. The aim of the current study was to clarify the significance of the prognostic nutritional index (PNI), which simply accounts for immunological and nutritional conditions, in patients with renal cell carcinoma (RCC).MethodsWe included 1437 patients who underwent nephrectomy for RCC between 1994 and 2008. PNI was calculated using the following formula: 10xa0×xa0serum albumin concentration (g/dL)xa0+xa00.005xa0×xa0lymphocyte counts (number/mm2) in peripheral blood. We examined the correlation of the preoperative PNI value with clinicopathological features. A Cox regression model and the Harrell concordance index with variables only or combined PNI data were used to evaluate the prognostic significance in the T1-4NallMall and T1-4N0M0 groups.ResultsThe mean preoperative PNI value was 52.7xa0±xa06.3 (range 27.7–85.3). The mean PNI values were significantly lower in patients with more advanced tumor T stage, regional lymph node metastasis, distant metastases, higher Fuhrman grade, and sarcomatoid differentiation than in patients without such factors (pxa0<xa00.001). Patients with low PNI (<51) had poor survival rates compared to those with high PNI in univariate analysis (>51, pxa0<xa00.001). Multivariate analysis showed that low PNI was significantly associated with cancer-specific survival (pxa0=xa00.026 and pxa0=xa00.009) and overall survival (pxa0=xa00.013 and pxa0=xa00.011) in the T1-4NallMall and T1-4N0M0 groups, respectively, after correcting for other clinicopathological factors.ConclusionsPNI is an independent prognostic factor for predicting survival after nephrectomy in patients with RCC.

Clinical significance of prognosis using the neutrophil-lymphocyte ratio and erythrocyte sedimentation rate in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma.

To evaluate the clinical significance of preoperative erythrocyte sedimentation rate (ESR) and neutrophil–lymphocyte ratio (NLR) as prognostic factors in patients undergoing radical nephroureterectomy for upper tract urothelial carcinoma (UTUC).

Transperitoneal versus retroperitoneal robotic partial nephrectomy: matched‑pair comparisons by nephrometry scores

PurposeThe purpose of this study was to compare perioperative outcomes of transperitoneal (TP) and retroperitoneal (RP) robot-assisted partial nephrectomy (RPN) by matched analysis using nephrometry systems.MethodsA total of 107 patients who underwent RPN by a single surgeon from December 2008 to June 2012 were analyzed; 57 patients underwent TP RPN and 50 patients underwent RP RPN. Baseline demographic characteristics, perioperative outcomes and changes in renal function were collected by retrospective review of medical records. Matched-pair comparisons were done using RENAL score and C-index.ResultsNo significant difference was observed between TP and RP RPN in patient age, body mass index, gender, laterality, clinical stage, tumor size, RENAL score or ASA score. The TP RPN had more cystic renal masses (TP vs. RPxa0=xa033 vs. 12xa0%, pxa0=xa00.012) and RP RPN had shorter median operation times (150 vs. 120xa0min, pxa0=xa00.015) and shorter mean warm ischemic times (26.2 vs. 22.6xa0min, pxa0=xa00.040) than TP RPN. In the matched-pair analysis, RP RPN showed shorter operation times with similar warm ischemic times. Estimated blood loss and visual analog pain scales showed no significant differences between groups. A total of 12 (11.4xa0%) postoperative complications occurred, all Clavien class I or II with no significant difference in incidence.ConclusionsRetroperitoneal robot-assisted partial nephrectomy showed shorter operation time and generally equivalent perioperative results to TP RPN. RP RPN is a viable treatment option for treating posterior or lateral renal masses.

Accuracy of preoperative multiparametric magnetic resonance imaging for prediction of unfavorable pathology in patients with localized prostate cancer undergoing radical prostatectomy

IntroductionWe investigated the accuracy of multiparametric MRI (mpMRI) for preoperative staging and its influence on the determination of neurovascular bundle sparing and disease prognosis in patients with localized prostate cancer.MethodsWe reviewed 1045 patients who underwent radical prostatectomy with preoperative mpMRI at a single institution. Clinical local stages determined from mpMRI were correlated with preoperative and postoperative pathological outcomes.ResultsThe sensitivity and specificity to diagnose seminal vesicle invasion (SVI) on mpMRI were 43.8 and 95.4xa0%, respectively. The negative predictive value was 78.9xa0%. The sensitivity and specificity to diagnose extracapsular extension (ECE) were 54.5 and 80.5xa0%, respectively. The overall sensitivity and specificity of diagnosing pathological T3 or higher were 52.6 and 82.1xa0%, respectively. Non-organ-confined disease determined by mpMRI was significantly associated with positive surgical margin and pathological T3 disease on multivariate analysis. Preoperative adverse findings on mpMRI were significantly associated with performance of the non-nerve-sparing technique.ConclusionmpMRI did not show outstanding diagnostic accuracy relative to our expectations in predicting SVI or ECE preoperatively. However, adverse findings on preoperative mpMRI were significantly related to worse postoperative pathological outcomes as well as postoperative biochemical recurrence.

Impact of body mass index in Korean patients with renal cell carcinoma

ObjectiveThe aim of the current study was to examine the impact of preoperative body mass index (BMI) in Korean patients with surgically treated renal cell carcinoma (RCC).MethodsFrom 1994 to 2008, a total of 1,487 patients underwent nephrectomy for RCC. All patients were classified into three groups according to Asian BMI classification by Asia Cohort Consortium: <18.5, 18.5 to <25, and 25xa0kg/m2 or greater group, which represents the underweight (nxa0=xa042, 2.8%), normal (nxa0=xa0833, 56.0%), and obesity (nxa0=xa0612, 41.2%) group, respectively. Survival analyses and predictive factors for cancer-specific survival among the three groups were evaluated. Subgroup survival analysis of organ-confined and advanced disease was performed.ResultsAn overall median follow-up was 54.8xa0months. Meanxa0±xa0SE estimated cancer-specific survival in all patients at 5 and 10xa0years was 88.0xa0±xa01.0% and 81.4xa0±xa01.4%, respectively. In the multivariate model after adjusting preoperative and postoperative variables, the underweight group had a significantly worse prognosis than the normal group (hazard ratio (HR): 2.17, 95% confidence interval (95% CI): 1.16–4.08, pxa0=xa00.016), meanwhile the obesity group was associated with improved survival (HR: 0.66, 95% CI: 0.45–0.96, pxa0=xa00.032). In the subgroup analysis of advanced RCC, obesity was associated with better prognosis than the normal group after applying multivariate analysis (pxa0=xa00.001).ConclusionsPreoperative underweight could be a new independent factor to predict unfavorable cancer-specific survival in Korean patients with RCC treated by surgery. Moreover, obesity was verified to be associated with superior cancer-specific survival.

Postoperative Outcome of Cystic Renal Cell Carcinoma Defined on Preoperative Imaging: A Retrospective Study

Purpose: We evaluated the postoperative outcome of cystic renal cell carcinoma defined on preoperative computerized tomography. We also sought to find the optimal cutoff of the cystic proportion in association with patient prognosis. Material and Methods: In this institutional review board approved study with waiver of informed consent, 1,315 patients were enrolled who underwent surgery for a single renal cell carcinoma with preoperative computerized tomography. The cystic proportion of renal cell carcinoma was determined on computerized tomography. The optimal cutoff of the cystic proportion was explored regarding cancer specific survival. Renal cell carcinomas were categorized as cystic or noncystic renal cell carcinoma according to a conventional cutoff (ie cystic proportion 75% or greater) and an optimal cutoff. Postoperative outcomes were then compared between the 2 groups. Multivariate Cox regression analysis was performed to determine the independent predictor of cancer specific survival. Results: Of the 1,315 lesions 107 (8.1%) were identified as cystic renal cell carcinoma according to a conventional cutoff. The postoperative outcome of cystic renal cell carcinoma was significantly better than that of noncystic renal cell carcinoma (p <0.001). Neither metastasis nor recurrence developed after surgery in patients with cystic renal cell carcinoma. In association with the cancer specific survival rate, the optimal cutoff of the cystic proportion was 45% and 197 cases (15.0%) were accordingly defined as cystic renal cell carcinoma. On Cox regression analysis, a cystic proportion of 45% or greater of the renal cell carcinoma was an independent predictor of a favorable outcome regarding cancer specific survival (HR 0.34, p = 0.03). Conclusions: Cystic renal cell carcinoma defined on preoperative computerized tomography is associated with low metastatic potential and favorable outcomes after surgery. Particularly, a cystic proportion of 45% or greater is an independent prognostic factor for favorable survival.

Prognostic Significance of Pre- to Postoperative Dynamics of the Prognostic Nutritional Index for Patients with Renal Cell Carcinoma Who Underwent Radical Nephrectomy

BackgroundThis study aimed to examine the prognostic role of Prognostic Nutritional Index (PNI) dynamics in the pre- and postoperative periods for patients with renal cell carcinoma (RCC) who undergo radical nephrectomy (RN).MethodsThe study analyzed 324 patients with RCC who underwent RN. The overall population was classified into four groups according to four types of pre- to postoperative PNI dynamics as follows: group 1 (lowxa0→xa0low PNI), group 2 (lowxa0→xa0high PNI), group 3 (highxa0→xa0low PNI), and group 4 (highxa0→xa0high PNI). The level of PNI was calculated using the following formula: 10xa0×xa0serum albumin level (g/dL)xa0+xa00.005xa0×xa0absolute lymphocyte counts in blood (/mm3). The primary end point was cancer-specific survival (CSS), and the secondary end point was overall survival (OS).ResultsThe patients with higher pre- and postoperative PNI (>45) had better survival outcomes than those with lower pre- and postoperative PNI (≤45). Notably, the patients in group 4 showed the best CSS and OS rates, whereas the patients in group 1 had the worst survival outcomes. Furthermore, PNI dynamics were identified as an independent predictor of CSS and OS outcomes, in addition to pre- and postoperative PNI, tumor size, and pathologic T (pT) stage. The patients with localized RCC (≤pT2) showed significant differences in both CSS and OS estimates, whereas the patients with advanced pT stage (≥pT3) demonstrated a difference only in OS outcomes, according to PNI dynamics.ConclusionsThis study is the first to provide the independent prognostic importance of dynamics of nutritional status for patients with RCC.