Kang Su Cho

Lymphovascular Invasion in Transurethral Resection Specimens as Predictor of Progression and Metastasis in Patients With Newly Diagnosed T1 Bladder Urothelial Cancer

PURPOSE We evaluated the clinical significance of lymphovascular invasion in transurethral resection of bladder tumor specimens in patients with newly diagnosed T1 urothelial carcinoma of the bladder. MATERIALS AND METHODS Enrolled in the study were 118 patients with newly diagnosed T1 urothelial carcinoma of the bladder who underwent transurethral resection of bladder tumor between 2001 and 2007. Patient records were retrieved from a prospectively maintained bladder cancer database. We evaluated the correlation between lymphovascular invasion and other clinicopathological features, and the impact of lymphovascular invasion on disease recurrence, disease progression and metastasis. RESULTS Lymphovascular invasion was histologically confirmed in 33 patients (28.0%). While lymphovascular invasion correlated with tumor grade (p = 0.002), it was not associated with gender, age, bladder tumor history, tumor size, multiplicity or concomitant carcinoma in situ. Recurrence, progression and metastasis developed in 45 (38.1%), 19 (16.1%) and 10 patients (8.5%), respectively. Univariate analysis showed that lymphovascular invasion was marginally associated with recurrence and significantly associated with progression (p = 0.011) and metastasis (p = 0.019). Multivariate Cox proportional hazards analysis revealed that recurrence was significantly associated with lymphovascular invasion (p = 0.029), and with bladder tumor history (p <0.001), tumor size (p = 0.031) and multiplicity (p = 0.043). Lymphovascular invasion was the only independent prognostic factor associated with progression (p = 0.016). CONCLUSIONS In patients with newly diagnosed T1 urothelial carcinoma of the bladder lymphovascular invasion in transurethral resection of bladder tumor specimens predicts disease progression and metastasis.

Extramammary Paget's disease of penis and scrotum.

OBJECTIVES To make clear the uncertainty of the clinical outcome of extramammary Pagets disease (EMPD). Penile and scrotal involvement of EMPD is exceedingly rare, and only small series or case reports have been reported. METHODS From 1995 to 2003, 36 patients with penile and scrotal EMPD were treated and followed up. Local wide excision was done in all patients with or without intraoperative frozen biopsy analysis. RESULTS Of the 36 patients, 13 (36.1%) underwent intraoperative frozen biopsy analysis and only 1 patient (7.7%) had a positive surgical margin. However, 23 (63.9%) underwent local wide excision with excessive surgical margins of up to 1 to 2 cm only by gross examination, but 17 (73.9%) of them had positive surgical margins (P <0.01). Of the 17 patients with positive surgical margins, 8 developed local recurrence at a median of 8 months of follow-up (P <0.05). One patient who had invasion to the subcutaneous tissue died of metastatic EMPD and internal malignancy (renal cell carcinoma) at 17 months after the initial operation. No patient had underlying adnexal carcinoma. CONCLUSIONS The results of our study indicate that local wide excision with intraoperative frozen biopsy analysis is essential to the complete treatment of EMPD.

Pretreatment assessment of tumor enhancement on contrast-enhanced computed tomography as a potential predictor of treatment outcome in metastatic renal cell carcinoma patients receiving antiangiogenic therapy.

Tumor vascularity is a potential predictor of treatment outcomes in metastatic renal cell carcinoma (mRCC), and contrast enhancement of tumors in computed tomography (CT) is correlated significantly with microvessel density. In this study, the authors investigated whether tumor enhancement in contrast‐enhanced CT (CECT) is useful for predicting outcomes in patients with mRCC who are receiving antiangiogenic therapy.

Lymphovascular invasion and pT stage are prognostic factors in patients treated with radical nephroureterectomy for localized upper urinary tract transitional cell carcinoma

OBJECTIVES To investigate the prognostic significance of lymphovascular invasion (LVI) in patients with localized upper urinary tract transitional cell carcinoma (UUT-TCC) after radical nephroureterectomy. METHODS The clinical records of 271 patients with UUT-TCC who underwent radical nephroureterectomy between 1986 and 2006 were reviewed. Patients with pT4 stage, lymph node involvement, or distant metastasis were excluded. A total of 238 patients with pTa-3N0M0 were eligible. The prognostic significance of various clinicopathologic factors was analyzed using univariate and multivariate analysis. The mean age was 64.1 years (range, 25-91 years) and the median follow-up duration was 53.4 months (range, 3-240 months). RESULTS LVI was present in 31 patients (13%). LVI was related to higher pT stage, high tumor grade, sessile architecture, and squamous differentiation. On univariate analysis, tumor architecture, squamous differentiation, LVI, tumor grade, and pT stage influenced disease-specific survival. On multivariate analysis, LVI (hazards ratio [HR], 2.33; P = .014) and pT stage (HR, 2.07; P = .021) showed significantly different rates of disease-specific survival. Patients were classified according to pT stage and LVI. The high-risk group (pT3 and LVI+) showed significantly worse disease-specific survival than the low- (pT < or = 2 and LVI-) or intermediate-risk groups (pT3 and LVI-, pT < or = 2 and LVI+) (P <.001 and P = .032, respectively). CONCLUSIONS LVI and pT stage are significant prognostic factors for recurrence-free and cancer-specific survivals in patients with localized UUT-TCC. LVI and pT stage would be helpful for selecting patients who are appropriate for postoperative adjuvant chemotherapy.

The Risk Factor for Urethral Recurrence after Radical Cystectomy in Patients with Transitional Cell Carcinoma of the Bladder

Purpose: We evaluated the incidence and risk factors for urethral recurrence following radical cystectomy and urinary diversion in transitional cell carcinoma. Patients and Methods: A retrospective review was performed of the 412 consecutive patients who underwent radical cystectomy and urinary diversion for transitional cell carcinoma of the bladder between 1986 and 2004. A total of 294 patients were enrolled in this study. We investigated the impact of various clinical and pathological features on urethral recurrence by univariate and multivariate analysis. Results: Urethral recurrence developed in 13 patients (4.4%) and the 5-year urethral recurrence-free probability was 94.9%. On univariate analysis, positive urethral margin, prostatic stromal invasion, and prostatic urethral involvement had a significant influence on urethral recurrence (p < 0.05). The other clinical and pathological features were not significantly associated with urethral recurrence (p > 0.05). A multivariate Cox proportional hazard model revealed that a positive urethral margin (hazards ratio (HR) = 18.33, p < 0.001), prostatic urethral involvement (HR = 7.95, p < 0.001), and prostatic stromal invasion (HR = 5.80, p = 0.018) were independent risk factors for urethral recurrence. Conclusion: A positive urethral margin is considered an absolute indication for prophylactic urethrectomy. In addition, more careful patient selection is necessary for orthotopic urinary diversion in patients with prostatic urethral involvement and prostatic stromal invasion.

Results of repeated transurethral resection for a second opinion in patients referred for nonmuscle invasive bladder cancer: the referral cancer center experience and review of the literature.

BACKGROUND AND PURPOSE We evaluated the results of a second transurethral resection (TUR) performed in patients referred after an initial TUR for nonmuscle invasive bladder cancer. PATIENTS AND METHODS From April 2001 to January 2008, patients who were referred for a second opinion and who underwent a second TUR at our institution were included in this study. Patients who had noninvasive bladder cancer and received the second TUR less than 8 weeks after the initial TUR were included in this analysis. The presence of residual tumor and changes of stage or grade from the two different TUR procedures were recorded and analyzed. RESULTS Fifty-six patients were evaluated in this study. The initial TUR specimens included the muscularis propria layers in 17 cases (30.4%), while the second opinion TUR specimens included the proper muscle layers in 47 cases (83.9%). Residual tumor was present in 16 of 25 (64.0%) patients with T(a) bladder cancer and in 20 of 30 (66.7%) patients with T(1) bladder cancer. Overall upstaging by the second TUR occurred for 9 patients (16.1%). Of 25 patients with T(a) bladder cancer, the second TUR confirmed the lamina propria invasion in one (4.0%) and muscle invasion in one (4.0%). The second TUR confirmed the muscle invasion in 7 of 30 (23.3%) patients with T(1) bladder cancer. Nine patients (16.1%) had their treatment strategy changed. CONCLUSION The previous results and our experiences suggest that a second TUR is recommended to reduce the chance of residual tumor and staging error because of nonstandardized TUR in the patients referred to an academic or referral center for a second opinion, irrespective of previous tumor stage.

Prostate stem cell antigen mRNA in peripheral blood as a potential predictor of biochemical recurrence in high-risk prostate cancer.

To determine whether the presence of prostate stem cell antigen (PSCA) mRNA in peripheral blood can predict biochemical recurrence (BCR) after radical prostatectomy in patients with high‐risk prostate cancer.

Efficacy and Safety of Photodynamic Therapy for Recurrent, High Grade Nonmuscle Invasive Bladder Cancer Refractory or Intolerant to Bacille Calmette-Guerin Immunotherapy

PURPOSE We evaluated the effectiveness of photodynamic therapy using Radachlorin in patients with high grade, nonmuscle invasive bladder cancer refractory or intolerant to bacillus Calmette-Guérin therapy who refused radical cystectomy. MATERIALS AND METHODS Between July 2009 and December 2011 photodynamic therapy was performed in 22 men and 12 women. Radachlorin (0.5 to 0.6 mg/kg) was injected intravenously 2 to 3 hours before photodynamic therapy. After complete transurethral resection, a diffuser using a 22Fr cystoscope was placed in the bladder for irradiation with a 662 nm laser. Output beam power was adjusted to 1.8 W and the light dose was 15 J/cm(2). Photodynamic therapy was performed for 16 to 30 minutes. Recurrence after photodynamic therapy was followed by regular cystoscopy at 1, 2 and 3 months, and at 3-month intervals thereafter for up to 2.8 years. Efficacy was assessed by cystoscopy, cytology and histology, and defined as the number of patients who were tumor free after initial photodynamic therapy. RESULTS Mean ± SD patient age was 62.94 ± 8.71 years. Average followup was 26.74 ± 6.34 months (median 28.12). As the primary efficacy outcome, the recurrence-free rate was 90.9% at 12 months, 64.4% at 24 months and 60.1% at 30 months. As the secondary efficacy outcome, there was no statistical difference in mass size, carcinoma in situ, number of previous bacillus Calmette-Guérin administrations, number of transurethral bladder resections or tumor multiplicity on Kaplan-Meier analysis (each p >0.05). No evidence of severe adverse effects was detected after photodynamic therapy. CONCLUSIONS Photodynamic therapy with Radachlorin is a safe, effective treatment for nonmuscle invasive bladder cancer refractory or intolerant to bacillus Calmette-Guérin therapy in select patients.

Lymphocele after extraperitoneal robot-assisted radical prostatectomy: A propensity score-matching study

To investigate the incidence of lymphocele and determine the risk factors for postoperative lymphocele after extraperitoneal robot‐assisted radical prostatectomy by using propensity score‐matching.

Relationship Between Prostatic Urethral Angle and Urinary Flow Rate: Its Implication in Benign Prostatic Hyperplasia Pathogenesis

OBJECTIVES The prostatic urethra is a bent tube, and the clinical significance of the prostatic urethral angle (PUA) is poorly understood. We investigated the effect of the PUA on the urinary flow rate in men without benign prostatic obstruction. METHODS In a theoretical model, the urinary flow rate at the end of the prostatic urethra was formulated according to some principles of fluid dynamics, including the Navier-Storkes equation, Bernoullis equation, and the loss of coefficient at bends. The change in the urinary flow rate according to the PUA was also calculated through mathematical simulations. In addition, the relationship between the PUA and the peak flow rate was evaluated in 65 healthy men without benign prostatic obstruction (age 50 to 59 years, prostate volume less than 30 cm(3), peak flow rate greater than 15 mL/s). The prostate volume and PUA were determined by transrectal ultrasonography. RESULTS Using the fluid dynamic model, the urinary flow rate increased in proportion to the urethral diameter and was inversely associated with the PUA. The mathematical simulations showed that the urinary flow rate decreased by more than 27% as the PUA increased from 35 degrees to 90 degrees. In the clinical setting, the peak flow rate was significantly associated with the PUA by linear regression analysis (R = 0.34, beta = -0.342, P = 0.005), but it was not associated with the total prostate volume (R = 0.18, beta = -0.181, P = 0.150). CONCLUSIONS The PUA was inversely associated with the urinary flow rate in this theoretical model and preliminary clinical study. This relationship could be an important factor in the pathogenesis of benign prostatic hyperplasia/lower urinary tract symptoms.