Kwangmo Kim

Intraprostatic locations of tumor foci of higher grade missed by diagnostic prostate biopsy among potential candidates for active surveillance

To establish optimal biopsy scheme for selection of candidates for active surveillance (AS) among prostate cancer (PCa) patients, information on topographical distribution of tumor foci of higher grade missed by contemporary biopsy amongst potential candidates of AS would certainly be useful. Thus we analyzed topographic distribution of tumor foci by examining prostatectomy specimens in 444 patients who underwent radical prostatectomy for low risk PCa. Anterior and posterior prostate areas were demarcated by a horizontal line drawn at midpoint of prostatic urethra. Among 444 subjects, patients with upgrading showed relatively higher prevalence of index tumor foci in anterior prostate than those without upgrading, though not reaching statistical significance (p = 0.252). Meanwhile, among 135 (30.4%) patients with very low risk PCa, patients with upgrading showed significantly higher prevalence of index tumor foci in anterior prostate than those without upgrading (52.2% vs 33.8%; p = 0.031). In conclusions, tumor foci of higher grade missed by diagnostic biopsy were mostly located in anterior prostate among very low risk PCa patients. Such finding would be concrete evidence to support the notion that more efforts are needed to increase accuracy in detecting tumor foci in anterior prostate among potential candidates for AS.

Impact of Prostatic Apical Shape and Protrusion on Early Recovery of Continence After Robot-assisted Radical Prostatectomy

OBJECTIVE To investigate the impact of prostatic apical shape from preoperative magnetic resonance imaging on early recovery of urinary continence after robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS We reviewed the records of 1011 patients who underwent RARP at a tertiary center from October 2007 to March 2013. Patients were stratified into 4 different groups by prostatic apical shapes as shown on preoperative magnetic resonance imaging (groups A-D). The early recovery of urinary continence was defined as 0 or 1 security pad/d within 12 weeks after the surgery. The association between early recovery of continence and various factors was analyzed. RESULTS Overall, 807 patients (79.8%) showed early recovery of urinary continence. The numbers of patients in groups A, B, C, and D were 88 (8.7%), 478 (47.3%), 167 (16.5%), and 278 (27.5%), respectively. There were no significant differences in the rates of early recovery of urinary continence between different groups (P = .257). On multivariate analysis, the patients age (odds ratio [OR], 0.960; P = .004), preoperative International Index of Erectile Function-5 score (OR, 1.029; P = .009), neurovascular bundle preservation (OR, 1.586; P = .013), and membranous urethral length (OR, 1.104; P = .001) were revealed as independent prognostic factors in the early recovery of urinary continence. CONCLUSION The results of our study showed that the prostatic apical shape does not influence the early recovery of urinary continence. We believe this is another strong point of RARP compared with conventional open surgery, particularly for patients with complex type of apical shape.

Comparison of the Width of Peritumoral Surgical Margin in Open and Robotic Partial Nephrectomy: A Propensity Score Matched Analysis

Background To compare the surgical margin status after open partial nephrectomy (OPN) and robotic partial nephrectomy (RPN) performed in patients with T1a renal cell carcinoma (RCC). Methods This was a propensity score-matched study including 702 patients with cT1a RCC treated with partial nephrectomy (PN) between May 2003 and July 2015. Perioperative parameters, including surgical margin width after PN, were compared between two surgical methods. After determining propensity score for tumor size and location, the width of peritumoral surgical margin was investigated. Multivariate logistic analysis to predict peritumoral surgical margin less than 1mm was analyzed. Results The mean width of peritumoral surgical margin was 2.61 ± 2.15 mm in OPN group (n = 385), significantly wider than the 2.29 ± 2.00 mm of RPN group (n = 317) (p = 0.042). The multivariate analysis showed surgical methods was significant factors to narrow surgical margin less than 1mm (p = 0.031). After propensity score matching, the surgical margin width was significantly longer in OPN (2.67 ± 2.14 mm) group than RPN (2.25 ± 2.03 mm) group (p = 0.016). A positive resection margin occurred in 7 (1.8%) patients in the OPN group and 4 (1.3%) in the RPN group. During the median follow-up of 48.3 months, two patients who underwent OPN had tumor bed recurrence. Conclusions RPN may result in a narrower peritumoral surgical margin than OPN. Further investigation on the potential impact of such a phenomenon should be performed in a larger-scale study.

Underweight is associated with mortality in patients with severe sepsis and septic shock

It is well known that obesity is associate with improved mortality in severe sepsis in western countries. However, the prognosis of the patients with sepsis in Asian countries might be different from that of western countries.

MP88-04 ANTI-TUMOR EFFECT OF NEW TYROSIN KINASE INHIBITORS (BOSUTINIB, NINTEDANIB, VATALANIB) IN HUMAN BLADDER CANCER CELLS

INTRODUCTION AND OBJECTIVES: Angiogenesis is known to play a major role in the pathogenesis of bladder cancer. Bosutinib is an orally bioavailable dual Src/Abl tyrosin kinase inhibitor (TKI). Nintedanib and vatalanib are TKI that inhibits the vascular endothelial growth factor receptor (VEGFR) and the platelet-derived growth factor receptor (PDGFR), has been demonstrated to exert anti-tumor effects. However, the molecular mechanisms underlying its effects on bladder cancer remain unknown. We examined anti-tumor effects of bosutinib, nintedanib, and vatalanib in human bladder cancer cells (T24, cisplatinresistant-T24R2). METHODS: Bladder cancer cells were treated with bosutinib, nintedanib, and vatalanib and cancer cell proliferation was determined using the cell counting kit-8 (CCK-8) assay and clonogenic assay. Cell cycle and apoptosis rate were measured by flow cytometry. Apoptosisand cell cycle-related protein expression was analyzed by Western blot assays. RESULTS: Bladder cancer cell proliferation and colony formation was significantly reduced by bosutinib and vatalanib treatment in a dose-dependent manner. Bosutinib, nintedanib, and vatalanib induced apoptosis and cell cycle arrest at G1 phase. Expression of apoptosis related proteins (caspase-3, -8, -9, PARP, cytochrome c, bad, and bax) was elevated by bosutinib, nintedanib, and vatalanib treatment. CONCLUSIONS: In conclusion, new TKI (bosutinib, nintedanib, and vatalanib) showed anticancer effect in bladder cancer cells through induce apoptosis and cell cycle arrest. These data suggest that bosutinib, nintedanib, and vatalanib may be a novel therapeutic approach in the bladder cancer.

Six-hour central venous oxygen saturation has no prognostic value in patients with septic shock

Methods We have retrospectively identified septic shock patients who received protocolized treatment in two tertiary academic EDs. All patients were treated using the early goaldirected protocol. The data with respect to demographics, predisposing factors, site of infection, and the admission APACHE II score were collected. Hemodynamic (mean arterial pressure and central venous pressure) and laboratory (arterial blood gas analysis, Scv02, and lactate level) parameters at baseline and 6-hour were also recorded. To test the prognostic value of 6-hour Scv02, the area under receiver operating characteristics curve (AUROC) to predict 1-month mortality was calculated and compared with that of 6-hour lactate level. Pearson correlation coefficient between 6-hour Scv02 or lactate level and the admission APACHE II score were also analyzed.