Sung Hoo Hong

Comparison of laparoscopic versus open radical nephrectomy for large renal tumors: a retrospective analysis of multi‐center results

Study Type – Therapy (case series)

dual growth factor incorporated heparin-pluronic hydrogel/gelatin-poly-tyramine hydrogel

The number of cases of erectile dysfunction (ED) caused after radical prostatectomy (RP) prostate cancer treatment is increasing steadily. Although various studies have been conducted for treatment of post-RP ED, there is still a need for more effective methods. A dual growth factor incorporated heparin-pluronic/gelatin-poly(ethylene glycol)-tyramine (HP/GPT) hydrogel, which consists of a basic fibroblast growth factor (bFGF)-loaded HP hydrogel and nerve growth factor (NGF)-loaded GPT hydrogel, can control dose and rate of growth factor release. In this study, we demonstrated that dual growth factor incorporated HP/GPT hydrogel could further improve erectile function in a rat model of bilateral cavernous nerve injury (BCNI). We showed that erectile function was decreased after BCNI, but it was further improved by treatment with a dual growth factor incorporated HP/GPT hydrogel compared with groups treated with single growth factor in a rat model of cavernous nerve injury. Also, we observed an increase in cyclic guanosine monophosphate (cGMP) levels in the dual growth factor group when compared with the groups treated with single growth factor. This effect was associated with greater upregulation of nitric oxide synthase and endothelial nitric oxide synthase expression in the penile tissue of the group treated with dual growth factor incorporated HP/GPT than in the other experimental groups. Apoptosis in the penile tissue treated with the dual growth factor incorporated HP/GPT hydrogel was lower than those treated singly with either bFGF or NGF incorporated GPT hydrogel. Both α-smooth muscle actin and CD31 expression increased in the group treated with dual growth factor incorporated HP/GPT hydrogel when compared to in the other experimental groups. Altogether, our results proved that the sequential and continuous release of growth factors from dual growth factor incorporated HP/GPT hydrogel prevented fibrosis and nerve damage induced by BCNI in the corpus cavernosum, and promoted the recovery of erectile function. Dual growth factor incorporated HP/GPT hydrogel may be a potent clinical application for the treatment of post-RP ED and could potentially be used various biomedical application in tissue regnerative medicine.

789 Adjuvant chemotherapy after radical cystectomy for muscle-invasive bladder cancer: A comparative study using inverse-probability-of-treatment weighting (IPTW)

INTRODUCTION AND OBJECTIVES: Inflammation plays an important role in the biology of many malignancies and is considered a hallmark of cancer. An elevated ratio of peripheral neutrophils to lymphocytes (NLR), a marker of host inflammation, has been associated with poor outcome in various solid tumors. We aimed to assess the association between pre-treatment NLR and survival in a large series of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). METHODS: Patients undergoing RC for UCB between 19882012 were identified using our institutional RC database. NLR was computed using complete blood counts with differentials performed preRC, or prior to neo-adjuvant chemotherapy where applicable. Given the heterogeneity of cutpoints used in the literature, time dependent receiver operator characteristics (ROC) curves were used to determine the optimal cutpoint for predicting recurrence-free (RFS), cancer-specific (CSS) and overall survival (OS) among the range of values used in the existing literature. The predictive ability of NLR was then assessed using Kaplan-Meier analyses and multivariable Cox-proportional hazards models adjusting for age, gender, co-morbidity score, hemogloblin, platelet count, stage, surgical margin status, and receipt of neo-adjuvant or adjuvant chemotherapy. Lastly, the likelihood ratio test was used to determine if multivariable models were improved by the inclusion of NLR. RESULTS: Of the final cohort of 416 patients, median follow up was 58.4 months. There were 178 (42%) deaths overall, 110 (26%) UCB-related deaths, and 138 recurrences (33%). An NLR of 3 was determined as the optimal cut-off value for predicting survival outcomes based on the inflection point of the ROC curves. Patients with NLR 3 had significantly worse survival outcomes (5y-RFS: 53% vs. 64%, logrank p1⁄40.013; 5y-CSS: 57% vs. 75%, log-rank p<0.001; 5y-OS: 43% vs. 64%, log-rank p<0.001). Upon adjusting for patient and diseasespecific predictors, NLR 3 was significantly associated with worse RFS (HR1⁄41.79; 95%CI1⁄41.22-2.63, p1⁄40.003), CSS (HR1⁄41.94; 95% CI1⁄41.44-2.60, p<0.001) and OS (HR1⁄41.66; 95%CI1⁄41.23-2.25, p1⁄40.001). The likelyhood ratio test confirmed that prognostic models were improved by including NLR. CONCLUSIONS: NLR is an inexpensive prognostic biomarker for patients undergoing radical cystectomy for UCB. It offers pre-treatment prognostic value in addition to established patient and disease-related prognostic indicators, and may be helpful in guiding treatment decisions.

478 Accuracy of FDG PET-CT compared with conventional CT for the lymph node staging in muscle invasive bladder cancer: Prospective study of 58 patients with extended lymphadenectomy

71.7%, pathology assistant 79.8%; p 0.84). Number of cases grossed did not correlate with either documenting the status of the perivesicular fat (quartile 4 73.6%, quartiles 1-3 76.9%; p 0.25) or the presence of fat invasion being corroborated microscopically (OR 0.99, 95% confidence interval: 0.97-1.02). CONCLUSIONS: A substantial proportion of cases at our institution do not have the gross impression of perivesicular fat invasion documented, which is necessary for pT3 substaging in bladder cancer. Improved assessment of fat invasion impacted substaging and may be a useful quality indicator. Understanding variables that impact pT3 staging could help account for differences in survival between institutions.