Tsu-Ming Chien

Is preoperative anemia a risk factor for upper tract urothelial carcinoma following radical nephroureterectomy

PURPOSE We aimed to identify the effect of preoperative anemia on oncologic outcomes in patients with upper tract urothelial carcinoma (UTUC) who had different levels of renal function. METHODS Between 2000 and 2013, we enrolled 370 patients who underwent radical nephroureterectomy for nonmetastatic UTUC. Preoperative anemia was defined as hemoglobin <130g/l in men and <120g/l in women based on the World Health Organization classification. Kaplan-Meier method was applied to estimate the effect anemia on survival, and hazard ratios (HR) of anemia and other clinicopathological parameters were evaluated by Cox regression model. The analyses were also performed in patients with different chronic kidney disease (CKD) stages. RESULTS In all, 242 (65.4%) patients were anemic before surgery. Those with preoperative anemia had worse CKD stage (P<0.001) and higher pathological tumor stage (P = 0.023). In univariate analysis, metastasis-free and cancer-specific survival rates were not significantly associated with preoperative anemia (HR = 1.51, 95% CI: 0.93-2.44, P = 0.093 and HR = 1.59, 95% CI: 0.93-2.72, PP = 0.094, respectively). However, in patients without stage 5 CKD, those with preoperative anemia had apparently inferior metastasis-free and cancer-specific survival than those without (HR = 1.88, 95% CI: 1.14-3.01, P = 0.014 and HR = 2.03, 95% CI: 1.16-3.56, P = 0.010, respectively). A multivariate Cox proportional hazards model indicated that preoperative anemia was an independent predictor for both metastasis-free (HR = 2.17, 95% CI: 1.21-3.90, P = 0.010) and cancer-specific survival (HR = 2.21, 95% CI: 1.15-4.21, P = 0.017). CONCLUSIONS Among patients without stage 5 CKD, preoperative anemia was a significant prognostic factor to predict metastatic progression and cancer-specific death in UTUC following radical nephroureterectomy. It was important to be aware of patients׳ renal function while evaluating the effect of anemia on outcome of UTUC.

Is Extracorporeal Shock Wave Lithotripsy Really Safe in Long-Term Follow-Up? A Nationwide Retrospective 6-Year Age-Matched Non-Randomized Study

Introduction: Shock wave lithotripsy (SWL) is widely used. However, several studies have reported increased blood pressure immediately after SWL. Until now, the association between SWL and new-onset hypertension has been a topic of discussion. This study is aimed at determining whether SWL leads to new-onset hypertension. Methods: Data were sourced from the Longitudinal Health Insurance Database 2000 of Taiwan, Republic of China, which was compiled from 1996 to 2010 using National Health Insurance data. Patients who had undergone SWL were compared with controls that were matched for age, sex, obesity, diabetes mellitus, and hyperlipidemia. Results: Patients who had undergone SWL had a higher incidence of new-onset hypertension compared to the control groups. Furthermore, new hypertension developed faster in the SWL group. Conclusions: The results of this study demonstrated that an association exists between nephrolithiasis patients who were treated with SWL and subsequent hypertension diagnosis. Patients who undergo SWL may need regular follow-up of blood pressure.

Percutaneous Nephrolithotomy Increases the Risk of New-onset Hypertension: A Nationwide 6-Year Follow-up Study

OBJECTIVE To determine whether percutaneous nephrolithotomy or ureteroscopic lithotripsy leads to the development of hypertension, using the Taiwan National Health Insurance database. METHODS Data were sourced from the Longitudinal Health Insurance Database (LHID2000) of Taiwan, Republic of China, compiled by the Taiwan National Health Insurance database from 1996 to 2010. Percutaneous nephrolithotomy and ureteroscopic lithotripsy were studied as time-dependent covariates in a Cox proportional hazard model to estimate the hazard ratio for the effect of new-onset hypertension. RESULTS A total of 2552 patients were included, with 232 PNL percutaneous nephrolithotomy, 1160 ureteroscopic lithotripsy patients, and 1160 comparison patients. There was a significant difference between the incidence of new-onset hypertension between the percutaneous nephrolithotomy and comparison groups (adjusted hazard ratio 1.48, 95% confidence interval 1.13-1.95, P = .005). The percutaneous nephrolithotomy group also had a higher incidence of new-onset hypertension than the ureteroscopic lithotripsy group (adjusted hazard ratio 1.39, 95% confidence interval 1.06-1.83, P = .018). The incidence rate of new hypertension during the follow-up period was 44.5 per 1000 person-years in the percutaneous nephrolithotomy group, 33.0 per 1000 person-years in the ureteroscopic lithotripsy group, and 30.2 per 1000 person-years in the comparison group. CONCLUSION An association exists between nephrolithiasis patients who were treated with percutaneous nephrolithotomy and subsequent hypertension diagnosis. Although the exact mechanisms for this phenomenon are not clear, patients who undergo percutaneous nephrolithotomy may need close monitoring of blood pressure during postoperative follow-up.

Epidermal growth factor receptor inhibitor with fluorouracil, leucovorin, and irinotecan as an alternative treatment for advanced upper tract urothelial carcinoma: a case report

BackgroundCurrently, there is no standard salvage regimen after the failure of cisplatin-based chemotherapy for advanced urothelial carcinoma. The combination of epidermal growth factor receptor inhibitor with fluorouracil, leucovorin, and irinotecan was originally designed for the treatment of metastatic colorectal cancer. Until now, there have been no reports using this combination therapy in treating advanced upper tract urothelial carcinoma. To the best of our knowledge, this is the first report showing this possible treatment regimen for advanced upper tract urothelial carcinoma.Case presentationWe report the case of a 90-year-old Chinese woman who was diagnosed with metastatic colorectal cancer and urothelial carcinoma of the bladder, ureter, and renal pelvis. The upper tract urothelial carcinoma was well controlled by the chemotherapy regimen for metastatic colorectal cancer. Considering her age, we used only laser ablation for the treatment of her urothelial carcinoma in combination with intravesical mitomycin C chemotherapy. Follow-up cystoscopy and ureterorenoscopy showed an unexpected regression of the upper tract urothelial tumor. Contrast-enhanced computed tomography also demonstrated the same results.ConclusionsThis novel regimen for the treatment of upper tract urothelial carcinoma may merit further investigation or evaluation in clinical trials.

Cox-2 gene overexpression in ureteral stump urothelial carcinoma following nephrectomy for renal cell carcinoma: A case report

IntroductionA primary ureteral stump tumor after a nephrectomy is rare; urothelial carcinoma of the ureteral stump after a nephrectomy for renal cell carcinoma is even rarer. A thorough review of the literature indicated that only seven cases have previously been reported. In this study, we report the first Taiwanese case of urothelial carcinoma of the ureteral stump after a nephrectomy. It is also the first female case in the literature. The relationship between inflammatory genes, medication history and ureteral stump carcinoma after a nephrectomy for renal cell carcinoma has not been reported.Case presentationA 72-year-old Asian Taiwanese women with chronic hepatitis C, liver cirrhosis and chronic kidney disease underwent a hand-assisted laparoscopic radical nephrectomy in 2001 due to renal cell carcinoma. Nine years later, she was diagnosed with ureteral stump urothelial carcinoma. Genetic and medication surveys were performed. Importantly, our patient had taken Chinese herbal drugs for more than 10 years and the inflammatory gene, Cox-2, was highly expressed in this patient. This is the first report to study the relationship between the Cox-2 gene and ureteral stump carcinoma after a nephrectomy for renal cell carcinoma.ConclusionLong-term multiple use of Chinese herbal drugs could be one of the important risk factors for developing urothelial cancer. Close functional coupling between Chinese herbal drugs, Cox-2 gene activation and urothelial cancer should be further investigated.

Predictors of Positive Bone Metastasis in Newly Diagnosed Prostate Cancer Patients

BACKGROUND The prevalence of prostate cancer (PCa) has been increasing in recent years. Treatment strategies are largely based on the results of bone scan screening. Therefore, our aim was to investigate predictors of positive bone metastasis in newly diagnosed PCa patients. MATERIALS AND METHODS After extensive review, 336 consecutive patients newly diagnosed with PCa between April 2010 and November 2013 at our institution were enlisted in the study. Patients were divided into two groups according to bone scan results. Univariate analyses (Chi-square test for discrete variables and independent t-test for continuous variables) were applied to determine the potentially significant risk factors associated with distant bone metastasis. Binary logistic regression analyses were used to further investigate the influence of these factors on bone metastasis. RESULTS The patient mean age was 71.9 ± 8.6 years (range: 48 to 94 years). The mean prostate specific antigen (PSA) level and biopsy Gleason score were 260.2 ± 1107.8 ng/mL and 7.4 ± 1.5, respectively. The body mass index (BMI) for the series was 24.5 ± 3.4 kg/m2. Sixty-four patients (19.0%) had a positive bone scan result. Patients with positive bone scan results had a significantly lower BMI (23.3 ± 3.5 vs. 24.8 ± 3.3; p=0.003), a higher Gleason score (8.5 ± 1.1 vs. 7.1 ± 1.5; p < 0.001), and a higher PSA level (1071.3 ± 2337.1 vs. 69.4 ± 235.5; p < 0.001) than those without bone metastasis. Multivariate logistic regression analysis employing the above independent predictors demonstrated that a Gleason score of ≥7, clinical stage ≥T3, BMI ≤22 kg/m2, and an initial PSA level of ≥20 ng/mL were all independent predictors of bone metastasis. CONCLUSIONS A bone scan might be necessary in newly diagnosed PCa patients with any of the following criteria: clinical stage T3 or higher, a Gleason score of 7 or higher, BMI equal to or less than 22, and a PSA level of 20 or higher.