Yang Hyun Cho

Predictors of Intravesical Recurrence After Radical Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma: An Inflammation-Based Prognostic Score

Purpose Systemic inflammatory responses, which are defined in terms of the Glasgow prognostic score (GPS), have been reported to be independent predictors of unfavorable outcomes in various human cancers. We assessed the utility of the GPS as a predictor of intravesical recurrence after radical nephroureterectomy (RNU) in upper urinary tract carcinoma (UTUC). Materials and Methods We collected data for 147 UTUC patients with no previous history of bladder cancer who underwent RNU from 2004 to 2012. Associations between perioperative clinicopathological variables and intravesical recurrence were analyzed by using univariate and multivariate Cox regression models. Results Overall, 71 of 147 patients (48%) developed intravesical recurrence, including 21 patients (30%) diagnosed with synchronous bladder tumor. In the univariate analysis, performance status, diabetes mellitus (DM), serum albumin, C-reactive protein, GPS, and synchronous bladder tumor were associated with intravesical recurrence. In the multivariate analysis, performance status (hazard ratio [HR], 2.33; 95% confidence interval [CI], 1.41-3.85; p=0.001), DM (HR, 2.04; 95% CI, 1.21-3.41; p=0.007), cortical thinning (HR, 2.01; 95% CI, 1.08-3.71; p=0.026), and GPS (score of 1: HR, 6.86; 95% CI, 3.69-12.7; p=0.001; score of 2: HR, 5.96; 95% CI, 3.10-11.4; p=0.001) were independent predictors of intravesical recurrence. Conclusions Our results suggest that the GPS as well as performance status, DM, and cortical thinning are associated with intravesical recurrence after RNU. Thus, more careful follow-up, coupled with postoperative intravesical therapy to avoid bladder recurrence, should be considered in these patients.

Novel immunotherapy in metastatic renal cell carcinoma

Despite the rapid development of therapeutic modalities for metastatic renal cell carcinoma (mRCC) over the past decade to include a number of targeted antiangiogenic therapies and traditional immunotherapy, such as high-dose interleukin-2 and interferon-α, mRCC continues to be associated with poor prognosis. Currently, several novel immunotherapy agents, such as cancer vaccines, adoptive cell therapy, and checkpoint inhibitors, such as programmed cell death-1 (PD-1 present on T cells), one of its ligands (PD-L1 present on antigen-presenting cells and tumor cells), and cytotoxic T-lymphocyte-associated protein-4 pathways, are being studied in mRCC and are showing promise as important steps in the management of this disease. This review summarizes the current landscape of standard and emerging immune therapeutics and other modalities for mRCC.

Is preoperative chronic kidney disease status associated with oncologic outcomes in upper urinary tract urothelial carcinoma? A multicenter propensity score-matched analysis

Purpose The aim of this study was to determine the effect of preoperative chronic kidney disease (CKD) on the prognosis of patients with upper urinary tract urothelial carcinoma (UTUC) who had undergone radical nephroureterectomy (RNU). Results The median follow-up period was 31.1 months (interquartile range: 16.2-55.7 months). Among the study patients, 224 patients in the non-CKD group were selected via propensity score matching. The median recurrence-free, cancer-specific, and overall survival were significantly shorter for patients with preoperative CKD than for non-CKD patients (p = 0.001, p = 0.001, and p = 0.001, respectively). According to multivariable Cox regression analysis, preoperative CKD was related to worse recurrence-free (hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.15-2.86, p = 0.011), cancer-specific (HR: 2.44, 95% CI: 1.44-4.14, p = 0.001), and overall survival (HR: 1.66, 95% CI: 1.15-2.40, p = 0.007). Methods A total of 566 patients who underwent RNU at 6 institutions from 2004 to 2014 were retrospectively reviewed. Of these patients, 342 had an estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2 (non-CKD group) and 224 patients had an eGFR <60 ml/min/1.73 m2 (CKD group). To adjust for potential baseline confounders, 224 patients in the non-CKD group were selected by propensity matching. Clinicopathological variables and survival rates were compared between the 2 groups. Conclusions Preoperative CKD appears to be an important independent prognostic factor for oncologic outcomes in patients with UTUC.PURPOSE The aim of this study was to determine the effect of preoperative chronic kidney disease (CKD) on the prognosis of patients with upper urinary tract urothelial carcinoma (UTUC) who had undergone radical nephroureterectomy (RNU). RESULTS The median follow-up period was 31.1 months (interquartile range: 16.2-55.7 months). Among the study patients, 224 patients in the non-CKD group were selected via propensity score matching. The median recurrence-free, cancer-specific, and overall survival were significantly shorter for patients with preoperative CKD than for non-CKD patients (p = 0.001, p = 0.001, and p = 0.001, respectively). According to multivariable Cox regression analysis, preoperative CKD was related to worse recurrence-free (hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.15-2.86, p = 0.011), cancer-specific (HR: 2.44, 95% CI: 1.44-4.14, p = 0.001), and overall survival (HR: 1.66, 95% CI: 1.15-2.40, p = 0.007). METHODS A total of 566 patients who underwent RNU at 6 institutions from 2004 to 2014 were retrospectively reviewed. Of these patients, 342 had an estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2 (non-CKD group) and 224 patients had an eGFR <60 ml/min/1.73 m2 (CKD group). To adjust for potential baseline confounders, 224 patients in the non-CKD group were selected by propensity matching. Clinicopathological variables and survival rates were compared between the 2 groups. CONCLUSIONS Preoperative CKD appears to be an important independent prognostic factor for oncologic outcomes in patients with UTUC.

Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratios Are More Effective than the Fournier's Gangrene Severity Index for Predicting Poor Prognosis in Fournier's Gangrene

BACKGROUND We investigated the value of the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) as markers of mortality in patients with Fourniers gangrene. METHODS Records from 62 patients treated for Fourniers gangrene between 2003 and 2014 were reviewed retrospectively. Data were collected regarding medical history, symptoms, physical examination findings, admission laboratory tests, and the extent of body surface area involved (%). Fourniers Gangrene Severity Index score, NLR, and PLR were calculated. The data were assessed separately for surviving and deceased patients. RESULTS Of the 62 patients, 36 survived (58%, group 1) and 26 died (42%, group 2). Parameters that were statistically different between the two groups (p < 0.05) were the NLR, PLR, Fourniers Gangrene Severity Index score, and admission laboratory parameters, including body temperature, heart rate, bicarbonate, albumin, and serum calcium. The average body surface area affected in group 2 was statistically different from that of group 1 (6.0% versus 2.3%, p = 0.001). A high Fourniers Gangrene Severity Index score (>9), high NLR (>8), and high PLR (>140) were associated more frequently with group 2 patients. Multivariable regression analysis showed that high NLR (adjusted odds ratio [OR], 4.66; 95% confidence interval [CI], 1.25-17.3; p = 0.022) and high PLR (adjusted OR, 11.6; 95% CI, 2.7-49.5; p = 0.001) were independent prognostic factors for poor prognosis from Fourniers gangrene. However, the Fourniers Gangrene Severity Index score did not shown any statistically significant effect on mortality (p = 0.086). CONCLUSIONS The Fourniers Gangrene Severity Index scoring system was not associated with determining poor prognosis, however, high NLR and high PLR were associated with predictors of mortality in patients with Fourniers gangrene.

Novel and Emerging Surveillance Markers for Bladder Cancer

A high likelihood of recurrence of bladder cancer has made the development of urinary markers a focus of intense pursuit with the hope of decreasing the burden which this disease places on patients and the healthcare system. Interests include the development of a single urinary marker that can be used in place of or as an adjunct to surveillance techniques, as well as identifying a molecular signature for an individual’s disease that can help predict progression, prognosis, and potential therapeutic response. Markers have shown potential value in improving diagnostic accuracy when used as an adjunct to current modalities, risk stratification of patients that could aid the clinician in determining aggressiveness of surveillance, and allowing for a decrease in invasive surveillance procedures. This review discusses the current understanding of emerging biomarkers, including gene signatures and their potential clinical value in surveillance tools, as well as limitations to their incorporation into medical practice.

MP67-08 PREOPERATIVE SYSTEMIC INFLAMMATORY MARKERS IN UPPER TRACT UROTHELIAL CELL CARCINOMA: WHICH IS BETTER AS A PROGNOSTIC FACTOR?

Eu Chang Hwang*, Yang Hyun Cho, Ho Seok Chung, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Gwangju, Korea, Republic of; Myung Ki Kim, Jeonju, Korea, Republic of; Sung Gu Kang, Seok Ho Kang, Jun Cheon, Seoul, Korea, Republic of; Ja Yoon Ku, Hong Koo Ha, Busan, Korea, Republic of; Chang Wook Jeong, Ja Hyeon Ku, Cheol Kwak, Seoul, Korea, Republic of; Tae Gyun Kwon, Tae-Hwan Kim, Seock Hwan Choi, Daegu, Korea, Republic of; Ill Young Seo, Iksan, Korea, Republic of

MP67-04 EVALUATION OF THE DE RITIS (ASPARTATE TRANSAMINASE/ALANINE TRANSAMINASE) RATIO AS A PREDICTOR OF ONCOLOGICAL OUTCOMES IN PATIENTS WITH UPPER URINARY TRACT UROTHELIAL CARCINOMA AFTER SURGERY

Eu Chang Hwang*, Yang Hyun Cho, Ho Seok Chung, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Gwangju, Korea, Republic of; Myung Ki Kim, Jeonju, Korea, Republic of; Sung Gu Kang, Jun Cheon, Seoul, Korea, Republic of; Ja Yoon Ku, Hong Koo Ha, Busan, Korea, Republic of; Chang Wook Jeong, Ja Hyeon Ku, Cheol Kwak, Seoul, Korea, Republic of; Tae Gyun Kwon, Tae-Hwan Kim, Seock Hwan Choi, Daegu, Korea, Republic of

A rare presentation of metastatic prostate cancer, initially a suspect for urothelial cell carcinoma of the ureter: a case report

BackgroundThe most common metastatic sites of prostate cancer are the lymph nodes and bone. Ureteral metastasis from prostate cancer is very unusual and only a few cases have been reported.Case presentationWe describe a 76-year-old male with ureteral metastasis of prostate cancer along with a review of the literature. Initially, based on the diagnostic evaluation, urothelial cell carcinoma of the left distal ureter was suspected. Nephroureterectomy with bladder cuff excision was performed. The final pathologic diagnosis was prostate cancer metastatic to the ureter.ConclusionAlthough rare and the mechanistic link between prostate cancer and distant ureteral metastasis has not been clarified on a clinical basis, this would be included in the differential diagnosis of ureteral lesions in patients with a history of prostate cancer. It is important to recognize this unusual manifestation so that timely appropriate treatment can be initiated.

MP74-12 DECREASED EXPRESSION OF CAVEOLIN 1 AND 2 IN THE AGING RAT URINARY BLADDER: POTENTIAL MARKER OF BLADDER DYSFUNCTION IN THE ELDERLY POPULATION

RESULTS: 126 patients were enrolled from March 2014 to July 2015. Logistic regression models to predict recovery within 14 days was dependent upon age (below 70, OR 4.11?2.18, p1⁄40.008), retention volume (over 450, OR 0.22?0.14, p1⁄40.017; over 600, OR 0.26?0.15, p1⁄40.024), recent operation (vs. spontaneous, OR 4.38?2.26, p1⁄40.004), and sex (females were less likely with OR 0.11?0.06, p<0.001) (p<0.001, ROC AUC1⁄40.83). CONCLUSIONS: The study generally disregards the cause of retention, attempting to present a general outline of when to expect recovery from acute urinary retention, unrelated to urological interventions. The results suggest that old age, female sex, and spontaneous occurrence are risks of delayed recovery. Furthermore, retention amounts incrementally at 450 and 600ml increase risk of delayed recovery.

Clinical factors associated with postoperative hydronephrosis after ureteroscopic lithotripsy

Purpose This study aimed to determine the predictors of ipsilateral hydronephrosis after ureteroscopic lithotripsy for ureteral calculi. Materials and Methods From January 2010 to December 2014, a total of 204 patients with ureteral calculi who underwent ureteroscopic lithotripsy were reviewed. Patients with lack of clinical data, presence of ureteral rupture, and who underwent simultaneous percutaneous nephrolithotomy (PNL) were excluded. Postoperative hydronephrosis was determined via computed tomographic scan or renal ultrasonography, at 6 months after ureteroscopic lithotripsy. Multivariable analysis was performed to determine clinical factors associated with ipsilateral hydronephrosis. Results A total of 137 patients were enrolled in this study. The mean age of the patients was 58.8±14.2 years and the mean stone size was 10.0±4.6 mm. The stone-free rate was 85.4%. Overall, 44 of the 137 patients (32.1%) had postoperative hydronephrosis. Significant differences between the hydronephrosis and nonhydronephrosis groups were noted in terms of stone location, preoperative hydronephrosis, impacted stone, operation time, and ureteral stent duration (all, p<0.05). On multivariable analysis, increasing preoperative diameter of the hydronephrotic kidney (adjusted odds ratio [OR], 1.21; 95% confidence interval [CI], 1.12–1.31; p=0.001) and impacted stone (adjusted OR, 3.01; 95% CI, 1.15–7.61; p=0.031) independently predicted the occurrence of postoperative hydronpehrosis. Conclusions Large preoperative diameter of the hydronephrotic kidney and presence of impacted stones were associated with hydronephrosis after ureteroscopic stone removal. Therefore, patients with these predictive factors undergo more intensive imaging follow-up in order to prevent renal deterioration due to postoperative hydronephrosis.