Purpose The cure rate of stage I seminoma patients is close to 100% and so the recent focus of clinical research has shifted onto the prevention of treatment-related complications. We assessed long-term cardiovascular complications and identified risk factors for cardiovascular events (CVEs) in stage I seminoma patients. Methods This retrospective cohort study included 406 consecutive stage I seminoma patients. Primary endpoint was CVE rate. Results During a median follow-up of 8.6 years, we observed 23 CVEs in 406 patients [10-year CVE risk 5.6% (95% CI 3.2 to 8.8)]. In univariable competing risk analysis, higher age, positive smoking status, history of diabetes and hypertension were significantly associated with the occurrence of CVE. In multi-state analysis, new onset of diabetes, hypertension and hyperlipidemia during follow-up predicted for an excessively increased CVE risk. In multivariable analysis adjusting for age and smoking, the development of hypertension and hyperlipidemia after tumor-specific treatment prevailed as risk factors for CVE. Regarding adjuvant treatment modalities, patients receiving adjuvant radiotherapy had a significantly higher probability of CVE than patients receiving adjuvant carboplatin [16% vs. 0%; risk difference (RD) = 16%, 95% CI 6 to 25%, p = 0.001]. This difference prevailed after adjusting for age, follow-up-time, diabetes, hypertension and smoking (RD = 11%, 95% CI 1 to 20%, p = 0.025). Conclusion We identified a panel of baseline risk factors and dynamically, occurring predictors of CVE in stage I seminoma patients. This information may be used for targeting comorbidity management in these patients. The observed association of adjuvant radiotherapy with higher CVE risk warrants further investigation.

OBJECTIVE: To evaluate the relationship between body mass index and reproductive hormones (FSH and LH) in infertile females. STUDY DESIGN: Analytical Case Control study. METHODOLOGY: One Hundred and fifty (150) normal, overweight and obese infertile females aged 20 to 39 years, who had ovarian and tubal blockage and causes of infertility, were included in the study. They were sub-divided into three groups in accordance with World Health Organization (WHO) classification for Body Mass Index (BMI). Each group comprised of fifty (50) subjects. After detailed history and general physical examination, samples of blood were drawn on day three (3) of the menstrual cycle in the subjects for the assay of serum reproductive hormone levels. RESULTS: Effect of increased BMI on serum hormone levels in normal, overweight and obese groups are observed in table below. Serum FSH was highly statistically significant (p=0.001**).Serum LH was statistically significant (p=0.048*). Analysis of Variance test revealed that serum FSH and LH levels were significantly associated with BMI in all the three groups. CONCLUSION: Increased BMI leads to significant negative association with reproductive hormones (FSH and LH) in infertile women.

OBJECTIVE:To investigate the potential prognostic significance of the neutrophil-lymphocyte ratio (NLR) in a large European cohort of patients with upper urinary tract urothelial cell carcinoma (UUT-UCC).PATIENTS AND METHODS:We retrospectively evaluated data from 202 consecutive patients with non-metastatic upper urinary tract urothelial cell carcinoma (UUT-UCC), who underwent surgery between 1990 and 2012 at a single tertiary academic centre. Patients' cancer-specific survival (CSS) and overall survival (OS) were assessed using the Kaplan-Meier method. To evaluate the independent prognostic significance of the NLR, multivariate proportional Cox regression models were applied for both endpoints.RESULTS:A higher NLR was significantly associated with shorter CSS (P = 0.002, log-rank test), as well as with shorter OS (P < 0.001, log-rank test). Multivariate analysis identified a high NLR as an independent prognostic factor for patients' CSS (hazard ratio 2.72, 95% CI 1.25-5.93, P = 0.012), and OS (hazard ratio 2.48, 95% CI 1.31-4.70, P = 0.005).CONCLUSIONS:In the present cohort, patients with a high preoperative NLR had higher cancer-specific and overall mortality after radical surgery for UUT-UCC, compared with those with a low preoperative NLR. This easily identifiable laboratory measure should be considered as an additional prognostic factor in UUT-UCC in future.

BACKGROUND:Pelvic lymph node dissection in patients undergoing radical prostatectomy for clinically localised prostate cancer is not without morbidity and its therapeutical benefit is still a matter of debate. The objective of this study was to develop a model that allows preoperative determination of the minimum number of lymph nodes needed to be removed at radical prostatectomy to ensure true nodal status.METHODS:We analysed data from 4770 patients treated with radical prostatectomy and pelvic lymph node dissection between 2000 and 2011 from eight academic centres. For external validation of our model, we used data from a cohort of 3595 patients who underwent an anatomically defined extended pelvic lymph node dissection. We estimated the sensitivity of pathological nodal staging using a beta-binomial model and developed a novel clinical (preoperative) nodal staging score (cNSS), which represents the probability that a patient has lymph node metastasis as a function of the number of examined nodes.RESULTS:In the development and validation cohorts, the probability of missing a positive lymph node decreases with increase in the number of nodes examined. A 90% cNSS can be achieved in the development and validation cohorts by examining 1-6 nodes in cT1 and 6-8 nodes in cT2 tumours. With 11 nodes examined, patients in the development and validation cohorts achieved a cNSS of 90% and 80% with cT3 tumours, respectively.CONCLUSIONS:Pelvic lymph node dissection is the only reliable technique to ensure accurate nodal staging in patients treated with radical prostatectomy for clinically localised prostate cancer. The minimum number of examined lymph nodes needed for accurate nodal staging may be predictable, being strongly dependent on prostate cancer characteristics at diagnosis.

Background: In recent years, plasma fibrinogen has been ascribed an important role in the pathophysiology of tumour cell invasion and metastases. A relatively small-scale study has indicated that plasma fibrinogen levels may serve as a prognostic factor for predicting clinical outcomes in non-metastatic renal cell carcinoma (RCC) patients. Methods: Data from 994 consecutive non-metastatic RCC patients, operated between 2000 and 2010 at a single, tertiary academic centre, were evaluated. Analyses of plasma fibrinogen levels were performed one day before the surgical interventions. Patients were categorised using a cut-off value of 466 mg dl −1 according to a calculation by receiver-operating curve analysis. Cancer-specific (CSS), metastasis-free (MFS), as well as overall survival (OS) were assessed using the Kaplan–Meier method. To evaluate the independent prognostic impact of plasma fibrinogen level, a multivariable Cox regression model was performed for all three different endpoints. Results: High plasma fibrinogen levels were associated with various well-established prognostic factors, including age, advanced tumour stage, tumour grade and histologic tumour necrosis (all P <0.05). Furthermore, in multivariable analysis, a high plasma fibrinogen level was statistically significantly associated with a poor outcome for patients’ CSS (hazard ratio (HR): 2.47, 95% confidence interval (CI): 1.49–4.11, P <0.001), MFS (HR: 2.15, 95% CI: 1.44–3.22, P <0.001) and OS (HR: 2.48, 95% CI: 1.80–3.40, P <0.001). Conclusion: A high plasma fibrinogen level seems to represent a strong and independent negative prognostic factor regarding CSS, MFS and OS in non-metastatic RCC patients. Thus, this easily determinable laboratory value should be considered as an additional prognostic factor for RCC patients’ individual risk assessment.

The neutrophil–lymphocyte ratio (NLR) has been proposed as an indicator of systemic inflammatory response. Several studies suggest a negative impact of increased NLR for patient's survival in different types of cancer. However, previous findings from small-scale studies revealed conflicting results about its prognostic significance with regard to different clinical end points in non-metastatic renal cell carcinoma (RCC) patients. Therefore, the aim of our study was the validation of the prognostic significance of NLR in a large cohort of RCC patients. Data from 678 consecutive non-metastatic clear cell RCC patients, operated between 2000 and 2010 at a single centre, were evaluated retrospectively. Cancer-specific, metastasis-free, as well as overall survival (OS) were assessed using the Kaplan–Meier method. To evaluate the independent prognostic significance of NLR, multivariate Cox regression models were applied for all three different end points. Influence of the NLR on the predictive accuracy of the Leibovich prognosis score was determined by Harrell's concordance index. Multivariate analysis identified increased NLR as an independent prognostic factor for overall (hazard ratio (HR)=1.59, 95% confidence interval (CI)=1.10–2.31, P=0.014), but not for cancer-specific (HR=1.59, 95% CI=0.84–2.99, P=0.148), nor for metastasis-free survival (HR=1.39, 95% CI=0.85–2.28, P=0.184). The estimated concordance index was 0.79 using the Leibovich risk score and 0.81 when NLR was added. Regarding patients' OS, an increased NLR represented an independent risk factor, which might reflect a higher risk for severe cardiovascular and other comorbidities. Adding the NLR to well-established prognostic models such as the Leibovich prognosis score might improve their predictive ability.

Background: The impact of statin use on biochemical recurrence (BCR) in patients treated with radical prostatectomy (RP) remains controversial. Methods: We retrospectively evaluated 6842 patients who underwent RP for clinically localized prostate cancer (PC) between 2000 and 2011. Uni- and multivariable cox regression models addressed the association of statin use with BCR. Results: Overall, 2275 (33.3%) patients used statins. Statin users were older and had a higher rate of positive surgical margins than patients not using statins ( P -values ⩽0.05). Within a median follow-up of 25 months (interquartile range: 8–42 months), 778 (11.4%) patients experienced BCR. Actuarial estimate 5-years BCR-free survival was 82%±1 for patients without statin use and 84±1% for patients using statins ( P =0.05); statin use was not associated with BCR (hazard ratio: 0.88, 95% confidence interval: 0.76–1.03, P =0.10) after adjusting for the effects of standard clinicopathologic features. Conclusions: In PC patients undergoing RP, statin use was not independently associated with lower risk of BCR.

The influence of overweight and obesity on sperm quality and reproductive hormone levels is under discussion. The aim of the present retrospective study was to evaluate the influence of body mass index (BMI) on sperm quality and reproductive hormones. We analysed semen samples and serum levels of FSH, LH, T and PRL of a total of 2110 men attending our andrology unit from 1994 to 2010 due to infertility work-up. Patients were stratified according to their BMI in four groups. Main outcome measures were sperm motility, morphology and concentration. Serum levels of FSH, LH, T and PRL were evaluated as well. No statistically significant difference was found for sperm quality and BMI between patients categorised according to the four BMI levels. T (P<0.001) and LH (P=0.006) significantly differed between the four groups. In multivariable analysis, BMI did not have significantly independent influence on all assessed sperm quality parameters, whereas BMI significantly influenced hormone values for LH (P=0.001), T (P=<0.001) and PRL (P=0.044). We therefore conclude that BMI has no significant impact on sperm quality parameters. However, serum levels of LH, T and PRL were significantly influenced by BMI.

You have accessJournal of UrologyProstate Cancer: Detection and Screening I1 Apr 20121210 BIOPSY-SPECIFIC PCA3- BASED PROSTATE BIOPSY NOMOGRAMS ARE HIGHLY ACCURATE Felix K.-H. Chun, Jens Hansen, Alexandre de la Taille, Hendrik van Poppel, Michael Marberger, Arnulf Stenzl, Peter F.A. Mulders, Hartwig Huland, Clement-Claude Abbou, Alexander B. Stillebroer, Martin P.M.Q. van Gils, Jack A. Schalken, Yves Fradet, Leonard S. Marks, William Ellis, Alan W. Partin, Karl Pummer, Alexander Haese, and Marco Auprich Felix K.-H. ChunFelix K.-H. Chun Hamburg, Germany More articles by this author , Jens HansenJens Hansen Hamburg, Germany More articles by this author , Alexandre de la TailleAlexandre de la Taille Créteil, France More articles by this author , Hendrik van PoppelHendrik van Poppel Leuven, Belgium More articles by this author , Michael MarbergerMichael Marberger Vienna, Austria More articles by this author , Arnulf StenzlArnulf Stenzl Tübingen, Germany More articles by this author , Peter F.A. MuldersPeter F.A. Mulders Nijmegen, Netherlands More articles by this author , Hartwig HulandHartwig Huland Hamburg, Germany More articles by this author , Clement-Claude AbbouClement-Claude Abbou Créteil, France More articles by this author , Alexander B. StillebroerAlexander B. Stillebroer Nijmegen, Netherlands More articles by this author , Martin P.M.Q. van GilsMartin P.M.Q. van Gils Nijmegen, Netherlands More articles by this author , Jack A. SchalkenJack A. Schalken Nijmegen, Netherlands More articles by this author , Yves FradetYves Fradet Quebec City, Canada More articles by this author , Leonard S. MarksLeonard S. Marks Culver City, CA More articles by this author , William EllisWilliam Ellis Seattle, WA More articles by this author , Alan W. PartinAlan W. Partin Baltimore, MD More articles by this author , Karl PummerKarl Pummer Graz, Austria More articles by this author , Alexander HaeseAlexander Haese Hamburg, Germany More articles by this author , and Marco AuprichMarco Auprich Graz, Austria More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1499AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It has been clearly demonstrated that urinary PCA3 in conjunction with established clinical risk factors helps identifying men who are at high risk of harboring prostate cancer (PCa) in the initial and repeat biopsy setting. However, only one externally validated PCA3-based nomogram which has been established in a mixed biopsy cohort has been published. To develop specific biopsy-specific PCA3- based nomograms. METHODS For initial and repeat biopsy, clinical and biopsy data including urinary PCA3 score were available in 772 and 834 men at risk of PCa from Graz/ Austria and from two multi- institutional studies. All patients underwent an extended initial or repeat biopsy. Biopsy indication was made based on suspicious digital rectal examination and/or elevated total PSA (>2.5-10ng/ml). Urinary PCA3 Scores were assessed according to the manufacturer's instructions. Five different PCA3 codings were tested for each biopsy setting. Biopsy cores were evaluated by an uro- pathologist at each participating center. Uni- and multivariate logistic regression models and a multiple bootstrap-corrected nomograms were calculated. RESULTS For initial and repeat biopsy, PCa was detected in 353 (45.7%) and 275 (33.0%), respectively. For initial biopsy, mean PCA3 scores were 32.0 vs.67.5 for biopsy negative vs. biopsy positive patients (p<0.001). For repeat biopsy, mean PCA3 scores were 40.3.0 vs.64.8 for biopsy negative vs. biopsy positive patients (p<0.001). In univariate analyses, the following risk factors of PCa at initial and repeat biopsy were identified: age, PSA, DRE prostate volume and five PCA3 codings (all p <0.05). In multivariate analyses, all risk factors including PCA3 remained statistically significant (all p < 0.05). Finally, the novel initial and repeat biopsy nomograms were between 78.3-78.9% and 78.3-79.5% accurate. CONCLUSIONS Our data suggest that biopsy-specific risk stratification has an important impact on clinical tools. We clearly demonstrate that the construction of PCA3-based biopsy-specific nomograms are more accurate than the previously published mixed biopsy cohort based PCA3 nomograms. Accuracy estimates of these novel biopsy-specific nomograms have to be externally validated prior to a broad clinical routine use. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e489-e490 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Metrics Author Information Felix K.-H. Chun Hamburg, Germany More articles by this author Jens Hansen Hamburg, Germany More articles by this author Alexandre de la Taille Créteil, France More articles by this author Hendrik van Poppel Leuven, Belgium More articles by this author Michael Marberger Vienna, Austria More articles by this author Arnulf Stenzl Tübingen, Germany More articles by this author Peter F.A. Mulders Nijmegen, Netherlands More articles by this author Hartwig Huland Hamburg, Germany More articles by this author Clement-Claude Abbou Créteil, France More articles by this author Alexander B. Stillebroer Nijmegen, Netherlands More articles by this author Martin P.M.Q. van Gils Nijmegen, Netherlands More articles by this author Jack A. Schalken Nijmegen, Netherlands More articles by this author Yves Fradet Quebec City, Canada More articles by this author Leonard S. Marks Culver City, CA More articles by this author William Ellis Seattle, WA More articles by this author Alan W. Partin Baltimore, MD More articles by this author Karl Pummer Graz, Austria More articles by this author Alexander Haese Hamburg, Germany More articles by this author Marco Auprich Graz, Austria More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

372 Background: Prognostic indicators in papillary renal cell carcinoma (PRCC) are not well defined. We evaluated the prognostic relevance of tumor-associated macrophages (TAM) in patients with PRCC. Methods: PRCC specimens were re-evaluated by one blinded pathologist (SM), with respect to pT-classification (TNM 2002), nodal status, Fuhrman grade (I-IV), tumor size, subtype (type 1 or 2), tumor necrosis, and presence of TAM. Presence of TAM was associated with pathological parameters (chi-square and fisher's exact tests). Impact of TAM on cancer-specific survival (CSS) was assessed (Kaplan-Meier method and log-rank test). A multivariate regression analysis including pT-stage, grade, vascular invasion, necrosis, tumor size, papillary subtype and TAM was performed with respect to CSS. Results: 177 patients operated for PRCC from 1984 to 2006, were evaluated. Presence of TAM was noted in 112/177 (63%) tumors and was significantly associated with favorable pathological parameters: low pT-classification (pT1a/b: 71/90, 79%; pT2: 14/31, 45%; pT3a/b: 27/56, 48%; p<0.001), node negative tumors (Nx/pN0: 111/170, 65% vs. pN1/2: 1/7, 14%; p=0.01), low grade (G1: 35/45, 78%; G2: 67/110, 61%; G3: 10/22, 45%; p=0.025), absence of vascular invasion (V0: 106/153, 69% vs. V1/2: 6/24, 25%; p<0.001), and papillary subtype (type 1: 64/87, 74% vs. 48/89, 54%; p=0.007), respectively. Median follow-up was 68.3 months. Five-year CSS probabilities for patients with TAM-positive tumors were 93.5%, compared with 72.5% in patients with TAM-negative tumors (p<0.001). Median survival was not reached in both groups. Multivariate analysis revealed node positive tumors (HR=2.4, 95%CI=1.1-5.0; p=0.025), distant metastases (HR=8.7, 95%CI=2.6-29.3; p<0.001), and tumor size (HR=1.2, 95%CI=1.0-1.3; p=0.03) as independent predictors of death from PRCC, whereas presence of TAM was independently associated with favorable outcome (HR=0.3, 95%CI=0.1-0.9, p=0.026). Conclusions: Presence of TAM was independently associated with a favorable outcome in patients with PRCC and was shown to reduce the risk of death from cancer by 66%. Presence of TAM should therefore be part of routine pathology reporting in PRCC. No significant financial relationships to disclose.

Prostate CAncer Gene 3 (PCA3) score was recently identified to predict small volume [tumor volume (TV) < 0.5ml], pathologically insignificant (IPCa), locally advanced (ECE, SVI) and aggressive [Gleason score (GS) ≥7] prostate cancer prior to RP. Objective was to evaluate PCA3's potential to improve the multivariable accuracy in the prediction of pathological features in a US-European cohort.