Impact of Cryopreserved Placental Allografts on Biochemical Recurrence in Prostate Cancer

BACKGROUND

Human placental allografts are widely used to promote wound healing. Placental (or amniotic membrane/umbilical cord) allografts are placed along the neurovascular bundles during radical prostatectomy to improve continence and erectile function recovery. It is unknown whether placental allografts impact biochemical recurrence (BCR).

METHODS

This was a single-surgeon retrospective study of 566 robotic radical prostatectomies performed from April 2015 to March 2021. The patients were divided into three groups: the negative control, Brand A, and Brand B. Brand A and Brand B were both cryopreserved amniotic membrane (CAM) allografts. A total of 324 cases were included for BCR Kaplan-Meier and risk-adjusted multivariate analyses (362 for continence analysis). In vitro analyses were performed to determine the effect of CAM allografts on prostate cancer (PCa) cell line growth.

RESULTS

For propensity score-matched analysis (adjusting for pre-operative PSA, tumor stage, Gleason Grade, and margin status), (1) the allograft groups did not show differences in time to BCR vs. the negative control group (p = 0.7), and (2) combined allograft treatment groups showed better continence recovery vs. the negative controls (p = 0.01). In vitro, placental allografts reduced PCa cell line growth in co-culture assays.

CONCLUSIONS

cryopreserved AM allografts (combined or individual brands) did not show a significant effect on BCR but improved continence recovery for PCa patients.

UTILIZAÇÃO DA PLACENTA HUMANA NA CICATRIZAÇÃO DE ÚLCERAS NOS PÉS DE PESSOAS COM DIABETES: REVISÃO INTEGRATIVA

Objetivo:Identificar na literatura as contribuições da utilização da placenta humana na cicatrização de úlceras nos pés de pessoas com diabetes. Método: Estudo de revisão integrativa realizado por meio da busca de artigos na Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, National Library of Medicine (PubMed), Web of Science e Scopus, com a utilização das estratégias de busca: Placenta AND “Pé diabético” e Placenta AND “Diabetic foot”. Resultados: A busca inicial resultou em 148 artigos. Após aplicação dos critérios de inclusão e exclusão, obteve-se amostra final de 12 artigos. Observou-se que a placenta tem potencial de promover a melhora do tecido de granulação e a circulação periférica, maior repitelização, redução na área da ferida, com uso majoritário de aloenxerto de membranas placentária e amniótica criopreservadas. Conclusão: A placenta humana é um material biológico rico em nutrientes que apresentou potencial para contribuir com o reparo tecidual de úlceras nos pés de pessoas com diabetes em menor período de tempo.

USE OF THE HUMAN PLACENTA IN THE HEALING OF FOOT ULCERS IN PEOPLE WITH DIABETES: INTEGRATIVE REVIEW

Objective: To identify in the literature the contributions of the use of the human placenta in the healing of foot ulcers in people with diabetes. Method: An integrative review study carried out by searching articles in Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, National Library of Medicine (PubMed), Web of Science and Scopus, using the search strategies: Placenta AND “Diabetic foot” and Placenta AND “Diabetic Foot”. Results: The initial search resulted in 148 articles. After applying the inclusion and exclusion criteria, a final sample of 12 articles was obtained. It was observed that the placenta has the potential to promote the improvement of granulation tissue and peripheral circulation, greater epithelialization, and reduction in the wound area, with the majority use of cryopreserved placental and amniotic membrane allograft. Conclusion: The human placenta is a nutrient-rich biological material that has the potential to contribute to the tissue repair of foot ulcers in people with diabetes in a shorter period of time.

Implantation of cryopreserved umbilical cord allograft in hard-to-heal foot wounds: a retrospective study

OBJECTIVE

The objective of this study was to assess the clinical effectiveness of surgically implanted cryopreserved human umbilical cord allograft in treating hard-to-heal wounds with and without osteomyelitis.

METHOD

In this single-centre, retrospective investigation, wounds (average size 6.9±10.1cm²) were included for analysis that had failed prior standard wound care for an average of 14.4±8.0 weeks.

RESULTS

After surgical implantation of cryopreserved umbilical cord between the deep tissue planes, 20 (95%) of the 21 wounds included in the study achieved complete closure in a median time of 7.8 weeks (range: 1-68) despite presence of residual osteomyelitis in 15 cases. A total of 12 wounds (57.1%) healed by 12 weeks, and 16 (76.2%) wounds healed by 24 weeks. A patient who presented with a limb-threatening calcaneal ulcer that was complicated by osteomyelitis at the time of treatment required subsequent amputation. No adverse events or complications related to cryopreserved umbilical cord were observed.

CONCLUSION

The results suggest that surgical implantation of cryopreserved umbilical cord allograft may be a safe and effective treatment in improving healing of hard-to-heal wounds. Further prospective, randomised controlled trials are warranted.

Advances in Dermoepidermal Skin Substitutes for Diabetic Foot Ulcers

Diabetic foot ulcers (DFUs) are one of the major complications of diabetes, representing a leading cause of hospitalisation and non-traumatic lower limb amputations. Multidisciplinary management, patient education, glucose control, debridement, off-loading, infection control, and adequate perfusion are the mainstays of standard care. Despite all these, at least 30% of DFUs fail to heal within 20 weeks. Therefore, dermoepidermal skin substitutes (DSS) have been used as a new therapeutic adjunct for DFUs. This brief review outlines the recent advances in DSS for the treatment of DFUs. PubMed and Cochrane databases were systematically searched in May to July 2018 for systematic reviews published after 2013 and for randomised controlled trials (RCTs). A retrospective evaluation of 28 RCTs was performed. Rates of complete wound closure and time to healing were examined for 17 commonly available DSS. Healing rates after 12 weeks and time to complete closure in DFUs are heterogeneous among the 28 RCT. The best healing rates at 12 weeks were accomplished with dermal cellular substitutes (Epifix®, 100% and Amnioband®, 85%) and with dermal acellular substitutes (Allopatch®, 80% and Hyalograft®, 78.8%). Based on these studies, DSS used in conjunction with standard care appear to improve the healing rates of DFUs, as compared with standard care alone. Nonetheless, new studies with more homogeneous samples are needed to ascertain the role of ulcer size, duration, depth and/or type in the efficacy of DSS. Moreover, future RCTs should include patients with severe comorbidities, in order to be more representative of clinical reality.

Focused shockwave therapy in diabetic foot ulcers: secondary endpoints of two multicentre randomised controlled trials

OBJECTIVE

The objective of this paper is to present the secondary safety and efficacy outcomes from two studies of focused extracorporeal shockwave therapy (ESWT) used adjunctively with standard care in the treatment of neuropathic diabetic foot ulcers (DFU) (1A or 2A on the University of Texas grading scheme), compared with sham treatment and standard care.

METHOD

We carried out two multicentre, multinational, randomised, sham-controlled, double-blinded, phase III clinical studies using standard care with adjunctive focused ESWT compared with sham treatment and standard care in patients with a DFU. DFUs that did not reduce in volume by at least 50% over two weeks' standard treatment were included. DFUs were randomised and managed with standard care and focused ESWT (pulsed acoustic cellular expression; dermaPACE System, SANUWAVE Health, Inc.) active therapy, or with standard care and sham treatment, four times over a two-week treatment phase in study 1 and up to eight times over 12 weeks in study 2. Standard care continued in both studies throughout the 12-week treatment phase. Secondary outcomes were indicators of wound closure and progression, pain, infection, amputation and recurrence, and device reliability. Efficacy-related secondary endpoints were measured at 12, 20 and 24 weeks. The studies were analysed separately and following statistical comparison to justify the method, as a pooled data set.

RESULTS

Wound area reduction (48.6% versus 10.7%, p=0.015, intention to treat (ITT) population with last observation carried forward (LOCF)) and perimeter reduction (46.4% versus 25.0%, p=0.022, ITT population with LOCF) were significantly greater in the active therapy group compared with the sham-treated group, respectively. The difference in time to wound closure in the pooled ITT population was significantly in favour of the active therapy group (84 days versus 112 days for 25% of subjects to reach wound closure in the active and sham-treated groups, respectively; p=0.0346). The proportion of subjects who achieved wound area reduction (WAR) from baseline at week 12 of ≥90% was significantly higher in the active therapy group. The incidence and nature of infection were consistent with previously published studies, and pain was not increased in the active therapy group. Amputation was insignificantly higher in the sham-treated group and recurrence did not differ. The ESWT device was found to be reliable.

CONCLUSION

The outcomes for the primary and secondary endpoints from these studies show that ESWT administered adjunctively with standard care is an effective advanced therapy for neuropathic DFUs (grade 1A and 2A) that do not respond to two weeks' standard care alone by reducing wound volume by at least 50%.

A single-center, retrospective review of robot-assisted laparoscopic prostatectomy with and without cryopreserved umbilical cord allograft in improving continence recovery

The objective of this study was to evaluate the safety and effectiveness of cryopreserved umbilical cord (UC) allograft as a nerve wrap around the neurovascular bundle (NVB) in accelerating return to continence after radical prostatectomy. A single-center, retrospective study was performed on 200 patients who underwent bilateral, nerve-sparing robot-assisted radical prostatectomy (RARP) with and without placement of UC around the NVBs (n = 100/group). Patients were excluded if they had previous simple or transurethral prostatectomy or history of pelvic radiation. Post-operative continence, defined as 0 or 1 safety pad, was analyzed between groups at 1, 3, 6, and 12 months. Complications, biochemical recurrence and adverse events were assessed to determine safety. Patients who underwent RARP with UC were significantly more likely to be continent at 1 month (65% vs. 44%, p = 0.018), 3 months (83% vs. 70%, p = 0.03), and 12 months (97% vs. 87%, p = 0.009). Sample stratification revealed that UC is beneficial for obese patients and those > 60 years, both of which are high risk for post-RARP incontinence. Biochemical failure was noted in 2 (UC) and 4 (control) patients. No adverse events or complications related to UC were observed. The results suggest that UC allograft is safe and accelerates continence recovery in post-RARP patients. Prospective, randomized trials are warranted.