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Radros J, Kjellman A, Henningsohn L, Forslin Y, Delle M, Hrebenyuk M, Thor A, Thiel T, Hermann M, Lundgren PO. Ablative or Surgical Treatment for Small Renal Masses (T1a): A Single-Center Comparison of Perioperative Morbidity and Complications. Curr Oncol 2024; 31:933-940. [PMID: 38392063 PMCID: PMC10888411 DOI: 10.3390/curroncol31020069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/01/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
The purpose of this study is to evaluate the treatment safety of thermal ablation compared to surgical treatment of T1a tumors (small renal masses) at a high-volume center. We conducted an observational single-center study based on data collected form the National Swedish Kidney Cancer Register (NSKCR) between 2015 and 2021. In total, 444 treatments of T1a tumors were included. Patients underwent surgery (partial or total nephrectomy) or ablative treatment-radiofrequency ablation (RFA) or microwave ablation (MWA). Patient characteristics were retrieved from patient records, and tumor complexity was estimated from pre-interventional CT scans. The odds ratio (OR) of suffering from a severe surgical complication following ablative treatment was estimated using a logistic regression model adjusted for age, BMI, ASA physical status classification, smoking status and RENAL nephrometry score. The frequency of severe surgical complications was 6.3% (16/256 treatments) after surgical intervention and 2.1% (4/188 treatments) following ablative treatment. Our primary hypothesis that ablative treatment is associated with a lower risk of severe surgical complications is supported by the results (OR 0.39; 0.19-0.79; p = 0.013). When adjusting for age, smoking status, ASA score, BMI score and RENAL nephrometry score, we see an even greater difference between the two groups (OR 0.34; 0.17-0.68; p = 0.002). Our study was limited by the differences in patient and tumor characteristics between the two compared groups and the study design. If oncological outcomes are found to be comparable, ablative treatment should be considered as a first-line treatment for all small renal masses.
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Affiliation(s)
- Jari Radros
- Karolinska Institute C1:77, Karolinska University Hospital, 141 86 Stockholm, Sweden; (J.R.); (A.K.); (Y.F.); (M.D.); (M.H.); (A.T.)
- Department of Urology, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Anders Kjellman
- Karolinska Institute C1:77, Karolinska University Hospital, 141 86 Stockholm, Sweden; (J.R.); (A.K.); (Y.F.); (M.D.); (M.H.); (A.T.)
- Department of Urology, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Lars Henningsohn
- Karolinska Institute C1:77, Karolinska University Hospital, 141 86 Stockholm, Sweden; (J.R.); (A.K.); (Y.F.); (M.D.); (M.H.); (A.T.)
- Department of Urology, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Yngve Forslin
- Karolinska Institute C1:77, Karolinska University Hospital, 141 86 Stockholm, Sweden; (J.R.); (A.K.); (Y.F.); (M.D.); (M.H.); (A.T.)
- Department of Radiology, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Martin Delle
- Karolinska Institute C1:77, Karolinska University Hospital, 141 86 Stockholm, Sweden; (J.R.); (A.K.); (Y.F.); (M.D.); (M.H.); (A.T.)
- Department of Radiology, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Marianna Hrebenyuk
- Karolinska Institute C1:77, Karolinska University Hospital, 141 86 Stockholm, Sweden; (J.R.); (A.K.); (Y.F.); (M.D.); (M.H.); (A.T.)
- Department of Urology, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Anna Thor
- Karolinska Institute C1:77, Karolinska University Hospital, 141 86 Stockholm, Sweden; (J.R.); (A.K.); (Y.F.); (M.D.); (M.H.); (A.T.)
- Department of Urology, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Tomas Thiel
- Karolinska Institute C1:77, Karolinska University Hospital, 141 86 Stockholm, Sweden; (J.R.); (A.K.); (Y.F.); (M.D.); (M.H.); (A.T.)
- Department of Urology, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Maria Hermann
- Karolinska Institute C1:77, Karolinska University Hospital, 141 86 Stockholm, Sweden; (J.R.); (A.K.); (Y.F.); (M.D.); (M.H.); (A.T.)
- Department of Urology, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Per-Olof Lundgren
- Karolinska Institute C1:77, Karolinska University Hospital, 141 86 Stockholm, Sweden; (J.R.); (A.K.); (Y.F.); (M.D.); (M.H.); (A.T.)
- Department of Urology, Karolinska University Hospital, 141 86 Stockholm, Sweden
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Gerdtsson A, Negaard HFS, Almås B, Bergdahl AG, Cohn-Cedermark G, Glimelius I, Halvorsen D, Haugnes HS, Hedlund A, Hellström M, Holmberg G, Karlsdóttir Á, Kjellman A, Larsen SM, Thor A, Wahlqvist R, Ståhl O, Tandstad T. Initial surveillance in men with marker negative clinical stage IIA non-seminomatous germ cell tumours. BJU Int 2024. [PMID: 38293778 DOI: 10.1111/bju.16289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVES To assess whether extended surveillance with repeated computed tomography (CT) scans for patients with clinical stage IIA (CS IIA; <2 cm abdominal node involvement) and negative markers (Mk-) non-seminomatous germ cell tumours (NSGCTs) can identify those with true CS I. To assess the rate of benign lymph nodes, teratoma, and viable cancer in retroperitoneal lymph node dissection (RPLND) histopathology for patients with CS IIA Mk- NSGCT. PATIENTS AND METHODS Observational prospective population-based study of patients diagnosed 2008-2019 with CS IIA Mk- NSGCT in the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) registry. Patients were managed with surveillance, with CT scans, and tumour markers every sixth week for a maximum of 18 weeks. Patients with radiological regression were treated as CS I, if progression with chemotherapy, and remaining CS IIA Mk- disease with RPLND. The end-point was the number and percentage of patients down-staged to CS I on surveillance and rate of RPLND histopathology presented as benign, teratoma, or viable cancer. RESULTS Overall, 126 patients with CS IIA Mk- NSGCT were included but 41 received therapy upfront. After surveillance for a median (range) of 6 (6-18) weeks, 23/85 (27%) patients were in true CS I and four (5%) progressed. Of the remaining 58 patients with lasting CS IIA Mk- NSGCT, 16 received chemotherapy and 42 underwent RPLND. The RPLND histopathology revealed benign lymph nodes in 11 (26%), teratoma in two (6%), and viable cancer in 29 (70%) patients. CONCLUSIONS Surveillance with repeated CT scans can identify patients in true CS I, thus avoiding overtreatment. The RPLND histopathology in patients with CS IIA Mk- NSGCT had a high rate of cancer and a low rate of teratoma.
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Affiliation(s)
- Axel Gerdtsson
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | | | - Bjarte Almås
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Anna Grenabo Bergdahl
- Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenborg, Sweden
| | - Gabriella Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Genitourinary Oncology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden
| | - Dag Halvorsen
- Department of Urology, St. Olavs University Hospital, Trondheim, Norway
| | - Hege Sagstuen Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UIT- The Arctic University of Norway, Tromsø, Norway
| | - Annika Hedlund
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Hellström
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Göran Holmberg
- Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenborg, Sweden
| | - Ása Karlsdóttir
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Anders Kjellman
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anna Thor
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Rolf Wahlqvist
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Olof Ståhl
- Department of Oncology, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Torgrim Tandstad
- The Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, The Norwegian University of Science and Technology, Trondheim, Norway
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Kourie M, Bogdanovic D, Mahmutyazicioglu K, Ghazi S, Panic N, Fjellgren E, Hellkvist L, Thiel T, Kjellman A, Kartalis N, Danielsson O, Dani L, Löhr JM, Vujasinovic M. Autoimmune Pancreatitis Type 1 with Biliary, Nasal, Testicular, and Pulmonary Involvement: A Case Report and a Systematic Review. J Clin Med 2023; 12:6340. [PMID: 37834983 PMCID: PMC10573784 DOI: 10.3390/jcm12196340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/16/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated condition associated with fibroinflammatory lesions that can occur at almost any anatomical site. It often presents as a multiorgan disease that may mimic malignancy, infection, or other immune-mediated conditions. Autoimmune pancreatitis (AIP) type 1 is the most prominent manifestation of IgG4-RD in the digestive tract, with common extra-pancreatic inflammation. We present the first patient with AIP and involvement of the testicles and nasal cavity. PATIENT AND METHODS A case of a patient with AIP type 1 and other organ involvement (bile ducts, testicles, nasal polyps, and lungs) is described. Additionally, a systematic review of AIP type 1 with testicular and nasal involvement was conducted. RESULTS The systematic review found two cases of AIP type 1 with testicular involvement and 143 cases with AIP type 1 with nasal cavity involvement. None of them had both testicular and nasal involvement. CONCLUSIONS This is the first case of AIP type 1 with other organ involvement, including testicular and nasal involvement, to be described. The number of patients with nasal and testicular involvement described in the literature is low. Creating awareness of this rare clinical condition is necessary, especially due to the very effective available treatment with corticosteroids and rituximab.
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Affiliation(s)
- Mourad Kourie
- Department of Medicine, Vrinnevisjukhuset, 603 79 Norrköping, Sweden;
| | - Darko Bogdanovic
- Department of Urology, Karolinska University Hospital, 141 86 Stockholm, Sweden; (D.B.); (T.T.); (A.K.)
| | - Kamran Mahmutyazicioglu
- Department of Radiology, Karolinska University Hospital, 141 86 Stockholm, Sweden; (K.M.); (N.K.)
| | - Sam Ghazi
- Department of Pathology, Karolinska University Hospital, 141 86 Stockholm, Sweden; (S.G.); (O.D.)
| | - Nikola Panic
- Digestive Endoscopy Unit, University Clinic “Dr Dragisa Misovic-Dedinje”, 11000 Belgrade, Serbia;
| | - Eva Fjellgren
- Medical Library, Karolinska University Hospital, 171 76 Stockholm, Sweden;
| | - Laila Hellkvist
- Department of Ear, Nose and Throat, Karolinska University Hospital, 171 76 Stockholm, Sweden;
| | - Tomas Thiel
- Department of Urology, Karolinska University Hospital, 141 86 Stockholm, Sweden; (D.B.); (T.T.); (A.K.)
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, 141 86 Stockholm, Sweden;
| | - Anders Kjellman
- Department of Urology, Karolinska University Hospital, 141 86 Stockholm, Sweden; (D.B.); (T.T.); (A.K.)
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, 141 86 Stockholm, Sweden;
| | - Nikolaos Kartalis
- Department of Radiology, Karolinska University Hospital, 141 86 Stockholm, Sweden; (K.M.); (N.K.)
| | - Olof Danielsson
- Department of Pathology, Karolinska University Hospital, 141 86 Stockholm, Sweden; (S.G.); (O.D.)
| | - Lara Dani
- Department of Rheumatology, Karolinska University Hospital, 141 86 Stockholm, Sweden;
| | - J.-Matthias Löhr
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, 141 86 Stockholm, Sweden;
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Miroslav Vujasinovic
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institute, 141 86 Stockholm, Sweden
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Gerdtsson A, Torisson G, Thor A, Grenabo Bergdahl A, Almås B, Håkansson U, Törnblom M, Negaard HFS, Glimelius I, Halvorsen D, Karlsdóttir Á, Haugnes HS, Larsen SM, Holmberg G, Wahlqvist R, Tandstad T, Cohn-Cedermark G, Ståhl O, Kjellman A. Validation of a prediction model for post-chemotherapy fibrosis in nonseminoma patients. BJU Int 2023; 132:329-336. [PMID: 37129962 DOI: 10.1111/bju.16040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To validate Vergouwe's prediction model using the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) RETROP database and to define its clinical utility. MATERIALS AND METHODS Vergouwe's prediction model for benign histopathology in post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) uses the following variables: presence of teratoma in orchiectomy specimen; pre-chemotherapy level of alpha-fetoprotein; β-Human chorionic gonadotropin and lactate dehydrogenase; and lymph node size pre- and post-chemotherapy. Our validation cohort consisted of patients included in RETROP, a prospective population-based database of patients in Sweden and Norway with metastatic nonseminoma, who underwent PC-RPLND in the period 2007-2014. Discrimination and calibration analyses were used to validate Vergouwe's prediction model results. Calibration plots were created and a Hosmer-Lemeshow test was calculated. Clinical utility, expressed as opt-out net benefit (NBopt-out ), was analysed using decision curve analysis. RESULTS Overall, 284 patients were included in the analysis, of whom 130 (46%) had benign histology after PC-RPLND. Discrimination analysis showed good reproducibility, with an area under the receiver-operating characteristic curve (AUC) of 0.82 (95% confidence interval 0.77-0.87) compared to Vergouwe's prediction model (AUC between 0.77 and 0.84). Calibration was acceptable with no recalibration. Using a prediction threshold of 70% for benign histopathology, NBopt-out was 0.098. Using the model and this threshold, 61 patients would have been spared surgery. However, only 51 of 61 were correctly classified as benign. CONCLUSIONS The model was externally validated with good reproducibility. In a clinical setting, the model may identify patients with a high chance of benign histopathology, thereby sparing patients of surgery. However, meticulous follow-up is required.
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Affiliation(s)
- Axel Gerdtsson
- Division of Urology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Gustav Torisson
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Anna Thor
- Division of Urology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Grenabo Bergdahl
- Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenborg, Sweden
| | - Bjarte Almås
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | | | - Magnus Törnblom
- Section of Urology, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Surgery, Visby County Hospital, Visby, Sweden
| | | | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden
| | - Dag Halvorsen
- Department of Urology, St. Olavs University Hospital, Trondheim, Norway
| | - Ása Karlsdóttir
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Hege Sagstuen Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UIT-The Arctic University of Norway, Tromsø, Norway
| | | | - Göran Holmberg
- Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenborg, Sweden
| | - Rolf Wahlqvist
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Torgrim Tandstad
- The Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Gabriella Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Genitourinary Oncology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Ståhl
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Anders Kjellman
- Division of Urology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
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Vujasinovic M, Dugic A, Thiel T, Kjellman A, Yang C, Löhr JM. Pancreatic exocrine insufficiency is a risk factor for kidney stones in patients with chronic pancreatitis. Pancreatology 2023; 23:294-298. [PMID: 36990843 DOI: 10.1016/j.pan.2023.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Most patients with chronic pancreatitis (CP) develop pancreatic exocrine insufficiency (PEI) over the course of the disease. PEI may lead to hyperoxaluria and development of urinary oxalate stones. It has been postulated that the patients with CP may be at increased risk of kidney stone formation, but the data is scarce. We aimed to estimate incidence and risk factors for nephrolithiasis in a Swedish cohort of patients with CP. PATIENTS AND METHODS We performed retrospective analysis of an electronical medical database of patients diagnosed with definite CP during 2003-2020. We excluded patients <18 years of age, those with missing relevant data in medical charts, patients with probable CP (according to the M-ANNHEIM classification system) and those in whom kidney stones were diagnosed before CP diagnosis. RESULTS Some 632 patients with definite CP were followed over a median of 5.3 (IQR 2.4-6.9) years. There were 41 (6.5%) patients diagnosed with kidney stones, of whom 33 (80.5%) were symptomatic. Comparing to patients without kidney stones, patients with nephrolithiasis were older, with median age of 65 (IQR 51-72) years, and a male predominance (80% vs 63%). Cumulative incidence of kidney stones was 2.1%, 5.7%, 12.4% and 16.1% at 5, 10, 15, and 20 years after CP diagnosis, respectively. Multivariable cause-specific Cox regression analysis revealed PEI as independent risk factor for nephrolithiasis (adjusted HR 4.95, 95%CI 1.65-14.84; p = 0.004). Another risk factors were increase in BMI (aHR 1.16 95% CI 1.04-1.30; p = 0.001 per unit increment), and a male sex (4.51, 95% CI 1.01-20.3, p = 0.049). CONCLUSION PEI and increase in BMI are risk factors for kidney stone development in patients with CP. Male CP patents are particularly at increased risk of nephrolithiasis. This should be taken into consideration in general clinical approach to raise awareness among patients and medical workers.
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Affiliation(s)
- Miroslav Vujasinovic
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.
| | - Ana Dugic
- Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Tomas Thiel
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - Anders Kjellman
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - Caroline Yang
- Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
| | - J-Matthias Löhr
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
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Tribukait B, Lundgren PO, Kjellman A, Norming U, Nyman CR, Jagarlmundi K, Gustafsson O. Prediction of Overall Survival by Thymidine Kinase 1 Combined with Prostate-Specific Antigen in Men with Prostate Cancer. Int J Mol Sci 2023; 24:ijms24065160. [PMID: 36982234 PMCID: PMC10049218 DOI: 10.3390/ijms24065160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/21/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Thymidine kinase 1 (TK1) is an intracellular enzyme involved in DNA-precursor synthesis. Increased serum TK1 levels are used as a biomarker in various malignancies. We combined serum TK1 with PSA and evaluated its capacity to predict overall survival (OS) in 175 men with prostate cancer (PCa), detected by screening in 1988-1989 (n = 52) and during follow-up (median 22.6 years) (n = 123). TK1 was measured in frozen serum, age was stratified into four groups, and dates of PCa diagnosis and dates of death were obtained from Swedish population-based registries. The median concentration of TK1 and PSA was 0.25 and 3.8 ng/ml. TK1 was an independent variable of OS. In the multivariate analysis, PSA was not statistically significant in combination with age whereas the significance remained for TK1 + PSA. Measured once, TK1 + PSA predicted a difference of up to 10 years (depending on patient subgroup) in OS at a median of 9 years before PCa diagnosis. The TK1 concentration in 193 controls without malignancies did not differ from that of the PCa patients, hence TK1 was likely not released from incidental PCa. Thus, TK1 in the blood circulation may indicate the release of TK1 from sources other than cancers, nonetheless associated with OS.
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Affiliation(s)
- Bernhard Tribukait
- Department of Oncology-Pathology, Karolinska Institute and University Hospital Solna, 141 86 Stockholm, Sweden
- Cancer Centrum Karolinska, CCK, Plan 00, Visionsgatan 56, Karolinska Universitetssjukhuset, Solna, 171 64 Stockholm, Sweden
| | - Per-Olof Lundgren
- Department of Clinical Science, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Anders Kjellman
- Department of Clinical Science, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Ulf Norming
- Department of Clinical Science and Education, Södersjukhuset, 118 83 Stockholm, Sweden
| | - Claes R Nyman
- Department of Clinical Science and Education, Södersjukhuset, 118 83 Stockholm, Sweden
| | - Kiran Jagarlmundi
- Research and Development Division, AroCell AB, 111 52 Stockholm, Sweden
| | - Ove Gustafsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, 141 86 Stockholm, Sweden
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Stattin P, Westerberg M, Lissbrant IF, Eriksson MH, Kjellman A, Ullén A, Vassilev Z, Sandstrom P, Weinrib R, Martinez D, Garcia-Albeniz X. Real World Outcomes in Patients With Metastatic, Castration-Resistant Prostate Cancer Treated With Radium-223 in Routine Clinical Practice in Sweden. Clin Genitourin Cancer 2023; 21:107.e1-107.e9. [PMID: 36180341 DOI: 10.1016/j.clgc.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 02/01/2023]
Abstract
AIM Estimate the effect of Radium-223 (Ra-223) on the incidence of bone fractures, prostate cancer death, and all-cause death compared with other standard treatments for metastatic, castration-resistant prostate cancer (mCRPC). METHODS Using a cohort design, we estimated the effect of Ra-223 on the risk of bone fractures, all-cause and prostate cancer-specific mortality across different lines of treatment for mCRPC using Prostate Cancer data Base Sweden (2013-2018). The comparator group comprised other standard treatments for mCRPC. We used 36-month risk differences and hazard ratios (HRs) as effect estimates. RESULTS The number of eligible individuals was 635, 453, 262, and 84 for the first-, second-, third-, and fourth-line cohorts, respectively. When compared Ra-223 to other standard treatments, the difference in the 36-month risk of fracture was 6% (95% confidence interval [CI], -7% to 18%) in the first-line cohort (n = 635) and 8% (95% CI, -7% to 18%) in the second-line cohort (n = 453). The number of fractures in the third-/fourth-line cohorts was too small for an adjusted comparison. The difference in 36-month mortality was higher in the first-line cohort 13% (95% CI, -3% to 31%), but lower in the second- and third-/fourth-line cohorts-8% (95% CI, -23% to 7%) and -14% (95% CI, -21% to 16%) respectively. Most deaths were due to prostate cancer. CONCLUSION Results suggest that the difference in the risk of fractures is small, if any. A difference in the risk of mortality may be present in first-line treatment, but a decreased risk of mortality was observed in second and later lines of treatment. The results on mortality need to be considered in the context of potential unmeasured or residual confounding.
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Affiliation(s)
- Pär Stattin
- Department of Surgical Sciences, Urology, Uppsala University, Sweden.
| | - Marcus Westerberg
- Department of Surgical Sciences, Urology, Uppsala University, Sweden; Department of Mathematics, Uppsala University, Sweden
| | - Ingela Franck Lissbrant
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Hjälm Eriksson
- Department of Surgery, Oncology section, Capio ST: Görans Hospital, Stockholm, Sweden
| | - Anders Kjellman
- Department of Urology and CLINTEC Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Ullén
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden Department of Pelvic Cancer, Genitourinary Oncology and Urology Unit, Karolinska University Hospital, Stockholm, Sweden; Department of Pelvic Cancer, Genitourinary Oncology and Urology Unit, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Rachel Weinrib
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
| | - David Martinez
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
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8
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Almdalal T, Karlsson Rosenblad A, Hellström M, Kjellman A, Lindblad P, Lundstam S, Sundqvist P, Ljungberg B. Predictive characteristics for disease recurrence and overall survival in non-metastatic clinical T1 renal cell carcinoma - results from the National Swedish Kidney Cancer Register. Scand J Urol 2023; 57:67-74. [PMID: 36520023 DOI: 10.1080/21681805.2022.2154383] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Patients with clinical T1 renal cell carcinoma (cT1RCC) have risks for recurrence and reduced overall survival despite being in the best prognostic group. This study aimed to evaluate the association of different treatments on disease recurrence and overall survival using clinical and pathological characteristics in a nation-wide cT1RCC cohort. MATERIALS AND METHODS A total of 4,965 patients, registered in the National Swedish Kidney Cancer Register (NSKCR) between 2005 and 2014, with ≥ 5-years follow-up were identified: 3,040 males and 1,925 females, mean age 65 years. Times to recurrence and overall survival were analyzed with Kaplan-Meier curves, log-rank test, and Cox regression models. RESULTS Age, TNM-stage, tumor size, RCC-type, and performed treatment were all associated with disease recurrence. Patients selected for ablative treatments had increased risk for recurrent disease: hazard ratio (HR) = 3.79 [95% confidence interval (CI) = 2.69-5.32]. In multivariate analyses, age, gender, tumor size, RCC-type, N-stage, recurrence and performed treatment were all independently associated with overall survival. Patients with chRCC had a 41% better overall survival (HR = 0.59, 95% CI = 0.44-0.78; p < 0.001) than ccRCC. Patients treated with partial nephrectomy (PN) had an 18% better overall survival (HR = 0.83, 95% CI = 0.71-0.95, p < 0.001) than patients treated with radical nephrectomy. CONCLUSIONS Age, gender, T-stage, tumor size, RCC type and treatment modality are all associated with risk of recurrence. Furthermore, age, male gender, tumor size, N-stage and recurrence are associated with reduced overall survival. Patients with chRCC, compared with ccRCC and pRCC patients, and PN compared with RN treated patients, had an advantageous overall survival, indicating a possible survival advantage of nephron sparing treatment.
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Affiliation(s)
- Tarik Almdalal
- Department of Surgery and Urology, Eskilstuna Country Hospital, Eskilstuna, Sweden
| | - Andreas Karlsson Rosenblad
- Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden.,Department of Medical Sciences, Division of Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Solna, Sweden
| | - Mikael Hellström
- Department of Radiology, Sahlgrenska Academy/Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden
| | - Anders Kjellman
- Department of Urology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Per Lindblad
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sven Lundstam
- Departments of Urology and Oncology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pernilla Sundqvist
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
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9
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Thor A, Grenabo Bergdahl A, Almas B, Halvorsen D, Cohn Cedermark G, Neegaard H, Karlsdottir A, Sagstuen Haugnes H, Stahl O, Gerdtsson A, Melsen Larsen S, Tandstad T, Kjellman A. The early results of the SWENOTECA (Swedish Norwegian Testicular Cancer Group) introduction of primary Retroperitoneal Lymph Node Dissection (RPLND) in seminoma stage IIA-IIb ≤ 3cm. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00796-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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10
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Yousef Yacoub S, Lundgren P, Kjellman A, Gustafsson O. The value of prostate-specific antigen density in long-term prostate cancer-mortality risk prediction. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01233-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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11
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Karlsson Rosenblad A, Sundqvist P, Harmenberg U, Hellström M, Hofmann F, Kjellman A, Kröger Dahlin BI, Lindblad P, Lindskog M, Lundstam S, Ljungberg B. Surgical waiting times and all-cause mortality in patients with non-metastatic renal cell carcinoma. Scand J Urol 2022; 56:383-390. [PMID: 35983600 DOI: 10.1080/21681805.2022.2107067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To examine the association between surgical waiting times (SWTs) and all-cause mortality (ACM) in non-metastatic patients with RCC, in relation to tumour stage. PATIENTS AND METHODS This nation-wide population-based cohort study included 9,918 M0 RCC patients registered in the National Swedish Kidney Cancer Register, between 2009 and 2021, followed-up for ACM until 9 December 2021, and having measured SWTs. The associations between primarily SWTs from date of radiological diagnosis to date of surgery (WRS) and secondarily SWTs from date of radiological diagnosis to date of treatment decision (WRT) and date of treatment decision to date of surgery (WTS), in relation to ACM, were analysed using Cox regression analysis, adjusted for clinical and demographic characteristics, stratified and unstratified according to T-stage. RESULTS During a mean follow-up time of 5 years (49,873 person-years), 23% (n = 2291) of the patients died. The adjusted hazard ratio (AHR) for WRS (months) for all patients was 1.03 (95% confidence interval [CI] = 1.02-1.04; p < 0.001). When subdividing WRS on T-stage, the AHRs were 1.03 (95% CI = 1.01-1.04; p < 0.001) and 1.05 (95% CI = 1.02-1.08; p = 0.003) for stages T1 and T3, respectively, while non-significant for T2 (p = 0.079) and T4 (p = 0.807). Similar results were obtained for WRT and WTS. CONCLUSIONS Prolonged SWTs significantly increased the risk of early overall death among patients with RCC. The increased risk of early death from any cause show the importance of shortening SWTs in clinical work of patients with this malignant disease.
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Affiliation(s)
- Andreas Karlsson Rosenblad
- Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden.,Department of Medical Sciences, Division of Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Sundqvist
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ulrika Harmenberg
- Department of Oncology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Mikael Hellström
- Department of Radiology, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden
| | | | - Anders Kjellman
- Department of Urology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Britt-Inger Kröger Dahlin
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Per Lindblad
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Magnus Lindskog
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Sven Lundstam
- Departments of Urology and Oncology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
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12
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Lindskog M, Laurell A, Kjellman A, Melichar B, Rey PM, Zieliński H, Villacampa F, Bigot P, Zoltan B, Parikh O, Alba DV, Jellvert Å, Flaskó T, Gallardo E, Caparrós MJR, Purkalne G, Suenaert P, Karlsson-Parra A, Ljungberg B. Ilixadencel, a Cell-based Immune Primer, plus Sunitinib Versus Sunitinib Alone in Metastatic Renal Cell Carcinoma: A Randomized Phase 2 Study. EUR UROL SUPPL 2022; 40:38-45. [PMID: 35638086 PMCID: PMC9142735 DOI: 10.1016/j.euros.2022.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 01/05/2023] Open
Abstract
Background The prognosis of patients with synchronous metastatic renal cell carcinoma (mRCC) is poor. Whereas single-agent tyrosine kinase inhibition (TKI) is clearly insufficient, the effects can be enhanced by combinations with immune checkpoint inhibitors. Innovative treatment options combining TKI and other immune-stimulating agents could prove beneficial. Objective To evaluate the clinical effects on metastatic disease when two doses of allogeneic monocyte-derived dendritic cells (ilixadencel) are administrated intratumorally followed by nephrectomy and treatment with sunitinib compared with nephrectomy and sunitinib monotherapy, in patients with synchronous mRCC. Design, setting, and participants A randomized (2:1) phase 2 multicenter trial enrolled 88 patients with newly diagnosed mRCC to treatment with the combination ilixadencel/sunitinib (ILIXA/SUN; 58 patients) or sunitinib alone (SUN; 30 patients). Outcome measurements and statistical analysis The primary endpoints were 18-mo survival rate and overall survival (OS). A secondary endpoint was objective response rate (ORR) assessed up to 18 mo after enrollment. Statistic evaluations included Kaplan-Meier estimates, log-rank tests, Cox regression, and stratified Cochran-Mantel-Haenszel tests. Results and limitations The median OS was 35.6 mo in the ILIXA/SUN arm versus 25.3 mo in the SUN arm (hazard ratio 0.73, 95% confidence interval 0.42–1.27; p = 0.25), while the 18-mo OS rates were 63% and 66% in the ILIXA/SUN and SUN arms, respectively. The confirmed ORR in the ILIXA/SUN arm were 42.2% (19/45), including three patients with complete response, versus 24.0% (six/25) in the SUN arm (p = 0.13) without complete responses. The study was not adequately powered to detect modest differences in survival. Conclusions The study failed to meet its primary endpoints. However, ilixadencel in combination with sunitinib was associated with a numerically higher, nonsignificant, confirmed response rate, including complete responses, compared with sunitinib monotherapy. Patient summary We studied the effects of intratumoral vaccination with ilixadencel followed by sunitinib versus sunitinib only in a randomized phase 2 study. The combination treatment showed numerically higher numbers of confirmed responses, suggesting an immunologic effect.
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Affiliation(s)
- Magnus Lindskog
- Department of Immunology, Genetics and Pathology, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
- Corresponding author. Department of Immunology, Genetics and Pathology, Uppsala University Hospital, Uppsala University, Akademiska sjukhuset, Entrance 100/101, 751 85 Uppsala, Sweden. Tel. +46 (0) 768434455.
| | - Anna Laurell
- Department of Oncology, Akademiska University Hospital, Uppsala, Sweden
| | - Anders Kjellman
- Department of Urology, CLINTEC, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Bohuslav Melichar
- Department of Urology and Urological Oncology, Wojewodzki Szpital Specjalistyczny im. Stefana Kardynała Wyszyńskiego, Lublin, Poland
| | | | - Henryk Zieliński
- Clinical Urology, Military Institute of Medicine, Warsaw, Poland
| | | | - Pierre Bigot
- Department of Urology, Centre Hospitalier Universitaire d'Angers, Angers Cedex, France
| | - Bajory Zoltan
- Szent-Györgyi Albert Klinikai Központ, Szegedi Tudomanyegyetem Altalanos Ovostudomanyi Kar Urologiai Klinika, Szeged, Hungary
| | - Omi Parikh
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | - David Vazquez Alba
- Servicio de Urología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Åsa Jellvert
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tibor Flaskó
- Department of Urology, Medical School, University of Debrecen, Debrecen, Hungary
| | - Enrique Gallardo
- Oncology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | | | - Gunta Purkalne
- Oncology Clinic, Pauls Stradins Clinical University Hospital, Rīga, Latvia
| | | | - Alex Karlsson-Parra
- Immunicum AB, Stockholm, Sweden
- Department of Immunology, Genetics and Pathology, Section of Clinical Immunology, Uppsala University, Uppsala, Sweden
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
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13
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Lundgren P, Tribukait B, Kjellman A, Norming U, Jagarlmudi K, Gustafsson O. Serum thymidine kinase 1 concentration as a predictive biomarker in prostate cancer. Prostate 2022; 82:911-916. [PMID: 35294068 PMCID: PMC9311431 DOI: 10.1002/pros.24335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/16/2022] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Thymidine kinase 1 (TK1) recycles DNA before cell division. We do not know if baseline blood concentrations of TK1 predict death in prostate cancer within 30 years. Our objective is to determine if there is an association between baseline levels of TK1 and future prostate cancer-specific mortality. METHODS With a "proof of concept" approach, we performed a nested case-control study among 1782 individuals screened for prostate cancer between 1988 and 1989. The concentration of TK1 was measured in frozen serum from 330 men, 36 of whom have died of prostate cancer. The primary endpoint was prostate cancer-specific mortality and outcomes after 30 years were analyzed using logistic regression modeling odds ratios (Ors). RESULTS The estimated OR (adjusted for age) for dying from prostate cancer among the men who had a TK1 value in the upper tertile was 2.39 (95% confidence interval 1.02-5.63). The corresponding OR, regardless of the cause of death, was 2.81 (1.24-6.34). CONCLUSIONS High levels of TK1 predicts death in prostate cancer within 30 years of follow-up.
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Affiliation(s)
- Per‐Olof Lundgren
- Department of Clinical Science, Intervention and TechnologyKarolinska Institute and Karolinska University HospitalStockholmSweden
| | - Bernhard Tribukait
- Department of Oncology‐PathologyKarolinska Institute and University HospitalStockholmSweden
| | - Anders Kjellman
- Department of Clinical Science, Intervention and TechnologyKarolinska Institute and Karolinska University HospitalStockholmSweden
| | - Ulf Norming
- Department of Clinical Science and EducationSödersjukhusetStockholmSweden
| | - Kiran Jagarlmudi
- Department of Anatomy, Physiology, and BiochemistrySwedish University of Agricultural SciencesUppsalaSweden
- Research and Development DivisionAroCell ABUppsalaSweden
| | - Ove Gustafsson
- Department of Clinical Science, Intervention and TechnologyKarolinska Institute and Karolinska University HospitalStockholmSweden
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14
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Gerdtsson A, Thor A, Grenabo Bergdahl A, Almås B, Håkansson U, Törnblom M, Negaard HFS, Glimelius I, Halvorsen D, Karlsdóttir Á, Sagstuen Haugnes H, Engen Andreassen K, Melsen Larsen S, Holmberg G, Wahlqvist R, Tandstad T, Cohn-Cedermark G, Ståhl O, Kjellman A. Unilateral or Bilateral Retroperitoneal Lymph Node Dissection in Nonseminoma Patients with Postchemotherapy Residual Tumour? Results from RETROP, a Population-based Mapping Study by the Swedish Norwegian Testicular Cancer Group. Eur Urol Oncol 2022; 5:235-243. [PMID: 33750683 DOI: 10.1016/j.euo.2021.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The distribution of retroperitoneal lymph node metastases for patients with nonseminoma and a residual tumour of 10-49 mm in a population-based setting is unknown. This information is needed to justify selection of patients for a unilateral template resection. OBJECTIVE To describe the location of retroperitoneal metastases and recurrences in patients with nonseminoma germ cell tumour (NSGCT) with a residual tumour of 10-49 mm. DESIGN, SETTING, AND PARTICIPANTS RETROP is a population-based prospective observational mapping study of 213 patients in Sweden and Norway with a retroperitoneal residual tumour of 10-49 mm who underwent postchemotherapy retroperitoneal lymph node dissection for metastatic NSGCT during 2007-2014 with median follow-up of 100 mo. Patients were classified according to the testis primary tumour and the distribution of unilateral or bilateral lymph node metastases (with reference to the aorta) present on pre- and/or postchemotherapy computed tomography (CT) scans. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The distribution and rate of teratoma or cancer in unilateral or bilateral retroperitoneal fields and the location and rate of retroperitoneal recurrence were measured. RESULTS AND LIMITATIONS In total, 65% of the patients had unilateral retroperitoneal lymph node metastases (RLNMs) on CT scans. Patients with unilateral RLNMs had a low risk of contralateral teratoma or cancer (1.6% for right- and 2.6% for left-sided NSGCT) or retroperitoneal recurrence (0% for right- and 4% for left-sided NSGCT). A weakness of the study is that the pathology specimen could not be fully designated to one specific area for some of the patients. CONCLUSIONS Men with postchemotherapy residual disease of 10-49 mm and unilateral metastases on pre- and postchemotherapy CT scans have a low risk of contralateral disease and should be considered for a unilateral template resection. PATIENT SUMMARY The surgeon can use computed tomography (CT) scans in deciding on the extent of lymph node dissection in patients with testicular cancer.
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Affiliation(s)
- Axel Gerdtsson
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden.
| | - Anna Thor
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Grenabo Bergdahl
- Department of Urology, Gothenburg University, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bjarte Almås
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | | | - Magnus Törnblom
- Department of Clinical Science and Education, Section of Urology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden; Department of Surgery, Visby County Hospital, Visby, Sweden
| | | | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Unit of Clinical and Experimental Oncology, Uppsala University, Uppsala, Sweden
| | - Dag Halvorsen
- Department of Urology, St. Olavs University Hospital, Trondheim, Norway
| | - Ása Karlsdóttir
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Hege Sagstuen Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UIT-The Arctic University of Norway, Tromsø, Norway
| | | | | | - Göran Holmberg
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rolf Wahlqvist
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Torgrim Tandstad
- The Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gabriella Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Genitourinary Oncology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Ståhl
- Department of Oncology, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anders Kjellman
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
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15
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Lundgren PO, Kjellman A, Norming U, Gustafsson O. Reply to the letter by Ferraro and Biganzoli. BJU Int 2022; 129:419. [PMID: 35297161 DOI: 10.1111/bju.15642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Per-Olof Lundgren
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Anders Kjellman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Norming
- Department of Clinical Science and Education, Karolinska Institutet and Södersjukhuset, Stockholm, Sweden
| | - Ove Gustafsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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16
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Myklebust MP, Thor A, Rosenlund B, Gjengstø P, Karlsdottir Á, Brydøy M, Bercea BS, Olsen C, Johnson I, Berg MI, Langberg CW, Andreassen KE, Kjellman A, Haugnes HS, Dahl O. Serum miR371 in testicular germ cell cancer before and after orchiectomy, assessed by digital-droplet PCR in a prospective study. Sci Rep 2021; 11:15582. [PMID: 34341387 PMCID: PMC8329070 DOI: 10.1038/s41598-021-94812-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/16/2021] [Indexed: 11/09/2022] Open
Abstract
MicroRNA-371a-3p (miR371) has been suggested as a sensitive biomarker in testicular germ cell cancer (TGCC). We aimed to compare miR371 with the classical biomarkers α-fetoprotein (AFP) and β-human chorionic gonadotropin (hCGβ). Overall, 180 patients were prospectively enrolled in the study, with serum samples collected before and after orchiectomy. We compared the use of digital droplet PCR (RT-ddPCR) with the quantitative PCR used by others for detection of miR371. The novel RT-ddPCR protocol showed high performance in detection of miR371 in serum samples. In the study cohort, miR371 was measured using RT-ddPCR. MiR371 detected CS1 of the seminoma and the non-seminoma sub-types with a sensitivity of 87% and 89%, respectively. The total sensitivity was 89%. After orchiectomy, miR371 levels declined in 154 of 159 TGCC cases. The ratio of miR371 pre- and post-orchiectomy was 20.5 in CS1 compared to 6.5 in systemic disease. AFP and hCGβ had sensitivities of 52% and 51% in the non-seminomas. MiR371 is a sensitive marker that performs better than the classical markers in all sub-types and clinical stages. Especially for the seminomas CS1, the high sensitivity of miR371 in detecting TGCC cells may have clinical implications.
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Affiliation(s)
- Mette Pernille Myklebust
- Mohn Cancer Research Laboratory, Department of Oncology and Medical Physics, Haukeland University Hospital, Jonas Lies vei 91B, 5021, Bergen, Norway.
| | - Anna Thor
- Department of Urology and CLINTEC Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Benedikte Rosenlund
- Mohn Cancer Research Laboratory, Department of Oncology and Medical Physics, Haukeland University Hospital, Jonas Lies vei 91B, 5021, Bergen, Norway
| | - Peder Gjengstø
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Ása Karlsdottir
- Mohn Cancer Research Laboratory, Department of Oncology and Medical Physics, Haukeland University Hospital, Jonas Lies vei 91B, 5021, Bergen, Norway
| | - Marianne Brydøy
- Mohn Cancer Research Laboratory, Department of Oncology and Medical Physics, Haukeland University Hospital, Jonas Lies vei 91B, 5021, Bergen, Norway
| | | | - Christian Olsen
- Mohn Cancer Research Laboratory, Department of Oncology and Medical Physics, Haukeland University Hospital, Jonas Lies vei 91B, 5021, Bergen, Norway
| | - Ida Johnson
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Mathilde I Berg
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | | | | | - Anders Kjellman
- Department of Urology and CLINTEC Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UIT-The Arctic University, Tromsø, Norway
| | - Olav Dahl
- Mohn Cancer Research Laboratory, Department of Oncology and Medical Physics, Haukeland University Hospital, Jonas Lies vei 91B, 5021, Bergen, Norway
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17
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Ehrenstein V, Heide-Jørgensen U, Schiødt M, Akre O, Herlofson BB, Hansen S, Larsson Wexell C, Nørholt SE, Tretli S, Kjellman A, Glennane A, Lowe KA, Sørensen HT. Osteonecrosis of the jaw among patients with cancer treated with denosumab or zoledronic acid: Results of a regulator-mandated cohort postauthorization safety study in Denmark, Norway, and Sweden. Cancer 2021; 127:4050-4058. [PMID: 34310704 DOI: 10.1002/cncr.33802] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/02/2021] [Accepted: 06/14/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Osteonecrosis of the jaw (ONJ) is an adverse effect of antiresorptive treatment. This study estimated incidence proportions and incidence rates of ONJ in cancer patients with bone metastases from solid tumors treated for the prevention of skeletal-related events in routine clinical practice. METHODS This cohort study in Denmark, Norway, and Sweden in 2011-2018 included 3 treatment cohorts: a denosumab inception cohort (DEIC), a zoledronic acid inception cohort (ZAIC), and a denosumab-switch cohort (DESC). The authors estimated 1- to 5-year incidence proportions and incidence rates of ONJ overall, by cancer site (breast, prostate, or other solid tumor), and by country. ONJ diagnoses were confirmed by adjudication. RESULTS There were 1340 patients in the DEIC, 1352 in the ZAIC, and 408 in the DESC. The median ages of the 3 cohorts were 70, 69, and 70 years, respectively; the proportions of men were 72.6%, 53.8%, and 48.3%, respectively; and the median follow-up was 19.8, 12.9, and 13.3 months, respectively. The 5-year incidence proportions of ONJ were 5.7% (95% confidence interval [CI], 4.4%-7.3%) in the DEIC, 1.4% (95% CI, 0.8%-2.3%) in the ZAIC, and 6.6% (95% CI, 4.2%-10.0%) in the DESC. The corresponding ONJ incidence rates per 100 person-years were 3.0 (95% CI, 2.3-3.7), 1.0 (95% CI, 0.6-1.5), and 4.3 (95% CI, 2.8-6.3). Incidence proportions and incidence rates were highest in patients with prostate cancer and in Denmark. CONCLUSIONS This study provides estimates of the risk of medically confirmed ONJ among patients initiating denosumab or zoledronic acid in routine clinical practice in 3 Scandinavian countries. The results varied by cancer site and by country. LAY SUMMARY Denosumab and zoledronic acid reduce the risk of bone fractures, pain, and surgery in patients with advanced cancers involving bone. Osteonecrosis of the jaw (ONJ)-death of a jawbone-is a known side effect of treatment with denosumab or zoledronic acid. The authors examined almost 2900 denosumab- or zoledronic acid-treated patients with cancer in Denmark, Norway, and Sweden. Over the course of 5 years, ONJ developed in 5.7% of the patients whose initial treatment was denosumab, in 1.4% of the patients whose initial treatment was zoledronic acid, and in 6.6% of the patients who switched from zoledronic acid to denosumab.
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Affiliation(s)
- Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Morten Schiødt
- Department of Oral and Maxillofacial Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Olof Akre
- Urology Department, Karolinska University Hospital, Stockholm, Sweden
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway.,Division for Head, Neck and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | - Svein Hansen
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Cecilia Larsson Wexell
- Department of Oral and Maxillofacial Surgery, Skåne University Hospital, Lund, Sweden.,Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Sven Erik Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Steinar Tretli
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Anders Kjellman
- Urology Department, Karolinska University Hospital, Stockholm, Sweden
| | | | - Kimberly A Lowe
- Center for Observational Research, Amgen, Inc, Thousand Oaks, California
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Lundgren PO, Kjellman A, Norming U, Gustafsson O. Association between one-time prostate-specific antigen (PSA) test with free/total PSA ratio and prostate cancer mortality: A 30-year prospective cohort study. BJU Int 2021; 128:490-496. [PMID: 33811738 DOI: 10.1111/bju.15417] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 03/01/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore if there is a long-term association between baseline prostate-specific antigen (PSA), including free/total PSA ratio and long-term (30-year) risk for prostate cancer death. SUBJECTS AND METHODS In all, 1782 men were screened for prostate cancer through PSA analysis. Some years later, frozen plasma samples were used to calculate the ratio of free to total PSA (f/t PSA). At 30-year follow-up, baseline PSA and f/t PSA were compared with recent data extracts from the Swedish Cause of Death Registry and Swedish Cancer Registry. PSA values and f/t PSA values were treated as continuous variables in a multivariable analysis and also stratified according to their distribution and useful clinical thresholds. RESULTS Risk of death from prostate cancer after 30 years of follow-up was significantly increased with a higher baseline PSA level, with the hazard ratio being 1.04 (95% confidence interval 1.03-1.09) per increase of one unit of PSA. Adding f/t PSA increased the model's ability to discriminate (concordance index 0.84-0.88). Men with PSA levels <1.0 ng/mL had a very low long-term risk of prostate cancer death (1.2% risk). An f/t PSA ≥ 0.25 extended the low-risk range to PSA < 2.0 ng/mL (1.5% risk). CONCLUSION Prostate-specific antigen testing can be carried out less frequently or can be discontinued in men aged 55-70 years if their PSA levels are <2.0 ng/mL and the f/t PSA is ≥0.25.
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Affiliation(s)
- Per-Olof Lundgren
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Anders Kjellman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Norming
- Department of Clinical Science and Education, Karolinska Institutet and Södersjukhuset, Stockholm, Sweden
| | - Ove Gustafsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Ljungberg B, Sundqvist P, Lindblad P, Kjellman A, Thorstenson A, Hellström M, Kröger Dahlin BI, Thomasson M, Harmenberg U, Lundstam S. Survival advantage of upfront cytoreductive nephrectomy in patients with primary metastatic renal cell carcinoma compared with systemic and palliative treatments in a real-world setting. Scand J Urol 2020; 54:487-492. [PMID: 32897123 DOI: 10.1080/21681805.2020.1815833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Recently, the CARMENA and SURTIME studies, suggested that upfront cytoreductive nephrectomy (CN) should be abandoned for patients with intermediate and high-risk metastatic renal cell carcinoma (mRCC). However, CN remains an indication in low-risk and when immediate systemic treatment is not required. The aim was to evaluate the long-term overall survival (OS) in patients with primary mRCC, based on the first line treatment. METHODS There were 1483 patients with primary mRCC in the National Kidney Cancer Registry from 2005 to 2013. Data on primary treatment, TNM stage, RCC type, tumor size, patient age and sex were extracted. Survival time was calculated from time of diagnosis to time of death or until July 2019. Mann-Whitney U and Chi-square tests, the Kaplan-Meyer method and Cox regression analyses were used. RESULTS Patients primary treated with CN had a significantly longer OS (p < .001) than patients primary treated with systemic therapy or palliation. In a Cox regression multivariate analysis, the hazard ratio for CN compared with no CN was 1.600, 95%Ci (1.492 - 1.691), p < .001. Also occurrence of lymph node metastases, T-stage, patients age and year of diagnosis, remained as independent predictors of OS. CONCLUSION Patients primary treated with CN survived significantly longer than patients primary treated with systemic therapy or palliation, in all age groups. CN was an important first-line treatment option in mRCC patients.
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Affiliation(s)
- Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Pernilla Sundqvist
- Department of Urology, Faculty of Medicine and Health, Örebro University, Sweden
| | - Per Lindblad
- Department of Urology, Faculty of Medicine and Health, Örebro University, Sweden
| | - Anders Kjellman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Thorstenson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Hellström
- Department of Radiology, Sahlgrenska Academy, Gothenburg University, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Britt-Inger Kröger Dahlin
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Marcus Thomasson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Ulrika Harmenberg
- Department of Oncology, Karolinska University Hospital/Karolinska Institute, Stockholm, Sweden
| | - Sven Lundstam
- Department of Urology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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20
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Lundgren PO, Kjellman A, Norming U, Gustafsson O. Association between dihydrotestosterone and long-term risk for prostate cancer mortality: A prospective cohort study. Prostate 2020; 80:777-781. [PMID: 32368817 DOI: 10.1002/pros.23991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND The androgen metabolism plays an important role in the progression of prostate cancer. Contradictory to what one might assume given the androgenic potency of dihydrotestosterone (DHT) there are indications that high DHT levels protect from prostate cancer. We want to determine whether there is a long-term association between baseline levels of DHT and death from prostate cancer. METHOD During the years 1988 and 1989, 1782 men out of 2400 invited were screened for prostate cancer. The invited men were randomly selected from a background population of more than 27 000 men. Serum levels of DHT were analyzed for all 65 men diagnosed in the trial and 130 controls from the same cohort without any signs of prostate cancer. In this study we evaluate outcomes for the whole cohort (n = 195), the men without clinical signs of prostate cancer at beginning of follow up (n = 130) and men with screening detected cancer (n = 65). The cohort was followed up after 30 years and data from the Swedish Cause of Death Registry and the Swedish Cancer Registry were extracted. Hazard ratios (HRs) were calculated using Cox regression models. RESULT High DHT levels were positively correlated to a lower risk for prostate cancer death in the entire cohort: HR = 0.44 (0.25-0.77 95% confidence interval [CI]). The positive correlation remained significant for the subgroup analysis. HR for the men enrolled in the study without any clinical signs of prostate cancer was 0.25 (0.07-0.88 95% CI) and for the men with a prostate cancer diagnosis at time of inclusion: HR = 0.50 (0.26-0.94 95% CI). CONCLUSION DHT is negatively associated with long-term prostate cancer death regardless of clinical presentation at time of inclusion.
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Affiliation(s)
- Per-Olof Lundgren
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Anders Kjellman
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Norming
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Ove Gustafsson
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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21
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Gerdtsson A, Thor A, Grenabo A, Almås B, Negaard H, Glimelius I, Halvorsen D, Karlsdóttir Á, Haugnes H, Andreassen K, Larsen S, Holmberg G, Wahlqvist R, Tandstad T, Cohn-Cedermark G, Ståhl O, Kjellman A. Location and histology of retroperitoneal metastases in post-chemotherapy retroperitoneal lymph node dissection for non-seminoma germ cell tumour. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32824-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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22
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Lindskog M, Laurell A, Kjellman A, Melichar B, Niezabitowski J, Maroto P, Zieliński H, Villacampa F, Bigot P, Bajory Z, Parikh O, Vazquez Alba D, Jellvert A, Flasko T, Gallardo Diaz E, Ribal MJ, Purkalne G, Suenaert P, Karlsson-Parra A, Ljungberg B. A randomized phase II study with ilixadencel, a cell-based immune primer, plus sunitinib versus sunitinib alone in synchronous metastatic renal cell carcinoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.5_suppl.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11 Background: Ilixadencel is a cell-based allogeneic off-the-shelf product aimed to prime anti-cancer immune response when injected intratumorally. The present randomized Phase II multicenter trial (MERECA; NCT02432846) evaluated intratumoral ilixadencel administration (2 doses 2 weeks apart) pre-nephrectomy followed by sunitinib post-nephrectomy compared with sunitinib monotherapy post-nephrectomy as first-line systemic therapy in patients with newly diagnosed synchronous metastatic renal cell carcinoma (mRCC). Methods: Patients were randomly assigned at two-to-one ratio to the combination (COMBO) or sunitinib (SUN) arm. Overall survival (OS) was assessed from enrollment while progression free survival (PFS) and tumor response was assessed per RECIST 1.1 (independent blinded central review) from start of sunitinib. Results: From April 2014 to January 2017, 88 patients (58 COMBO, 30 SUN) were randomized. In the COMBO arm, 2 patients did not receive ilixadencel, 10 did not receive sunitinib, and 1 did not have any follow up CT-scan. Five patients in the SUN arm never received sunitinib. Five patients (11%) in the COMBO arm had a complete response as best response versus one patient (4%) in the SUN arm. Confirmed ORR was 42.2 % (19/45) versus 24.0% (6/25). Median Duration of Response was 7.1 months versus 2.9 months. Median PFS was 11.8 months versus 11.0 months. Median OS has still not been reached in either group. As of July 2019, 57% and 43% were alive in the COMBO and SUN arms, respectively. Treatment with ilixadencel did not add any treatment-related Grade 3-4 Adverse Events. Conclusions: Compared to sunitinib monotherapy, combined treatment with ilixadencel followed by sunitinib demonstrated higher confirmed ORR, including several complete responses and longer duration of response, in patients with newly diagnosed synchronous mRCC. Clinical trial information: 02432846.
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Affiliation(s)
| | - Anna Laurell
- Department of Oncology, Uppsala University, Uppsala, Sweden
| | - Anders Kjellman
- Department of Urology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Bohuslav Melichar
- Fakultni Nemocnice Olomouc/Onkologicka Klinika, Pavlova, Czech Republic
| | - Jacek Niezabitowski
- Szpital Kliniczny Przemienienia Panskiego Uniwersytetu Medycznego im., Poznan, Poland
| | - Pablo Maroto
- Department of Medical Oncology, Hospital de Sant Pau, Barcelona, Spain
| | | | | | - Pierre Bigot
- Service d’Urologie CHU Angers, Université d’Angers, Angers, France
| | - Zoltan Bajory
- Szegedi Tudomanyegyetem Altalanos Ovostudomanyi Kar, Szeged, Hungary
| | - Omi Parikh
- Royal Preston Hospital, Preston, United Kingdom
| | | | - Asa Jellvert
- Sahlgrenska Universitetssjukhuset, Gothenburg, Sweden
| | - Tibor Flasko
- Debreceni Egyetem Orvos-es Egeszsegtudomanyi Centrum, Debrecen, Hungary
| | | | | | - Gunta Purkalne
- Pauls Stradins Clinical University Hospital, Riga, Latvia
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23
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Gerdtsson A, Håkansson U, Törnblom M, Jancke G, Negaard HFS, Glimelius I, Halvorsen D, Karlsdóttir Á, Haugnes HS, Andreassen KE, Larsen SM, Holmberg G, Wahlqvist R, Tandstad T, Cohn-Cedermark G, Ståhl O, Kjellman A. Surgical Complications in Postchemotherapy Retroperitoneal Lymph Node Dissection for Nonseminoma Germ Cell Tumour: A Population-based Study from the Swedish Norwegian Testicular Cancer Group. Eur Urol Oncol 2019; 3:382-389. [PMID: 31506250 DOI: 10.1016/j.euo.2019.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/31/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Reports on perioperative complications after postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for nonseminoma germ cell tumour (NSGCT) are from experienced single centres, with a lack of population-based studies. OBJECTIVE To assess the complications of bilateral and unilateral PC-RPLND. DESIGN, SETTING, AND PARTICIPANTS A prospective, population-based, observational multicentre study included all patients with NSGCT who underwent PC-RPLND in Norway and Sweden during 2007-2014. Of a total of 318 patients, 87 underwent bilateral PC-RPLND and 231 underwent unilateral PC-RPLND. The median follow-up was 6 yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Bilateral and unilateral PC-RPLND were compared for the outcomes of intra- and postoperative complications (graded by Clavien-Dindo) and retrograde ejaculation (with or without nerve-sparing surgery). Complications were reported as absolute counts and percentages. The χ2 test was used for comparisons. RESULTS AND LIMITATIONS The incidence of intraoperative complications was higher for bilateral PC-RPLND than for unilateral PC-RPLND (14% vs 4.3%, p = 0.003), with ureteral injury as the most frequent reported complication (2% of the patients). Postoperative complications were more common after bilateral than after unilateral PC-RPLND (45% vs 25%, p = 0.001) with Clavien ≥3b reported in 8.3% and 2.2%, respectively (p = 0.009). Lymphatic leakage was the most common complication occurring in 11% of the patients. Retrograde ejaculation occurred more frequently after bilateral than after unilateral surgery (59% vs 32%, p < 0.001). Limitations of the study include reporting of retrograde ejaculation, which was based on a chart review. CONCLUSIONS Intra- and postoperative complications including retrograde ejaculation are more frequent after bilateral PC-RPLND than after unilateral PC-RPLND. PATIENT SUMMARY Lymph node dissection in patients with testicular cancer puts them at risk of complications. In this study, we present the complications after lymph node dissection.
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Affiliation(s)
- Axel Gerdtsson
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden.
| | | | - Magnus Törnblom
- Department of Clinical Science and Education, Section of Urology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden; Department of Surgery, Visby County Hospital, Visby, Sweden
| | | | | | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Unit of Clinical and Experimental Oncology, Uppsala University, Sweden
| | - Dag Halvorsen
- Department of Urology, St. Olavs University Hospital, Trondheim, Norway
| | - Ása Karlsdóttir
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Hege Sagstuen Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UIT-The Arctic University of Norway, Tromsø, Norway
| | | | | | - Göran Holmberg
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rolf Wahlqvist
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Torgrim Tandstad
- The Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Gabriella Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; PO Bäckencancer, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Ståhl
- Department of Oncology, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anders Kjellman
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
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Sjöström C, Bergkvist M, Thulin H, Kjellman A, Thorstenson A. Reduced bleeding with DRY CUT ® transurethral resection of the prostate (TURP) compared to standard TURP. Scand J Urol 2019; 53:235-239. [PMID: 31328609 DOI: 10.1080/21681805.2019.1637376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To compare bleeding and transfusion rate between patients who undergo standard transurethral resection of the prostate (TURP) and patients who undergo DRY CUT® TURP.Materials and methods: A retrospective comparison was made of 626 patients who underwent a standard monopolar TURP during 2004-2007 at the Karolinska University Hospital Huddinge with 620 patients who underwent monopolar DRY CUT® TURP during 2011-2014 at the same clinic. Transfusion rate, perioperative bleeding, prostate volume, resection weight, use of anticoagulation therapy, presence of prostate cancer, whether the operation was performed by a specialist doctor in urology or a resident and length of hospital stay were evaluated.Results: The median bleeding was 300 ml (IQR = 100-645 ml) in the group of patients who underwent standard TURP compared to 75 ml (IQR 30-268 ml) in the DRY CUT® TURP group. The bleeding quotient for standard TURP was 2.3-times the perioperative bleeding for DRY CUT® TURP. In a logistic regression model the patients who underwent standard TURP were more likely to undergo blood transfusion compared to DRY CUT® TURP (OR = 3.18, 95% CI = 1.72-5.88). The results were not affected by adjustment for patient age, presence of prostate cancer, anticoagulation therapy or operation performed by a specialist in urology. However, the resection weight did influence the bleeding quotient.Conclusions: The shift from standard TURP to DRY CUT® TURP has decreased the perioperative bleeding and need for blood transfusion at our hospital.
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Affiliation(s)
- Carin Sjöström
- Section of Urology, Department of Surgery, Capio S:t Göran's Hospital, Stockholm, Sweden.,Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Bergkvist
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
| | - Helena Thulin
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
| | - Anders Kjellman
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
| | - Andreas Thorstenson
- Section of Urology, Department of Surgery, Capio S:t Göran's Hospital, Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
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Lundgren PO, Kjellman A, Norming U, Gustafsson O. Long-Term Outcome of a Single Intervention Population Based Prostate Cancer Screening Study. J Urol 2018; 200:82-88. [DOI: 10.1016/j.juro.2018.01.080] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Per-Olof Lundgren
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet (UN), Stockholm, Sweden
| | - Anders Kjellman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet (UN), Stockholm, Sweden
| | - Ulf Norming
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet (UN), Stockholm, Sweden
| | - Ove Gustafsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet (UN), Stockholm, Sweden
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26
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Larsson Wexell C, Kjellman A, Akre O. [Osteonecrosis of the jaws (ONJ) associated to antiresorptive treatment]. Lakartidningen 2018; 115:E394. [PMID: 29809272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Osteonecrosis of the jaws (ONJ) has been associated to antiresorptive treatment and is an increasing problem all over the world. ONJ is a severe adverse effect of antiresorptive treatment with bisphosphonate and denosumab used for treatment of osteoporosis, metastases from certain malignant conditions and as an adjuvant treatment in postmenopausal women with breast cancer, and of treatment with certain chemotherapeutic drugs. In this paper the epidemiology, symptoms, diagnostic features, clinical findings, and treatment are reviewed. Guidelines are presented for dental treatment, surgery and referral of patients on antiresorptive treatment.
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Affiliation(s)
- Cecilia Larsson Wexell
- Vastra Gotalandsregion - Avd. för käkkirurgi SÄS, Borås, Sweden - Avd. för käkkirurgi Borås, Sweden
| | - Anders Kjellman
- Karolinska Universitetssjukhuset Urologiska kliniken - Stockholm, Sweden Karolinska Universitetssjukhuset Urologiska kliniken - Stockholm, Sweden
| | - Olof Akre
- Karolinska Universitetssjukhuset - Urologkliniken Stockholm, Sweden Karolinska Universitetssjukhuset - Urologkliniken Stockholm, Sweden
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Gerdtsson A, Håkansson U, Holmberg G, Halvorsen D, Wahlqvist R, Haugnes H, Tandstad T, Ståhl O, Cohn-Cedermark G, Kjellman A. MP37-17 COMPLICATIONS OF POSTCHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION FOR ADVANCED TESTICULAR CANCER. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
The firms who are most successfully surviving crisis in Finland emphasise growth and innovation and do less downsizing.
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Affiliation(s)
| | | | - Tage Vest
- Swedish School of Economics and Business Administration, Vaasa, Finland
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Acquavella J, Ehrenstein V, Schiødt M, Heide-Jørgensen U, Kjellman A, Hansen S, Larsson Wexell C, Herlofson BB, Noerholt SE, Ma H, Öhrling K, Hernandez RK, Sørensen HT. Design and methods for a Scandinavian pharmacovigilance study of osteonecrosis of the jaw and serious infections among cancer patients treated with antiresorptive agents for the prevention of skeletal-related events. Clin Epidemiol 2016; 8:267-72. [PMID: 27499646 PMCID: PMC4959599 DOI: 10.2147/clep.s107270] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective Osteonecrosis of the jaw (ONJ) is a recognized complication of potent antiresorptive therapies, especially at the doses indicated to prevent skeletal complications for cancer patients with bone metastases. This paper describes the rationale and methods for a prospective, post-authorization safety study of cancer patients treated with antiresorptive therapies. Methods As part of a comprehensive pharmacovigilance plan, developed with regulators’ input, the study will estimate incidence of ONJ and of serious infections among adult cancer patients with bone metastases treated with denosumab (120 mg subcutaneously) or zoledronic acid (4 mg intravenously, adjusted for renal function). Patients will be identified using routinely collected data combined with medical chart review in Denmark, Sweden, and Norway. Followup will extend from the first administration of antiresorptive treatment to the earliest of death, loss-to-follow-up, or 5 years after therapy initiation. Results will be reported for three treatment cohorts: denosumab-naïve patients, zoledronic acid-naïve patients, and patients who switch from bisphosphonate treatment to denosumab. ONJ cases will be identified in three newly established national ONJ databases and adjudicated by the committee that functioned during the XGEVA® clinical trials program. Conclusion This study will provide a real world counterpart to the clinical trial-estimated risks for ONJ and serious infections for cancer patients initiating denosumab or zoledronic acid. The establishment of ONJ databases in the three Scandinavian countries will have potential benefits outside this study for the elucidation of ONJ risk factors and the evaluation of ONJ treatment strategies.
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Affiliation(s)
- John Acquavella
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Schiødt
- Department of Oral and Maxillofacial Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Kjellman
- Department of Urology, Karolinska University Hospital; Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Svein Hansen
- Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway
| | - Cecilia Larsson Wexell
- Department of Oral and Maxillofacial Surgery, Södra Älvsborg Hospital, Borås, Sweden; Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Sven Erik Noerholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Haijun Ma
- Global Biostatistical Science, Amgen Inc., Thousand Oaks, CA, USA
| | | | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Tandstad T, Ståhl O, Dahl O, Haugnes H, Håkansson U, Karlsdottir Å, Kjellman A, Langberg C, Laurell A, Oldenburg J, Solberg A, Söderström K, Stierner U, Cavallin-Ståhl E, Wahlqvist R, Wall N, Cohn-Cedermark G. Treatment of stage I seminoma, with one course of adjuvant carboplatin or surveillance, risk-adapted recommendations implementing patient autonomy: a report from the Swedish and Norwegian Testicular Cancer Group (SWENOTECA). Ann Oncol 2016; 27:1299-304. [DOI: 10.1093/annonc/mdw164] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/29/2016] [Indexed: 11/14/2022] Open
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Tandstad T, Solberg A, Håkansson U, Stahl O, Haugnes HS, Oldenburg J, Dahl O, Kjellman A, Angelsen A, Cohn-Cedermark G. Bilateral testicular germ cell tumors in patients treated for clinical stage I non-seminoma within two risk-adapted SWENOTECA protocols. Acta Oncol 2015; 54:493-9. [PMID: 25192551 DOI: 10.3109/0284186x.2014.953256] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A contralateral tumor occurs in 3.5-5% of men diagnosed with testicular germ cell cancer (TGCC). Biopsy of the contralateral testis may detect intratubular germ cell neoplasia ITGCNU, a precursor of TGCC. Biopsy of the contralateral testis to detect ITGCNU is controversial. If adjuvant chemotherapy (ACT) protects against bilateral cancer is debated. MATERIAL AND METHODS A total of 1003 patients with clinical stage I (CS I) non-seminomatous testicular germ cell cancer (NSGCT) were included in two prospective, population-based protocols. Fifteen patients were excluded. Treatment was either adjuvant chemotherapy (n = 494), or surveillance (n = 494). Contralateral testicular biopsy was recommended for all patients, but was performed only in 282 patients. In case of ITGCNU radiotherapy (RT) to 16 Gy was recommended. RESULTS During a follow-up of 8.3 years, 31 (3.6%) patients developed contralateral TGCC. ITGCNU was detected in 3.2% (9/282) of biopsied patients. The incidence of bilateral TGCC was similar following ACT, 2.5% (11/494), and surveillance, 3.4% (13/494), p = 0.41. Young age was a risk factor for metachronous TGCC (HR 0.93; 95% CI 0.88-0.99, p = 0.02). In total 2.2% (6/273) of patients without ITGCNU in the biopsy developed contralateral TGCC. One irradiated patient developed contralateral cancer, and one developed contralateral tumor before RT was given. CONCLUSION ACT did not reduce the incidence of contralateral TGCC. Young patients had the highest risk of developing contralateral TGCC. The proportion of false negatives biopsies was higher than reported in earlier trials, but this may in part be related to patient selection, single biopsies and lack of mandatory immunohistochemistry.
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MESH Headings
- Adult
- Age Factors
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy/statistics & numerical data
- Bleomycin/administration & dosage
- Chemotherapy, Adjuvant
- Etoposide/administration & dosage
- Humans
- Incidence
- Kaplan-Meier Estimate
- Male
- Neoplasms, Germ Cell and Embryonal/drug therapy
- Neoplasms, Germ Cell and Embryonal/epidemiology
- Neoplasms, Germ Cell and Embryonal/pathology
- Neoplasms, Germ Cell and Embryonal/prevention & control
- Neoplasms, Germ Cell and Embryonal/surgery
- Neoplasms, Multiple Primary/drug therapy
- Neoplasms, Multiple Primary/epidemiology
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/prevention & control
- Norway/epidemiology
- Orchiectomy/statistics & numerical data
- Prospective Studies
- Risk Factors
- Sweden/epidemiology
- Testicular Neoplasms/drug therapy
- Testicular Neoplasms/epidemiology
- Testicular Neoplasms/pathology
- Testicular Neoplasms/prevention & control
- Testicular Neoplasms/surgery
- Testis/pathology
- Time Factors
- Vinblastine/administration & dosage
- Watchful Waiting
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Affiliation(s)
- Torgrim Tandstad
- The Cancer Clinic, St. Olavs University Hospital , Trondheim , Norway
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Tandstad T, Solberg A, Hakansson U, Angelsen A, Haugnes HS, Oldenburg J, Kjellman A, Dahl O, Cohn-Cedermark G. Bilateral testicular cancer within two prospective, population-based SWENOTECA protocols in clinical stage I nonseminoma. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.4508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4508 Background: Contralateral tumor (CLT) occurs in 3.5-5% in men diagnosed with testicular cancer. The precursor lesion, ITGCNU, transforms into invasive germ cell cancer in 50-100%. Although radiotherapy eradicates ITGCNU effectively, mandatory biopsy of the contralateral testis to detect ITGCNU is controversial. Whether, adjuvant chemotherapy (ACT) reduces the incidence of bilateral cancer is also uncertain. Methods: 988 patients with clinical stage 1 nonseminoma were included in two prospective, population-based SWENOTECA protocols. Thirteen patients were excluded due to previous contralateral biopsy, synchronous bilateral cancer or protocol violations. Treatment was either adjuvant chemotherapy (n=490), or surveillance (n=485). Contralateral testicular biopsy was recommended, but performed only in 283 patients. In case of ITGCNU radiotherapy to 16 Gy was recommended.The estimated cumulative incidence of CLT was calculated using the Kaplan-Meier method. Results: With a median follow-up of 6.3 years, twenty-nine (3.9%) patients developed CLT including five patients with synchronous cancer. Biopsies showed ITGCNU in 3.2%. The incidence of CLT was similar following ACT, 3.7 % (11/490), and surveillance, 3.1% (12/485), p=0.99. Biopsied patients had a risk of developing CLT of 4.3% (9/283), and seven patients treated for CIS never developed CLT. Unbiopsied patients had a risk of 3.0 % (14/668). The proportion of bilateral cancers was similar in biopsy negative patients 3.6% (7/274) and unbiopsied patients 3.0 % (14/668). Young age at orchiectomy was a significant risk factor for metachronous cancer, HR 0.94 (CI: 0.89-0.99), p=0.04. All patients with ITGCNU were offered RT. One irradiated patient developed CLT cancer, and one developed CLT before RT was given. Conclusions: In this selected population ACT did not reduce the incidence of CLT. There was a high proportion of false negative biopsies, which might explain why biopsy negative patients had the same risk of CLT as patients not undergoing biopsy. Young patients had the highest risk of developing contralateral cancer, the risk of CLT decreased by 6% yearly.
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Affiliation(s)
| | | | | | | | | | - Jan Oldenburg
- Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Anders Kjellman
- Department of Urology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Olav Dahl
- Institute of Medicine, University of Bergen, Bergen, Norway
| | - Gabriella Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and University Hospital, Stockholm, Sweden
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Kjellman A, Akre O, Gustafsson O, Høyer-Hansen G, Lilja H, Norming U, Piironen T, Törnblom M. Soluble urokinase plasminogen activator receptor as a prognostic marker in men participating in prostate cancer screening. J Intern Med 2011; 269:299-305. [PMID: 21138491 DOI: 10.1111/j.1365-2796.2010.02284.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The urokinase plasminogen activator (uPA) system is involved in tissue remodelling processes and is up-regulated in many types of malignancies. We investigated whether serum levels of different forms of soluble uPA receptor (suPAR) are associated with survival and in particular with prostate cancer and cardiovascular disease mortality. METHODS Using time-resolved fluorescence immunoassays, we measured intact suPAR [suPAR(I-III)] and intact plus cleaved suPAR [suPAR(I-III) + suPAR(II-III)] and thus calculated the amount of suPAR(II-III) in serum samples from 375 men participating in a prostate cancer screening trial. A total of 312 men were free of prostate cancer and 63 men had prostate cancer diagnosed at the time of screening. The cohort was followed for 15 years. We assessed survival using Kaplan-Meier estimation and Cox proportional hazards regression. RESULTS The mean age at blood sampling was 64 years. In total, 152 men died during follow-up. SuPAR(I-III) and suPAR(II-III) were significantly positively associated with mortality (P = 0.001 and P < 0.0001, respectively). In a Cox regression model adjusting for age and prostate cancer status, an increase in suPAR(I-III) and suPAR(II-III) by 1-unit (ln-scale) was associated with a hazard ratio (HR) of 2.26 [95% confidence interval (CI) 1.17-4.35] and 2.53 (95% CI 1.56-4.10), respectively. There was a trend towards an increased risk of death from prostate cancer in screening-detected prostate cancer patients with increased values of either suPAR form. However, this difference was not significant and the association disappeared after adjusting for age, tumour stage, tumour grade and prostate-specific antigen. Being in the highest quartile of any of the suPAR forms was associated with a highly significant increased risk of cardiovascular death, with HR adjusted for age of 3.27 (95% CI 1.38-7.73) for suPAR(I-III) quartile 4 versus quartile 1. Conclusions. High concentrations of serum suPAR(I-III) and suPAR(II-III) were associated with poor overall survival. The association was particularly strong for death from cardiovascular disease. No similar association was found for prostate cancer after adjustment for other prognostic factors.
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Affiliation(s)
- A Kjellman
- Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden.
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Abstract
BACKGROUND The role of the prostate as an active endocrine organ and the hormonal changes after radical prostatectomy (RP) has not been well studied. The objective of this study was to investigate the serum and urine hormonal changes after RP. METHODS Fifty-five healthy men with localized prostate cancer were enrolled in this cross-sectional study at a single academic center. We measured serum levels of testosterone, dihydrotestosterone (DHT), sex hormone binding globulin (SHBG), luteinizing hormone (LH), and follicle stimulating hormone (FSH) in all 55 patients preoperatively and in 53 patients 90 days postoperatively. Free testosterone was calculated in all patients. Inhibin B levels was analyzed in 44 patients pre- and postoperatively. Steroid urine profile including testosterone, DHT, 5alpha-androstane-3alpha,17beta-diol (3alphaAdiol), and androsterone (ADT) was also determined preoperatively and 90 days postoperatively in 18 patients. RESULTS There were 53% increase in serum LH (P < 0.0001), 21% increase in serum FSH (P < 0.0001), and 13% decrease in DHT levels (P < 0.03). There were no significant changes in any other serum hormone investigated. Urinary levels of DHT glucuronides (DHT-G) decreased by 67% (P < 0.0003) while Androsterone-G and 3alphaAdiol-G increased by 37% (P = 0.019) and 44% (P = 0.023), respectively. There were no alterations in the urinary levels of the other steroids investigated. Inhibin B levels correlated inversely with both FSH (r = -0.67, P < 0.0001) and LH (r = -0.51, P = 0.0004). CONCLUSION RP leads to significant increases in serum gonadotropins and significant DHT decrease in both serum and urine. These hormonal changes are independent of inhibin B.
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Affiliation(s)
- Mats Olsson
- Division of Urology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
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Kjellman A, Akre O, Norming U, Törnblom M, Gustafsson O. 15-year followup of a population based prostate cancer screening study. J Urol 2009; 181:1615-21; discussion 1621. [PMID: 19233435 DOI: 10.1016/j.juro.2008.11.115] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE We evaluated long-term survival in attendees and nonattendees of a 1-time screening for prostate cancer. MATERIALS AND METHODS A total of 2,400 men 55 to 70 years old in 1988 were randomly selected and invited to a screening for prostate cancer. Of the invited men 1,782 (74%) attended. Screening attendees were examined with digital rectal examination, transrectal ultrasound and prostate specific antigen analysis. When cancer was suspected, prostate biopsies were taken. A total of 65 men with prostate cancer were detected by this procedure. The entire source population comprising 27,204 men, including 618 nonattendees (26%), was followed for prostate cancer diagnosis and survival for 15 years. RESULTS Incidence rate ratios were calculated using Poisson regression models. We found no effect of this screening procedure on the risk of death from prostate cancer and other causes of death (incidence rate ratio 1.10, 95% CI 0.83-1.46 and 0.98, 95% CI 0.92-1.05, respectively) when comparing all invited men with the source population. However, attending the screening program was associated with a significantly decreased risk of death from causes other than prostate cancer (vs source population incidence rate ratio 0.82, 95% CI 0.76-0.90). In contrast, the corresponding incidence rate ratio in nonattendees was 1.53 (95% CI 1.37-1.71). CONCLUSIONS We found no evidence of a beneficial effect of this specific screening procedure but strong evidence of a difference in overall survival in screening attendees and nonattendees. These findings should be considered when interpreting previous and upcoming studies of the effect of screening programs.
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Affiliation(s)
- Anders Kjellman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Kjellman A, Akre O, Norming U, Törnblom M, Gustafsson O. Dihydrotestosterone Levels and Survival in Screening-Detected Prostate Cancer: A 15-yr Follow-up Study. Eur Urol 2008; 53:106-11. [PMID: 17482753 DOI: 10.1016/j.eururo.2007.04.063] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 04/18/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVES It has been hypothesized that dihydrotestosterone (DHT), the main intracellular androgen in the prostate, affects prostatic tumour progression. In this study, we evaluated serum DHT levels at the time of prostate-cancer diagnosis in relation to survival. METHODS Sixty-five screening-detected patients diagnosed in 1988-1989 were followed for 15 yr. DHT levels at the time of diagnosis were determined through radio-immuno assay. Subjects were followed up through the nationwide tax register. Medical records of all dead subjects were reviewed, and cause of death was established by an endpoint committee. Data were analyzed through Kaplan-Meier estimation and Cox proportional-hazards regression. RESULTS Seventeen of 41 deaths in the cohort during follow-up were attributed to prostate cancer. Patients with DHT above the median had a significant better prostate-cancer-specific survival than those with DHT below the median (log rank p=0.0075). In the univariate analyses, one unit increase in DHT was associated with a hazard ratio (HR) of 0.14 (95% CI=0.02-0.93). In the multivariate model, including prostate-specific antigen level, the association between DHT and prostate-cancer-specific survival was not significant (HR=0.18; 95% CI=0.02-1.6). DHT level below the median remained significantly associated with decreased survival in the multivariate model (HR=0.23; 95% CI=0.06-0.90). No association was found between DHT level and hazard of dying from causes other than prostate cancer. CONCLUSIONS Although the prognostic value of DHT levels at diagnosis remains unclear, these results provides evidence of an association between low DHT and decreased survival in prostate cancer patients.
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Affiliation(s)
- Anders Kjellman
- Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden.
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Kjellman A, Akre O, Norming U, Törnblom M, Gustafsson O. 227: Dihydrotestosterone as a Prognostic Factor in Men with Screening-detected Prostate Cancer. J Urol 2007. [DOI: 10.1016/s0022-5347(18)30492-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kjellman A. Trials with computerized EMG read-outs. Electroencephalogr Clin Neurophysiol 1969; 26:339. [PMID: 4183461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Kjellman A, Larsson LE, Prevec T. Potentials evoked by tapping recorded from the human scalp over the cortical somato-sensory region. Electroencephalogr Clin Neurophysiol 1967; 23:396. [PMID: 4167833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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