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Hensley PJ, Labbate C, Zganjar A, Howard J, Huelster H, Durdin T, Pham J, Xiao L, Pallauf M, Lombardo K, Glezerman I, Singla N, Raman JD, Coleman J, Spiess PE, Margulis V, Potretzke AM, Matin SF. Development and Validation of a Multivariable Nomogram Predictive of Post-Nephroureterectomy Renal Function. Eur Urol Oncol 2024:S2588-9311(24)00030-0. [PMID: 38307832 DOI: 10.1016/j.euo.2024.01.005] [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: 09/22/2023] [Revised: 12/08/2023] [Accepted: 01/04/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND AND OBJECTIVE The timing of perioperative nephrotoxic chemotherapy for upper tract urothelial carcinoma (UTUC) remains controversial and strongly depends on predicted platinum eligibility after radical nephroureterectomy (RNU). The study objective was to develop and validate a multivariable nomogram to predict estimated glomerular filtration rate (eGFR) following RNU. METHODS This was a multi-institutional retrospective study of patients with UTUC treated with RNU from 2000 to 2020 at seven high-volume referral centers. Use of adjuvant chemotherapy was risk-stratified. Patients were retrospectively randomly allocated 2:1 to discovery and validation cohorts. Discovery data were used to identify independent factors associated with GFR at 1-3 mo after RNU on linear regression, and backward selection was applied for model construction. Accuracy was defined as the percentage of predicted eGFR results within 30% of the corresponding observed eGFR. KEY FINDINGS AND LIMITATIONS We included 1100 patients, of whom 733 were in the discovery and 367 were in the validation cohort. Multivariable predictors of postoperative eGFR decline included advanced age (odds ratio [OR] -0.18, 95% confidence interval [CI] -0.28 to -0.08), diabetes (OR -2.38, 95% CI -4.64 to -0.11), and hypertension (OR -2.24, 95% CI -4.16 to -0.32). Factors associated with favorable postoperative eGFR included larger tumor size (OR 10.57, 95% CI 7.4-13.74 for tumors >5 cm vs ≤2 cm) and preoperative eGFR (OR 0.44, 95% CI 0.39-0.49). A composite nomogram predicted postoperative eGFR with good accuracy in both the discovery (80.5%) and validation (78.6%) cohorts. Limitations include exclusion of patients who received neoadjuvant chemotherapy. CONCLUSIONS A nomogram that incorporates ubiquitous preoperative clinical variables can predict post-RNU eGFR and was validated with an independent cohort. PATIENT SUMMARY We developed a tool that uses patient data to predict eligibility for chemotherapy after surgery to remove the kidney and ureter in patients with cancer in the upper urinary tract.
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Affiliation(s)
- Patrick J Hensley
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Markey Cancer Center, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Craig Labbate
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeffrey Howard
- Department of Urology, The University of Texas Southwestern, Dallas, TX, USA
| | - Heather Huelster
- Department of Urology, Moffitt Cancer Center, Tampa, FL, USA; Department of Urology, Indiana University Health, Indianapolis, IN, USA
| | - Trey Durdin
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan Pham
- Department of Urology, Penn State Health, Hershey, PA, USA
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maximilian Pallauf
- James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA; Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Kara Lombardo
- James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Ilya Glezerman
- Department of Nephrology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nirmish Singla
- James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Jay D Raman
- Department of Urology, Penn State Health, Hershey, PA, USA
| | - Jonathan Coleman
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Vitaly Margulis
- Department of Urology, The University of Texas Southwestern, Dallas, TX, USA
| | | | - Surena F Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Linehan J, Gottlieb J, Woldu SL, Labbate C, Rose K, Sexton W, Kaimakliotis H, Jacob J, Dickstein R, Nieder A, Bjurlin M, Humphreys M, Ghodoussipour S, Quek M, O'Donnell M, Eisner BH, Feldman AS, Matin SF, Lotan Y, Murray KS. Corrigendum to "Route of Administration for UGN-101 and Impact on Oncological and Safety Outcomes" [Eur. Urol. Focus (2023)]. Eur Urol Focus 2024; 10:211. [PMID: 37640582 DOI: 10.1016/j.euf.2023.08.006] [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: 08/31/2023]
Affiliation(s)
| | - Josh Gottlieb
- Providence Specialty Medical Group, Santa Monica, CA, USA.
| | - Solomon L Woldu
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Craig Labbate
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kyle Rose
- Moffitt Cancer Center, Tampa, FL, USA
| | | | | | - Joseph Jacob
- State University of New York Upstate Medical Center, Syracuse, NY, USA
| | - Rian Dickstein
- University of Maryland Medical Center, Baltimore Washington Medical Center, Glen Burnie, MD, USA; Chesapeake Urology, Baltimore, MD, USA
| | - Alan Nieder
- Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Marc Bjurlin
- University of North Carolina Medical Center, Chapel Hill, NC, USA
| | | | | | - Marcus Quek
- Loyola University Medical Center, Maywood, IL, USA
| | | | | | | | - Surena F Matin
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yair Lotan
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Jacob JM, Woldu SL, Linehan J, Labbate C, Rose KM, Sexton WJ, Tachibana I, Kaimakliotis H, Nieder A, Bjurlin MA, Humphreys M, Ghodoussipour SB, Quek ML, Johnson B, O'Donnell M, Eisner BH, Feldman AS, Murray KS, Matin SF, Lotan Y, Dickstein RJ. First analysis of the safety and efficacy of UGN-101 in the treatment of ureteral tumors. Urol Oncol 2024; 42:20.e17-20.e23. [PMID: 37517898 DOI: 10.1016/j.urolonc.2023.07.004] [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] [Received: 05/04/2023] [Revised: 06/10/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE UGN-101 has been approved for the chemoablation of low-grade upper tract urothelial cancer (UTUC) involving the renal pelvis and calyces. Herein is the first reported cohort of patients with ureteral tumors treated with UGN-101. PATIENTS AND METHODS We performed a retrospective review of patients treated with UGN-101 for UTUC at 15 high-volume academic and community centers focusing on outcomes of patients treated for ureteral disease. Patients received UGN-101 with either adjuvant or chemo-ablative intent. Response rates are reported for patients receiving chemo-ablative intent. Adverse outcomes were characterized with a focus on the rate of ureteral stenosis. RESULTS In a cohort of 132 patients and 136 renal units, 47 cases had tumor involvement of the ureter, with 12 cases of ureteral tumor only (8.8%) and 35 cases of ureteral plus renal pelvic tumors (25.7%). Of the 23 patients with ureteral involvement who received UGN-101 induction with chemo-ablative intent, the complete response was 47.8%, which did not differ significantly from outcomes in patients without ureteral involvement. Fourteen patients (37.8%) with ureteral tumors had significant ureteral stenosis at first post-treatment evaluation, however, when excluding those with pre-existing hydronephrosis or ureteral stenosis, only 5.4% of patients developed new clinically significant stenosis. CONCLUSIONS UGN-101 appears to be safe and may have similar efficacy in treating low-grade urothelial carcinoma of the ureter as compared to renal pelvic tumors.
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Affiliation(s)
- Joseph M Jacob
- State University of New York Upstate Medical Center, Syracuse, NY
| | - Solomon L Woldu
- University of Texas Southwestern Medical Center, Dallas, TX.
| | | | - Craig Labbate
- University of Texas M.D. Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | - Marc A Bjurlin
- University of North Carolina Medical Center, Chapel Hill, NC
| | | | | | | | - Brett Johnson
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | | | - Surena F Matin
- University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Yair Lotan
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Rian J Dickstein
- University of Maryland Baltimore Washington Medical Center, Glen Burnie, MD; Chesapeake Urology, Baltimore, MD
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Linehan J, Gottlieb J, Woldu SL, Labbate C, Rose K, Sexton W, Kaimakliotis H, Jacob J, Dickstein R, Nieder A, Bjurlin M, Humphreys M, Ghodoussipor S, Quek M, O'Donnell M, Eisner BH, Feldman AS, Matin SF, Lotan Y, Murray KS. Route of Administration for UGN-101 and Impact on Oncological and Safety Outcomes. Eur Urol Focus 2023; 9:1052-1058. [PMID: 37263827 DOI: 10.1016/j.euf.2023.05.012] [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] [Received: 02/09/2023] [Revised: 04/19/2023] [Accepted: 05/09/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND UGN-101 can be used for chemoablation of low-grade upper tract urothelial carcinoma (UTUC). The gel can be administered via a retrograde route through a ureteral catheter or an antegrade route via a nephrostomy tube. OBJECTIVE To report outcomes of UGN-101 by route of administration. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective review of 132 patients from 15 institutions who were treated with UGN-101 for low-grade UTUC via retrograde versus antegrade administration. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Survival outcomes are reported per patient. Treatment, complications, and recurrence outcomes are reported per renal unit. Statistical analysis was performed for primary endpoints of oncological response and ureteral stricture occurrence. RESULTS AND LIMITATIONS A total of 136 renal units were evaluated, comprising 78 retrograde and 58 antegrade instillations. Median follow-up was 7.4 mo. There were 120 cases (91%) of biopsy-proven low-grade UTUC. Tumors were in the renal pelvis alone in 89 cases (65%), in the ureter alone in 12 cases (9%), and in both in 35 cases (26%). Seventy-six patients (56%) had residual disease before UGN-101 treatment. Chemoablation with UGN-101 was used in 50/78 (64%) retrograde cases and 26/58 (45%) antegrade cases. A complete response according to inspection and cytology was achieved in 31 (48%) retrograde and 30 (60%) antegrade renal units (p = 0.1). Clavien grade 3 ureteral stricture occurred in 21 retrograde cases (32%) and only six (12%) antegrade cases (p < 0.01). Limitations include treatment bias, as patients in the antegrade group were more likely to undergo endoscopic mechanical ablation before UGN-101 instillation. CONCLUSIONS These preliminary results show a significantly lower rate of stricture occurrence with antegrade administration of UGN-101, with no apparent impact on oncological efficacy. PATIENT SUMMARY We compared results for two different delivery routes for the drug UGN-101 for treatment of cancer in the upper urinary tract. For the antegrade route, a tube is inserted through the skin into the kidney. For the retrograde route, a catheter is inserted past the bladder into the upper urinary tract. Our results show a lower rate of narrowing of the ureter (the tube draining urine from the kidney into the bladder) using the antegrade route, with no difference in cancer control.
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Affiliation(s)
| | - Josh Gottlieb
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Solomon L Woldu
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Craig Labbate
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kyle Rose
- Moffitt Cancer Center, Tampa, FL, USA
| | | | | | - Joseph Jacob
- State University of New York Upstate Medical Center, Syracuse, NY, USA
| | - Rian Dickstein
- University of Maryland Medical Center, Baltimore Washington Medical Center, Glen Burnie, MD, USA; Chesapeake Urology, Baltimore, MD, USA
| | - Alan Nieder
- Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Marc Bjurlin
- University of North Carolina Medical Center, Chapel Hill, NC, USA
| | | | | | - Marcus Quek
- Loyola University Medical Center, Maywood, IL, USA
| | | | | | | | - Surena F Matin
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yair Lotan
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Rose KM, Murray KS, Labbate C, Woldu S, Linehan J, Jacob J, Kaimakliotis H, Dickstein R, Feldman A, Matin SF, Lotan Y, Humphreys MR, Sexton WJ. Mitomycin Gel (UGN-101) as a Kidney-sparing Treatment for Upper Tract Urothelial Carcinoma in Patients with Imperative Indications and High-grade Disease. Eur Urol Focus 2023; 9:807-812. [PMID: 37059620 DOI: 10.1016/j.euf.2023.03.016] [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] [Received: 01/14/2023] [Revised: 02/24/2023] [Accepted: 03/23/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Intracavitary UGN-101 is approved for the treatment of low-grade noninvasive upper tract urothelial carcinoma (UTUC). Post-commercialization studies underscore the benefit of UGN-101 administration for patients with imperative indications for whom radical nephroureterectomy (RNU) is not a viable option. OBJECTIVE To describe the use, efficacy, and safety of UGN-101 in patients with UTUC with imperative indications for renal preservation, including high-grade disease. DESIGN, SETTING, AND PARTICIPANTS Patients receiving UGN-101 with imperative indications were retrospectively analyzed using a multicenter centralized registry from 15 high-volume academic and community centers. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We defined imperative indications as patients with a solitary kidney, the presence of chronic kidney disease (CKD) with a glomerular filtration rate <30 ml/min, bilateral UTUC, and patients unfit for or unwilling to undergo surgical extirpation. Tumor characteristics, disease progression/recurrence, and adverse events were recorded on a per-renal-unit basis. RESULTS AND LIMITATIONS UGN-101 was instilled into 52 renal units (38%) in 48 patients for imperative indications, including 29 patients (56%) with a solitary kidney, 11 kidneys (21%) in the setting of bilateral UTUC, six patients (12%) with CKD, and six patients (12%) who were unfit for or unwilling to undergo RNU. Twelve renal units had biopsy-proven high-grade papillary disease. Tumors were completely ablated before induction therapy in 34% of cases, while 66% had tumor present. Following induction therapy, 17 patients (40%) had no evidence of disease (NED) on ureteroscopy, 88% of whom maintained this status at median follow-up of 10.8 mo. In the cohort with high-grade disease, five patients (45%) had NED at initial post-induction primary disease evaluation. Adverse events included pyelonephritis (8%), ureteral stenosis (8%), anemia (6%), and acute renal failure (4%). Limitations include the retrospective study design, the lack of long-term follow up, and patient selection bias. CONCLUSIONS Intracavitary therapy with UGN-101 in patients with UTUC and imperative indications shows promise as a kidney-sparing treatment modality. While long-term follow-up is needed, this intracavitary treatment may help in prolonging time to RNU and delaying the morbidity of hemodialysis in this comorbid population. PATIENT SUMMARY We reviewed results for patients with cancer in the upper urinary tract and an additional condition that would not allow kidney removal who received treatment with a gel called UGN-101. Our results suggest that UGN-101 shows promise as a kidney-sparing treatment. It may delay the time until kidney removal is needed in these patients and avoid the negative effects associated with dialysis.
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Affiliation(s)
- Kyle M Rose
- H. Lee Moffitt Cancer Center, Tampa, FL, USA.
| | | | - Craig Labbate
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Solomon Woldu
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Joseph Jacob
- SUNY Upstate Medical University, Syracuse, NY, USA
| | | | | | | | - Surena F Matin
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yair Lotan
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Kaimakliotis HZ, Tachibana I, Woldu S, Labbate C, Jacob J, Murray K, Rose K, Sexton W, Dickstein R, Linehan J, Nieder A, Bjurlin M, Humphreys M, Ghodoussipour S, Quek M, O'Donnell M, Eisner BH, Matin SF, Lotan Y, Feldman AS. The ablative effect of mitomycin reverse thermal gel: Expanding the role for nephron preservation therapy in low grade upper tract urothelial carcinoma. Urol Oncol 2023; 41:387.e1-387.e7. [PMID: 37246135 DOI: 10.1016/j.urolonc.2023.04.010] [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] [Received: 12/31/2022] [Revised: 04/05/2023] [Accepted: 04/09/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE Assess the real-world ablative effect of mitomycin reverse thermal gel for low-grade upper tract urothelial carcinoma (UTUC) in patients who undergo biopsy only or partial ablation and evaluate utility of complete ablation prior to UGN-101. MATERIAL AND METHODS We retrospectively reviewed low-grade UTUC patients treated with UGN-101 from 15 high-volume centers. Patients were categorized based on initial endoscopic ablation (biopsy only, partial ablation, or complete ablation) and by size of remaining tumor (complete ablation, <1cm, 1-3cm, or >3cm) prior to UGN-101. The primary outcome was rendered disease free (RDF) rate at first post-UGN-101 ureteroscopy (URS), defined as complete response or partial response with minimal mechanical ablation to endoscopically clear the upper tract of visible disease. RESULTS One hundred and sixteen patients were included for analysis after excluding those with high-grade disease. At first post-UGN-101 URS, there were no differences in RDF rates between those who at initial URS (pre-UGN-101) had complete ablation (RDF 77.0%), partial ablation (RDF 55.9%) or biopsy only (RDF 66.7%) (P = 0.14). Similarly, a complimentary analysis focusing on tumor size (completely ablated, <1cm, 1-3cm or >3cm) prior to UGN-101 induction did not demonstrate significant differences in RDF rates (P = 0.17). CONCLUSION The results of the early real-world experience suggest that UGN-101 may play a role in initial chemo-ablative cytoreduction of larger volume low-grade tumors that may not initially appear to be amenable to renal preservation. Further studies will help to better quantify the chemo-ablative effect and to identify clinical factors for patient selection.
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Affiliation(s)
| | - Isamu Tachibana
- Department of Urology, Indiana University Medical Center, Indianapolis, IN
| | - Solomon Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Craig Labbate
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joseph Jacob
- Department of Urology, State University of New York Upstate Medical Center, Syracuse, NY
| | - Katie Murray
- Department of Surgery, University of Missouri, Columbia, MO
| | - Kyle Rose
- Department of Urology, Moffitt Cancer Center, Tampa, FL
| | - Wade Sexton
- Department of Urology, Moffitt Cancer Center, Tampa, FL
| | - Rian Dickstein
- Department of Urology, University of Maryland Medical Center, Baltimore, MD; Department of Urology, Chesapeake Urology, Baltimore, MD
| | - Jennifer Linehan
- Department of Urology, Providence Specialty Medical Group, Santa Monica, CA
| | - Alan Nieder
- Department of Urology, Mount Sinai Medical Center, Miami Beach, FL
| | - Marc Bjurlin
- Department of Urology, University of North Carolina Medical Center, Chapel Hill, NC
| | | | - Saum Ghodoussipour
- Department of Urology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Marcus Quek
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Michael O'Donnell
- Department of Urology, University of Iowa Health Care, Iowa City, IA
| | - Brian H Eisner
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Surena F Matin
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Adam S Feldman
- Department of Urology, Massachusetts General Hospital, Boston, MA
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Labbate C, Woldu S, Murray K, Rose K, Sexton W, Tachibana I, Kaimakliotis H, Jacob J, Dickstein R, Linehan J, Nieder A, Bjurlin M, Humphreys M, Ghodoussipour S, Quek M, O'Donnell M, Eisner B, Feldman A, Lotan Y, Matin SF. Efficacy and Safety of Mitomycin Gel (UGN-101) as an Adjuvant Therapy After Complete Endoscopic Management of Upper Tract Urothelial Carcinoma. J Urol 2023; 209:872-881. [PMID: 36657029 DOI: 10.1097/ju.0000000000003185] [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: 07/22/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE We describe a novel application of the reverse thermal polymer gel of mitomycin C (UGN-101) as adjuvant therapy after complete endoscopic ablation of upper tract urothelial carcinoma. MATERIALS AND METHODS We retrospectively reviewed patients treated with UGN-101 from 15 high-volume centers. Adjuvant therapy was defined as treatment administered following visually complete endoscopic ablation. Response at primary endoscopic evaluation was defined as no visual tumor or negative biopsy. Ipsilateral disease-free and progression-free survival were estimated by the Kaplan-Meier method. Ureteral stenosis and other adverse events were abstracted from the medical records. Ureteral stenosis was defined as a condition requiring ureteral stent or nephrostomy, or that would typically warrant stent or nephrostomy. RESULTS Adjuvant UGN-101 after complete endoscopic ablation was used in 52 of 115 (45%) renal units in the oncologic analysis. At first endoscopic evaluation, 36/52 (69%) were without visible disease. At 6.8 months' median follow-up, the ipsilateral disease-free rate was 63%. Recurrence after adjuvant UGN-101 therapy was more likely in multifocal tumors compared to unifocal (HR 3.3, 95% CI 1.07-9.91). Compared with UGN-101 treatment for chemoablation of measurable disease, there were significantly fewer disease detections with adjuvant therapy (P < .001). Ureteral stenosis after UGN-101 was diagnosed in 10 patients (19%) undergoing adjuvant therapy compared to 17 (29%) undergoing chemoablative therapy (P = .28). CONCLUSIONS In patients being considered for UGN-101, maximal endoscopic ablation prior to UGN-101 treatment may result in fewer patients with disease at first endoscopy and possibly fewer adverse events than primary chemoablative therapy. Longer follow-up is needed to determine if UGN-101 after complete endoscopic ablation will lead to durable disease-free interval.
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Affiliation(s)
- Craig Labbate
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Solomon Woldu
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Katie Murray
- Department of Surgery, University of Missouri, Columbus, Missouri
| | - Kyle Rose
- Department of Urology, Moffitt Cancer Center, Tampa, Florida
| | - Wade Sexton
- Department of Urology, Moffitt Cancer Center, Tampa, Florida
| | - Isamu Tachibana
- Department of Urology, Indiana University Medical Center, Indianapolis, Indiana
| | | | - Joseph Jacob
- State University of New York Upstate Medical Center, Syracuse, New York
| | - Rian Dickstein
- University of Maryland Medical Center, Baltimore, Maryland
- Chesapeake Urology, Baltimore, Maryland
| | | | - Alan Nieder
- Mount Sinai Medical Center, Miami Beach, Florida
| | - Marc Bjurlin
- University of North Carolina Medical Center, Chapel Hill, North Carolina
| | | | | | - Marcus Quek
- Loyola University Medical Center, Maywood, Illinois
| | | | - Brian Eisner
- Massachusetts General Hospital, Boston, Massachusetts
| | - Adam Feldman
- Massachusetts General Hospital, Boston, Massachusetts
| | - Yair Lotan
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Surena F Matin
- University of Texas MD Anderson Cancer Center, Houston, Texas
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Woldu SL, Labbate C, Murray KS, Rose K, Sexton W, Tachibana I, Kaimakliotis H, Jacob J, Dickstein R, Linehan J, Nieder A, Bjurlin MA, Humphreys M, Ghodoussipour S, Quek ML, O'Donnell M, Eisner BH, Feldman AS, Matin SF, Lotan Y. Early experience with UGN-101 for the treatment of upper tract urothelial cancer - A multicenter evaluation of practice patterns and outcomes. Urol Oncol 2023; 41:147.e15-147.e21. [PMID: 36424224 DOI: 10.1016/j.urolonc.2022.10.029] [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: 07/11/2022] [Revised: 09/28/2022] [Accepted: 10/30/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND UGN-101 is a novel delivery system for intracavitary treatment of upper tract urothelial cancer (UTUC). UGN-101 was approved based on a pivotal trial for small volume residual low-grade UTUC. Our aim was to report our experience with UGN-101 in a more heterogenous and real-world setting. METHODS We performed a retrospective review of all UGN-101 cases from 15 institutions with a focus on practice patterns, efficacy, and adverse effects. We include UGN-101 utilization in both the chemoablative and adjuvant setting. RESULTS There were a total 136 renal units treated from 132 patients. The majority of cases were biopsy proven low-grade UTUC. Practice patterns varied considerably - the most common administration technique was antegrade instillation via a percutaneous nephrostomy. When utilized in the adjuvant setting, 69% of patients were disease free at the time of their first endoscopic evaluation, while in the chemoablative setting, 37% were endoscopically clear on the first evaluation (P < 0.001). Complete response was higher in patients with smaller tumor size prior to UGN-101 induction; low volume (<1 cm) residual disease was associated with a 70% complete response, similar to disease free rate at first endoscopic evaluation when UGN-101 was used in the adjuvant setting. The use of maintenance doses of UGN-101 was reported in 27% of cases. The overall incidence of new onset, clinically significant ureteral stenosis was 23%. CONCLUSIONS This study represents the largest review of patients treated with UGN-101 and can serve as a basis of ongoing hypotheses regarding treatment with UGN-101 for UTUC.
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Affiliation(s)
| | - Craig Labbate
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | - Joseph Jacob
- State University of New York Upstate Medical Center, Syracuse, NY
| | - Rian Dickstein
- University of Maryland Medical Center, Baltimore, MD; Chesapeake Urology, Baltimore, MD
| | | | | | - Marc A Bjurlin
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | | | | | | | | | | | - Surena F Matin
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yair Lotan
- University of Texas Southwestern Medical Center, Dallas, TX.
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Babajide R, Labbate C, Saoud R, Agarwal PK. Early Experience with Intravesical Gemcitabine-Docetaxel for BCG-Naïve Patients with High Grade Non-Muscle Invasive Bladder Cancer. Urol Oncol 2020. [DOI: 10.1016/j.urolonc.2020.10.038] [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: 10/22/2022]
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Adamic B, Kirkire L, Andolfi C, Labbate C, Aizen J, Gundeti M. Robot‐assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy in children: Step‐by‐step and modifications to UChicago technique. BJUI Compass 2020; 1:32-40. [PMID: 35474913 PMCID: PMC8988522 DOI: 10.1002/bco2.7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/12/2020] [Accepted: 01/12/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Brittany Adamic
- Pediatric Urology Section of Urology Department of Surgery Comer Children's Hospital The University of Chicago Pritzker School of Medicine Chicago IL USA
| | - Lakshmi Kirkire
- The University of Chicago Pritzker School of Medicine Chicago IL USA
| | - Ciro Andolfi
- Pediatric Urology Section of Urology Department of Surgery Comer Children's Hospital The University of Chicago Pritzker School of Medicine Chicago IL USA
| | - Craig Labbate
- Pediatric Urology Section of Urology Department of Surgery Comer Children's Hospital The University of Chicago Pritzker School of Medicine Chicago IL USA
| | - Joshua Aizen
- Pediatric Urology Section of Urology Department of Surgery Comer Children's Hospital The University of Chicago Pritzker School of Medicine Chicago IL USA
| | - Mohan Gundeti
- Pediatric Urology Section of Urology Department of Surgery Comer Children's Hospital The University of Chicago Pritzker School of Medicine Chicago IL USA
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Na R, Labbate C, Yu H, Shi Z, Fantus RJ, Wang CH, Andriole GL, Isaacs WB, Zheng SL, Helfand BT, Xu J. Single-Nucleotide Polymorphism-Based Genetic Risk Score and Patient Age at Prostate Cancer Diagnosis. JAMA Netw Open 2019; 2:e1918145. [PMID: 31880795 PMCID: PMC6991229 DOI: 10.1001/jamanetworkopen.2019.18145] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE Few studies have evaluated the association between a single-nucleotide polymorphism-based genetic risk score (GRS) and patient age at prostate cancer (PCa) diagnosis. OBJECTIVES To test the association between a GRS and patient age at PCa diagnosis and to compare the performance of a GRS with that of family history (FH) in PCa risk stratification. DESIGN, SETTING, AND PARTICIPANTS A cohort study of 3225 white men was conducted as a secondary analysis of the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) chemoprevention trial, a 4-year, randomized, double-blind, placebo-controlled multicenter study conducted from March 2003 to April 2009 to evaluate the safety and efficacy of dutasteride in reducing PCa events. Participants were confirmed to be cancer free by prostate biopsy (6-12 cores) within 6 months prior to the study and underwent 10 core biopsies every 2 years per protocol. The dates for performing data analysis were from July 2016 to October 2019. INTERVENTIONS A well-established, population-standardized GRS was calculated for each participant based on 110 known PCa risk-associated single-nucleotide polymorphisms, which is a relative risk compared with the general population. Men were classified into 3 GRS risk groups based on predetermined cutoff values: low (<0.50), average (0.50-1.49), and high (≥1.50). MAIN OUTCOMES AND MEASURES Prostate cancer diagnosis-free survival among men of different risk groups. RESULTS Among 3225 men (median age, 63 years [interquartile range, 58-67 years]) in the study, 683 (21%) were classified as low risk, 1937 (60%) as average risk, and 605 (19%) as high risk based on GRS alone. In comparison, 2789 (86%) were classified as low or average risk and 436 (14%) as high risk based on FH alone. Men in higher GRS risk groups had a PCa diagnosis-free survival rate that was worse than that of those in the lower GRS risk group (χ2 = 53.3; P < .001 for trend) and in participants with a negative FH of PCa (χ2 = 45.5; P < .001 for trend). Combining GRS and FH further stratified overall genetic risk, indicating that 957 men (30%) were at high genetic risk (either high GRS or positive FH), 1667 men (52%) were at average genetic risk (average GRS and negative FH), and 601 men (19%) were at low genetic risk (low GRS and negative FH). The median PCa diagnosis-free survival was 74 years (95% CI, 73-75 years) for men at high genetic risk, 77 years (95% CI, 75 to >80 years) for men at average genetic risk, and more than 80 years (95% CI, >80 to >80 years) for men at low genetic risk. In contrast, the median PCa diagnosis-free survival was 73 years (95% CI, 71-76 years) for men with a positive FH and 77 years (95% CI, 76-79 years) for men with a negative FH. CONCLUSIONS AND RELEVANCE This study suggests that a GRS is significantly associated with patient age at PCa diagnosis. Combining FH and GRS may better stratify inherited risk than FH alone for developing personalized PCa screening strategies.
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Affiliation(s)
- Rong Na
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
- Huashan Hospital, Fudan Institute of Urology, Fudan University, Shanghai, China
- Ruijin Hospital, Department of Urology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Craig Labbate
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
- Section of Urology, University of Chicago Medicine, Chicago, Illinois
| | - Hongjie Yu
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
| | - Zhuqing Shi
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
| | - Richard J. Fantus
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
- Section of Urology, University of Chicago Medicine, Chicago, Illinois
| | - Chi-Hsiung Wang
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
| | - Gerald L. Andriole
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - William B. Isaacs
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - S. Lilly Zheng
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
| | - Brian T. Helfand
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
| | - Jianfeng Xu
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois
- Huashan Hospital, Fudan Institute of Urology, Fudan University, Shanghai, China
- Section of Urology, University of Chicago Medicine, Chicago, Illinois
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Labbate C, Hatogai K, Werntz R, Stadler WM, Steinberg GD, Eggener S, Sweis RF. Complete response of renal cell carcinoma vena cava tumor thrombus to neoadjuvant immunotherapy. J Immunother Cancer 2019; 7:66. [PMID: 30857555 PMCID: PMC6413449 DOI: 10.1186/s40425-019-0546-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/22/2019] [Indexed: 12/13/2022] Open
Abstract
Background Clinically localized renal cell carcinoma is treated primarily with surgery followed by observation or adjuvant sunitinib in selected high-risk patients. The checkpoint inhibitor immunotherapeutic agents nivolumab and ipilimumab have recently shown a survival benefit in the first-line metastatic setting. To date, there have been no reports on the response of localized renal cancer to modern immunotherapy. We report a remarkable response of an advanced tumor thrombus to combined immunotherapy which facilitated curative-intent resection of the non-responding primary renal tumor. We characterized the tumor microenvironment within the responding and non-responding tumors. Case presentation A 54-year-old female was diagnosed with a locally advanced clear cell renal cell carcinoma with a level IV tumor thrombus of the vena cava. She was initially deemed unfit for surgical resection due to poor performance status. She underwent neoadjuvant immunotherapy with nivolumab and ipilimumab with a complete response of the vena cava and renal vein tumor thrombus, but had stable disease within her renal mass. She underwent complete surgical resection with negative margins and remains disease-free longer than 1 year after her diagnosis with no further systemic therapy. Notably, pathologic analysis showed a complete response within the vena cava and renal vein, but substantial viable cancer remained in the kidney. Multichannel immunofluorescence was performed and showed marked infiltration of immune cells including CD8+ T cells and Batf3+ dendritic cells in the thrombus, while the residual renal tumor showed a non-T cell-inflamed phenotype. Conclusions Preoperative immunotherapy with nivolumab and ipilimumab for locally advanced clear cell renal cancer resulted in a complete response of an extensive vena cava tumor thrombus, which enabled curative-intent resection of a non-responding primary tumor. If validated in larger cohorts, preoperative immunotherapy for locally advanced renal cell carcinoma may ultimately impact surgical planning and long-term prognosis.
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Affiliation(s)
- Craig Labbate
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Ken Hatogai
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Ryan Werntz
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Walter M Stadler
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Gary D Steinberg
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Scott Eggener
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Randy F Sweis
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA.
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Riedinger CB, Labbate C, Werntz RP, Eggener SE. Late Relapse of Nonseminomatous Germ Cell Tumor 24 Years Later. Urology 2018; 122:16-18. [PMID: 30170087 DOI: 10.1016/j.urology.2018.08.014] [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] [Received: 06/16/2018] [Revised: 08/07/2018] [Accepted: 08/14/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - Craig Labbate
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL
| | - Ryan P Werntz
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL
| | - Scott E Eggener
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL
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Abstract
Cigarette smoking is a leading cause of preventable morbidity and mortality in the United States. Although public policies have resulted in a decreased number of new smokers, smoking rates remain stubbornly high in certain demographics with 20% of all American middle-aged men smoking. In addition to the well-established harmful effects of smoking (i.e. coronary artery disease and lung cancer), the past three decades have led to a compendium of evidence being compiled into the development of a relationship between cigarette smoking and erectile dysfunction. The main physiologic mechanism that appears to be affected includes the nitric oxide signal transduction pathway. This review details the recent literature linking cigarette smoking to erectile dysfunction, epidemiological associations, dose dependency and the effects of smoking cessation on improving erectile quality.
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Affiliation(s)
| | - C Labbate
- Department of Urology and The Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - R Ramasamy
- Department of Urology and The Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - D Tang
- Department of Urology and The Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - L I Lipshultz
- Department of Urology and The Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
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Unal R, Yao-Borengasser A, Varma V, Rasouli N, Labbate C, Kern PA, Ranganathan G. Matrix metalloproteinase-9 is increased in obese subjects and decreases in response to pioglitazone. J Clin Endocrinol Metab 2010; 95:2993-3001. [PMID: 20392866 PMCID: PMC2902064 DOI: 10.1210/jc.2009-2623] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
CONTEXT The study investigated the regulation of matrix metalloproteinases (MMP)-9 in obesity-associated insulin resistance in humans. OBJECTIVES The objectives of the investigation were to study MMP-9 regulation by insulin resistance and pioglitazone treatment in impaired glucose tolerant subjects using adipose tissue biopsies and study the mechanism of MMP-9 regulation by pioglitazone in adipocyte cultures. RESEARCH DESIGN 86 nondiabetic, weight-stable subjects between 21 and 66 yr of age were recruited in a university hospital research center setting. All subjects underwent a sc adipose tissue incisional biopsy from the lower abdominal wall and insulin sensitivity testing using a frequently sampled iv glucose tolerance test. Impaired glucose-tolerant subjects were randomized to receive metformin or pioglitazone for 10 wk. To study the mechanism of MMP-9 regulation in adipocytes, cells were treated with pioglitazone or protein kinase C alpha antisense oligomers, and MMP-9 levels were examined. RESULTS There was a positive correlation between MMP-9 and body mass index (r = 0.40, P < 0.01) and negative correlation between MMP-9 and insulin sensitivity (r = -0.46, P < 0.001). The improvement in insulin sensitivity from pioglitazone resulted in a 52 +/- 0.2% reduction in MMP-9 mRNA. Fractionation of adipose tissue indicated that MMP-9 was mostly in the stromal vascular fraction. Pioglitazone also decreased MMP-9 in 3T3-F442A adipocytes and THP1 macrophages. Coculture of adipocytes with macrophages augmented MMP-9 expression in adipocytes and pioglitazone decreased MMP-9 in both adipocytes and macrophages. CONCLUSION These data indicate that MMP-9 is elevated in insulin resistance and is reduced by pioglitazone.
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Affiliation(s)
- Resat Unal
- Division of Endocrinology, Department of Medicine, University of Kentucky, and Barnstable Brown Diabetes and Obesity Center, Lexington, Kentucky 40536, USA
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Unal R, Yao-Borengasser A, Varma V, Rasouli N, Labbate C, Kern PA, Ranganathan G. Matrix Metalloproteinase-9 Is Increased in Obese Subjects and Decreases in Response to Pioglitazone. Mol Endocrinol 2010. [DOI: 10.1210/mend.24.5.9997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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