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Kim AH, Ruel NH, Yamzon J, Zhumkhawala AA, Lau CS, Yuh BE, Chan KG. Indiana Pouch Continent Cutaneous Urinary Diversion After Robotic-assisted Radical Cystectomy: A 16-Year Experience. Urology 2024; 183:e325-e327. [PMID: 37951362 DOI: 10.1016/j.urology.2023.10.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/15/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Population-based practice patterns in the United States reveal continent diversions are only performed in 8%-10.4% of patients.1-4 Ideally, for patients undergoing radical cystectomy the choice of urinary diversion should be influenced by clinical factors and patient preference, with discussions surrounding quality of life. Unfortunately, receipt of continent diversion has been shown to be influenced by a plethora of other factors such as surgeon preference/training, geography, socioeconomic status, gender, and hospital volume.1-3 Thus, by providing detailed instruction and long-term follow-up, we hope to mitigate some of these disparities by changing the perceptions regarding feasibility and complications of continent diversions. OBJECTIVE To provide step-by-step instruction and to report long-term clinical outcomes in bladder cancer patients receiving an Indiana pouch continent cutaneous urinary diversion (CCUD) after robot-assisted radical cystectomy. DESIGN, SETTING, AND PARTICIPANTS After Institutional Review Board approval, a prospectively maintained bladder cancer database was queried for patients with T1-T4, N0-N1, M0 bladder cancer undergoing radical cystectomy with CCUD at a tertiary referral center from 2004 to 2020. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Complications at 30- and 90-day were recorded according to the Clavien-Dindo classification. Continence rates were recorded by chart review. RESULTS AND LIMITATIONS A total of 97 patients were included with a median follow-up of 93months. Clinically, 91.8% had ≤T2 disease and 29.9% received neoadjuvant chemotherapy. The median length of surgery was 8.0 hours, length of hospital stay was 8.3days, and urinary continence rate was 99.0%. The overall complication rate was 73.2% and 76.5% at 30- and 90-day, respectively. The major complication rate (Clavien III-V) was 17.5% at 30-day and 22.7% at 90-day. The most common major complications were abdominal infection and uretero-colonic stricture. The readmission rate was 21.4% and median overall survival was 108months. CONCLUSION CCUD provides exceptional functional outcomes with acceptable complication rates compared to other diversion types. CCUD is a reliable reconstructive option and with this step-by-step video as a reference, we hope it will be offered to more patients.
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Affiliation(s)
- Albert H Kim
- Louis Stokes Cleveland Veterans Affairs Medical Center, Urology Section, Cleveland, OH
| | - Nora H Ruel
- City of Hope National Medical Center, Division of Biostatistics, Department of Computational and Biostatistics, Duarte, CA
| | - Jonathan Yamzon
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Duarte, CA
| | - Ali-Ashgar Zhumkhawala
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Duarte, CA
| | - Clayton S Lau
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Duarte, CA
| | - Bertram E Yuh
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Duarte, CA
| | - Kevin G Chan
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Duarte, CA.
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Lugo Santiago N, Han ES, Raoof M, Wu X, Cho H, Lee S, Lin WC, Lin JFH, Stewart DB, Ruel NH, Wang EW, Paz IB, Wakabayashi MT, Rodriguez-Rodriguez L, Cristea MC, Dellinger TH. Cisplatin-induced nephrotoxicity in hyperthermic intraperitoneal chemotherapy (HIPEC) is mitigated by sodium thiosulfate: Clinical and toxicotranscriptomic results of a prospective trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
5570 Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin confers a survival benefit in epithelial ovarian cancer (EOC). Unfortunately, cisplatin is associated with significant renal toxicities. Sodium thiosulfate (ST) has been suggested as a nephroprotectant for patients undergoing HIPEC with cisplatin. Methods: A feasibility trial ( ClinicalTrials.gov: NCT01970722) evaluated safety outcomes of HIPEC with cisplatin 75 mg/m2 during optimal cytoreductive surgery (CRS) in patients with EOC and endometrial cancer (n = 40), with or without ST. Twenty-one patients received no sodium-thiosulfate (nST group), and nineteen patients received sodium thiosulfate (ST group). Toxicities were reported according to CTCAE v. 5. Progression-free survival was followed. Normal tissue biopsies were collected intra-operatively immediately following HIPEC and cisplatin exposure in a subset of patients (n = 21), and profiled with transcriptomic sequencing to identify RNAseq signatures correlating with toxicities. Hierarchical cluster analyses identified distinct transcriptomic signatures in post-HIPEC normal samples of patients with renal AEs (rAEs) compared to no renal AEs (nrAEs). KEGG pathway analysis identified up- or downregulated gene sets using GSEA. Results: Forty patients had HIPEC at time of optimal CRS. Renal toxicities were higher in the nST group (no sodium thiosulfate) compared to the ST group. nST patients had 17% any grade, and 9% Grade 3 AEs for acute and chronic kidney injuries. In contrast, ST patients suffered 0% renal AEs. rAE patients demonstrated upregulation of immune signaling pathways (Toll-like receptor, Natural killer cell, Nod-like receptor); and downregulation of metabolic pathways. Top upregulated genes in rAE patients included immune (e.g. neutrophil) related genes, while downregulated genes included metabolism genes. Kaplan-Meier curves demonstrated improved PFS in primary ovarian cancer patients undergoing HIPEC who were treated with ST vs no ST (p = 0.04, NR vs 13.4 mo). Conclusions: HIPEC with cisplatin results in significant renal toxicities. The mechanisms of cisplatin-induced nephrotoxicity in HIPEC are immune-related and reflect reduced metabolism. Sodium thiosulfate abrogated renal toxicities and did not decrease PFS. Clinical trial information: NCT01970722.
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Affiliation(s)
| | | | - Mustafa Raoof
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Xiwei Wu
- City of Hope Beckman Research Institute, Duarte, CA
| | - Hyejin Cho
- City of Hope National Medical Center, Duarte, CA
| | - Stephen Lee
- City of Hope National Medical Center, Duarte, CA
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Villarreal-Garza C, Ferrigno AS, Aranda-Gutierrez A, Frankel PH, Ruel NH, Fonseca A, Narod S, Chavarri-Guerra Y, Sifuentes E, Magallanes-Hoyos MC, Herzog J, Castillo D, Alvarez-Gomez RM, Mohar-Betancourt A, Weitzel JN. Influence of germline BRCA genotype on the survival of patients with triple-negative breast cancer. Cancer Res Commun 2021; 1:140-147. [PMID: 35875314 PMCID: PMC9307147 DOI: 10.1158/2767-9764.crc-21-0099] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
The presence of BRCA pathogenic variants (PVs) in triple-negative breast cancer (TNBC) is associated with a distinctive genomic profile that makes the tumor particularly susceptible to DNA-damaging treatments. However, patients with BRCA PVs can develop treatment resistance through the appearance of reversion mutations and restored BRCA expression. As copy-number variants (CNV) could be less susceptible to reversion mutations than point mutations, we hypothesize that carriers of BRCA CNVs may have improved survival after treatment compared to carriers of other BRCA PVs or BRCA wild-type. Women diagnosed with stage I-III TNBC at ≤50 years at a cancer center in Mexico City were screened for BRCA PVs using a recurrent PV assay (HISPANEL; 77% sensitivity). The recurrence-free (RFS) and overall survival (OS) were compared according to mutational status. Among 180 women, 17 (9%) were carriers of BRCA1 ex9-12del CNV and 26 (14%) of other BRCA PVs. RFS at ten years for the whole cohort was 79.2% (95% CI 72.3-84.6%), with no significant differences according to mutational status. 10-year OS for the entire cohort was 85.3% (95%CI: 78.7-90.0%), with BRCA CNV carriers demonstrating numerically superior OS rates other PV carriers and non-carriers (100% vs. 78.6% and 84.7%; log-rank p=0.037 and p=0.051, respectively). This study suggests that BRCA1 ex9-12del CNV carriers with TNBC may have a better OS, and supports the hypothesis that the genotype of BRCA PVs may influence survival by limiting treatment resistance mediated by reversion mutations among CNV carriers.
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Affiliation(s)
- Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico.,Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Ana S. Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | | | | | | | - Alan Fonseca
- Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Steven Narod
- Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Yanin Chavarri-Guerra
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | | | - Jeffrey N. Weitzel
- Latin American School of Oncology, Sierra Madre, California.,Corresponding Author: Jeffrey N. Weitzel, Latin American School of Oncology, 578 Acacia Street, Sierra Madre, CA 91024. Phone: 626-233-9713; E-mail:
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Mian A, Pachorek M, Sam AP, Ruel NH, Yang D, Kohler TS, Warner JN. Predictors of Storage Symptom Improvement After Plasma Kinetic Enucleation of the Prostate. Urology 2021; 160:182-186. [PMID: 34813839 DOI: 10.1016/j.urology.2021.11.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/21/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate which preoperative findings portend poor improvement in storage symptoms in patients undergoing plasma kinetic enucleation of prostate (PKEP). METHODS A single surgeon series of patients who had undergone PKEP with minimum 1 year follow up were evaluated. Patients were grouped into those with less than 33% improvement in storage symptoms (LIS) according to the international prostate symptom score (IPSS) and those with greater than 33% improvement in storage symptoms (GIS). Pre and postoperative factors were evaluated, along with IPSS, storage symptoms percentage (the total from frequency, urgency and nocturia divided by the total IPSS), bother index, and post void residual (PVR) at 6 weeks, 4 months, and yearly. RESULTS Two hundred sixty-eight patients had a minimum 1 year of follow up and had completed the IPSS. IPSS and bother index improved significantly from preoperatively to all time points post operatively in both groups, but the difference was greater in the GIS group. Patients in the GIS group had significantly larger prostates, more prostatic ingrowth, higher preoperative PVR, and a higher overall IPSS compared to the LIS group. Those in the LIS group had a higher incidence of prior prostate surgery, and a higher BMI. However, storage symptom percentages were equal between the GIS and LIS groups at all time points. CONCLUSION Greater prostatic ingrowth, larger prostate volume, higher preoperative PVR volume, and a higher overall IPSS was associated with greater improvement in storage symptoms. Prior prostate surgery and higher BMI portend less improvement in storage symptoms.
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Affiliation(s)
| | | | | | - Nora H Ruel
- Department of Biostatistics, City of Hope National Medical Center, Duarte, CA
| | - David Yang
- Department of Surgery, Division of Urology, Mayo Clinic, Rochester, MN; Departemnt of Urology, Mayo Clinic, Rochester, MN
| | - Tobias S Kohler
- Department of Surgery, Division of Urology, City of Hope National Medical Center, Duarte, CA; Departemnt of Urology, Mayo Clinic, Rochester, MN
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Kim AH, Ruel NH, Yamzon J, Zhumkhawala AA, Lau CS, Yuh BE, Chan KG. Novel Antibiotic-Irrigating Wound Protector Reduces Infectious Complications in Robot-Assisted Radical Cystectomy with Extracorporeal Urinary Diversion. Urology 2021; 159:160-166. [PMID: 34678310 DOI: 10.1016/j.urology.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/30/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine whether use of an antibiotic-irrigating wound protector (AWP) reduces infectious complications after robotic radical cystectomy with extracorporeal urinary diversion (RCUD). METHODS A prospectively maintained bladder cancer database was queried for patients undergoing robotic RCUD at a tertiary referral center one year prior to implementing an AWP and one year after (2018-2020). All diversions were performed extra-corporally. 92 patients total. 46 consecutive patients using a traditional wound protector (TWP) and 46 consecutive with an AWP. Infections were classified as symptomatic urinary tract infection, blood stream infection, and surgical site infection. The incidence of infectious complications at 30- and 90-days were compared. RESULTS Baseline patient characteristics between the 2 groups showed no statistically significant differences. The overall complication rate was 65.2% in the TWP group and 26.1% in the AWP group at 30-days, and 67.4% vs 30.4% at 90-days. Focusing on infections, the 30-day complication rate was 30.4% in the TWP group compared to 6.5% in the AWP group (P =.003). This pattern persisted at 90-days with 37.0% in the TWP group compared to 6.5% in the AWP group (P =.004). Most complications were symptomatic UTI and blood stream infections, 14/24 (58%), requiring parenteral antibiotic treatment. CONCLUSION We provide preliminary data showing use of an AWP can reduce infectious complications after RCUD. While larger prospective studies are warranted, our findings are a significant step towards decreasing morbidity of an already highly morbid procedure.
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Affiliation(s)
- Albert H Kim
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Department of Surgery, Duarte, CA
| | - Nora H Ruel
- City of Hope National Medical Center, Division of Biostatistics, Department of Computational and Biostatistics, Duarte, CA
| | - Jonathan Yamzon
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Department of Surgery, Duarte, CA
| | - Ali-Ashgar Zhumkhawala
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Department of Surgery, Duarte, CA
| | - Clayton S Lau
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Department of Surgery, Duarte, CA
| | - Bertram E Yuh
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Department of Surgery, Duarte, CA
| | - Kevin G Chan
- City of Hope National Medical Center, Division of Urology and Urologic Oncology, Department of Surgery, Duarte, CA.
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Mazanec P, Ferrell B, Virani R, Alayu J, Ruel NH. Preparing New Graduate RNs to Provide Primary Palliative Care. J Contin Educ Nurs 2021; 51:280-286. [PMID: 32463902 DOI: 10.3928/00220124-20200514-08] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/18/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND More than 90 million Americans are struggling to live with serious illness and are in need of palliative and end-of-life care. Yet, many novice RNs have not been adequately prepared during their undergraduate programs to care for them. METHOD A large southwestern Magnet comprehensive cancer center piloted integrating the End-of-Life Nursing Education Consortium (ELNEC)-Undergraduate Curriculum into their nurse residency program during 2018 with 55 new RNs. RESULTS A pre-and posteducation evaluation questionnaire measured comfort with caring for patients with serious illness, competence, and knowledge in six areas of palliative care. All eight evaluation questions demonstrated statistically significant improvement posteducational intervention. Many nurse residents reported a change in clinical practice 1 month posteducation. CONCLUSION The nurse residency is an opportune training time to prepare novice nurses to provide primary palliative care for all patients with serious illness and their families. [J Contin Educ Nurs. 2020;51(6):280-286.].
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Cristea MC, Ruel NH, Frankel PH, Synold TW, Stewart DB, Wang EW, Jung A, Wilczynski S, Tran M, Konecny GE, Eng M, Kilpatrick L, Chen YJ, Glaser S, Dellinger TH, Hakim A, Lee S, Morgan R, Han ES. A phase I study of mirvetuximab soravtansine (MIRV) and gemcitabine (G) in patients (Pts) with selected frα-positive solid tumors: Results in the ovarian cancer (EC) cohort. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
5542 Background: Mirvetuximab soravtansine (MIRV) is an ADC comprising a FRα-binding antibody, cleavable linker, and the maytansinoid DM4, a potent tubulin-targeting agent. MIRV has promising single agent activity in FRα-positive medium/high expression epithelial ovarian cancer (EOC), at 6 mg/kg, based on adjusted ideal body weight (AIBW) IV every (q) 21 days. This study evaluated MIRV and G in recurrent EOC, endometrial and triple negative breast cancer. The recommended phase 2 dose (RP2D) was established at MIRV 6 mg/kg AIBW IV, day 1 and G 800 mg/m2 IV, d1, 8 q21 days (J Clin Oncol 37, 2019, Abs. #3009). Here we report the results from the EOC cohort. Methods: Patients (pts) with FRα-positive platinum resistant EOC with ≤4 prior chemotherapy (CT) regimens, were eligible. FRα positivity was initially defined as ≥ 25% of cells with PS2+ staining intensity (low to high FRα expression) and was subsequently revised to require medium/high FRα expression (≥50%/ ≥75% of cells with PS2+ staining intensity). Results: From 10/2017 to 12/2020, 113 EOC pts underwent FRα screening, with 74 FRα-positive results. Thirty total EOC pts (with median 3 prior lines of therapy) were treated; 8 pts during dose escalation and 22 EOC pts at the RP2D (all evaluable for response). Fifteen (50%) pts had high FRα, 10 pts (33%) medium FRα, and 5 pts (17%) low FRα expression. Eleven (36%) of the 30 EOC pts achieved a partial response (PR), 15 pts (50%) had SD and 4 pts (13%) progressed. Among the 11 responders, 5 pts had high FRα, 4 pts medium FRα and 2 pts low FRα expression. Non-heme clinically significant adverse events (AEs) included: G2 sensory neuropathy (4 pts) G3 diarrhea (3 pts), G3 fatigue (2 pts), G3 pneumonitis (2 pts), and 1 pt with G5 respiratory failure (secondary to pneumonia but drug-induced pneumonitis could not be ruled out). Conclusions: MIRV in combination with G has promising clinical activity in late line platinum resistant FRα-positive EOC, with best responses observed in high FRα expression. The regimen is well tolerated with expected AEs based on the known toxicities of each agent. This study was approved and funded by the National Comprehensive Cancer Network (NCCN) Oncology Research Program from general research support provided by ImmunoGen Corp and Cancer Center Support Grant P30CA033572. Clinical trial information: NCT02996825.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Melissa Eng
- City of Hope National Medical Center, Duarte, CA
| | | | | | - Scott Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | | | | | - Stephen Lee
- City of Hope National Medical Center, Duarte, CA
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Ferrell B, Chung V, Hughes MT, Koczywas M, Azad NS, Ruel NH, Knight L, Cooper RS, Smith TJ. A Palliative Care Intervention for Patients on Phase 1 Studies. J Palliat Med 2020; 24:846-856. [PMID: 33103938 DOI: 10.1089/jpm.2020.0597] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Phase 1 clinical trials remain vital for oncology care. Patients on these trials require supportive care for quality-of-life (QOL) concerns. Objective: To test a Palliative Care Intervention (PCI) for patients with solid tumors enrolled in Phase I therapeutic trials with a priori hypothesis that psychological distress, QOL, satisfaction, symptoms, and resource utilization would be improved in the PCI group. Design: This unblinded randomized trial compared the PCI with usual care in patients accrued to Phase I Clinical Trials. Subjects (n = 479) were followed for 24 weeks, with 12 weeks as the primary outcome. Setting: Two Comprehensive Cancer Centers in the United States. Subjects: A consecutive sample, 21 years or older, English fluency, with solid tumors initiating a Phase 1 trial. Measurements: Psychological Distress (Distress Thermometer), QOL total and subscales (FACT-G), satisfaction (FAM-CARE), survival, and resource utilization (chart audit). Results: PCI subjects showed improved Psychological Distress (-0.47, p = 0.015) and Emotional Well-Being (0.81, p = 0.045), with differences on variables of QOL and distress between sites. High rates of symptom-management admissions (41.3%) and low rates of Advance Directive completion (39.0%), and hospice enrollment (30.7%), despite a median survival in both groups of 10.1 months from initiating a Phase 1 study. Conclusions: A nurse-delivered PCI can improve some QOL outcomes and distress for patients participating in Phase 1 trials. Greater integration of PC is needed to provide quality care to these patients and to support transitions from treatment to supportive care, especially at the end of life. ClinicalTrials.gov Identifier: NCT01612598.
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Affiliation(s)
- Betty Ferrell
- Division of Nursing Research and Education, Beckman Research Institute, City of Hope National Medical Center, Duarte, California, USA
| | - Vincent Chung
- Department of Medical Oncology and Therapeutics Research, Beckman Research Institute, City of Hope National Medical Center, Duarte, California, USA
| | - Mark T Hughes
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Marianna Koczywas
- Department of Medical Oncology and Therapeutics Research, Beckman Research Institute, City of Hope National Medical Center, Duarte, California, USA
| | - Nilofer Saba Azad
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Nora H Ruel
- Department of Computational and Quantitative Medicine, Beckman Research Institute, City of Hope National Medical Center, Duarte, California, USA
| | - Louise Knight
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Rhonda S Cooper
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Thomas J Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
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Ferrell B, Chung V, Koczywas M, Borneman T, Irish TL, Ruel NH, Azad NS, Cooper RS, Smith TJ. Spirituality in cancer patients on phase 1 clinical trials. Psychooncology 2020; 29:1077-1083. [PMID: 32227382 DOI: 10.1002/pon.5380] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/05/2020] [Accepted: 03/17/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Patients with cancer who are at a transition to Phase I investigational treatments have been identified as an underserved population with regard to palliative care. This disease transition is often accompanied by spiritual and existential concerns. The study objective was to conduct a secondary analysis of data from a larger study testing a palliative care intervention. This paper reports the findings of this secondary focus on the spiritual needs of this population. METHODS Patients (n = 479) were accrued to this study prior to initiating a Phase I clinical trial with data collected at baseline, and 4, 12, and 24 week follow-up. RESULTS Qualitative data revealed that the transition to Phase 1 trial participation is a time of balancing hope for extended life with the reality of advancing disease. Quantitative results demonstrated increased spirituality over time in both religious- and non-religious-affiliated patients. CONCLUSIONS Patients entering Phase I trials have important spiritual needs as they face treatment decisions, advancing disease, and often mortality. Spiritual care should be provided to seriously ill patients as a component of quality care.
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Affiliation(s)
- Betty Ferrell
- Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, California, USA
| | - Vincent Chung
- Department of Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Marianna Koczywas
- Department of Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Tami Borneman
- Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, California, USA
| | - Terry L Irish
- City of Hope National Medical Center, Duarte, California, USA
| | - Nora H Ruel
- Beckman Research Institute, City of Hope National Medical Center, Duarte, California, USA
| | - Nilofer S Azad
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Rhonda S Cooper
- Chaplain of the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Thomas J Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
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Shen JK, Jamnagerwalla J, Yuh BE, Bassett MR, Chenam A, Warner JN, Zhumkhawala A, Yamzon JL, Whelan C, Ruel NH, Lau CS, Chan KG. Real-time indocyanine green angiography with the SPY fluorescence imaging platform decreases benign ureteroenteric strictures in urinary diversions performed during radical cystectomy. Ther Adv Urol 2019; 11:1756287219839631. [PMID: 31057669 PMCID: PMC6452578 DOI: 10.1177/1756287219839631] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 11/18/2018] [Accepted: 03/04/2019] [Indexed: 01/09/2023] Open
Abstract
Background Ischemia is thought to contribute to benign ureteroenteric stricture (UES) after radical cystectomy with urinary diversion (RCUD). Our institution adopted the use of ureteral perfusion assessment during all RCUDs using real-time indocyanine green angiography using the SPY fluorescence imaging platform (Stryker Corp., Kalamazoo, MI, USA). This guides the location of ureteral transection prior to ureteroenteric anastomosis. We sought to compare UES rates before and after adoption of SPY. Methods A retrospective chart review was undertaken for the first 47 consecutive cases of RCUD using SPY as well as the previous 47 consecutive cases, which were performed without SPY. Fisher's exact and Wilcoxon rank-sum tests were used to compare benign UES rates and the length of ureter excised during anastomosis. A p < 0.05 indicated statistical significance. Results Median follow up was 12.0 months for SPY cases and 24.3 months for non-SPY cases. The UES rate for SPY RCUDs was 0% (0/93 ureters) compared with 7.5% (7/93 ureters) for non-SPY RCUDs (p = 0.01). Amongst SPY RCUDs, 86 ureters had no hydronephrosis and 7 had mild hydronephrosis with reflux on loopogram. A total of 34.4% of ureters (32/93) had poor distal perfusion, requiring a more proximal anastomosis. The median length excised for ureters with poor distal perfusion was 3.8 cm, compared with 2.2 cm for ureters with good distal perfusion (p < 0.0001). No complications attributable to the use of SPY were noted. Conclusion Use of SPY to assess ureteral perfusion was associated with a decrease in the UES rate after RCUD. A total of 34.4% of ureters demonstrated poor distal perfusion, requiring a significantly more proximal ureteroenteric anastomosis.
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Affiliation(s)
- Jim K Shen
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Juzar Jamnagerwalla
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Bertram E Yuh
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Mitchell R Bassett
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Avinash Chenam
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Jonathan N Warner
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Ali Zhumkhawala
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Jonathan L Yamzon
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Christopher Whelan
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Nora H Ruel
- Department of Biostatistics, City of Hope National Medical Center, Duarte, CA, USA
| | - Clayton S Lau
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Kevin G Chan
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, 1500 East Duarte Road, MOB L002H, Duarte, CA 91010, USA
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Audenet F, Sfakianos JP, Waingankar N, Ruel NH, Galsky MD, Yuh BE, Gin GE. A delay ≥8 weeks to neoadjuvant chemotherapy before radical cystectomy increases the risk of upstaging. Urol Oncol 2019; 37:116-122. [DOI: 10.1016/j.urolonc.2018.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/08/2018] [Accepted: 11/11/2018] [Indexed: 11/26/2022]
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12
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Blenman KRM, He TF, Frankel PH, Ruel NH, Schwartz EJ, Krag DN, Tan LK, Yim JH, Mortimer JE, Yuan Y, Lee PP. Sentinel lymph node B cells can predict disease-free survival in breast cancer patients. NPJ Breast Cancer 2018; 4:28. [PMID: 30155518 PMCID: PMC6107630 DOI: 10.1038/s41523-018-0081-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 03/07/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 12/31/2022] Open
Abstract
Tumor invasion into draining lymph nodes, especially sentinel lymph nodes (SLNs), is a key determinant of prognosis and treatment in breast cancer as part of the TNM staging system. Using multicolor histology and quantitative image analysis, we quantified immune cells within SLNs from a discovery cohort of 76 breast cancer patients. We found statistically more in situ CD3+ T cells in tumor negative vs. tumor positive nodes (mean of 8878 vs. 6704, respectively, p = 0.006), but no statistical difference in CD20+ B cells or CD1a+ dendritic cells. In univariate analysis, a reduced hazard was seen with a unit increase in log CD3 with HR 0.49 (95% CI 0.30–0.80) and log CD20 with HR 0.37 (95% CI 0.22–0.62). In multivariate analysis, log CD20 remained significant with HR 0.42 (95% CI 0.25–0.69). When restricted to SLN tumor negative patients, increased log CD20 was still associated with improved DFS (HR = 0.26, 95% CI 0.08–0.90). The CD20 results were validated in a separate cohort of 21 patients (n = 11 good outcome, n = 10 poor outcome) with SLN negative triple-negative breast cancer (TNBC) (“good” mean of 7011 vs. “poor” mean of 4656, p = 0.002). Our study demonstrates that analysis of immune cells within SLNs, regardless of tumor invasion status, may provide additional prognostic information, and highlights B cells within SLNs as important in preventing future recurrence. B cells within the tumor-draining lymph nodes may have an important biological role in preventing relapse of breast cancer. A team led by Peter Lee from City of Hope in Duarte, California, USA, quantified the levels of three populations of immune cells—T cells, B cells and dendritic cells—within sentinel lymph nodes biopsied from a cohort of 76 patients. They found that larger numbers of T cells and B cells were both linked to longer progression-free survival in the women. However, after statistically accounting for correlations between the two immune cell types, the researchers concluded that B cells had the dominant beneficial effect on survival times. They validated the finding that high B-cell counts are a prognostic indicator of better outcomes in a separate cohort of 21 women with triple-negative breast cancer.
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Affiliation(s)
- Kim R M Blenman
- 1Department of Immuno-Oncology, City of Hope and Beckman Research Institute, Duarte, CA USA.,8Present Address: Department of Dermatology, Yale University, New Haven, CT USA
| | - Ting-Fang He
- 1Department of Immuno-Oncology, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Paul H Frankel
- 2Department of Biostatistics, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Nora H Ruel
- 2Department of Biostatistics, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Erich J Schwartz
- 3Department of Pathology, Stanford University, Stanford, CA USA.,9Present Address: Department of Pathology, Beaumont Health, Farmington Hills, MI USA
| | - David N Krag
- 4Department of Surgery, University of Vermont College of Medicine, Burlington, VT USA
| | - Lee K Tan
- 5Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - John H Yim
- 6Department of Surgery, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Joanne E Mortimer
- 7Department of Women's Health, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Yuan Yuan
- 7Department of Women's Health, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Peter P Lee
- 1Department of Immuno-Oncology, City of Hope and Beckman Research Institute, Duarte, CA USA
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13
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Gin GE, Ruel NH, Kardos SV, Sfakianos JP, Uchio E, Lau CS, Yuh BE. Utilization of perioperative systemic chemotherapy in upper tract urothelial carcinoma. Urol Oncol 2017; 35:192-200. [DOI: 10.1016/j.urolonc.2016.11.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 11/22/2016] [Accepted: 11/29/2016] [Indexed: 11/15/2022]
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14
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Gin GE, Ruel NH, Parihar JS, Warner JN, Yuh BE, Yamzon J, Wilson TG, Lau CS, Chan KG. Ureteroenteric anastomotic revision as initial management of stricture after urinary diversion. Int J Urol 2017; 24:390-395. [PMID: 28295645 DOI: 10.1111/iju.13323] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/31/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report our experience with ureteroenteric anastomotic revision as initial treatment of stricture after urinary diversion. METHODS An institutional review board-approved retrospective study was carried out. A total of 41 patients who underwent primary ureteroenteric anastamotic revision were identified between 2007 and 2015. Data analyzed included patient characteristics, type of diversion, estimated blood loss, operative time, change in renal function, length of stay, postoperative complications and time with nephrostomy/stent. Success of revision was defined as an improvement in hydronephrosis on radiographic imaging and/or reflux during pouchogram. Predictors of length of stay and complications were analyzed using analysis of covariance. RESULTS A total of 50 renal units were revised with a success rate of 100%. The median length of stay was 6 days (2-16 days). There were a total of 15 complications (one major, 14 minor) in 14 patients (33% 30-day complication rate). The most common were wound infection (n = 4) and arrhythmia (n = 4). Robotic revision (n = 5) had a median length of stay of 3 days (2-4) with no complications. CONCLUSIONS Primary ureteroenteric anastomotic revisions have an excellent success rate at an experienced center and might obviate the need for multiple interventions. Open revision is associated with mostly minor complications. Robotic revision might reduce the morbidity of open revision in select cases.
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Affiliation(s)
- Greg E Gin
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Nora H Ruel
- Division of Biostatistics, City of Hope National Medical Center, Duarte, California, USA
| | - Jaspreet S Parihar
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Jonathan N Warner
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Bertram E Yuh
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Jonathan Yamzon
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Timothy G Wilson
- Division of Urologic Oncology, Providence St. John's Health Center, Santa Monica, California, USA
| | - Clayton S Lau
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Kevin G Chan
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, California, USA
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Dumitra S, Sun V, Ruel NH, Lee B, Woo Y, Melstrom LG, Melstrom K, Sentovich S, Singh G, Fong Y. Wireless Real-Time Program Successfully Monitors Recovery after Major Abdominal Surgery. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.557] [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: 11/26/2022]
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16
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Wittenberg E, Ferrell B, Goldsmith J, Ruel NH. Family Caregiver Communication Tool: a new measure for tailoring communication with cancer caregivers. Psychooncology 2016; 26:1222-1224. [PMID: 27530695 DOI: 10.1002/pon.4251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/30/2016] [Accepted: 08/14/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Elaine Wittenberg
- Division of Nursing Research and Education, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Betty Ferrell
- Division of Nursing Research and Education, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Joy Goldsmith
- University of Memphis, Department of Communication, Memphis, TN, USA
| | - Nora H Ruel
- Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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Kardos SV, Chan KG, Yuh B, Yamzon J, Ruel NH, Zachariah F, Lau CS, Crocitto L. PD02-02 ENHANCED RECOVERY AFTER SURGERY AND CARE COORDINATION PATHWAY AT CITY OF HOPE: DECREASED LENGTH OF STAY, READMISSIONS, AND COMPLICATIONS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2076] [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: 10/22/2022]
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18
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Yuh B, Torrey RR, Ruel NH, Wittig K, Tobis S, Linehan J, Lau CS, Chan KG, Yamzon J, Wilson TG. Intermediate-Term Oncologic Outcomes of Robot-Assisted Radical Cystectomy for Urothelial Carcinoma. J Endourol 2014; 28:939-45. [DOI: 10.1089/end.2014.0073] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bertram Yuh
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Robert R. Torrey
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Nora H. Ruel
- Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Kristina Wittig
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Scott Tobis
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jennifer Linehan
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Clayton S. Lau
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Kevin G. Chan
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jonathan Yamzon
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Timothy G. Wilson
- Department of Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
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Yuh BE, Ruel NH, Mejia R, Novara G, Wilson TG. Standardized comparison of robot-assisted limited and extended pelvic lymphadenectomy for prostate cancer. BJU Int 2013; 112:81-8. [DOI: 10.1111/j.1464-410x.2012.11788.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Bertram E. Yuh
- Urology; City of Hope National Cancer Center; Duarte; CA; USA
| | - Nora H. Ruel
- Urology; City of Hope National Cancer Center; Duarte; CA; USA
| | - Rosa Mejia
- Urology; City of Hope National Cancer Center; Duarte; CA; USA
| | - Giacomo Novara
- Department of Surgical, Oncological and Gastroenterological Sciences, Urology Clinic; University of Padua; Padua; Italy
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20
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Pal SK, Ruel NH, Wilson TG, Yuh BE. Retrospective analysis of clinical outcomes with neoadjuvant cisplatin-based regimens for muscle-invasive bladder cancer. Clin Genitourin Cancer 2012; 10:246-50. [PMID: 22981208 DOI: 10.1016/j.clgc.2012.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 07/14/2012] [Accepted: 08/16/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND The benefit of neoadjuvant methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (MVAC) for muscle-invasive bladder cancer (MIBC) has been prospectively demonstrated in a phase III study. Extrapolating from comparative data in the metastatic setting, platinum doublets such as cisplatin-gemcitabine (CG) have been adopted. We sought to compare clinical outcomes in patients treated for MIBC with neoadjuvant CG and MVAC at our institution. PATIENTS AND METHODS Patients with MIBC were identified from a prospectively maintained registry. Clinicopathologic information and clinical outcome data were obtained directly from the registry. When available, pharmacy records were reviewed to ascertain the use of growth factors and chemotherapy dose intensity (DI). Survival was compared in subgroups divided by the regimen of chemotherapy rendered (ie, CG vs. MVAC) using the Kaplan-Meier method. RESULTS Median overall survival (OS) in the overall cohort (N = 61) was 23 months. OS was improved in patients receiving either MVAC or CG chemotherapy compared with patients receiving "other" chemotherapy (35.3 vs. 16.3 months; P = .055). Although the median OS associated with neoadjuvant CG numerically exceeded the survival associated with neoadjuvant MVAC (104.3 and 21.8 months, respectively), this was not statistically significant (P = .73). Pathologic downstaging predicted improved OS with both neoadjuvant CG and MVAC, and the rates of downstaging were similar with both regimens. CONCLUSIONS Although warranting prospective validation, our data suggest that CG is a possible alternative neoadjuvant approach to traditional regimens such as MVAC for patients with MIBC.
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Affiliation(s)
- Sumanta K Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
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Wu X, Weng L, Li X, Guo C, Pal SK, Jin JM, Li Y, Nelson RA, Mu B, Onami SH, Wu JJ, Ruel NH, Wilczynski SP, Gao H, Covarrubias M, Figlin RA, Weiss LM, Wu H. Identification of a 4-microRNA signature for clear cell renal cell carcinoma metastasis and prognosis. PLoS One 2012; 7:e35661. [PMID: 22623952 PMCID: PMC3356334 DOI: 10.1371/journal.pone.0035661] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 03/18/2012] [Indexed: 01/01/2023] Open
Abstract
Renal cell carcinoma (RCC) metastasis portends a poor prognosis and cannot be reliably predicted. Early determination of the metastatic potential of RCC may help guide proper treatment. We analyzed microRNA (miRNA) expression in clear cell RCC (ccRCC) for the purpose of developing a miRNA expression signature to determine the risk of metastasis and prognosis. We used the microarray technology to profile miRNA expression of 78 benign kidney and ccRCC samples. Using 28 localized and metastatic ccRCC specimens as the training cohort and the univariate logistic regression and risk score methods, we developed a miRNA signature model in which the expression levels of miR-10b, miR-139-5p, miR-130b and miR-199b-5p were used to determine the status of ccRCC metastasis. We validated the signature in an independent 40-sample testing cohort of different stages of primary ccRCCs using the microarray data. Within the testing cohort patients who had at least 5 years follow-up if no metastasis developed, the signature showed a high sensitivity and specificity. The risk status was proven to be associated with the cancer-specific survival. Using the most stably expressed miRNA among benign and tumorous kidney tissue as the internal reference for normalization, we successfully converted his signature to be a quantitative PCR (qPCR)-based assay, which showed the same high sensitivity and specificity. The 4-miRNA is associated with ccRCC metastasis and prognosis. The signature is ready for and will benefit from further large clinical cohort validation and has the potential for clinical application.
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Affiliation(s)
- Xiwei Wu
- Department of Molecular Medicine, City of Hope National Medical Center and Beckman Research Institute, Duarte, California, United States of America
| | - Lihong Weng
- Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, California, United States of America
| | - Xuejun Li
- Department of Information Sciences, City of Hope National Medical Center and Beckman Research Institute, Duarte, California, United States of America
| | - Chao Guo
- Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, California, United States of America
| | - Sumanta K. Pal
- Department of Medical Oncology and Experimental Therapeutics, City of Hope National Medical Center and Beckman Research Institute, Duarte, California, United States of America
| | - Jennifer M. Jin
- Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, California, United States of America
| | - Yuping Li
- Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, California, United States of America
| | - Rebecca A. Nelson
- Department of Information Sciences, City of Hope National Medical Center and Beckman Research Institute, Duarte, California, United States of America
| | - Bing Mu
- Department of Information Sciences, City of Hope National Medical Center and Beckman Research Institute, Duarte, California, United States of America
| | - Susan H. Onami
- Department of Medical Oncology and Experimental Therapeutics, City of Hope National Medical Center and Beckman Research Institute, Duarte, California, United States of America
| | - Jeffrey J. Wu
- Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, California, United States of America
| | - Nora H. Ruel
- Department of Information Sciences, City of Hope National Medical Center and Beckman Research Institute, Duarte, California, United States of America
| | - Sharon P. Wilczynski
- Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, California, United States of America
| | - Hanlin Gao
- Department of Cancer Biology, City of Hope National Medical Center and Beckman Research Institute, Duarte, California, United States of America
| | - Maricela Covarrubias
- Department of Molecular Medicine, City of Hope National Medical Center and Beckman Research Institute, Duarte, California, United States of America
| | - Robert A. Figlin
- Department of Medical Oncology and Experimental Therapeutics, City of Hope National Medical Center and Beckman Research Institute, Duarte, California, United States of America
| | - Lawrence M. Weiss
- Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, California, United States of America
| | - Huiqing Wu
- Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, California, United States of America
- * E-mail:
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Talug C, Josephson DY, Ruel NH, Lau C, Kawachi MH, Wilson TG. Controlling the dorsal venous complex during robotic prostatectomy. Can J Urol 2012; 19:6147-6154. [PMID: 22316521] [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: 05/31/2023]
Abstract
INTRODUCTION The objective of our study was to determine whether dorsal venous complex (DVC) control technique influences positive apical margins following robotic assisted laparoscopic radical prostatectomy (RALRP). MATERIALS AND METHODS One thousand fifty-eight patients who underwent RALRP at City of Hope from June 2007 to October 2009 were assessed. Endoscopic stapling and suture ligature of the DVC were compared. Positive apical margins were identified and compared based on DVC-control technique. Recurrence probability was estimated using the Kaplan-Meier method, and logistic regression analysis was used to predict the odds of positive apical margins. RESULTS Of 1058 patients, 633 (60%) underwent endoscopic stapling, and 425 (40%) had suture ligature. The groups had similar baseline characteristics including age and body mass index. We observed a statistically different PSA (5.4 ng/mL versus 5.2 ng/mL, p = 0.03) and operative time (2.8 hours versus 2.7 hours, p = 0.02) between stapling and suture groups, but the actual difference was small. Operative time, Gleason score, pathologic stage, and overall positive margin rates were not significantly different between groups. Positive apical margins were observed in 39 (6%) and 27 (6%) patients in the staple and suture groups, respectively. Multivariate analysis showed that the positive apical margin rate was greater in patients with higher pathologic stage and final pathological Gleason score. CONCLUSIONS During RALRP, there is no difference in positive apical margin rate when the DVC is controlled using either endoscopic stapling or suture ligature. However, patients with a higher pathologic stage and final pathologic Gleason score are at higher risk for positive apical surgical margins.
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Affiliation(s)
- Can Talug
- Department of Urology, City of Hope, Duarte, California 91010, USA
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23
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Lau CS, Talug J, Williams SB, Josephson DY, Ruel NH, Chan KG, Wilson TG. Robotic-assisted laparoscopic radical cystectomy in the octogenarian. Int J Med Robot 2012; 8:247-52. [DOI: 10.1002/rcs.460] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2011] [Indexed: 01/22/2023]
Affiliation(s)
- Clayton S. Lau
- Department of Urology, Division of Urologic Oncology; City of Hope Comprehensive Cancer Center
| | - John Talug
- Department of Urology, Division of Urologic Oncology; City of Hope Comprehensive Cancer Center
| | - Stephen B. Williams
- Associated Urologists of Orange County, Division of Urologic Oncology; The Center for Cancer Prevention and Treatment at St. Joseph Hospital
| | - David Y. Josephson
- Department of Urology, Division of Urologic Oncology; City of Hope Comprehensive Cancer Center
| | - Nora H. Ruel
- Department of Biostatistics; City of Hope Comprehensive Cancer Center
| | - Kevin G. Chan
- Department of Urology, Division of Urologic Oncology; City of Hope Comprehensive Cancer Center
| | - Timothy G. Wilson
- Department of Urology, Division of Urologic Oncology; City of Hope Comprehensive Cancer Center
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Kenanova V, Olafsen T, Williams LE, Ruel NH, Longmate J, Yazaki PJ, Shively JE, Colcher D, Raubitschek AA, Wu AM. Radioiodinated versus radiometal-labeled anti-carcinoembryonic antigen single-chain Fv-Fc antibody fragments: optimal pharmacokinetics for therapy. Cancer Res 2007; 67:718-26. [PMID: 17234783 DOI: 10.1158/0008-5472.can-06-0454] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antibody fragments with optimized pharmacokinetic profiles hold potential for detection and therapy of tumor malignancies. We studied the behavior of three anti-carcinoembryonic antigen (CEA) single-chain Fv-Fc (scFv-Fc) variants (I253A, H310A, and H310A/H435Q; Kabat numbering system) that exhibited differential serum persistence. Biodistribution studies done on CEA-positive tumor xenografted mice revealed that the 111In-labeled I253A fragment with the slowest clearance kinetics (T1/2beta, 27.7 h) achieved the highest tumor uptake (44.6% ID/g at 24 h), whereas the radiometal-labeled H310A/H435Q fragment with the most rapid elimination (T1/2beta, 7.05 h) reached a maximum of 28.0% ID/g at 12 h postinjection. The H310A protein was characterized by both intermediate serum half-life and tumor uptake. The 111In-based biodistribution studies showed that all three fragments were eliminated primarily through the liver, and hepatic radiometal activity correlated with the rate of fragment clearance. The 111In-labeled H310A/H435Q protein exhibited the highest liver uptake (23.5% ID/g at 24 h). Metabolism of the 125I-labeled scFv-Fc proteins resulted in low normal organ activity. Finally, the 125I/111In biodistribution data allowed for dose estimations, which suggest the 131I-labeled scFv-Fc H310A/H435Q as a promising candidate for radioimmunotherapy.
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Affiliation(s)
- Vania Kenanova
- Division of Molecular Biology, Beckman Research Institute of the City of Hope, Department of Radioimmunotherapy, Duarte, CA, USA
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