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Lane BR, Cheaib JG, Boynton D, Pierorazio P, Noyes SL, Peabody H, Singla N, Johnson A, Ghani KR, Krumm A, Singh K. Development and validation of a multicenter Cox regression model to predict all-cause mortality in patients with renal masses suspicious for renal cancer. Urol Oncol 2024:S1078-1439(24)00429-0. [PMID: 38704319 DOI: 10.1016/j.urolonc.2024.04.007] [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: 09/01/2023] [Revised: 03/20/2024] [Accepted: 04/07/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Life expectancy models are useful tools to support clinical decision-making. Prior models have not been used widely in clinical practice for patients with renal masses. We sought to develop and validate a model to predict life expectancy following the detection of a localized renal mass suspicious for renal cell carcinoma. MATERIALS AND METHODS Using retrospective data from 2 large centers, we identified patients diagnosed with clinically localized renal parenchymal masses from 1998 to 2018. After 2:1 random sampling into a derivation and validation cohort stratified by site, we used age, sex, log-transformed tumor size, simplified cardiovascular index and planned treatment to fit a Cox regression model to predict all-cause mortality from the time of diagnosis. The model's discrimination was evaluated using a C-statistic, and calibration was evaluated visually at 1, 5, and 10 years. RESULTS We identified 2,667 patients (1,386 at Corewell Health and 1,281 at Johns Hopkins) with renal masses. Of these, 420 (16%) died with a median follow-up of 5.2 years (interquartile range 2.2-8.3). Statistically significant predictors in the multivariable Cox regression model were age (hazard ratio [HR] 1.04; 95% confidence interval [CI] 1.03-1.05); male sex (HR 1.40; 95% CI 1.08-1.81); log-transformed tumor size (HR 1.71; 95% CI 1.30-2.24); cardiovascular index (HR 1.48; 95% CI 1.32-1.67), and planned treatment (HR: 0.10, 95% CI: 0.06-0.18 for kidney-sparing intervention and HR: 0.20, 95% CI: 0.11-0.35 for radical nephrectomy vs. no intervention). The model achieved a C-statistic of 0.74 in the derivation cohort and 0.73 in the validation cohort. The model was well-calibrated at 1, 5, and 10 years of follow-up. CONCLUSIONS For patients with localized renal masses, accurate determination of life expectancy is essential for decision-making regarding intervention vs. active surveillance as a primary treatment modality. We have made available a simple tool for this purpose.
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Affiliation(s)
- Brian R Lane
- Division of Urology, Corewell Health West, Grand Rapids, MI; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI.
| | - Joseph G Cheaib
- Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD
| | - Dennis Boynton
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI
| | | | | | - Henry Peabody
- Division of Urology, Corewell Health West, Grand Rapids, MI
| | - Nirmish Singla
- Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD
| | - Anna Johnson
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Khurshid R Ghani
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Andrew Krumm
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Karandeep Singh
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
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Davis R, Hirsch AM, Morrill CC, Haffar A, Maruf M, Cheaib J, Pierorazio P, Di Carlo HN. Higher prevalence of benign tumors in men with testicular tumors and history of treated cryptorchidism. Urol Oncol 2024; 42:33.e1-33.e6. [PMID: 38072736 DOI: 10.1016/j.urolonc.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/09/2023] [Accepted: 11/19/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVES To identify if surgically treated cryptorchidism correlated with testicular tumor pathology at presentation. MATERIALS AND METHODS An institutional database of patients treated for testicular cancer between 2003 and 2020 was reviewed. Inclusion criteria included orchiectomy patients. Exclusion criteria included unknown cryptorchidism history or pathology or laterality of orchiectomy. Data collection included demographics, surgical history, and tumor marker status. RESULTS A total of 435 patients were included. Thirty-three of these patients had a history of UDT. There was no statistical difference in age at orchiectomy, laterality of orchiectomy, or lymphovascular invasion with regard to UDT history. There was a statistical difference in tumor pathology after orchiectomy, P = 0.03. On secondary analysis, benign pathology was significantly more common in patients with a history of UDT (15.2%) than without (4.7%), P = 0.01. Mixed GCT was also found at a significantly lower rate in patients with a history of UDT (18.2%) compared to those with no history of UDT (37.3%), P = 0.03. There were no statistically significant differences in other pathology. CONCLUSION Previous studies have shown that there is a greater rate of seminoma in patients with testicular cancer in an undescended testis. This study shows that in patients with a history of UDT compared to those without a history of UDT, there is a greater percentage of patients with benign testicular masses after orchiectomy. Guideline based practices including monthly self-examination and testis-sparing surgery for appropriate patients may reduce rates of radical orchiectomy for benign tumors.
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Affiliation(s)
- Rachel Davis
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
| | - Alexander M Hirsch
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD.
| | - Christian C Morrill
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
| | - Ahmad Haffar
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
| | - Mahir Maruf
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
| | - Joseph Cheaib
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Phillip Pierorazio
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Heather N Di Carlo
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
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Siemens DR, Pierorazio P, Regala J. The Evolution of THE Journal: Enhancing the JU Experience for All Constituents. J Urol 2024; 211:3-4. [PMID: 37947274 DOI: 10.1097/ju.0000000000003783] [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: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Affiliation(s)
| | | | - Jennifer Regala
- Director of Publications/Executive Editor, American Urological Association
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4
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Saltzman AF, Hensley P, Ross J, Woo L, Billmire D, Rescorla F, Puri D, Patel S, Pierorazio P, Bagrodia A, Cary C, Cost NG. Critical elements of pediatric testicular germ cell tumors surgery. Semin Pediatr Surg 2023; 32:151343. [PMID: 38006835 DOI: 10.1016/j.sempedsurg.2023.151343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
Children, adolescents and young adults with testicular germ cell tumors require appropriate surgical care to insure excellent outcomes. This article presents the most critical elements, and their basis in evidence, for surgery in this population. Specifically, the importance of inguinal radical orchiectomy for malignant tumors, partial orchiectomy for prepubertal tumors and normal serum tumor markers, and the appropriate use of post-chemotherapy retroperitoneal lymph node dissection in those with residual retroperitoneal masses.
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Affiliation(s)
| | - Patrick Hensley
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | - Jonathan Ross
- Department of Urology, Rush University, Chicago, IL, USA
| | - Lynn Woo
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Deborah Billmire
- Department of Pediatric Surgery, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Frederick Rescorla
- Department of Pediatric Surgery, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Dhruv Puri
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Sunil Patel
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Aditya Bagrodia
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Clint Cary
- Department of Urology, Indiana University, Indianapolis, IN, USA
| | - Nicholas G Cost
- Division of Urology, Department of Surgery at the University of Colorado School of Medicine, Aurora, CO, USA; The Surgical Oncology Program, Children's Hospital Colorado, Aurora, CO, USA.
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5
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Daneshmand S, Cary C, Masterson T, Einhorn L, Adra N, Boorjian SA, Kollmannsberger C, Schuckman A, So A, Black P, Bagrodia A, Skinner E, Alemozaffar M, Brand T, Eggener S, Pierorazio P, Stratton K, Nappi L, Nichols C, Luo C, Li M, Hu B. Surgery in Early Metastatic Seminoma: A Phase II Trial of Retroperitoneal Lymph Node Dissection for Testicular Seminoma With Limited Retroperitoneal Lymphadenopathy. J Clin Oncol 2023; 41:3009-3018. [PMID: 36913642 DOI: 10.1200/jco.22.00624] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [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] [Received: 03/14/2022] [Accepted: 01/31/2023] [Indexed: 03/15/2023] Open
Abstract
PURPOSE The long-term toxicities of chemotherapy and radiotherapy can represent a significant burden to testicular cancer survivors. Retroperitoneal lymph node dissection (RPLND) is an established treatment for testicular germ cell tumors with minimal late morbidity although little data exist on its efficacy in early metastatic seminoma. Surgery in early metastatic seminoma is a prospective phase II single-arm, multi-institutional trial of RPLND as first-line treatment for testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy. PATIENTS AND METHODS Twelve sites in the United States and Canada prospectively enrolled adult patients with testicular seminoma and isolated retroperitoneal lymphadenopathy (1-3 cm). Open RPLND was performed by certified surgeons with a primary end point of 2-year recurrence-free survival (RFS). Complication rates, pathologic up/downstaging, recurrence patterns, adjuvant therapies, and treatment-free survival were assessed. RESULTS A total of 55 patients were enrolled, with a median (IQR) largest clinical lymph node size of 1.6 cm (1.3-1.9). RPLND pathology demonstrated a median (IQR) largest lymph node size of 2.3 cm (0.9-3.5); nine patients (16%) were pN0, 12 (22%) pN1, 31 (56%) pN2, and 3 (5%) pN3. One patient received adjuvant chemotherapy. With a median (IQR) follow-up of 33 months (12.0-61.6), 12 patients experienced recurrence, with a 2-year RFS of 81% and a recurrence rate of 22%. Of the patients who experienced recurrence, 10 were treated with chemotherapy and two underwent additional surgery. At last follow-up, all patients who experienced a recurrence were disease-free and the 2-year overall survival was 100%. Four patients (7%) experienced short-term complications, and four patients experienced long-term complications including incisional hernia (1) and anejaculation (3). CONCLUSION RPLND is a treatment option for testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy and is associated with low long-term morbidity.
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Affiliation(s)
- Siamak Daneshmand
- Department of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Clint Cary
- Department of Urology, Indiana University, Indianapolis, IN
| | | | - Lawrence Einhorn
- Division of Hematology & Medical Oncology, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Nabil Adra
- Division of Hematology & Medical Oncology, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Anne Schuckman
- Department of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Alan So
- Department of Urological Sciences, The Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | - Peter Black
- Department of Urological Sciences, The Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Eila Skinner
- Department of Urology, Stanford University, Stanford, CA
| | | | - Timothy Brand
- Department of Urology, Madigan Army Medical Center, Tacoma, WA
| | - Scott Eggener
- Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, IL
| | - Phillip Pierorazio
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MA
| | - Kelly Stratton
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Lucia Nappi
- Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Craig Nichols
- Department of Population and Public Health Sciences, USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Chunqiao Luo
- Department of Population and Public Health Sciences, USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Ming Li
- Department of Population and Public Health Sciences, USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Brian Hu
- Department of Urology, Loma Linda University, Loma Linda, CA
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6
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Avulova S, Enemchukwu E, Kaufman M, Khavari R, Mir C, Moses K, Pierorazio P, Samplaski M, Seideman C, Siemens DR, Suskind A. Reflections on Diversity, Equity, and Inclusion in Medical Publishing: The Journal of Urology® HEAD Table. J Urol 2023; 209:830-832. [PMID: 37026640 DOI: 10.1097/ju.0000000000003376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
| | - Ekene Enemchukwu
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Melissa Kaufman
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rose Khavari
- Department of Urology, Methodist Hospital, Houston, Texas
| | - Carmen Mir
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Kelvin Moses
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Phillip Pierorazio
- Department of Urology, University of Pennsylvania Health System: Penn Medicine, Philadelphia, Pennsylvania
| | - Mary Samplaski
- Department of Urology, University of Southern California, Los Angeles, California
| | - Casey Seideman
- Department of Urology, Oregon Health and Science University, Portland, Oregon
| | - D Robert Siemens
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| | - Anne Suskind
- Department of Urology, University of California San Francisco, San Francisco, California
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7
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Singla N, Nirschl T, Obradovic A, Shenderov E, Lombardo KA, Liu X, Pons A, Zarif J, Rowe SP, Trock BJ, Hammers HJ, Bivalacqua T, Pierorazio P, Deutsch JS, Lotan TL, Taube JM, Ged Y, Gorin MA, Allaf ME, Drake CG. Immunomodulatory response to neoadjuvant nivolumab in non-metastatic clear cell renal cell carcinoma. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.708] [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: 03/16/2023] Open
Abstract
708 Background: Novel perioperative strategies are needed to reduce recurrence rates in patients undergoing nephrectomy for high-risk, non-metastatic clear cell renal cell carcinoma (ccRCC). We sought to (1) elucidate the effects of PD-1 inhibition on primary tumor-infiltrating and circulating immune cell populations in ccRCC and (2) correlate tumor microenvironment and circulating immune cell compositions with response to anti-PD-1 therapy. Methods: We conducted a prospective, phase I trial of neoadjuvant nivolumab prior to nephrectomy in 15 evaluable patients with non-metastatic ccRCC. We leveraged tissue from this cohort to elucidate the effects of PD-1 inhibition on immune cell populations in ccRCC and correlate the evolving immune milieu with anti-PD-1 response using fluorescence-activated cell sorting, bulk RNA sequencing with protein activity inference, and enzyme-linked immunosorbent assay for circulating cytokines. Results: We found that nivolumab durably promotes a pro-inflammatory state within the primary tumor, as evidenced by a sustained increase in the effector T cell phenotype and decreased representation of regulatory T cell subsets. Baseline immune infiltration within the primary tumor including T effector and myeloid enrichment along with angiogenic depletion correlates with nivolumab responsiveness. Nivolumab increases CTLA-4 expression in the primary tumor, and subsequent nephrectomy increases circulating concentrations of sPD-L1, sPD-L3 (sB7-H3), and s4-1BB. Conclusions: Our findings form the basis to consider neoadjuvant immune checkpoint inhibition (ICI) for high-risk ccRCC while the tumor remains in situ and provide the rationale for perioperative strategies of novel ICI combinations. Clinical trial information: NCT02575222 .
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Affiliation(s)
- Nirmish Singla
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | | | | | | | | | - Steven P. Rowe
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bruce J. Trock
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Trinity Bivalacqua
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Julie S. Deutsch
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | | | | | - Yasser Ged
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Mohamad E. Allaf
- James Buchanan Brady Urological Institute, Dept. of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
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Heidenreich A, Ladi Seyedian S, Alsyouf M, Hu B, Cary C, Masterson T, Einhorn L, Adra N, Boorjian S, Schuckman A, Bagrodia A, Kollmannsberger C, So A, Black P, Skinner E, Alemozaffar M, Brand T, Eggener S, Pierorazio P, Pierorazio K, Nappi L, Nichols C, Daneshmand S. Surgical and oncologic outcomes of surgery in early metastatic seminoma: Multi-institutional retrospective study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00795-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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9
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Matin S, Smith A, Linehan J, Pierorazio P, Kleinmann N, Gore J, Hu B, Hubosky S, Quek M, Raman J, Scherr D, Weight C, Weizer A, Kaimakliotis H, Humphreys M, Pak R, Lifshitz D, Verni M, Thacker K, Misir S, Seltzer E, Schoenberg M, Lerner S. MP48-18 FEMALE PATIENTS WITH LOW-GRADE UPPER TRACT UROTHELIAL CARCINOMA: PRIMARY CHEMOABLATION AND DURABILITY OF RESPONSE IN A SUBGROUP ANALYSIS FROM THE OLYMPUS TRIAL. J Urol 2021. [DOI: 10.1097/ju.0000000000002074.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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McConkey DJ, Singla N, Pierorazio P, Lombardo K, Matoso A, Hoffman-Censits J. Molecular subtypes of upper tract urothelial cancer: Setting the stage for precision therapy. Cancer Cell 2021; 39:745-747. [PMID: 34129819 DOI: 10.1016/j.ccell.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A comprehensive genomic characterization of a large, high-quality cohort of upper tract urothelial carcinomas (UTUCs) in this issue of Cancer Cell reveals that UTUCs can be divided into five DNA-based molecular subtypes. Feasibility data establish that molecular subtyping can be performed non-invasively by sequencing tumor DNA in urine.
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Affiliation(s)
- David J McConkey
- Upper Tract Urothelial Cancer Program, Johns Hopkins Greenberg Bladder Cancer Institute and Brady Urological Institute, Baltimore, MD.
| | - Nirmish Singla
- Upper Tract Urothelial Cancer Program, Johns Hopkins Greenberg Bladder Cancer Institute and Brady Urological Institute, Baltimore, MD
| | - Phillip Pierorazio
- Upper Tract Urothelial Cancer Program, Johns Hopkins Greenberg Bladder Cancer Institute and Brady Urological Institute, Baltimore, MD
| | - Kara Lombardo
- Upper Tract Urothelial Cancer Program, Johns Hopkins Greenberg Bladder Cancer Institute and Brady Urological Institute, Baltimore, MD
| | - Andres Matoso
- Upper Tract Urothelial Cancer Program, Johns Hopkins Greenberg Bladder Cancer Institute and Brady Urological Institute, Baltimore, MD
| | - Jean Hoffman-Censits
- Upper Tract Urothelial Cancer Program, Johns Hopkins Greenberg Bladder Cancer Institute and Brady Urological Institute, Baltimore, MD
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11
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Wainger JJ, Cheaib JG, Patel HD, Huang MM, Biles MJ, Metcalf MR, Canner JK, Singla N, Trock BJ, Allaf ME, Pierorazio P. Volume-outcome relationships for kidney cancer may be driven by disparities and patient risk. Urol Oncol 2021; 39:439.e1-439.e8. [PMID: 34078583 DOI: 10.1016/j.urolonc.2021.04.036] [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: 10/17/2020] [Revised: 04/04/2021] [Accepted: 04/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Provider and hospital factors influence healthcare quality, but data are lacking to assess their impact on renal cancer surgery. We aimed to assess factors related to surgeon and hospital volume and study their impact on 30-day outcomes after radical nephrectomy. MATERIALS AND METHODS Renal surgery data were abstracted from Maryland's Health Service Cost Review Commission from 2000 to 2018. Patients ≤18 years old, without a diagnosis of renal cancer, and concurrently receiving another major surgery were excluded. Volume categories were derived from the mean annual cases distribution. Multivariable logistic and linear regression models assessed the association of volume on length of stay, intensive care days, cost, 30-day mortality, readmission, and complications. RESULTS 7,950 surgeries, completed by 573 surgeons at 48 hospitals, were included. Demographic, surgical, and admission characteristics differed between groups. Radical nephrectomies performed by low volume surgeons demonstrated increased post-operative complication frequency, mortality frequency, length of stay, and days spent in intensive care relative to other groups. However, after logistic regression adjusting for clinical risk and socioeconomic factors, only increased length of stay and ICU days remained associated with lower surgeon volume. Similarly, after adjusted logistic regression, hospital volume was not associated with the studied outcomes. CONCLUSIONS Surgeons and hospitals differ in regards to patient demographic and clinical factors. Barriers exist regarding access to high-volume care, and thus some volume-outcome trends may be driven predominantly by disparities and case mix.
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Affiliation(s)
- Julia J Wainger
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Joseph G Cheaib
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hiten D Patel
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mitchell M Huang
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael J Biles
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Meredith R Metcalf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph K Canner
- Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nirmish Singla
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bruce J Trock
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Phillip Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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12
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Singla N, Pierorazio P, Allaf M, Ged Y. Re: Robert J. Motzer, Paul Russo, Naomi Haas, et al. Adjuvant Pazopanib Versus Placebo After Nephrectomy in Patients with Localized or Locally Advanced Renal Cell Carcinoma: Final Overall Survival Analysis of the Phase 3 PROTECT Trial. Eur Urol 2021;79:334-8: PROTECTing Patients with Locally Advanced Kidney Cancer. Eur Urol 2021; 80:e33-e34. [PMID: 33962807 DOI: 10.1016/j.eururo.2021.04.025] [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: 04/03/2021] [Accepted: 04/17/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Nirmish Singla
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Phillip Pierorazio
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohamad Allaf
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yasser Ged
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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13
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Gupta N, Rasmussen S, Haney N, Smith A, Pierorazio P, Johnson M, Hoffman-Censits J, Bivalacqua T. 130 Understanding Psychosocial and Sexual Health Concerns among Women with Bladder Cancer Undergoing Radical Cystectomy. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.149] [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: 11/30/2022]
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Egan J, Cheaib JG, Biles MJ, Huang MM, Metcalf M, Matoso A, Pierorazio P. Testis-sparing Surgery: A Single Institution Experience. Urology 2020; 147:192-198. [PMID: 33137349 DOI: 10.1016/j.urology.2020.10.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To demonstrate the safety and efficacy of testis-sparing surgery (TSS) in 2 specific circumstances: small, nonpalpable masses suspected to be benign and masses suspicious for germ cell tumor in a solitary or functionally solitary testicle or bilateral disease. METHODS Our institutional review board-approved testicular cancer registry was reviewed for men who underwent inguinal exploration with intent for TSS (2013-2020). The attempted TSS and completed TSS groups were evaluated for differences using Student's t test for normally-distributed variables, chi-squared and Fisher's exact tests for proportions, and Wilcoxon rank-sum test for nonparametric variables. RESULTS TSS was attempted in 28 patients and completed in 14. TSS was completed only if intraoperative frozen section demonstrated benign disease, except for 1 patient with stage I seminoma and solitary testicle. Sensitivity and specificity of frozen section analysis was 100% and 93%, respectively. There were no significant differences in demographics between attempted vs completed TSS cohorts. Median tumor size was significantly smaller in the completed TSS cohort (1.0 cm vs 1.7 cm, P = .03). In patients with unilateral masses without history of testis cancer, the testis was successfully spared in 9 of 22 cases (41%). In patients with bilateral disease or germ cell tumor in solitary testis, the testis was spared in 5 of 6 cases (83%). At a median follow up of 12.2 months, all patients were alive, and 27 of 28 had no evidence of disease (96%). CONCLUSION TSS is safe and effective for small, benign masses and in the setting of bilateral disease or tumor in a solitary testis.
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Affiliation(s)
- Jillian Egan
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC
| | - Joseph G Cheaib
- Brady Urological Institute and Department of Urology, Johns Hopkins Medicine, Baltimore, MD
| | - Michael J Biles
- Brady Urological Institute and Department of Urology, Johns Hopkins Medicine, Baltimore, MD
| | - Mitchell M Huang
- Brady Urological Institute and Department of Urology, Johns Hopkins Medicine, Baltimore, MD
| | - Meredith Metcalf
- Brady Urological Institute and Department of Urology, Johns Hopkins Medicine, Baltimore, MD
| | - Andres Matoso
- Brady Urological Institute and Department of Urology, Johns Hopkins Medicine, Baltimore, MD; Department of Pathology, Johns Hopkins University, Baltimore, MD
| | - Phillip Pierorazio
- Brady Urological Institute and Department of Urology, Johns Hopkins Medicine, Baltimore, MD.
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Gilligan T, Lin DW, Aggarwal R, Chism D, Cost N, Derweesh IH, Emamekhoo H, Feldman DR, Geynisman DM, Hancock SL, LaGrange C, Levine EG, Longo T, Lowrance W, McGregor B, Monk P, Picus J, Pierorazio P, Rais-Bahrami S, Saylor P, Sircar K, Smith DC, Tzou K, Vaena D, Vaughn D, Yamoah K, Yamzon J, Johnson-Chilla A, Keller J, Pluchino LA. Testicular Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 17:1529-1554. [PMID: 31805523 DOI: 10.6004/jnccn.2019.0058] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Testicular cancer is relatively uncommon and accounts for <1% of all male tumors. However, it is the most common solid tumor in men between the ages of 20 and 34 years, and the global incidence has been steadily rising over the past several decades. Several risk factors for testicular cancer have been identified, including personal or family history of testicular cancer and cryptorchidism. Testicular germ cell tumors (GCTs) comprise 95% of malignant tumors arising in the testes and are categorized into 2 main histologic subtypes: seminoma and nonseminoma. Although nonseminoma is the more clinically aggressive tumor subtype, 5-year survival rates exceed 70% with current treatment options, even in patients with advanced or metastatic disease. Radical inguinal orchiectomy is the primary treatment for most patients with testicular GCTs. Postorchiectomy management is dictated by stage, histology, and risk classification; treatment options for nonseminoma include surveillance, systemic therapy, and nerve-sparing retroperitoneal lymph node dissection. Although rarely occurring, prognosis for patients with brain metastases remains poor, with >50% of patients dying within 1 year of diagnosis. This selection from the NCCN Guidelines for Testicular Cancer focuses on recommendations for the management of adult patients with nonseminomatous GCTs.
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Affiliation(s)
- Timothy Gilligan
- 1Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Daniel W Lin
- 2University of Washington/Seattle Cancer Care Alliance
| | | | | | | | | | | | | | | | | | | | | | | | - Will Lowrance
- 14Huntsman Cancer Institute at the University of Utah
| | | | - Paul Monk
- 16The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Joel Picus
- 17Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | | | | | - Daniel Vaena
- 24St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - David Vaughn
- 25Abramson Cancer Center at the University of Pennsylvania
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Alsyouf M, Pierorazio P, Groegler J, Hu B. Chemoablation in Urothelial Carcinoma: A Systematic Review and Future Perspectives. Urology 2020; 144:28-37. [PMID: 32540302 DOI: 10.1016/j.urology.2020.05.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
Abstract
Chemoablation is an emerging treatment for urothelial carcinomas. This review provides an overview of the evidence for intracavitary chemoablation in the treatment of urothelial carcinomas. The benefits of such agents include a reduction in morbidity and diseased organ preservation. While numerous agents have shown promise, research is limited due to small patient cohorts, varying follow-up, and no standardized methodology to assess response. Therefore, to date, chemoablation has not been widely adopted. This may change as a novel mitomycin formulation has recently been approved for treating low-grade upper tract urothelial carcinoma. Future studies are ongoing which evaluate other promising chemoablation options in urothelial carcinoma.
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Affiliation(s)
- Muhannad Alsyouf
- Department of Urology, Loma Linda University Health, Loma Linda, CA
| | - Phillip Pierorazio
- Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jason Groegler
- Department of Urology, Loma Linda University Health, Loma Linda, CA
| | - Brian Hu
- Department of Urology, Loma Linda University Health, Loma Linda, CA.
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Cheaib* J, Claus L, Ghandour R, Patel H, Gupta M, Kates M, Johnson M, Hahn N, Hoffman-Censits J, Bivalacqua T, Pierorazio P. MP14-20 SITE OF METASTATIC RECURRENCE IMPACTS PROGNOSIS IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA. J Urol 2020. [DOI: 10.1097/ju.0000000000000839.020] [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: 11/25/2022]
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18
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Bagrodia A, Pierorazio P, Singla N, Albers P. The Complex and Nuanced Care for Early-stage Testicular Cancer: Lessons from the European Association of Urology and American Urological Association Testis Cancer Guidelines. Eur Urol 2020; 77:139-141. [DOI: 10.1016/j.eururo.2019.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/04/2019] [Indexed: 11/28/2022]
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19
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Porter J, Eggener S, Castle E, Pierorazio P. Recurrence After Robotic Retroperitoneal Lymph Node Dissection Raises More Questions than Answers. Eur Urol 2019; 76:610-611. [PMID: 31543365 DOI: 10.1016/j.eururo.2019.08.013] [Citation(s) in RCA: 5] [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: 07/30/2019] [Accepted: 08/08/2019] [Indexed: 11/24/2022]
Affiliation(s)
| | - Scott Eggener
- Section of Urology, University of Chicago, Chicago, IL, USA
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Sadasivam M, Noel S, Lee SA, Gong J, Allaf ME, Pierorazio P, Rabb H, Hamad ARA. Activation and Proliferation of PD-1 + Kidney Double-Negative T Cells Is Dependent on Nonclassical MHC Proteins and IL-2. J Am Soc Nephrol 2019; 30:277-292. [PMID: 30622155 DOI: 10.1681/asn.2018080815] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/29/2018] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND CD4- CD8- double-negative (DN) αβ T cells with innate-like properties represent a significant component of T cells in human and mouse kidneys. They spontaneously proliferate in the steady state and protect against ischemic AKI. However, the mechanisms regulating DN T cell homeostasis and responses to external danger signals from "sterile" inflammation remain poorly understood. METHODS We used knockout mice, functional assays, and an established ischemic AKI model to investigate the role of various MHC class I and II molecules in regulating kidney DN T cells. We also studied human nephrectomy samples. RESULTS Deficiency of β2m-dependent MHC class I (but not MHC class II) molecules led to significant reduction in frequency or absolute numbers of kidney DN T cells due to impaired activation, proliferation, increased apoptosis, and loss of an NK1.1+ subset of DN T cells. The remaining DN T cells in β2m knockout mice mainly comprised a programmed cell death protein-1 receptor (PD-1+) subset that depends on IL-2 provided by conventional T cells for optimal homeostasis. However, this PD-1+ subset remained highly responsive to changes in milieu, demonstrated by responses to infused lymphocytes. It was also the major responder to ischemic AKI; the NK1.1+ subset and CD8+ T cells had minimal responses. We found both DN T cell subsets in normal and cancerous human kidneys, indicating possible clinical relevance. CONCLUSIONS DN T cells, a unique population of kidney T cells, depend on nonclassical β2m molecules for homeostasis and use MHC-independent mechanisms to respond to external stimuli. These results have important implications for understanding the role these cells play during AKI and other immune cell-mediated kidney diseases.
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Affiliation(s)
| | | | | | | | - Mohamad E Allaf
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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21
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Semerjian A, Pierorazio P. Editorial Commentary. Urology Practice 2018. [DOI: 10.1016/j.urpr.2017.03.022] [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: 10/18/2022]
Affiliation(s)
- Alice Semerjian
- The Brady Urological Institution and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Phillip Pierorazio
- The Brady Urological Institution and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Srivastava A, Patel H, Gupta M, Joice G, Schwen Z, Alam R, Gorin M, Johnson M, Allaf M, Pierorazio P. PD51-10 CHARACTERIZING THE INCIDENCE, PREDICTORS, AND SURVIVAL OF DISAPPEARING RENAL TUMORS FROM THE DISSRM REGISTRY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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23
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Liao R, Gupta M, Schwen Z, Patel H, Kates M, Johnson M, Hahn N, McConkey D, Bivalacqua T, Pierorazio P. MP18-01 INCIDENCE OF LOWER PATHOLOGIC STAGE IN PATIENTS TREATED WITH NEOADJUVANT CHEMOTHERAPY FOR HIGH-RISK UPPER TRACT UROTHELIAL CARCINOMA. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Gupta M, Patel H, Semerjian A, Gorin M, Johnson M, Allaf M, Pierorazio P. MP88-03 USE OF URINARY METABOLOMICS TO IDENTIFY HIGH-RISK CLEAR CELL RENAL CELL CARCINOMA. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2923] [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: 12/01/2022]
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25
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Schwen Z, Patel H, Gorin M, Joice G, Allaf M, Pierorazio P. PD04-11 DELAY OF THE INITIATION OF SYSTEMIC THERAPY AFTER CYTOREDUCTIVE NEPHRECTOMY IS NOT ASSOCIATED WITH WORSE OVERALL SURVIVAL. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.230] [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: 10/19/2022]
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26
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Chappidi M, Kates M, Stimson C, Chalfin H, Tosoian J, Han M, Allaf M, Ross A, Carter HB, Pierorazio P, Partin A, Bivalacqua T. PD32-08 CAUSES, TIMING, AND HOSPITAL COSTS OF INDEX VS. NON-INDEX HOSPITAL READMISSIONS FOLLOWING RADICAL PROSTATECTOMY: IMPLICATIONS FOR COST CONTAINMENT STRATEGIES. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1399] [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: 10/19/2022]
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Schwen Z, Joice G, Patel H, Gorin M, Allaf M, Pierorazio P. PD04-08 METASTASECTOMY IS ASSOCIATED WITH IMPROVED SURVIVAL IN THE TARGETED THERAPY ERA FOR METASTATIC RENAL CELL CARCINOMA. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.227] [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: 10/19/2022]
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28
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Semerjian A, Milbar N, Kates M, Gorin M, Chalfin H, Stimson C, Yang W, Frank S, Hobson D, Robertson L, Lee K, Johnson M, Pierorazio P, Bivalacqua T. PD67-11 ENHANCED RECOVERY AFTER RADICAL CYSTECTOMY REDUCES COST AND LENGTH OF STAY: THE JOHNS HOPKINS EXPERIENCE. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Patel H, Druskin S, Rowe S, Pierorazio P, Gorin M, Allaf M. PD52-04 SURGICAL HISTOPATHOLOGY FOR SUSPECTED ONCOCYTOMA ON RENAL MASS BIOPSY: RETROSPECTIVE INSTITUTIONAL COHORT WITH SYSTEMATIC REVIEW AND META-ANALYSIS. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chappidi M, Kates M, Joice G, Pierorazio P, Bivalacqua T. PD69-10 DOES SURGICAL APPROACH AFFECT RATES OF ERECTILE DYSFUNCTION TREATMENT FOLLOWING RADICAL CYSTECTOMY: ANALYSIS OF A NATIONWIDE INSURANCE CLAIMS DATABASE. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.3151] [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: 10/19/2022]
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31
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Uzosike A, Johnson M, Patel H, Riffon M, Gorin M, Pavlovich C, Chang P, Wagner A, Trock B, Allaf M, Pierorazio P. PD59-02 VARIABILITY IN GROWTH KINETICS OF SMALL RENAL MASSES ON ACTIVE SURVEILLANCE: RESULTS FROM THE DISSRM REGISTRY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chappidi M, Kates M, Bivalacqua T, Pierorazio P. PD14-12 COMPARISON OF INITIAL AND FOLLOW-UP HOSPITAL COSTS FOR MINIMALLY INVASIVE VS. OPEN RADICAL CYSTECTOMY IN A NATIONALLY REPRESENTATIVE SAMPLE. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.713] [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: 10/19/2022]
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Abdelfatah E, Page A, Sacks J, Pierorazio P, Bivalacqua T, Efron J, Terezakis S, Gearhart S, Fang S, Safar B, Pawlik TM, Armour E, Hacker-Prietz A, Herman J, Ahuja N. Postoperative complications following intraoperative radiotherapy in abdominopelvic malignancy: A single institution analysis of 113 consecutive patients. J Surg Oncol 2017; 115:883-890. [PMID: 28252805 DOI: 10.1002/jso.24597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 12/28/2016] [Accepted: 02/09/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Intraoperative radiotherapy (IORT) has advantages over external beam radiation therapy (EBRT). Few studies have described side effects associated with its addition. We evaluated our institution's experience with abdominopelvic IORT to assess safety by postoperative complication rates. METHODS Prospectively collected IRB-approved database of all patients receiving abdominopelvic IORT (via high dose rate brachytherapy) at Johns Hopkins Hospital between November 2006 and May 2014 was reviewed. Patients were discussed in multidisciplinary conferences. Those selected for IORT were patients for whom curative intent resection was planned for which IORT could improve margin-negative resection and optimize locoregional control. Perioperative complications were classified via Clavien-Dindo scale for postoperative surgical complications. RESULTS A total of 113 patients were evaluated. Most common diagnosis was sarcoma (50/113, 44%) followed by colorectal cancer (45/113, 40%), most of which were recurrent (84%). There were no perioperative deaths. A total of 57% of patients experienced a complication Grade II or higher: 24% (27/113) Grade II; 27% (30/113) Grade III; 7% (8/113) Grade IV. Wound complications were most common (38%), then gastrointestinal (25%). No radiotherapy variables were significantly associated with complications on uni/multi-variate analysis. CONCLUSIONS Our institution's experience with IORT demonstrated historically expected postoperative complication rates. IORT is safe, with acceptable perioperative morbidity.
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Affiliation(s)
- Eihab Abdelfatah
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew Page
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin Sacks
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Phillip Pierorazio
- Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Trinity Bivalacqua
- Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan Efron
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephanie Terezakis
- Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan Gearhart
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sandy Fang
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bashar Safar
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy M Pawlik
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elwood Armour
- Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amy Hacker-Prietz
- Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph Herman
- Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nita Ahuja
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Chappidi M, Kates M, Schwen Z, Sopko N, Tran P, Ahuja N, Terezakis S, Pierorazio P, Bivalacqua T. MP23-12 INTRAOPERATIVE RADIATION THERAPY DURING GENITOURINARY SURGERY: THE IMPORTANCE OF SPECIMEN MARGIN STATUS IN IMPROVING SURVIVAL. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.734] [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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35
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Ball M, Gorin M, Pierorazio P, Allaf M. PD48-03 PARTIAL AND RADICAL NEPHRECTOMY OFFER EQUIVALENT ONCOLOGIC OUTCOMES FOR CT1 TO PT3 UPSTAGED RENAL MASSES. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chappidi M, Kates M, Bivalacqua T, Pierorazio P. MP27-15 TUMOR LOCATION AS A PREDICTOR OF SURVIVAL FOLLOWING NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CANCER: A U.S. POPULATION BASED ANALYSIS (2004-2012). J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pearce S, Gorin M, Luckenbaugh A, Williams S, Ward J, Montgomery J, Hafez K, Weizer A, Pierorazio P, Allaf M, Porter J, Eggener S. MP23-10 MULTICENTER EVALUATION OF PRIMARY ROBOT-ASSISTED LAPAROSCOPIC RPLND IN LOW-STAGE NON-SEMINOMATOUS TESTICULAR CANCER. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Kates M, Ball M, Chappidi M, Sopko N, Pierorazio P, BIvalacqua T, Schoenberg M. PD33-08 UTILITY OF URETHRAL FROZEN SECTIONS DURING RADICAL CYSTECTOMY FOR BLADDER CANCER. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.717] [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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39
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Ball M, Gorin M, Gunters G, Pierorazio P, Netto G, Paller C, Hammers H, Diaz L, Allaf M. MP03-09 CIRCULATING TUMOR DNA AS A BIOMARKER IN ADVANCED RENAL CELL CARCINOMA. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gorin M, Ball M, Davis D, Pierorazio P, Hammers H, Pienta K, Allaf M. MP39-13 DEVELOPMENT OF A NOVEL METHOD FOR DETECTING RENAL CELL CARCINOMA CIRCULATING TUMOR CELLS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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An Y, Ball M, Gorin M, Pierorazio P, Allaf M. MP84-03 CLINICAL, PATHOLOGICAL AND RENAL FUNCTIONAL OUTCOMES OF PARTIAL AND RADICAL NEPHRECTOMY IN ELDERLY PATIENTS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pierorazio P, Johnson M, Ball M, Gorin M, Chang P, Wagner A, McKiernan J, Trock B, Allaf M. MP50-01 RESULTS FROM A MULTI-INSTITUTIONAL, PROSPECTIVE CLINICAL TRIAL OF DELAYED INTERVENTION AND SURVEILLANCE FOR SMALL RENAL MASSES: THE DISSRM REGISTRY. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kates M, Patel H, Joice G, Tosoian J, Sopko N, Liu JJ, Pierorazio P, Bivalacqua T. MP67-12 THE MODIFIED FRAILTY INDEX AS A MARKER OF ADVERSE OUTCOMES DURING CYSTECTOMY FOR UROTHELIAL CANCER. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2495] [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: 10/23/2022]
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Gorin M, Rowe S, Gordetsky J, Ball M, Pierorazio P, Epstein J, Javadi M, Allaf M. MP35-16 PILOT STUDY EVALUATING
99M
TC-SESTAMIBI SPECT/CT FOR THE DIFFERENTIATION OF ONCOCYTOMA FROM RENAL CELL CARCINOMA. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1117] [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: 10/23/2022]
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Meyer A, Woldu SL, Weinberg AC, Thoreson GR, Pierorazio P, Matulay JT, Benson MC, DeCastro GJ, McKiernan JM. Predicting Renal Parenchymal Loss after Nephron Sparing Surgery. J Urol 2015; 194:658-63. [PMID: 25818030 DOI: 10.1016/j.juro.2015.03.098] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE We analyze the relationship among various patient, operative and tumor characteristics to determine which factors correlate with renal parenchymal volume loss after nephron sparing surgery using a novel 3-dimensional volume assessment. MATERIALS AND METHODS We conducted a retrospective review of an institutional database of patients who underwent nephron sparing surgery from 1992 to 2014 for a localized renal mass. Tumors were classified according to the R.E.N.A.L. nephrometry system. Using 3-dimensional reconstruction imaging software, preoperative and postoperative renal parenchymal volume was calculated for the ipsilateral and contralateral kidney. RESULTS A total of 158 patients were analyzed. Mean patient age was 58.7 years and mean followup was 40.1 months. Mean preoperative tumor volume was 34.0 cc and mean tumor dimension was 3.4 cm. Mean R.E.N.A.L. nephrometry score was 6.2, with 60.1%, 34.2% and 5.7% of tumors classified as low, medium and high complexity, respectively. Mean change in renal parenchymal volume after nephron sparing surgery was -15.3% for the ipsilateral kidney and -6.8% for total kidney volume. On univariate analysis ischemia time, tumor size, R.E.N.A.L. nephrometry score, complexity grouping and the individual nephrometry components of tumor size, percent exophytic, anterior/posterior, depth and tumor proximity to the renal artery or vein were associated with greater renal parenchymal volume loss. On multivariate analysis only ischemia time, tumor size, posterior location and percent exophytic were independently associated with more renal parenchymal volume loss. CONCLUSIONS Using precise 3-dimensional volumetric analysis we found that ischemia time, tumor size and endophytic/exophytic properties of a localized renal mass are the most important determinants of renal parenchymal volume loss.
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Affiliation(s)
- Alexa Meyer
- Columbia University Medical Center, New York, New York
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Pierorazio P, Ball M, Danzig M, Ghandour R, Chang P, Hartman R, Wagner A, McKiernan J, Allaf M. PD17-06 ACTIVE SURVEILLANCE FOR SMALL RENAL MASSES NON-INFERIOR TO PRIMARY INTERVENTION: 5-YEAR ANALYSIS OF THE MULTI-INSTITUTIONAL, PROSPECTIVE DISSRM (DELAYED INTERVENTION AND SURVEILLANCE FOR SMALL RENAL MASSES) REGISTRY. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pierorazio P, Readal N, Danzig M, Ghandour R, Chang P, Hartman R, Wagner A, McKiernan J, Allaf M. MP54-03 FIRST SURVEILLANCE IMAGE FOR PATIENTS WITH A SMALL RENAL MASS SHOULD NOT DETERMINE OUTCOME: RESULTS FROM THE DISSRM REGISTRY. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1592] [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: 10/25/2022]
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Danzig M, Ghandour R, Kotamarti S, Schubert T, RoyChoudhury A, Pierorazio P, Badani K, Allaf M, McKiernan J. MP54-04 PARTIAL NEPHRECTOMY IS EQUIVALENT TO ACTIVE SURVEILLANCE IN PRESERVING RENAL FUNCTION FOR PATIENTS WITH SMALL RENAL MASSES. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1593] [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: 10/25/2022]
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Ball M, Kates M, Gorin M, Patel H, Pierorazio P, Allaf M. MP59-08 COMPARISON OF COMPLICATIONS AND PERIOPERATIVE OUTCOMES AFTER RADICAL AND PARTIAL NEPHRECTOMY USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1804] [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: 10/25/2022]
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Pierorazio P, Ball M, Danzig M, Ghandour R, Chang P, Hartman R, Wagner A, McKiernan J, Allaf M. MP64-09 PROSPECTIVE ANALYSIS OF TUMOR GROWTH RATES BASED ON PATIENT COMORBIDITIES AND IMAGING CHARACTERISTICS FROM THE DISSRM REGISTRY: IMPLICATIONS FOR FUTURE NEPHRON-SPARING SURGERY. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1926] [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: 10/25/2022]
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