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Debatin NF, Bady E, Mandelkow T, Huang Z, Lurati MCJ, Raedler JB, Müller JH, Vettorazzi E, Plage H, Samtleben H, Klatte T, Hofbauer S, Elezkurtaj S, Furlano K, Weinberger S, Giacomo Bruch P, Horst D, Roßner F, Schallenberg S, Marx AH, Fisch M, Rink M, Slojewski M, Kaczmarek K, Ecke TH, Hallmann S, Koch S, Adamini N, Lennartz M, Minner S, Simon R, Sauter G, Zecha H, Schlomm T, Blessin NC. Prognostic Impact and Spatial Interplay of Immune Cells in Urothelial Cancer. Eur Urol 2024:S0302-2838(24)00065-4. [PMID: 38383257 DOI: 10.1016/j.eururo.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 12/01/2023] [Accepted: 01/29/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Quantity and the spatial relationship of specific immune cell types can provide prognostic information in bladder cancer. OBJECTIVE To characterize the spatial interplay and prognostic role of different immune cell subpopulations in bladder cancer. DESIGN, SETTING, AND PARTICIPANTS A total of 2463 urothelial bladder carcinomas were immunostained with 21 antibodies using BLEACH&STAIN multiplex fluorescence immunohistochemistry in a tissue microarray format and analyzed using a framework of neuronal networks for an image analysis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Spatial immune parameters were compared with histopathological parameters and overall survival data. RESULTS AND LIMITATIONS The identification of > 300 different immune cell subpopulations and the characterization of their spatial relationship resulted in numerous spatial interaction patterns. Thirty-nine immune parameters showed prognostic significance in univariate analyses, of which 16 were independent from pT, pN, and histological grade in muscle-invasive bladder cancer. Among all these parameters, the strongest association with prolonged overall survival was identified for intraepithelial CD8+ cytotoxic T cells (time-dependent area under receiver operating characteristic curve [AUC]: 0.70), while stromal CD8+ T cells were less relevant (AUC: 0.65). A favorable prognosis of inflamed cancers with high levels of "exhaustion markers" suggests that TIM3, PD-L1, PD-1, and CTLA-4 on immune cells do not hinder antitumoral immune response in tumors rich of tumor infiltrating immune cells. CONCLUSIONS The density of intraepithelial CD8+ T cells was the strongest prognostic feature in muscle-invasive bladder cancer. Given that tumor cell killing by CD8+ cytotoxic T lymphocytes through direct cell-to-cell-contacts represents the "terminal end route" of antitumor immunity, the quantity of "tumor cell adjacent CD8+ T cells" may constitute a surrogate for the efficiency of cancer recognition by the immune system that can be measured straightaway in routine pathology as the CD8 labeling index. PATIENT SUMMARY Quantification of intraepithelial CD8+ T cells, the strongest prognostic feature identified in muscle-invasive bladder cancer, can easily be assessed by brightfield immunohistochemistry and is therefore "ready to use" for routine pathology.
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Affiliation(s)
- Nicolaus F Debatin
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elena Bady
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Mandelkow
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Zhihao Huang
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Magalie C J Lurati
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas B Raedler
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; College of Arts and Sciences, Boston University, Boston, MA, USA
| | - Jan H Müller
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henning Plage
- Department of Urology, Charité Berlin, Berlin, Germany
| | - Henrik Samtleben
- Department of Pathology, Academic Hospital Fuerth, Fuerth, Germany
| | - Tobias Klatte
- Department of Urology, Charité Berlin, Berlin, Germany; Department of Urology, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | | | | | - Kira Furlano
- Department of Urology, Charité Berlin, Berlin, Germany
| | | | | | - David Horst
- Institute of Pathology, Charité Berlin, Berlin, Germany
| | | | | | - Andreas H Marx
- Department of Pathology, Academic Hospital Fuerth, Fuerth, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcin Slojewski
- Department of Urology, University Hospital Stettin, Stettin, Poland
| | | | - Thorsten H Ecke
- Department of Urology, Charité Berlin, Berlin, Germany; Department of Urology, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | - Steffen Hallmann
- Department of Urology, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | - Stefan Koch
- Department of Pathology, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | - Nico Adamini
- Department of Urology, Albertinen Hospital, Hamburg, Germany
| | - Maximilian Lennartz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Minner
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ronald Simon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henrik Zecha
- Department of Urology, Albertinen Hospital, Hamburg, Germany
| | | | - Niclas C Blessin
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Ecke TH, Meisl CJ, Schlomm T, Rabien A, Labonté F, Rong D, Hofbauer S, Friedersdorff F, Sommerfeldt L, Gagel N, Gössl A, Barski D, Otto T, Grunewald CM, Niegisch G, Hennig MJP, Kramer MW, Koch S, Roggisch J, Hallmann S, Weiß S, Waldner M, Graff J, Veltrup E, Linden F, Hake R, Eidt S, Wirtz RM. BTA stat®, NMP22® BladderChek®, UBC® Rapid Test, and CancerCheck® UBC® rapid VISUAL as urinary marker for bladder cancer: Final results of a German multicenter study. Urol Oncol 2023; 41:484.e17-484.e26. [PMID: 37407421 DOI: 10.1016/j.urolonc.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/15/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION AND OBJECTIVE BTA stat®, NMP22® BladderChek®, UBC® Rapid Test, and CancerCheck® UBC® rapid VISUAL are urinary-based rapid tests. This multicenter study is the first study comparing all available rapid tests on a large cohort of bladder cancer patients and healthy controls in one setting. METHODS In total 732 urine samples (second morning urine) in a real-world assessment have been analyzed. We evaluated clinical samples from 464 patients with histologically confirmed urothelial tumors of the urinary bladder (17 solitary CIS, 189 low-grade, 187 high-grade nonmuscle invasive, 71 high-grade muscle invasive), 77 patients with No Evidence of Disease (NED), and from 191 healthy controls. Urine samples were analyzed by the BTA stat®, NMP22® BladderChek®, UBC® Rapid Test point-of-care (POC) system using the concile Omega 100 POC reader, and CancerCheck® UBC® rapid VISUAL. Sensitivities and specificities were calculated by contingency analyses. RESULTS All investigated urinary markers detected more pathological concentrations in urine of bladder cancer patients compared to tumor-free patients. The calculated diagnostic sensitivities for BTA stat®, NMP22® BladderChek®, UBC® Rapid Test, CancerCheck® UBC® rapid VISUAL, and cytology were 62.4%, 13.4%, 58.2%, 28.6%, 36.2% for low-grade, 83.4%, 49.5%, 84.5%, 63.1%, 71.2% for high-grade nonmuscle invasive, and 95.8%, 35.2%, 76.1%, 50.7%, 67.7% for high-grade muscle-invasive bladder cancer. The specificity was 67.9%, 95.5%, 79.4%, 94.4%, and 83.7%, respectively. The area under the curve (AUC) after receiver operating characteristics (ROC) analysis for high-grade non-muscle-invasive tumors was 0.757, 0.725, 0.819, 0.787, and 0.774, respectively. CONCLUSIONS The analysis of more than 700 urine samples offers an objective view on urine-based rapid diagnostics. Elevated pathological concentrations of markers in urine of bladder cancer patients were detected in all investigated tests. The highest sensitivities for high-grade non-muscle-invasive tumors were calculated for BTA stat® and UBC® Rapid Test, whereas NMP22® BladderChek®, and cytology showed the highest specificities. BTA stat® and UBC® Rapid Test have the potential to be used as a clinical valuable urinary protein biomarker for the detection of high-grade non-muscle-invasive bladder cancer patients and could be included in the management of these tumors.
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Affiliation(s)
- Thorsten H Ecke
- Department of Urology, Helios Hospital, Bad Saarow, Germany; Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Christina J Meisl
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thorsten Schlomm
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anja Rabien
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Flora Labonté
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dezhi Rong
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Hofbauer
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Lilli Sommerfeldt
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Nella Gagel
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Andreas Gössl
- Department of Urology, Rheinland Klinikum Neuss, Neuss, Germany
| | - Dimitri Barski
- Department of Urology, Rheinland Klinikum Neuss, Neuss, Germany
| | - Thomas Otto
- Department of Urology, Rheinland Klinikum Neuss, Neuss, Germany; University Hospital Essen, Essen, Germany
| | - Camilla M Grunewald
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Günter Niegisch
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Mario W Kramer
- Department of Urology, University Hospital Lübeck, Lübeck, Germany
| | - Stefan Koch
- Helios Hospital, Institute of Pathology, Bad Saarow, Germany; Brandenburg Medical School, Brandenburg, Germany
| | - Jenny Roggisch
- Helios Hospital, Institute of Pathology, Bad Saarow, Germany
| | | | - Sarah Weiß
- Department of Urology, Helios Hospital, Bad Saarow, Germany
| | - Michael Waldner
- Department of Urology, St. Elisabeth Hospital, Cologne, Germany
| | - Johannes Graff
- Department of Urology, St. Elisabeth Hospital, Cologne, Germany
| | - Elke Veltrup
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | | | - Roland Hake
- Institute of Pathology, St. Elisabeth Hospital, Cologne, Germany
| | - Sebastian Eidt
- Institute of Pathology, St. Elisabeth Hospital, Cologne, Germany
| | - Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
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Ecke TH, Lotan Y, Massfelder T. Editorial: Identifying novel biomarkers in bladder cancer. Front Oncol 2023; 13:1191736. [PMID: 37469396 PMCID: PMC10353301 DOI: 10.3389/fonc.2023.1191736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/22/2023] [Indexed: 07/21/2023] Open
Affiliation(s)
- Thorsten H. Ecke
- Department of Urology, Helios Hospital Bad, Saarow, Germany
- Deparment of Urology, Universitätsmedizin Berlin Charité, Berlin, Germany
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Thierry Massfelder
- INSERM (French National Institute of Health and Medical Research) UMR_S1260, Université de Strasbourg, Regenerative Nanomedicine, Centre de Recherche en Biomédecine de Strasbourg, Strasbourg, France
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Ecke TH, Wirtz RM, Friedersdorff F, Füssel S, Hoffmann MJ, Gaisa NT, Nawroth R. [Research in bladder cancer: translation into the clinic-report of 13th annual meeting of the German Research Group on Bladder Cancer (DFBK) in Berlin]. Urologie 2023:10.1007/s00120-023-02093-6. [PMID: 37115302 DOI: 10.1007/s00120-023-02093-6] [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] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Thorsten H Ecke
- Klinik für Urologie, Helios Klinikum Bad Saarow, Bad Saarow, Deutschland.
- Klinik für Urologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
| | - Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Köln, Deutschland
| | - Frank Friedersdorff
- Klinik für Urologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Klinik für Urologie, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Deutschland
| | - Susanne Füssel
- Klinik für Urologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - Michèle J Hoffmann
- Klinik für Urologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - Nadine T Gaisa
- Institut für Pathologie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Roman Nawroth
- Urologische Klinik und Poliklinik des Klinikums rechts der Isar, Technische Universität München, München, Deutschland
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Wirtz RM, Voss PC, Friedersdorff F, Barski D, Otto T, Waldner M, Veltrup E, Linden F, Schwandt M, Hake R, Eidt S, Roggisch J, Rieger C, Kastner L, Heidenreich A, Koch S, Baum RP, Ecke TH. Prediction of response to neoadjuvant chemotherapy of patients with muscle invasive bladder cancer by molecular subtyping and radioligand target quantitation: Preview of the Bladder BRIDGister. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.543] [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
543 Background: Patients with muscle invasive urothelial carcinoma achieving pathological complete response (pCR) upon neoadjuvant chemotherapy (NACT) have improved prognosis. Molecular subtypes of bladder cancer differ markedly with regard to sensitivity to cisplatinum based chemotherapy and harbour FGFR treatment targets to various content. Previously we did show that lumina tumors respond better to NACT, while FGFR1 expression is associated with chemo resistance (Ecke et al. 2022). The objective of this study was to determine wether radioligand therapy may be an appropriate option in chemoresistent tumors to justify subsequent prospective validation within the "Bladder BRIDGister". Methods: Formalin fixed paraffin embedded (FFPE) tissues from transurethral resections (TUR) before chemotherapy and cystectomy samples after NACT of 36 patients were retrospectively collected. RNA from FFPE tissues were extracted by commercial kits, relative gene expression of subtyping markers (KRT5, KRT20, FGFR1) and radioligand target genes (CXCR4, FAP) were analyzed by standardized RT-qPCR systems (STRATIFYER Molecular Pathology GmbH, Cologne). Spearman correlation, hierarchical clustering, Kruskal-Wallis, chi square and contingency tests were done by JMP 9.0.0 (SAS software). Results: The neoadjuvant cohort consisted of 36 patients (median age: 69, male 83% vs. female 17%) with 92% of patients being histopathologically node negative. When comparing pretreatment with post treatment samples the median expression of KRT20 dropped 128fold, while FGFR1, CXCR4 and FAP mRNA expression increased 6,8fold, 1,9 fold and 2,9 fold, respectively. FAP was positively associated with KRT5, FGFR1 and CXCR4 in treatment naïve TUR biopsies (r=0.4051 p=0.0141, r=0.6458 p<0.0001 and r=0.7586 p<0.0001, respectively), but negatively associated with KRT20 (r=-0.3879 p=0.0194). As previously described, FGFR1 was negatively associated with pCR (r=-0.6418 p<0.0001). Similarly, CXCR4 and FAP trended to be negatively associated with pCR (r=-0.3181 p=0.0586; r=-0.3072 p=0.0684). Hierarchical clustering revealed that CXCR4 and FAP are elevated in stromal rich, KRT5 & KRT20 negative tumors not responding to NACT. Elevated FAP above median mRNA expression was significantly associated with resistance to NACT (chi2 4.314 p=0,0378). Combining elevated FAP and CXCR4 mRNA expression did identify 28% of the patients to be at high risk of NACT resistance (90%). Conclusions: Expression of the radioligand targets CXCR4 and FAP are associated with basal/stromal enriched tumors and resistance to NACT. Theranostic targeting of CXCR4 and FAP before NACT might increase response towards NACT in this poor prognosis group.
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Affiliation(s)
| | | | - Frank Friedersdorff
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Thomas Otto
- Dpt. of Urology, Rheinlandklinikum, Neuss, Germany
| | | | - Elke Veltrup
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | | | | | - Roland Hake
- Department of Pathology, St. Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
| | - Sebastian Eidt
- Department of Pathology, St. Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
| | | | | | - Lucas Kastner
- Department of Urology, University Clinic Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - Stefan Koch
- Dpt of Pathology, Helios Hospital, Bad Saarow, Germany
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Wirtz RM, Voss PC, Friedersdorff F, Barski D, Otto T, Waldner M, Veltrup E, Linden F, Schwandt M, Hake R, Eidt S, Roggisch J, Rieger C, Kastner L, Heidenreich A, Koch S, Ecke TH. Prediction of response to neoadjuvant chemotherapy of patients with muscle invasive bladder cancer by molecular subtyping and antibody drug conjugate target gene quantitation: Preview of Bladder BRIDGister. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.545] [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: 03/15/2023] Open
Abstract
545 Background: Patients with muscle invasive urothelial carcinoma achieving pathological complete response (pCR) upon neoadjuvant chemotherapy (NACT) have improved prognosis. Molecular subtypes of bladder cancer differ markedly with regard to sensitivity to cisplatinum based chemotherapy. Previously we did show that luminal tumors respond better to NACT, while FGFR1 expression is associated with chemo resistance (Ecke et al. 2022). The objective of this study was to determine which patients may benefit from Antibody Drug Conjugate (ADC) treatment in addition to NACT to justify subsequent prospective analysis within the "Bladder BRIDGister". Methods: Formalin fixed paraffin embedded (FFPE) tissues from transurethral resections (TUR) before chemotherapy and cystectomy samples after NACT of 36 patients were retrospectively collected. RNA from FFPE tissues were extracted by commercial kits, relative gene expression of subtyping markers (KRT5, KRT20, FGFR1) and radioligand target genes (NECTIN4, TROP2) were analyzed by standardized RT-qPCR systems (STRATIFYER Molecular Pathology GmbH, Cologne). Spearman correlation, hierarchical clustering, Kruskal-Wallis, chi square and contingency tests were done by JMP 9.0.0 (SAS software). Results: The neoadjuvant cohort consisted of 36 patients (median age: 69, male 83% vs. female 17%) with 92% of patients being pathohistologically node negative. When comparing pretreatment with post treatment samples the median expression of KRT20 dropped 128fold, while FGFR1 expression increased 6.8 fold. Interestingly, TROP2 and NECTIN4 mRNA expression also dropped significantly upon NACT by 5.7 fold and 7.1 fold, respectively. TROP2 and NECTIN4 were positively associated with the response marker KRT20 in therapy naïve TUR biopsies (r=0.5562 p=0.0004; r=0.5833 p=0.0002), but negatively associated with the resistance marker FGFR1 (r=-0.2903 p=0,0858; r=-0.3396 p=0,0427). However, TROP2 and NECTIN4 were not associated with pCR in spearman analysis with minor trend for TROP2 (r=0,2139 p=0,2103). Cluster analysis revealed a subgroup of KRT20 positive and FGFR1 negative tumors expression TROP2 and NECTIN4, which achieved 80% pCR. In addition elevated TROP2 and NECTIN4 expression was found in KRT20 positive tumors coexpressing FGFR1 and being resistant to NACT. Conclusions: Expression of the ADC targets TROP2 and NECTIN4 is associated with KRT20 positive, luminal tumors being highly sensitive to neoadjuvant chemotherapy alone. KRT5 positive, basal tumors do exhibit only very low expression of TROP2 and NECTIN4 mRNA. In view of toxicities the addition of TROP2 and NECTIN4 treatment to NACT might be considered only in luminal tumors exhibiting elevated FGFR1 expression as resistance mechanism and therefore do not respond to NACT.
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Affiliation(s)
| | | | | | | | - Thomas Otto
- Dpt. of Urology, Rheinlandklinikum, Neuss, Germany
| | | | - Elke Veltrup
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | | | | | - Roland Hake
- Institute of Pathology, St. Elisabeth-Krankenhaus Hohenlind, Cologne, Germany
| | - Sebastian Eidt
- Institute of Pathology, St. Elisabeth Hospital Hohenlind, Cologne, Germany
| | | | | | - Lucas Kastner
- Department of Urology, University Clinic Cologne, Cologne, Germany
| | | | - Stefan Koch
- Dpt of Pathology, Helios Hospital, Bad Saarow, Germany
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Ecke TH, Benderska-Söder N, Bismarck E, van Rhijn BWG, Todenhöfer T, Schmitz-Dräger BJ. Considering the Effects of Modern Point-of-Care Urine Biomarker Assays in Follow-Up of Patients with High-Risk Non-muscle-Invasive Bladder Cancer. Methods Mol Biol 2023; 2684:199-212. [PMID: 37410236 DOI: 10.1007/978-1-0716-3291-8_12] [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: 07/07/2023]
Abstract
BACKGROUND Although a plethora of urine markers for diagnosis and follow-up of patients with bladder cancer (BC) has been developed and studied, the clinical impact of urine testing on patient management remains unclear. The goal of this manuscript is to identify scenarios for a potential use of modern point-of-care (POC) urine marker assays in the follow-up of patients with high-risk non-muscle-invasive BC (NMIBC) and estimate potential risks and benefits. METHODS To permit comparison between different assays, the results of 5 different POC assays studied in a recent prospective multicenter study including 127 patients with suspicious cystoscopy undergoing TURB were used for this simulation. For the current standard of care (SOC), a "marker-enforced" procedure, and a combined strategy sensitivity (Se), estimated number of cystoscopies, and the numbers needed to diagnose (NND) over a 1-year follow-up period were calculated. RESULTS For regular cystoscopy (SOC), a Se of 91.7% and a NND of 42.2 repetitive office cystoscopies (WLCs) for 1 recurrent tumor at 1 year were calculated. For the "marker-enforced" strategy, marker sensitivities between 94.7% and 97.1% were observed. The "combined" strategy yielded for markers with a Se exceeding 50% an overall Se at 1 year similar or superior to the current SOC. Savings regarding the number of cystoscopies in the "marker-enforced" strategy vs. the SOC were small, while, depending on the marker, up to 45% of all cystoscopies may be saved using the "combined" strategy. CONCLUSIONS Based on the results of this simulation, a marker-supported follow-up of patients with high-risk (HR) NMIBC is safe and offers options to significantly reduce the number of cystoscopies without compromising the Se. Further research focusing on prospective randomized trials is needed to finally find a way to include marker results into clinical decision-making.
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Affiliation(s)
- Thorsten H Ecke
- Department of Urology, Helios Hospital, Bad Saarow, Germany.
- Department of Urology, Universitätsmedizin Berlin Charité, Berlin, Germany.
- German Study Group of Bladder Cancer (DFBK e.V.), Munich, Germany.
| | | | | | - Bas W G van Rhijn
- Department Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Urology, University of Regensburg, Caritas-Hospital St. Josef, Regensburg, Germany
| | - Tilman Todenhöfer
- Studienpraxis Urologie, Nürtingen, Germany
- Medical Faculty, University of Tübingen, Tübingen, Germany
| | - Bernd J Schmitz-Dräger
- Urologie 24, Nürnberg, Germany
- Department of Urology, Friedrich-Alexander University, Erlangen, Germany
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8
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Ecke TH, Voß PC, Schlomm T, Rabien A, Friedersdorff F, Barski D, Otto T, Waldner M, Veltrup E, Linden F, Hake R, Eidt S, Roggisch J, Heidenreich A, Rieger C, Kastner L, Hallmann S, Koch S, Wirtz RM. Prediction of Response to Cisplatin-Based Neoadjuvant Chemotherapy of Muscle-Invasive Bladder Cancer Patients by Molecular Subtyping including KRT and FGFR Target Gene Assessment. Int J Mol Sci 2022; 23:ijms23147898. [PMID: 35887247 PMCID: PMC9323197 DOI: 10.3390/ijms23147898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 02/01/2023] Open
Abstract
Patients with muscle-invasive urothelial carcinoma achieving pathological complete response (pCR) upon neoadjuvant chemotherapy (NAC) have improved prognosis. Molecular subtypes of bladder cancer differ markedly regarding sensitivity to cisplatin-based chemotherapy and harbor FGFR treatment targets to various content. The objective of the present study was to evaluate whether preoperative assessment of molecular subtype as well as FGFR target gene expression is predictive for therapeutic outcome—rate of ypT0 status—to justify subsequent prospective validation within the “BladderBRIDGister”. Formalin-fixed paraffin-embedded (FFPE) tissue specimens from transurethral bladder tumor resections (TUR) prior to neoadjuvant chemotherapy and corresponding radical cystectomy samples after chemotherapy of 36 patients were retrospectively collected. RNA from FFPE tissues were extracted by commercial kits, Relative gene expression of subtyping markers (e.g., KRT5, KRT20) and target genes (FGFR1, FGFR3) was analyzed by standardized RT-qPCR systems (STRATIFYER Molecular Pathology GmbH, Cologne). Spearman correlation, Kruskal−Wallis, Mann−Whitney and sensitivity/specificity tests were performed by JMP 9.0.0 (SAS software). The neoadjuvant cohort consisted of 36 patients (median age: 69, male 83% vs. female 17%) with 92% of patients being node-negative during radical cystectomy after 1 to 4 cycles of NAC. When comparing pretreatment with post-treatment samples, the median expression of KRT20 dropped most significantly from DCT 37.38 to 30.65, which compares with a 128-fold decrease. The reduction in gene expression was modest for other luminal marker genes (GATA3 6.8-fold, ERBB2 6.3-fold). In contrast, FGFR1 mRNA expression increased from 33.28 to 35.88 (~6.8-fold increase). Spearman correlation revealed positive association of pretreatment KRT20 mRNA levels with achieving pCR (r = 0.3072: p = 0.0684), whereas pretreatment FGFR1 mRNA was associated with resistance to chemotherapy (r = −0.6418: p < 0.0001). Hierarchical clustering identified luminal tumors of high KRT20 mRNA expression being associated with high pCR rate (10/16; 63%), while the double-negative subgroup with high FGFR1 expression did not respond with pCR (0/9; 0%). Molecular subtyping distinguishes patients with high probability of response from tumors as resistant to neoadjuvant chemotherapy. Targeting FGFR1 in less-differentiated bladder cancer subgroups may sensitize tumors for adopted treatments or subsequent chemotherapy.
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Affiliation(s)
- Thorsten H. Ecke
- Department of Urology, Helios Hospital Bad Saarow, 15526 Bad Saarow, Germany;
- Department of Urology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (P.C.V.); (T.S.); (A.R.); (F.F.)
- Correspondence:
| | - Paula Carolin Voß
- Department of Urology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (P.C.V.); (T.S.); (A.R.); (F.F.)
| | - Thorsten Schlomm
- Department of Urology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (P.C.V.); (T.S.); (A.R.); (F.F.)
| | - Anja Rabien
- Department of Urology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (P.C.V.); (T.S.); (A.R.); (F.F.)
| | - Frank Friedersdorff
- Department of Urology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (P.C.V.); (T.S.); (A.R.); (F.F.)
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, 10365 Berlin, Germany
| | - Dimitri Barski
- Department of Urology, Rheinlandklinikum, 41464 Neuss, Germany; (D.B.); (T.O.)
| | - Thomas Otto
- Department of Urology, Rheinlandklinikum, 41464 Neuss, Germany; (D.B.); (T.O.)
| | - Michael Waldner
- Department of Urology, St. Elisabeth Hospital, 50935 Cologne, Germany;
| | - Elke Veltrup
- STRATIFYER Molecular Pathology GmbH, 50935 Cologne, Germany; (E.V.); (F.L.); (R.M.W.)
| | - Friederike Linden
- STRATIFYER Molecular Pathology GmbH, 50935 Cologne, Germany; (E.V.); (F.L.); (R.M.W.)
| | - Roland Hake
- Institute of Pathology, St. Elisabeth Hospital, 50935 Cologne, Germany; (R.H.); (S.E.)
| | - Sebastian Eidt
- Institute of Pathology, St. Elisabeth Hospital, 50935 Cologne, Germany; (R.H.); (S.E.)
| | - Jenny Roggisch
- Institute of Pathology, Helios Hospital, 15526 Bad Saarow, Germany; (J.R.); (S.K.)
| | - Axel Heidenreich
- Department of Urology, Universitäsklinikum Köln, 50937 Cologne, Germany; (A.H.); (C.R.); (L.K.)
| | - Constantin Rieger
- Department of Urology, Universitäsklinikum Köln, 50937 Cologne, Germany; (A.H.); (C.R.); (L.K.)
| | - Lucas Kastner
- Department of Urology, Universitäsklinikum Köln, 50937 Cologne, Germany; (A.H.); (C.R.); (L.K.)
| | - Steffen Hallmann
- Department of Urology, Helios Hospital Bad Saarow, 15526 Bad Saarow, Germany;
| | - Stefan Koch
- Institute of Pathology, Helios Hospital, 15526 Bad Saarow, Germany; (J.R.); (S.K.)
- Brandenburg Medical School, 16816 Neuruppin, Germany
| | - Ralph M. Wirtz
- STRATIFYER Molecular Pathology GmbH, 50935 Cologne, Germany; (E.V.); (F.L.); (R.M.W.)
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9
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Ecke TH, Le Calvez-Kelm F, Otto T. Molecular Diagnostic and Prognostication Assays for the Subtyping of Urinary Bladder Cancer Are on the Way to Illuminating Our Vision. Int J Mol Sci 2022; 23:5620. [PMID: 35628431 PMCID: PMC9145419 DOI: 10.3390/ijms23105620] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022] Open
Abstract
After the successful publication of three Special Issues devoted to highlighting novel scientific research results in the field of bladder cancer and their clinical implications, we are now directing our efforts towards a fourth edition which will aim at compiling innovative research strategies that will ultimately guide and support clinicians in the decision-making process for targeted bladder cancer therapies [...].
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Affiliation(s)
- Thorsten H. Ecke
- Department of Urology, HELIOS Hospital Bad Saarow, 15526 Bad Saarow, Germany
- Department of Urology, Universitätsmedizin Berlin-Charité, 10098 Berlin, Germany
| | | | - Thomas Otto
- Department of Urology, Rheinland Klinikum Neuss, 41464 Neuss, Germany;
- University Hospital Essen, 45147 Essen, Germany
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10
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Meisl CJ, Karakiewicz PI, Einarsson R, Koch S, Hallmann S, Weiß S, Hemdan T, Malmström P, Styrke J, Sherif A, Hasan MN, Pichler R, Tulchiner G, Palou J, Rodríguez Faba Ó, Hennenlotter J, Stenzl A, Ritter R, Niegisch G, Grunewald CM, Schlomm T, Friedersdorff F, Barski D, Otto T, Gössl A, Arndt C, Esuvaranathan K, Kesavan NR, Zhijiang Z, Kramer MW, Hennig MJ, Ecke TH. Nomograms including UBC® Rapid Test to detect primary bladder cancer based on a multicenter data set. BJU Int 2021; 130:754-763. [DOI: 10.1111/bju.15677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/06/2021] [Accepted: 12/11/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Christina J. Meisl
- Dept. of Urology Charité ‐ Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humbold‐Universität zu Berlin Berlin Institute of Health Berlin Germany
| | | | | | - Stefan Koch
- Dept. of Pathology HELIOS Hospital Bad Saarow Bad Saarow Germany
- Brandenburg Medical School Theodor Fontane Neuruppin Germany
| | | | - Sarah Weiß
- Dept. of Urology HELIOS Hospital Bad Saarow Bad Saarow Germany
| | - Tammer Hemdan
- Dept. of Surgical Sciences Uppsala University Uppsala Sweden
| | | | - Johan Styrke
- Dept. of Surgical and Perioperative Sciences, Urology and Andrology Umeå University Umeå Sweden
| | - Amir Sherif
- Dept. of Surgical and Perioperative Sciences, Urology and Andrology Umeå University Umeå Sweden
| | | | - Renate Pichler
- Dept. of Urology Medical University Innsbruck Innsbruck Austria
| | | | - Joan Palou
- Dept. of Urology Fundació Puigvert Autonomous University of Barcelona Barcelona Spain
| | - Óscar Rodríguez Faba
- Dept. of Urology Fundació Puigvert Autonomous University of Barcelona Barcelona Spain
| | - Jörg Hennenlotter
- Dept. of Urology University Hospital Faculty of Medicine Tübingen Tübingen Germany
| | - Arnulf Stenzl
- Dept. of Urology University Hospital Faculty of Medicine Tübingen Tübingen Germany
| | - René Ritter
- Dept. of Urology Diakonie‐Klinikum Stuttgart Stuttgart Germany
| | - Günter Niegisch
- Dept. of Urology Medical Faculty Heinrich‐Heine University Düsseldorf Düsseldorf Germany
| | - Camilla M. Grunewald
- Dept. of Urology Medical Faculty Heinrich‐Heine University Düsseldorf Düsseldorf Germany
| | - Thorsten Schlomm
- Dept. of Urology Charité ‐ Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humbold‐Universität zu Berlin Berlin Institute of Health Berlin Germany
| | - Frank Friedersdorff
- Dept. of Urology Charité ‐ Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humbold‐Universität zu Berlin Berlin Institute of Health Berlin Germany
- Dept. of Urology Evangelisches Krankenhaus Königin Elisabeth Herzberge Berlin Germany
| | | | - Thomas Otto
- Dept. of Urology Rheinland Klinikum Neuss Neuss Germany
- Medical Faculty University of Duisburg‐Essen Essen Germany
| | - Andreas Gössl
- Dept. of Urology HELIOS Hospital Krefeld Krefeld Germany
| | | | | | - Nisha R. Kesavan
- Dept. of Urology National University Hospital Singapore City Singapore
| | - Zang Zhijiang
- Dept. of Urology National University Hospital Singapore City Singapore
| | - Mario W. Kramer
- Dept. of Urology University Hospital Schleswig‐Holstein Campus Lübeck Lübeck Germany
| | - Martin J.P. Hennig
- Dept. of Urology University Hospital Schleswig‐Holstein Campus Lübeck Lübeck Germany
| | - Thorsten H. Ecke
- Dept. of Urology Charité ‐ Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humbold‐Universität zu Berlin Berlin Institute of Health Berlin Germany
- Dept. of Urology HELIOS Hospital Bad Saarow Bad Saarow Germany
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11
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Weiß S, Hallmann S, Koch S, Eidt S, Stoehr R, Veltrup E, Roggisch J, Wirtz RM, Ecke TH. Identifying the Molecular Mechanisms Contributing to Progression, Metastasis, and Death in Low-grade Non-muscle-invasive Bladder Cancer: A Case Report. EUR UROL SUPPL 2021; 27:29-32. [PMID: 34337514 PMCID: PMC8317895 DOI: 10.1016/j.euros.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 11/19/2022] Open
Abstract
Transitional cell carcinoma of the bladder is a common malignancy with an estimated 549 393 new cases occurring in 2018 alone. Both non–muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) show high recurrence and progression rates, and therefore impose a great burden on patients and health care systems. Current risk stratification and therapy strategies are predominantly based on clinical and histopathological findings for tumor stage and grade. The chemoresistance and metastasis of low-grade tumors suggest an incomplete understanding of disease mechanisms, despite numerous studies on differentiating molecular subtypes of bladder cancer to identify tumor drivers and potential therapeutic targets. We present a highly unusual course for a low-grade bladder tumor leading to metastasis and death, for which we used postmortem histopathological and molecular analyses to evaluate targetable alterations in key signaling pathways driving the underlying tumor biology.
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Affiliation(s)
- Sarah Weiß
- Department of Urology, Helios Hospital, Bad Saarow, Germany
- Corresponding author. Helios Klinikum Bad Saarow, Pieskower Strasse 33, 15526 Bad Saarow, Germany. Tel.: +49 03363173466.
| | | | - Stefan Koch
- Department of Pathology, Helios Hospital, Bad Saarow, Germany
- Brandenburg Medical School, Bad Saarow, Germany
| | - Sebastian Eidt
- Institute of Pathology, St. Elisabeth Hospital Cologne-Hohenlind, Cologne, Germany
| | - Robert Stoehr
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Elke Veltrup
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | - Jenny Roggisch
- Department of Pathology, Helios Hospital, Bad Saarow, Germany
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12
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Ecke TH, Schwaiger D, Nesterov G, Koswig S, Selinski S, Barrett T, Gnanapragasam V, Koch S, Hallmann S. Comparison of initial and second opinion reads of multiparametric magnetic resonance imaging of the prostate for transperineal template-guided biopsies with MRI-Ultrasound fusion. Urol Oncol 2021; 39:781.e1-781.e7. [PMID: 33563540 DOI: 10.1016/j.urolonc.2021.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/23/2020] [Revised: 12/11/2020] [Accepted: 01/07/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the value of second-opinion evaluation of multiparametric prostate magnetic resonance imaging (MRI) by subspecialised uroradiologists for the detection of significant cancer in transperineal fusion prostate biopsy. METHODS The evaluated data included age, PSA (ng/ml), PSA density, Gleason score, digital rectal examination (DRE), prostate volume of 149 patients. Twenty-seven patients (18%) had no previous prostate biopsy, 114 patients (77%) had a previous negative biopsy, and 8 patients (5%) were on active surveillance. Using PI-RADS v2 scores for mpMRI a second report was performed by a specialist uroradiologist. In all cases a subsequent transperineal biopsy was performed with at least 2 cores per target and additional background systemic cores. Initial and second-opinion radiology reports were evaluated for detection of any cancer and Gleason score (GS) 7-10 cancer, including positive predictive value and negative (NPV) and compared by Fisher's exact test. RESULTS At transperineal biopsy, 51 % (76/149) of patients had a GS 6-10 prostate cancer (PCa), 27 % (40/149) of patients had a GS 3 + 3 PCa and 12 % (18/149) a GS 3 + 4 and 12 % (18/149) had a GS ≥4 + 3 PCa. Agreement between initial and second-opinion reads was observed in 57.7% (86/149; kappa value = 0.32). The detection of clinically significant cancers with second-opinion reads was significantly higher (0.61; 17/28) compared to initial reads (0.35; 17/49); P = 0.034. CONCLUSIONS Second reading of prostate mpMRIs by subspecialised uroradiologists significantly improved the positive predictive value for detection of clinically significant prostate cancer and showed a trend towards improved NPV for MRI-negative cases where biopsy could be safely avoided. Urologists should be aware that the experience of the reporter will affect the report when making decisions if and how to obtain biopsies. Reporter experience may help to reduce overcalling and avoid over-targeting of lesions.
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Affiliation(s)
- Thorsten H Ecke
- Department of Urology, HELIOS Hospital, Bad Saarow, Germany; Brandenburg Medical School, BB, Germany.
| | - Dagmar Schwaiger
- Department of Radiology, Vivantes Klinikum Friedrichshain, Berlin, Germany
| | | | - Stephan Koswig
- Department of Radio-Oncology, HELIOS Hospital Bad Saarow, Germany
| | - Silvia Selinski
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Dortmund, Germany
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | | | - Stefan Koch
- Brandenburg Medical School, BB, Germany; Institute of Pathology, HELIOS Hospital Bad Saarow, Germany
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13
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Ecke TH, Otto T, Le Calvez-Kelm F. Evaluating the Utility of Combined Bladder Cancer Biomarkers, the Molecular Prognostication of Tumor Subtypes, or What Else Is Needed to Illuminate Our Vision? Int J Mol Sci 2020; 21:E9657. [PMID: 33352845 PMCID: PMC7766346 DOI: 10.3390/ijms21249657] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/14/2020] [Indexed: 12/24/2022] Open
Abstract
In the last few years, we published two special issues devoted to highlighting important scientific results in the field of bladder cancer research and clinical implications [...].
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Affiliation(s)
- Thorsten H. Ecke
- Department of Urology, HELIOS Hospital Bad Saarow, DE-15526 Bad Saarow, Germany
| | - Thomas Otto
- Department of Urology, Rheinland Klinikum Neuss, DE-41464 Neuss, Germany;
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14
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Achenbach F, Rose M, Ortiz-Brüchle N, Seillier L, Knüchel R, Weyerer V, Hartmann A, Morsch R, Maurer A, Ecke TH, Garczyk S, Gaisa NT. SWI/SNF Alterations in Squamous Bladder Cancers. Genes (Basel) 2020; 11:genes11111368. [PMID: 33227989 PMCID: PMC7699259 DOI: 10.3390/genes11111368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/10/2020] [Accepted: 11/17/2020] [Indexed: 12/24/2022] Open
Abstract
Dysfunction of the SWI/SNF complex has been observed in various cancers including urothelial carcinomas. However, the clinical impact of the SWI/SNF complex in squamous-differentiated bladder cancers (sq-BLCA) remains unclear. Therefore, we aimed to analyze potential expression loss and genetic alterations of (putative) key components of the SWI/SNF complex considering the co-occurrence of genetic driver mutations and PD-L1 expression as indicators for therapeutic implications. Assessment of ARID1A, SMARCA2, SMARCA4, SMARCB1/INI1, SMARCC1, SMARCC2 and PBRM1 mutations in a TCGA data set of sq-BLCA (n = 45) revealed that ARID1A was the most frequently altered SWI/SNF gene (15%) while being associated with protein downregulation. Genetic alterations and loss of ARID1A were confirmed by Targeted Next Generation Sequencing (NGS) (3/6) and immunohistochemistry (6/116). Correlation with further mutational data and PD-L1 expression revealed co-occurrence of ARID1A loss and TP53 mutations, while positive correlations with other driver mutations such as PIK3CA were not observed. Finally, a rare number of sq-BLCA samples were characterized by both ARID1A protein loss and strong PD-L1 expression suggesting a putative benefit upon immune checkpoint inhibitor therapy. Hence, for the first time, our data revealed expression loss of SWI/SNF subunits in sq-BLCA, highlighting ARID1A as a putative target of a small subgroup of patients eligible for novel therapeutic strategies.
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Affiliation(s)
- Fabian Achenbach
- Institute of Pathology, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany; (F.A.); (M.R.); (N.O.-B.); (L.S.); (R.K.); (A.M.); (S.G.)
| | - Michael Rose
- Institute of Pathology, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany; (F.A.); (M.R.); (N.O.-B.); (L.S.); (R.K.); (A.M.); (S.G.)
| | - Nadina Ortiz-Brüchle
- Institute of Pathology, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany; (F.A.); (M.R.); (N.O.-B.); (L.S.); (R.K.); (A.M.); (S.G.)
| | - Lancelot Seillier
- Institute of Pathology, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany; (F.A.); (M.R.); (N.O.-B.); (L.S.); (R.K.); (A.M.); (S.G.)
| | - Ruth Knüchel
- Institute of Pathology, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany; (F.A.); (M.R.); (N.O.-B.); (L.S.); (R.K.); (A.M.); (S.G.)
| | - Veronika Weyerer
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (V.W.); (A.H.)
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (V.W.); (A.H.)
| | - Ronja Morsch
- Department of Urology, RWTH Aachen University, 52074 Aachen, Germany;
| | - Angela Maurer
- Institute of Pathology, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany; (F.A.); (M.R.); (N.O.-B.); (L.S.); (R.K.); (A.M.); (S.G.)
| | - Thorsten H. Ecke
- Department of Urology, Helios Clinic, 15526 Bad Saarow, Germany;
| | - Stefan Garczyk
- Institute of Pathology, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany; (F.A.); (M.R.); (N.O.-B.); (L.S.); (R.K.); (A.M.); (S.G.)
| | - Nadine T. Gaisa
- Institute of Pathology, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany; (F.A.); (M.R.); (N.O.-B.); (L.S.); (R.K.); (A.M.); (S.G.)
- Correspondence: ; Tel.: +49-241-8036118; Fax: +49-241-8082439
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15
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Ecke TH, Kiani A, Schlomm T, Friedersdorff F, Rabien A, Jung K, Kilic E, Boström P, Tervahartiala M, Taimen P, Gleichenhagen J, Johnen G, Brüning T, Koch S, Roggisch J, Wirtz RM. Prognostic Role of Survivin and Macrophage Infiltration Quantified on Protein and mRNA Level in Molecular Subtypes Determined by RT-qPCR of KRT5, KRT20, and ERBB2 in Muscle-Invasive Bladder Cancer Treated by Adjuvant Chemotherapy. Int J Mol Sci 2020; 21:ijms21197420. [PMID: 33050010 PMCID: PMC7582791 DOI: 10.3390/ijms21197420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/18/2020] [Accepted: 09/30/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Bladder cancer is a heterogeneous malignancy. Therefore, it is difficult to find single predictive markers. Moreover, most studies focus on either the immunohistochemical or molecular assessment of tumor tissues by next-generation sequencing (NGS) or PCR, while a combination of immunohistochemistry (IHC) and PCR for tumor marker assessment might have the strongest impact to predict outcome and select optimal therapies in real-world application. We investigated the role of proliferation survivin/BIRC5 and macrophage infiltration (CD68, MAC387, CLEVER-1) on the basis of molecular subtypes of bladder cancer (KRT5, KRT20, ERBB2) to predict outcomes of adjuvant treated muscle-invasive bladder cancer patients with regard to progression-free survival (PFS) and disease-specific survival (DSS). MATERIALS AND METHODS We used tissue microarrays (TMA) from n = 50 patients (38 males, 12 female) with muscle-invasive bladder cancer. All patients had been treated with radical cystectomy followed by adjuvant triple chemotherapy. Median follow-up time was 60.5 months. CD68, CLEVER-1, MAC387, and survivin protein were detected by immunostaining and subsequent visual inspection. BIRC5, KRT5, KRT20, ERBB2, and CD68 mRNAs were detected by standardized RT-qPCR after tissue dot RNA extraction using a novel stamp technology. All these markers were evaluated in three different centers of excellence. RESULTS Nuclear staining rather than cytoplasmic staining of survivin predicted DSS as a single marker with high levels of survivin being associated with better PFS and DSS upon adjuvant chemotherapy (p = 0.0138 and p = 0.001, respectively). These results were validated by the quantitation of BIRC5 mRNA by PCR (p = 0.0004 and p = 0.0508, respectively). Interestingly, nuclear staining of survivin protein was positively associated with BIRC5 mRNA, while cytoplasmic staining was inversely related, indicating that the translocation of survivin protein into the nucleus occurred at a discrete, higher level of its mRNA. Combining survivin/BIRC5 levels based on molecular subtype being assessed by KRT20 expression improved the predictive value, with tumors having low survivin/BIRC5 and KRT20 mRNA levels having the best survival (75% vs. 20% vs. 10% 5-year DSS, p = 0.0005), and these values were independent of grading, node status, and tumor stage in multivariate analysis (p = 0.0167). Macrophage infiltration dominated in basal tumors and was inversely related with the luminal subtype marker gene expression. The presence of macrophages in survivin-positive or ERBB2-positive tumors was associated with worse DSS. CONCLUSIONS For muscle-invasive bladder cancer patients, the proliferative activity as determined by the nuclear staining of survivin or RT-qPCR on the basis of molecular subtype characteristics outperforms single marker detections and single technology approaches. Infiltration by macrophages detected by IHC or PCR is associated with worse outcome in defined subsets of tumors. The limitations of this study are the retrospective nature and the limited number of patients. However, the number of molecular markers has been restricted and based on predefined assumptions, which resulted in the dissection of muscle-invasive disease into tumor-biological axes of high prognostic relevance, which warrant further investigation and validation.
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Affiliation(s)
- Thorsten H. Ecke
- Department of Urology, HELIOS Hospital Bad Saarow, DE-15526 Bad Sarrow, Germany
- Brandenburg Medical School, DE-14770 Brandenburg, Germany;
- Correspondence: ; Tel.: +49-33631-72267; Fax: +49-33631-73136
| | - Adisch Kiani
- Department of Urology, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, DE-10098 Berlin, Germany; (A.K.); (T.S.); (F.F.); (A.R.); (K.J.)
| | - Thorsten Schlomm
- Department of Urology, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, DE-10098 Berlin, Germany; (A.K.); (T.S.); (F.F.); (A.R.); (K.J.)
| | - Frank Friedersdorff
- Department of Urology, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, DE-10098 Berlin, Germany; (A.K.); (T.S.); (F.F.); (A.R.); (K.J.)
| | - Anja Rabien
- Department of Urology, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, DE-10098 Berlin, Germany; (A.K.); (T.S.); (F.F.); (A.R.); (K.J.)
- Berlin Institute for Urological Research, DE-10098 Berlin, Germany
| | - Klaus Jung
- Department of Urology, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, DE-10098 Berlin, Germany; (A.K.); (T.S.); (F.F.); (A.R.); (K.J.)
- Berlin Institute for Urological Research, DE-10098 Berlin, Germany
| | - Ergin Kilic
- Institute of Pathology, DE-51375 Leverkusen, Germany;
| | - Peter Boström
- Department of Urology, Turku University Hospital, FI-20521 Turku, Finland;
| | - Minna Tervahartiala
- MediCity Research Laboratory, Department of Medical Microbiology and Immunology, University of Turku, FI-20520 Turku, Finland;
| | - Pekka Taimen
- Institute of Pathology, Turku University Hospital, FI-20521 Turku, Finland;
| | - Jan Gleichenhagen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Institute of the Ruhr University Bochum, DE-44789 Bochum, Germany; (J.G.); (G.J.); (T.B.)
| | - Georg Johnen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Institute of the Ruhr University Bochum, DE-44789 Bochum, Germany; (J.G.); (G.J.); (T.B.)
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Institute of the Ruhr University Bochum, DE-44789 Bochum, Germany; (J.G.); (G.J.); (T.B.)
| | - Stefan Koch
- Brandenburg Medical School, DE-14770 Brandenburg, Germany;
- Institute of Pathology, HELIOS Hospital Bad Saarow, DE-15526 Bad Sarrow, Germany;
| | - Jenny Roggisch
- Institute of Pathology, HELIOS Hospital Bad Saarow, DE-15526 Bad Sarrow, Germany;
| | - Ralph M. Wirtz
- STRATIFYER Molecular Pathology GmbH, DE-50935 Cologne, Germany;
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Huang-Tiel HJ, Otto I, Golka K, Selinski S, Koswig S, Bathe K, Hallmann S, Ecke TH. Health-related quality of life and rates of toxicity after high-dose-rate brachytherapy in combination with external beam radiation therapy for high-risk prostate cancer. Investig Clin Urol 2020; 61:250-259. [PMID: 32377600 PMCID: PMC7189115 DOI: 10.4111/icu.2020.61.3.250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/03/2019] [Indexed: 11/22/2022] Open
Abstract
Purpose High-dose-rate brachytherapy (HDR-BT) with external beam radiation therapy (EBRT) is a common treatment option for locally advanced prostate cancer. Quality of life is an important factor when discussing therapy options for high-risk prostate cancer. This study evaluated adverse effects and health-related quality of life (HRQOL). Materials and Methods Ninety male patients (median age, 71 years; range, 50 to 79 years) with high-risk prostate cancer underwent HDR-BT after EBRT between December 2009 and January 2017 with a median follow-up of 43 months. A total of 57 patients (69.5%) answered the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life of Cancer Patients questionnaire (QLQ-C30; ver. 3.0), and 8 patients died during follow-up. In order to put the results of this study in context, we compared the results with reference data from the EORTC QLQ-C30 Scoring Manual. Correlations of prostate-specific antigen (PSA) values, International Prostate Symptom Score, and HRQOL measures were calculated. Results The study participants reported better physical functioning and better global health compared with the reference data, but worse social, role, and cognitive functioning. We found negative statistically significant correlations between the last-measured PSA value and social functioning (p>0.01), cognitive functioning, pain, and constipation (all p<0.05). Toxicity rates were 10.0% for gastrointestinal and 12.2% for genitourinary adverse effects. All reported complications for toxicity were Grade I. Conclusions The described therapy results in high biochemical control rates with minimal adverse effects. Compared with reference groups, the HRQOL of this study cohort was acceptable. PSA values during follow-up seem to be a possible indicator to influence HRQOL.
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Affiliation(s)
- Hui-Juan Huang-Tiel
- Department of Neurology/Emergency Unit, Vivantes Hospital Spandau, Berlin, Germany
| | - Isabella Otto
- Institute of Medical Psychology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Klaus Golka
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Dortmund, Germany
| | - Silvia Selinski
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Dortmund, Germany
| | - Stephan Koswig
- Department of Radio-Oncology, HELIOS Hospital, Bad Saarow, Germany
| | - Kathrin Bathe
- Department of Radio-Oncology, HELIOS Hospital, Bad Saarow, Germany
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17
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Ecke TH, Otto T. Illumination of a Vision 2020-Urinary Based Biomarkers for Bladder Cancer on the Way to Clinical Decisions-Dream or Nightmare? Int J Mol Sci 2020; 21:ijms21051694. [PMID: 32121621 PMCID: PMC7084301 DOI: 10.3390/ijms21051694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 01/14/2023] Open
Affiliation(s)
- Thorsten H. Ecke
- Department of Urology, HELIOS Hospital Bad Saarow, D-15526 Bad Saarow, Germany
- Correspondence: (T.H.E.); (T.O.)
| | - Thomas Otto
- Department of Urology, Lukaskrankenhaus Neuss, D-41464 Neuss, Germany
- University Hospital Essen, D-45147 Essen, Germany
- Correspondence: (T.H.E.); (T.O.)
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18
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Zuiverloon TCM, van Kessel KEM, Bivalacqua TJ, Boormans JL, Ecke TH, Grivas PD, Kiltie AE, Liedberg F, Necchi A, van Rhijn BW, Roghmann F, Sanchez-Carbayo M, Schmitz-Dräger BJ, Wezel F, Kamat AM. Recommendations for follow-up of muscle-invasive bladder cancer patients: A consensus by the international bladder cancer network. Urol Oncol 2018; 36:423-431. [PMID: 29496372 DOI: 10.1016/j.urolonc.2018.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 01/04/2018] [Accepted: 01/24/2018] [Indexed: 10/17/2022]
Abstract
RATIONALE Several guidelines exist that address treatment of patients with nonmetastatic muscle-invasive bladder cancer (MIBC). However, most only briefly mention follow-up strategies for patients and hence the treating physician is often left to infer on what the preferred follow-up schema would be for an individual patient. Herein, we aim to synthesize recommendations for follow-up of patients with MIBC for easy reference. METHODS A multidisciplinary MIBC expert panel from the International Bladder Cancer Network was assembled to critically assess currently available major guidelines on surveillance of MIBC patients. Recommendations for follow-up were extracted and critically evaluated. Important considerations for guideline assessment included both aspects of oncological and functional follow-up-frequency of visits, the use of different imaging modalities, the role of cytology and molecular markers, and the duration of follow-up. OUTCOME An International Bladder Cancer Network expert consensus recommendation was constructed for the follow-up of patients with MIBC based on the currently available evidence-based data.
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Affiliation(s)
- Tahlita C M Zuiverloon
- Department of Urology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands; University of Colorado Comprehensive Cancer Center, Aurora, CO
| | - Kim E M van Kessel
- Department of Pathology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Trinity J Bivalacqua
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MA
| | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | | | - Petros D Grivas
- Department of Hematology/Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Anne E Kiltie
- Department of Oncology, University of Oxford, Oxford, UK
| | - Fredrik Liedberg
- Department of Urology, Skåne University Hospital, Lund, Sweden; Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Bas W van Rhijn
- Division of Surgical Oncology (Urology), Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Marta Sanchez-Carbayo
- Lucio Lascaray Research Center, University of the Basque Country, Vitoria-Gasteiz, Spain
| | - Bernd J Schmitz-Dräger
- Department of Urology, Friedrich-Alexander University, Erlangen and Urologie24, Nuremberg, Germany
| | - Felix Wezel
- Department of Urology, Ulm University Hospital, Ulm, Germany
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
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Ecke TH, Otto T. Illumination of a Vision-How Arthur Rimbaud Will Give Us Motivation to Find New Input into Bladder Cancer Biomarker Research. Int J Mol Sci 2017; 18:ijms18112463. [PMID: 29156599 PMCID: PMC5713429 DOI: 10.3390/ijms18112463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
- Thorsten H Ecke
- Department of Urology, HELIOS Hospital Bad Saarow, 15526 Bad Saarow, Germany.
| | - Thomas Otto
- Department of Urology, Lukaskrankenhaus Neuss, 41464 Neuss, Germany.
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20
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Ecke TH, Stier K, Weickmann S, Zhao Z, Buckendahl L, Stephan C, Kilic E, Jung K. miR-199a-3p and miR-214-3p improve the overall survival prediction of muscle-invasive bladder cancer patients after radical cystectomy. Cancer Med 2017; 6:2252-2262. [PMID: 28879675 PMCID: PMC5633587 DOI: 10.1002/cam4.1161] [Citation(s) in RCA: 24] [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: 01/13/2017] [Revised: 07/05/2017] [Accepted: 07/17/2017] [Indexed: 12/19/2022] Open
Abstract
To improve the clinical decision‐making regarding further treatment management and follow‐up scheduling for patients with muscle‐invasive bladder cancer (MIBC) after radical cystectomy (RC), a better prediction accuracy of prognosis for these patients is urgently needed. The objective of this study was to evaluate the validity of differentially expressed microRNAs (miRNAs) based on a previous study as prognostic markers for overall survival (OS) after RC in models combined with clinicopathological data. The expression of six miRNAs (miR‐100‐5p, miR‐130b‐3p, miR‐141‐3p, miR‐199a‐3p, miR‐205‐5p, and miR‐214‐3p) was measured by RT‐qPCR in formalin‐fixed, paraffin‐embedded tissue samples from 156 MIBC patients who received RC in three urological centers. Samples from 2000 to 2013 were used according to their tissue availability, with follow‐up until June 2016. The patient cohort was randomly divided into a training (n = 100) and test set (n = 56). Seventy‐three samples from adjacent normal tissue were used as controls. Kaplan–Meier, univariate and multivariate Cox regression, and decision curve analyses were carried out to assess the association of clinicopathological variables and miRNAs to OS. Both increased (miR‐130b‐3p and miR‐141‐3p) and reduced (miR‐100‐5p, miR‐199a‐3p, and miR‐214‐3p) miRNA expressions were found in MIBC samples in comparison to nonmalignant tissue samples (P < 0.0001). miR‐199a‐3p and miR‐214‐3p were independent markers of OS in Cox regression models with the significant clinicopathological variables age, tumor status, and lymph node status. The prediction model with the clinicopathological variables was improved by these two miRNAs in both sets. The predictive benefit was confirmed by decision curve analysis. In conclusion, the inclusion of both miRNAs into models based on clinical data for the outcome prediction of MIBC patients after RC could be a valuable approach to improve prognostic accuracy.
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Affiliation(s)
| | - Katja Stier
- Department of Urology, Campus Benjamin Franklin, University Hospital Charité, Germany
| | - Sabine Weickmann
- Department of Urology, Campus Charité Mitte, University Hospital Charité, Germany
| | - Zhongwei Zhao
- Department of Urology, Campus Charité Mitte, University Hospital Charité, Germany
| | - Laura Buckendahl
- Department of Urology, Campus Charité Mitte, University Hospital Charité, Germany
| | - Carsten Stephan
- Department of Urology, Campus Charité Mitte, University Hospital Charité, Germany.,Berlin Institute for Urologic Research, Berlin, Germany
| | - Ergin Kilic
- Institute of Pathology, University Hospital Charité, Germany
| | - Klaus Jung
- Department of Urology, Campus Charité Mitte, University Hospital Charité, Germany.,Berlin Institute for Urologic Research, Berlin, Germany
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Ecke TH, Weiß S, Stephan C, Hallmann S, Barski D, Otto T, Gerullis H. UBC ® Rapid Test for detection of carcinoma in situ for bladder cancer. Tumour Biol 2017; 39:1010428317701624. [PMID: 28468590 DOI: 10.1177/1010428317701624] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UBC® Rapid Test is a test that detects fragments of cytokeratins 8 and 18 in urine. We present results of a multicentre study measuring UBC® Rapid Test in bladder cancer patients and healthy controls with focus on carcinoma in situ (CIS) and high-grade bladder cancer. From our study with N = 452 patients, we made a stratified sub-analysis for carcinoma in situ of the urinary bladder. Clinical urine samples were used from 87 patients with tumours of the urinary bladder (23 carcinoma in situ, 23 non-muscle-invasive low-grade tumours, 21 non-muscle-invasive high-grade tumours and 20 muscle-invasive high-grade tumours) and from 22 healthy controls. The cut-off value was defined at 10.0 µg/L. Urine samples were analysed by the UBC® Rapid Test point-of-care system (concile Omega 100 POC reader). Pathological levels of UBC Rapid Test in urine are higher in patients with bladder cancer in comparison to the control group (p < 0.001). Sensitivity was calculated at 86.9% for carcinoma in situ, 30.4% for non-muscle-invasive low-grade bladder cancer, 71.4% for nonmuscle-invasive high grade bladder cancer and 60% for muscle-invasive high-grade bladder cancer, and specificity was 90.9%. The area under the curve of the quantitative UBC® Rapid Test using the optimal threshold obtained by receiveroperated curve analysis was 0.75. Pathological values of UBC® Rapid Test in urine are higher in patients with high-grade bladder cancer in comparison to low-grade tumours and the healthy control group. UBC® Rapid Test has potential to be more sensitive and specific urinary protein biomarker for accurate detection of high-grade patients and could be added especially in the diagnostics for carcinoma in situ and non-muscle-invasive high-grade tumours of urinary bladder cancer.
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Affiliation(s)
- Thorsten H Ecke
- 1 Department of Urology, HELIOS Hospital Bad Saarow, Bad Saarow, Germany
| | - Sarah Weiß
- 2 Department of Urology, Charité University Hospital, Berlin, Germany
| | - Carsten Stephan
- 2 Department of Urology, Charité University Hospital, Berlin, Germany.,3 Berlin Institute for Urological Research, Berlin, Germany
| | - Steffen Hallmann
- 1 Department of Urology, HELIOS Hospital Bad Saarow, Bad Saarow, Germany
| | - Dimitri Barski
- 4 Department of Urology, Lukas Hospital Neuss, Neuss, Germany
| | - Thomas Otto
- 4 Department of Urology, Lukas Hospital Neuss, Neuss, Germany
| | - Holger Gerullis
- 5 University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
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Gerullis H, Ecke TH, Barski D, Bantel C, Weyland A, Uphoff J, Jansen T, Wawroschek F, Winter A. Retrospective analysis of a surgical innovation using the IDEAL framework: radical cystectomy with epidural anaesthesia. J Int Med Res 2017; 45:714-722. [PMID: 28415929 PMCID: PMC5536649 DOI: 10.1177/0300060516684721] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Indexed: 11/16/2022] Open
Abstract
Objectives To retrospectively analyse experience of radical cystectomy using spinal/epidural anaesthesia and to classify this method using the IDEAL criteria. Methods Data from patients who had undergone radical cystectomy using spinal/epidural anaesthesia were evaluated retrospectively, focusing on clinical data, intraoperative and perioperative parameters and postoperative complications. Current literature reporting on this technique was reviewed and, together with the present study, evaluated according to the IDEAL recommendations. Results Three male patients aged 66–79 years who had undergone radical cystectomy with epidural anaesthesia were identified. The operating time ranged from 159–261 min and only minor complications occurred. Between 2013 and 2015, three published studies reported experiences with radical cystectomy with epidural/spinal anaesthesia; one was prospective and two were retrospective in nature and they included a total of 55 patients. According to the IDEAL classification, the present study corresponds to stage 1 (idea) and overall the surgical technique can be ranked as stage 2a (development). Conclusions Radical cystectomy with epidural anaesthesia is feasible and applicable for those who are not fit for general anaesthesia. The present study confirmed the functional results of this technique, which can be classified as IDEAL stage 2a on the basis of published studies.
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Affiliation(s)
- Holger Gerullis
- 1 University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
| | - Thorsten H Ecke
- 2 Department of Urology, HELIOS Hospital, Bad Saarow, Germany
| | | | - Carsten Bantel
- 4 University Hospital for Anaesthesiology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
| | - Andreas Weyland
- 4 University Hospital for Anaesthesiology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
| | - Jens Uphoff
- 1 University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
| | - Thomas Jansen
- 1 University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
| | - Friedhelm Wawroschek
- 1 University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
| | - Alexander Winter
- 1 University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
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Gerullis H, Barski D, Georgas E, Borós M, Ramon A, Ecke TH, Selinski S, Luedders D, Kramer MW, Winter A, Wawroschek F, Otto T. Protocol for a Randomized Phase II Trial for Mesh Optimization by Autologous Plasma Coating in Prolapse Repair: IDEAL Stage 3. Adv Ther 2017; 34:995-1006. [PMID: 28233277 DOI: 10.1007/s12325-017-0493-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Mesh-related complications especially after vaginal implantation have raised awareness lately because of severe adverse reactions and legal aspects. About 20% of patients suffer from complications after mesh insertion in the anterior vaginal wall. Autologous plasma coating of meshes prior to implantation has shown potential to improve the biocompatibility of meshes in vivo and in vitro. This innovative approach has been developed according to the IDEAL recommendations for surgical innovations. The method has still to be assessed at stage 3 accordingly. METHODS A protocol is developed for a prospective single-blinded randomized controlled phase II trial for biocompatibility optimization of anterior vaginal meshes for prolapse repair by autologous plasma coating versus non-coated meshes. RESULTS The protocol aims at fulfilling the requirements for stage 3 (assessment) according to IDEAL. Eligible for inclusion are women with primary cystocele, requiring a surgical procedure, suitable for randomization, and willing to be randomized. Participants will be followed up by postal questionnaires (6 months post surgery and 12 months post randomization) and will also be reviewed in clinic 12 and 24 months post surgery. Primary endpoint is the assessment of mesh-related complications following the Clavien-Dindo classifications. QoL, sexual function assessment, efficacy, and validation of an already developed long-term register are considered secondary endpoints. To afford a calculated 10% reduction of postoperative complications through plasma-coated meshes vs. non-coated meshes at 1-year follow-up, a total 214 women in each arm will be necessary to achieve 80% power at a significance level of 5%. CONCLUSION The protocol for this randomized clinical trial represents the conditions to assess the surgical innovation of plasma coating of meshes in order to improve the meshes' biocompatibility at stage 3 according to the IDEAL recommendations.
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Affiliation(s)
- Holger Gerullis
- Department of Urology, Lukas Hospital Neuss, Neuss, Germany.
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany.
- The IDEAL collaboration, Oxford, UK.
| | - Dimitri Barski
- Department of Urology, Lukas Hospital Neuss, Neuss, Germany
- The IDEAL collaboration, Oxford, UK
| | | | - Mihaly Borós
- Department of Experimental Surgery, University of Szeged, Szeged, Hungary
| | - Albert Ramon
- International Tissue Engineering Research Association (ITERA), Antwerp, Belgium
| | - Thorsten H Ecke
- The IDEAL collaboration, Oxford, UK
- Department of Urology, HELIOS Hospital, Bad Saarow, Germany
| | - Silvia Selinski
- Leibniz Research Centre for Working Environment and Human Factors, IfADo, Dortmund, Germany
| | - Dörte Luedders
- University Hospital for Gynecology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
| | - Mario W Kramer
- Department of Urology, University of Luebeck, Luebeck, Germany
| | - Alexander Winter
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
| | - Friedhelm Wawroschek
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
| | - Thomas Otto
- Department of Urology, Lukas Hospital Neuss, Neuss, Germany
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Gerullis H, Schwartmann K, Ecke TH, Georgas E, Herberg P, Winter A, Wawroschek F, Barski D, Otto T. Transvesical Suprapubic Externalization of Ureteral Stents - Introduction of a Surgical Innovation at the Development Stage. Urol Int 2017; 99:69-76. [DOI: 10.1159/000458709] [Citation(s) in RCA: 2] [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] [Received: 11/01/2016] [Accepted: 01/31/2017] [Indexed: 11/19/2022]
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Hallmann S, Petersein J, Ruttloff J, Ecke TH. Successful evacuation of large perirenal hematoma after extracorporeal shock wave lithotripsy (ESWL) - step 1 of the IDEAL recommendations of surgical innovation. Clin Case Rep 2017; 5:123-125. [PMID: 28174635 PMCID: PMC5290594 DOI: 10.1002/ccr3.792] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 07/06/2016] [Revised: 09/12/2016] [Accepted: 10/27/2016] [Indexed: 11/08/2022] Open
Abstract
Larger perirenal hematomas after extracorporeal shock wave lithotripsy (ESWL) are sometimes related to the loss of renal function due to compression of the normal renal tissue. After computed tomography-guided drainage and locally applied urokinase, the hematoma was fractionally evacuated. This procedure is a save and fast way to recover normal renal function.
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Affiliation(s)
| | - Jan Petersein
- Institute of Radiology HELIOS Hospital Bad Saarow Germany
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Ecke TH, Barski D, Weingart G, Lange C, Hallmann S, Ruttloff J, Wawroschek F, Gerullis H. Presentation of a method at the Exploration Stage according to IDEAL: Percutaneous nephrolithotomy (PCNL) under local infiltrative anesthesia is a feasible and effective method - retrospective analysis of 439 patients. Int J Med Sci 2017; 14:302-309. [PMID: 28553161 PMCID: PMC5436471 DOI: 10.7150/ijms.17963] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/28/2016] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION This study addresses minimally invasive anesthesiologic and analgetic approaches for stone surgery in the upper urinary tract. Aim of this retrospective analysis is to compare feasibility, safety and complication rates of percutaneous nephrolithotomy (PCNL) under local infiltration anesthesia alone (Group I) and additive intravenous analgetics and/or sedative medications (Group II). MATERIAL AND METHODS This is a single center study. A total of 439 patients have been included from November 2003 until March 2012. A total of 226 patients were assigned to Group I receiving local infiltration anesthesia alone, whereas 213 patients were assigned to Group II receiving additive intravenous analgetics and/or sedative medications. Demographic characteristics and stone characteristics have been evaluated to determine feasibility, complication rates for safety, and stone-free rates for effectiveness. The study and the reported technique have then been retrospectively analysed according to the IDEAL stages of surgical innovation. RESULTS All included patients who accepted local infiltration anesthesia underwent PCNL successfully. The mean American Society of Anesthesiologists score (ASA) of the included patients was 2.15 ±0.37 (range, 1-4). PCNL was indicated in 138 patients due to pelvic calculi, in 171 patients due to renal calculi, in 66 patients due to partial staghorn, in 48 patients due to complete staghorn and in 16 patients due to upper ureteral stones. The total stone free rate in our patients was 78.4% over all stone localizations. Compared to the possibility of using additive intravenous analgetics and/or sedative medications we could show differences in the median age (p=0.005) suggesting that older patients did better tolerate the infiltration anesthesia than patients at younger ages. We did also remark not statistically significant differences in Group I and Group II as for number of tracts, operation duration, hemoglobin drop, fever, transfusion rate, and stone free rate, but not for severe complications such as perirenal hematoma, colon perforation, pleura perforation, AV fistula, skin fistula, and mortality rate. CONCLUSION PCNL performed under local infiltration anesthesia is a feasible method. It provides satisfactory positive clinical outcomes. Younger age seems to predispose to conversion to extended anesthesiologic procedures. When retrospectively applying the IDEAL criteria, the method can be assigned to the E level or stage 2b.
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Affiliation(s)
| | | | | | - Carsten Lange
- Department of Urology, HELIOS Hospital, Bad Saarow, Germany
| | | | | | - Friedhelm Wawroschek
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
| | - Holger Gerullis
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
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Ecke TH, Arndt C, Stephan C, Hallmann S, Lux O, Otto T, Ruttloff J, Gerullis H. Preliminary Results of a Multicentre Study of the UBC Rapid Test for Detection of Urinary Bladder Cancer. Anticancer Res 2015; 35:2651-2655. [PMID: 25964541] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM UBC Rapid is a test detecting fragments of cytokeratins 8 and 18 in urine. These are cytokeratins frequently overexpressed in tumor cells. We present the first results of a multi-centre study using UBC Rapid in patients with bladder cancer and healthy controls. MATERIALS AND METHODS Clinical urine samples from 92 patients with tumors of the urinary bladder (45 low-grade and 47 high-grade tumors) and from 33 healthy controls were used. Urine samples were analyzed by the UBC Rapid point-of-care (POC) system and evaluated both visually and quantitatively using a concile Omega 100 POC reader. For visual evaluation, different thresholds of band intensity for considering a test as positive were applied. Sensitivities and specificities were calculated by contingency analyses. RESULTS We found that pathological concentrations by UBC Rapid are detectable in urine of patients with bladder cancer. The calculated diagnostic sensitivity of UBC Rapid in urine was 68.1% for high-grade, but only 46.2% for low-grade tumors. The specificity was 90.9%. The area under the curve (AUC) after receiver-operated curve (ROC) analysis was 0.733. Pathological levels of UBC Rapid in urine are higher in patients with bladder cancer in comparison to the control group (p<0.0001). CONCLUSION UBC rapid can differentiate between patients with bladder cancer and controls. Further studies with a greater number of patients will show how valuable these results are.
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Affiliation(s)
| | - Christian Arndt
- Lukaskrankenhaus Neuss, Department of Urology, Neuss, Germany
| | - Carsten Stephan
- Department of Urology, Charité University Hospital, Berlin, Germany Berlin Institute for Urological Research, Berlin, Germany
| | | | - Oliver Lux
- HELIOS Hospital, Department of Urology, Bad Saarow, Germany
| | - Thomas Otto
- Lukaskrankenhaus Neuss, Department of Urology, Neuss, Germany
| | | | - Holger Gerullis
- Lukaskrankenhaus Neuss, Department of Urology, Neuss, Germany School of Medicine and Health Sciences Carl von Ossietzky, University Oldenburg, Oldenburg, Germany
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Ecke TH, Koch S, Ruttloff J, Hallmann S. Clinical and pathological features of metastatic adenocarcinoma of the prostate to the ileum. Cent European J Urol 2015; 67:357-60. [PMID: 25667754 PMCID: PMC4310893 DOI: 10.5173/ceju.2014.04.art8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 08/17/2014] [Accepted: 09/12/2014] [Indexed: 11/22/2022] Open
Abstract
We present a case of a 74-year-old white male with a history of prostate cancer with unusual metastasis to the ileum, and with ileus as a very unusual first symptom of prostate cancer. This patient presented to us with histologically confirmed metastasis of the ileum after resection in the Department of Surgery.
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Affiliation(s)
| | - Stefan Koch
- HELIOS Hospital, Institute of Pathology, Bad Saarow, Germany
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Stephan C, Wilkosz J, Różański W, Ecke TH, Lein M, Bryś M, Krześlak A, Chwatko G, Jung K. Urinary thiosulfate as failed prostate cancer biomarker – an exemplary multicenter re-evaluation study. ACTA ACUST UNITED AC 2015; 53:477-83. [DOI: 10.1515/cclm-2014-0729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 09/02/2014] [Indexed: 11/15/2022]
Abstract
AbstractIn 2013, thiosulfate in urine has been proposed as promising prostate cancer (PCa) biomarker. However, a missing comparison with other proven PCa markers suggested a re-evaluation study. Therefore, together with the authors from the initial study, the diagnostic accuracy of thiosulfate was compared with that of urinary prostate cancer associated 3 (PCA3), serum prostate health index (Phi), and percent free prostate-specific antigen (%fPSA). Thiosulfate was further measured in a multicenter approach to exclude center-related biases.Thiosulfate, calculated as ratio of thiosulfate to urinary creatinine (TS/Crea ratio), was measured in two cohorts in a total of 269 patients. In the retrospective study (n=160) PCA3, Phi, PSA, and %fPSA were compared with the TS/Crea ratio between patients with and without PCa according to the prostate needle biopsy results. The second prospective cohort included 109 patients from four centers.The median TS/Crea ratio was not statistically different between the patients with and without PCa. The receiver-operating characteristics showed that the TS/Crea ratio was unable to discriminate between patients with and without PCa in contrast to %fPSA, Phi, and PCA3. In all four centers, the low median TS/Crea ratios (<1 mmol/mol) in both patient cohorts were confirmed and thiosulfate was again not able to distinguish between them (p-values, 0.13–0.90).This study could not confirm the previously observed high median TS/Crea ratio in PCa patients in comparison to non-PCa patients. Thiosulfate subsequently failed as PCa biomarker while PCA3 and Phi showed the expected diagnostic improvement.
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Haines L, Bamias A, Krege S, Lin CC, Hahn N, Ecke TH, Moshier E, Sonpavde G, Godbold J, Oh WK, Galsky MD. The Impact of Gender on Outcomes in Patients With Metastatic Urothelial Carcinoma. Clin Genitourin Cancer 2013; 11:346-52. [DOI: 10.1016/j.clgc.2013.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 02/23/2013] [Accepted: 04/02/2013] [Indexed: 11/27/2022]
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Galsky MD, Krege S, Lin CC, Hahn N, Ecke TH, Moshier E, Sonpavde G, Godbold J, Oh WK, Bamias A. Cisplatin-based combination chemotherapy in septuagenarians with metastatic urothelial cancer. Urol Oncol 2013; 32:30.e15-21. [PMID: 23428534 DOI: 10.1016/j.urolonc.2012.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 10/02/2012] [Accepted: 11/02/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Cisplatin-based chemotherapy is standard first-line treatment for metastatic urothelial carcinoma. However, cisplatin is frequently avoided in elderly patients due to concerns regarding toxicities. We analyzed the efficacy, and tolerability, of cisplatin-based chemotherapy in elderly patients. METHODS Individual patient data were pooled from 8 phase II and III trials evaluating cisplatin-based first-line chemotherapy in patients with metastatic urothelial carcinoma. Adverse events, treatment delivery, response proportions, and survival outcomes were compared between patients aged<70 vs. ≥ 70 years. RESULTS Of the 543 patients included, 162 patients (30%) were ≥ 70 years old. The majority (93%) of elderly patients were aged 70 to 79 years. There was no significant difference in the proportions of patients experiencing Grade 3 to 4 renal failure, febrile neutropenia, or treatment-related death between younger and older patient cohorts. The median survival of the patients ≥ 70 years was 12.1 months compared to 12.8 months for patients<70 years (P = 0.91). There was no significant difference in survival between age groups when controlling for baseline performance status or the presence of visceral metastases or both. CONCLUSIONS Fit septuagenarians, with adequate renal function, tolerate cisplatin-based chemotherapy similarly to their younger counterparts and achieve comparable clinical outcomes.
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Affiliation(s)
- Matthew D Galsky
- The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY.
| | - Susan Krege
- Urologische Klinik, Alexianer Krefeld GmbH, Krefeld, Germany
| | - Chia-Chi Lin
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Noah Hahn
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | - Erin Moshier
- The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY
| | - Guru Sonpavde
- US Oncology Research, LLC, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Webster, TX
| | - James Godbold
- The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY
| | - William K Oh
- The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY
| | - Aristotle Bamias
- University of Athens & Hellenic Cooperative Oncology Group, Athens, Greece
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Ecke TH. When do we need a prophylactic treatment for asymptomatic bacteriuria? Cent European J Urol 2013; 66:328. [PMID: 24707375 PMCID: PMC3974490 DOI: 10.5173/ceju.2013.03.art19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ecke TH. We need to know the treatment urethral injuries. Cent European J Urol 2013; 66:359-60. [PMID: 24707386 PMCID: PMC3974495 DOI: 10.5173/ceju.2013.03.art30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Gerullis H, Eimer C, Georgas E, Homburger M, El-Baz AG, Wishahi M, Borós M, Ecke TH, Otto T. Muscle-derived cells for treatment of iatrogenic sphincter damage and urinary incontinence in men. ScientificWorldJournal 2012; 2012:898535. [PMID: 22919359 PMCID: PMC3417204 DOI: 10.1100/2012/898535] [Citation(s) in RCA: 33] [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: 05/11/2012] [Accepted: 06/05/2012] [Indexed: 12/21/2022] Open
Abstract
Introduction. Aim of this study was to assess the safety and efficacy of injection of autologous muscle-derived cells into the urinary sphincter for treatment of postprostatectomy urinary incontinence in men and to characterize the injected cells prior to transplantation. Methods. 222 male patients with stress urinary incontinence and sphincter damage after uroloical procedures were treated with transurethral injection of autologous muscle-derived cells. The transplanted cells were investigated after cultivation and prior to application by immunocytochemistry using different markers of myogenic differentiation. Feasibility and functionality assessment was achieved with a follow-up of at least 12 months. Results. Follow-up was at least 12 months. Of the 222 treated patients, 120 responded to therapy of whom 26 patients (12%) were continent, and 94 patients (42%) showed improvement. In 102 (46%) patients, the therapy was ineffective. Clinical improvement was observed on average 4.7 months after transplantation and continued in all improved patients. The cells injected into the sphincter were at least ~50% of myogenic origin and representative for early stages of muscle cell differentiation. Conclusions. Transurethral injection of muscle-derived cells into the damaged urethral sphincter of male patients is a safe procedure. Transplanted cells represent different phases of myogenic differentiation.
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Affiliation(s)
- H Gerullis
- West German Cancer Center (WTZ), University of Essen, Essen, Germany.
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Ecke TH, Hallmann S, Koch S, Ruttloff J, Cammann H, Gerullis H, Miller K, Stephan C. External validation of an artificial neural network and two nomograms for prostate cancer detection. ISRN Urol 2012; 2012:643181. [PMID: 22830050 PMCID: PMC3399415 DOI: 10.5402/2012/643181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/13/2012] [Indexed: 11/23/2022]
Abstract
Background. Multivariate models are used to increase prostate cancer (PCa) detection rate and to reduce unnecessary biopsies. An external validation of the artificial neural network (ANN) “ProstataClass” (ANN-Charité) was performed with daily routine data. Materials and Methods. The individual ANN predictions were generated with the use of the ANN application for PSA and free PSA assays, which rely on age, tPSA, %fPSA, prostate volume, and DRE (ANN-Charité). Diagnostic validity of tPSA, %fPSA, and the ANN was evaluated by ROC curve analysis and comparisons of observed versus predicted probabilities. Results. Overall, 101 (35.8%) PCa were detected. The areas under the ROC curve (AUCs) were 0.501 for tPSA, 0.669 for %fPSA, 0.694 for ANN-Charité, 0.713 for nomogram I, and 0.742 for nomogram II, showing a significant advantage for nomogram II (P = 0.009) compared with %fPSA while the other model did not differ from %fPSA (P = 0.15 and P = 0.41). All models overestimated the predicted PCa probability. Conclusions. Beside ROC analysis, calibration is an important tool to determine the true value of using a model in clinical practice. The worth of multivariate models is limited when external validations were performed without knowledge of the circumstances of the model's development.
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Affiliation(s)
- Thorsten H Ecke
- Department of Urology, HELIOS Hospital, 15526 Bad Saarow, Germany
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Golka K, Abreu-Villaca Y, Anbari Attar R, Angeli-Greaves M, Aslam M, Basaran N, Belik R, Butryee C, Dalpiaz O, Dzhusupov K, Ecke TH, Galambos H, Galambos H, Gerilovica H, Gerullis H, Gonzalez PC, Goossens ME, Gorgishvili-Hermes L, Heyns CF, Hodzic J, Ikoma F, Jichlinski P, Kang BH, Kiesswetter E, Krishnamurthi K, Lehmann ML, Martinova I, Mittal RD, Ravichandran B, Romics I, Roy B, Rungkat-Zakaria F, Rydzynski K, Scutaru C, Shen J, Soufi M, Toguzbaeva K, Vu Duc T, Widera A, Wishahi M, Hengstler JG. Bladder cancer documentation of causes: multilingual questionnaire, 'bladder cancer doc'. Front Biosci (Elite Ed) 2012; 4:2709-2722. [PMID: 22652680 DOI: 10.2741/e585] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
There is a considerable discrepancy between the number of identified occupational-related bladder cancer cases and the estimated numbers particularly in emerging nations or less developed countries where suitable approaches are less or even not known. Thus, within a project of the World Health Organisation Collaborating Centres in Occupational Health, a questionnaire of the Dortmund group, applied in different studies, was translated into more than 30 languages (Afrikaans, Arabic, Bengali, Chinese, Czech, Dutch, English, Finnish, French, Georgian, German, Greek, Hindi, Hungarian, Indonesian, Italian, Japanese, Kannada, Kazakh, Kirghiz, Korean, Latvian, Malay, Persian (Farsi), Polish, Portuguese, Portuguese/Brazilian, Romanian, Russian, Serbo-Croatian, Slovak, Spanish, Spanish/Mexican, Tamil, Telugu, Thai, Turkish, Urdu, Vietnamese). The bipartite questionnaire asks for relevant medical information in the physician's part and for the occupational history since leaving school in the patient's part. Furthermore, this questionnaire is asking for intensity and frequency of certain occupational and non-occupational risk factors. The literature regarding occupations like painter, hairdresser or miner and exposures like carcinogenic aromatic amines, azo dyes, or combustion products is highlighted. The questionnaire is available on www.ifado.de/BladderCancerDoc.
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Affiliation(s)
- Klaus Golka
- Leibniz Research Centre for Working Environment and Human Factors, Ardeystrasse 67, 44139 Dortmund, Germany.
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Ecke TH, Gerullis H, Heuck CJ, Hallmann S, Lange C, Ruttloff J. Idiopathic giant abdominal lymph cyst: a case report. J Med Case Rep 2011; 5:21. [PMID: 21247429 PMCID: PMC3033842 DOI: 10.1186/1752-1947-5-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Accepted: 01/19/2011] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Giant lymph cysts are a relatively frequent complication after surgical procedures in the abdomen, often after kidney transplantation, but there are also cases after pelvic surgery such as lymphadenectomy and others. In the recent literature, there have been no reported cases of idiopathic giant lymphocyst. CASE PRESENTATION We present the case of a 76-year-old Caucasian man who had a lymph cyst he had known of for more than 15 years. Laparoscopic treatment was necessary because of hydronephrosis of the left kidney. CONCLUSION This case shows that laparoscopic drainage and partial resection of the lymph cyst is a safe and effective treatment.
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Affiliation(s)
| | - Holger Gerullis
- Lukas Hospital, Department of Urology, Neuss, Germany
- West German Cancer Center, University of Essen, Essen, Germany
| | - Christoph J Heuck
- Montefiore Medical Center, Department of Medical Oncology, The Albert Einstein Cancer Center, New York, USA
| | | | - Carsten Lange
- HELIOS Hospital, Department of Urology, Bad Saarow, Germany
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Gerullis H, Ecke TH, Eimer C, Heuck CJ, Otto T. mTOR-inhibition in metastatic renal cell carcinoma. Focus on temsirolimus: a review. MINERVA UROL NEFROL 2010; 62:411-423. [PMID: 20944541] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The potent inhibitor of the mammalian target of rapamycin, temsirolimus, comprises for cell cycle, angiogenesis and proliferation and has proven beneficial in the treatment of advanced renal cell carcinoma (RCC). Temsirolimus is officially approved for first line therapy in high risk previously untreated mRCC patients. This review summarizes the current clinical role of temsirolimus in the treatment of advanced renal cell carcinoma with regard to pharmacological features, toxicity and tolerability. It particularily discusses quality of life issues as important outcome parameters in palliative treatment of patients with mRCC and gives an outlook on current clinical developments regarding possible future combining/ sequencing strategies of temsirolimus.
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Affiliation(s)
- H Gerullis
- Department of Urology, Lukas Hospital, Neuss, Germany.
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Gerullis H, Ecke TH, Wishahi M, Georgas E, Eimer C, Otto T. What happens if nothing happens?--History of an untreated urothelial carcinoma of the bladder. J Egypt Soc Parasitol 2010; 40:789-796. [PMID: 21268545] [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: 05/30/2023]
Abstract
UNLABELLED Bladder cancer is controllable when adequately diagnosed and treated according to current recommendations. Radical cystectomy with urinary diversion is the standard therapy for muscle invasive tumors. In patients unfit or unwilling to get radical surgery, external beam or combined chemo-radiotherapy display alternative treatment options and can be safely performed. Every therapy implies the patient's disposition to cooperate. CASE PRESENTATION This case report describes the clinical course over 31 months after initial diagnosis of a 56-years-old Caucasian, white man with an initial pT1G3 urothelial carcinoma of the bladder. The patient denied early radical cystectomy, radio-chemotherapy and almost all alternative treatment possibilities. He finally died 31 months after initial verification of the disease.
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Affiliation(s)
- H Gerullis
- Department of Urology, Lukas Hospital, Neuss, Germany
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Gerullis H, Schwartmann K, Eimer C, Bagner JW, Kocheril S, Otto T, Ecke TH, Heuck CJ. Reply. Urology 2010. [DOI: 10.1016/j.urology.2009.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gerullis H, Ecke TH, Schwartmann K, Heuck CJ, Eimer C, Bagner JW, Kocheril S, Otto T. Nephrocutaneous Bypass in Ureteral Obstruction. Urology 2010; 76:480-5. [DOI: 10.1016/j.urology.2009.10.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 10/29/2009] [Accepted: 10/30/2009] [Indexed: 10/19/2022]
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Ecke TH, Gerullis H, Heuck CJ, Bartel P, Hallmann S, Koch S, Ruttloff J. Does a new ultrasound probe change the complication rates of transrectal ultrasound-guided needle biopsies of the prostate? Anticancer Res 2010; 30:3071-3076. [PMID: 20683057] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Transrectal ultrasound-guided prostate needle biopsies are performed to diagnose prostate cancer. This study prospectively evaluated the safety, morbidity and complication rates with two different ultrasound probes. PATIENTS AND METHODS Three huntred and thirty-two patients were biopsied using a biplane 7.5 MHz probe (GE Medical Systems Kretz Ultrasound, Zipf, Austria) and 101 patients using a biplane 5-10 MHz probe (BK-Medical, Herlev, Denmark). Four weeks after the procedure the patients were asked to fill out a questionnaire. RESULTS There were 3 major and 75 minor complications. The most common complication was haematuria in 8.1% of cases, followed by pain with urination in 5.3% of cases. After changing the ultrasound probe, the complication rates were slightly higher, but no statistical difference in any of the complication rates was found between the two groups. CONCLUSIONS Changing the method within the same team has no influence on complication rates and on prostate cancer detection rates.
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Affiliation(s)
- Thorsten H Ecke
- Department of Urology, HELIOS Hospital, Pieskower Strasse 33, D-15526 Bad Saarow, Germany.
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Ecke TH, Schlechte HH, Schiemenz K, Sachs MD, Lenk SV, Rudolph BD, Loening SA. TP53 gene mutations in prostate cancer progression. Anticancer Res 2010; 30:1579-1586. [PMID: 20592345] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND We assessed the predictive value of TP53 mutations and prostate-specific antigen (PSA) for tumor progression in prostate cancer (PCa) patients. MATERIALS AND METHODS Ninety tumor tissue samples of patients with PCa from radical prostatectomy were used. Tumor progression was estimated biochemically by the PSA level (> 0.2 microg/l) or by detection of metastases. Screening for TP53 mutations was performed by temperature gradient gel electrophoresis (TGGE) in exon-specific manner. Follow-up data were collected from medical protocols. Statistical analysis was performed by uni- and multivariate techniques. RESULTS In 32 out of 90 patients (35.6%), TP53 mutations were detected. Thirteen out of 32 patients (40.6%) with TP53 mutations and nine out of 58 patients (15.5%) with TP53 wild-type showed tumor progression after 25 and 45 months, respectively. CONCLUSION TP53 mutations in exon 7 and exon 8 are factors of tumor progression in PCa. Their contribution to tumor recurrence is more significant than tumor stage and pretherapeutic PSA level.
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Affiliation(s)
- Thorsten H Ecke
- HELIOS Hospital, Department of Urology, Bad Saarow, Germany.
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Ecke TH, Bartel P, Hallmann S, Koch S, Ruttloff J, Cammann H, Lein M, Schrader M, Miller K, Stephan C. Outcome prediction for prostate cancer detection rate with artificial neural network (ANN) in daily routine. Urol Oncol 2010; 30:139-44. [PMID: 20363164 DOI: 10.1016/j.urolonc.2009.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 12/09/2009] [Accepted: 12/11/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND We evaluated the use of the artificial neural network (ANN) program "ProstataClass" of the Department of Urology and the Institute of Medical Informatics at the Charité-Universitätsmedizin Berlin in daily routine to increase prostate cancer (CaP) detection rate and to reduce unnecessary biopsies. MATERIALS AND METHODS From May 2005 to April 2007, a total of 204 patients were included in the study. The Beckman Access PSA assay was used, and pretreatment prostate specific antigen (PSA) was measured prior to digital rectal examination (DRE) and 12 core systematic transrectal ultrasound (TRUS) guided biopsies. The individual ANN predictions were generated with the use of the ANN application for the Beckman Access PSA and free PSA assays, which relies on age, PSA, percent free prostate specific antigen (%fPSA), prostate volume, and DRE. Diagnostic validity of total prostate specific antigen (tPSA), %fPSA, and the ANN was evaluated by ROC curve analysis. RESULTS PSA and %fPSA ranged from 4.01 to 9.91 ng/ml (median: 6.65) and 5% to 48% (median: 15%), respectively. Of all men, 46 (22.5%) demonstrated suspicious DRE findings. Total prostate volume ranged from 7.1 to 119.2 cc (median: 35). Overall, 71 (34.8%) CaP were detected. Of men with suspicious DRE, 28 (60.9%) had CaP on initial biopsy. The ANN was 78% accurate in the original report. The AUC of ROC curve analysis was 0.51 for PSA, 0.66 for %PSA, and 0.72 for the ANN-Output, respectively. CONCLUSIONS Our results in this independent cohort show that ANN is a very helpful parameter in daily routine to increase the CaP detection rate and reduce unnecessary biopsies.
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Affiliation(s)
- Thorsten H Ecke
- Department of Urology, HELIOS Hospital, Bad Saarow, Germany.
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Sturgeon CM, Duffy MJ, Hofmann BR, Lamerz R, Fritsche HA, Gaarenstroom K, Bonfrer J, Ecke TH, Grossman HB, Hayes P, Hoffmann RT, Lerner SP, Löhe F, Louhimo J, Sawczuk I, Taketa K, Diamandis EP. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for use of tumor markers in liver, bladder, cervical, and gastric cancers. Clin Chem 2010; 56:e1-48. [PMID: 20207771 DOI: 10.1373/clinchem.2009.133124] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Updated National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for the use of tumor markers in the clinic have been developed. METHODS Published reports relevant to use of tumor markers for 4 cancer sites--liver, bladder, cervical, and gastric--were critically reviewed. RESULTS Alpha-fetoprotein (AFP) may be used in conjunction with abdominal ultrasound for early detection of hepatocellular carcinoma (HCC) in patients with chronic hepatitis or cirrhosis associated with hepatitis B or C virus infection. AFP concentrations >200 microg/L in cirrhotic patients with typical hypervascular lesions >2 cm in size are consistent with HCC. After a diagnosis of HCC, posttreatment monitoring with AFP is recommended as an adjunct to imaging, especially in the absence of measurable disease. Although several urine markers have been proposed for bladder cancer, none at present can replace routine cystoscopy and cytology in the management of patients with this malignancy. Some may, however, be used as complementary adjuncts to direct more effective use of clinical procedures. Although carcinoembryonic antigen and CA 19-9 have been proposed for use gastric cancer and squamous cell carcinoma antigen for use in cervical cancer, none of these markers can currently be recommended for routine clinical use. CONCLUSIONS Implementation of these recommendations should encourage optimal use of tumor markers for patients with liver, bladder, cervical, or gastric cancers.
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Affiliation(s)
- Catharine M Sturgeon
- Department of Clinical Biochemistry, Royal Infirmary of Edinburgh, Edinburgh, UK.
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Ecke TH, Bartel P, Hallmann S, Ruttloff J. Evaluation of Symptoms and Patients' Comfort for JJ-ureteral Stents With and Without Antireflux-membrane Valve. Urology 2010; 75:212-6. [DOI: 10.1016/j.urology.2009.07.1258] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 07/14/2009] [Accepted: 07/28/2009] [Indexed: 10/20/2022]
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Ecke TH, Hallmann S, Gerullis H, Ruttloff J. Reconstruction of the urethra with a Surgisis onlay patch in urethral reconstructive surgery: two case reports. J Med Case Rep 2009; 3:7232. [PMID: 19830143 PMCID: PMC2726482 DOI: 10.1186/1752-1947-3-7232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 01/03/2009] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION We present two case reports of patients with recurrent stricture of the urethra. We used Surgisis((R)) for reconstruction. CASE PRESENTATION In these two case reports, we show the positive results of reconstructive surgery with Surgisis((R)) as an alternative surgical approach to common onlay patch surgery of the urethra performed on two Caucasian patients: a 48-year-old man and a 55-year-old man. CONCLUSION Compared to buccal mucosa flap or foreskin graft surgeries for urethral reconstruction, reconstructive surgery with Surgisis((R)) is considered a relevant therapeutic alternative because of the shorter operation time and the preventable surgery of the buccal cavity or foreskin.
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Ecke TH, Gerullis H, Bartel P, Koch S, Ruttloff J. Palliative chemotherapy with gemcitabine, paclitaxel, and cisplatin as first-line treatment following gemcitabine monotherapy for patients with transitional cell carcinoma of the urothelium. MINERVA UROL NEFROL 2009; 61:1-8. [PMID: 19417721] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM Chemotherapeutic agents are active in transitional cell cancer of the urothelium, and combinations have shown promising results. The objective of this study was to evaluate the palliative chemotherapy with gemcitabine, paclitaxel, and cisplatin for transitional cell carcinoma. METHODS Thirty-four patients with advanced transitional cell carcinoma of the urothelium were treated between 2000 and 2007. All patients received chemotherapy with intravenous gemcitabine at a dose of 1000 mg/m2 on days I and VIII, intravenous paclitaxel at a dose of 80 mg/m2 on days I and VIII, and intravenous cisplatin at a dose of 50 mg/m2 on day II. Treatment courses were repeated every 21 days. After completion of four to six courses in this regimen an application of intravenous gemcitabine at a dose of 1000 mg/m2 followed repeating every 28 days. RESULTS Twelve patients (35.3%) had 1 visceral sites of metastases. Twenty two patients (64.7%) had achieved objective responses to treatment (29.4% complete responses). The median actuarial survival was 18.5 months, and the actuarial one-year and two-year survival rates were 56% and 26% respectively. After a median follow-up of 16.3 months, 18 patients remained alive. The median progression-free survival was 7 months. Median survival time for patients with ECOG status 0, 1, and 2 was 45, 12, and 10.5 months respectively. Grade 3-4 neutropenia occurred in 41.2% of patients. CONCLUSIONS The combination of gemcitabine, paclitaxel, and cisplatin is a highly effective and tolerable regimen for patients with advanced transitional cell carcinoma of the urothelium. This treatment should be considered as a suitable option that deserves further prospective evaluation. ECOG performance status and visceral metastases are important predictive factors for survival.
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Affiliation(s)
- T H Ecke
- Department of Urology, HELIOS Hospital, Bad Saarow, Germany.
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Ecke TH, Hallmann S, Ruttloff J. Multimodal stone therapy for two forgotten and encrusted ureteral stents: a case report. Cases J 2009; 2:106. [PMID: 19183439 PMCID: PMC2642782 DOI: 10.1186/1757-1626-2-106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 01/30/2009] [Indexed: 11/16/2022]
Abstract
Introduction Ureteral stent placement is a common procedure in daily urologic practice. To manage the problems of forgotten stents for many years needs multimodal stone therapy. Case presentation We present a case of a 26-years-old Caucasian, white woman with two forgotten encrusted ureteral stents for 48 months. Multimodal stone therapy including extracorporeal shock wave (SWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS), cystolithotripsy with Lithoclast, and open surgery was necessary to remove all the stones. Using the described combination of techniques, our patient was rendered stone and stent free. Urologists should bear in mind the presence of severe encrustations when they have to deal with a forgotten stent. Conclusion This case shows that combined urologic techniques can achieve successful and safe management of forgotten stents, but treatment should be tailored to the volume of encrustation and associated stone.
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Affiliation(s)
- Thorsten H Ecke
- Department of Urology, HELIOS Hospital, Pieskower Str 33, Bad Saarow 15526, Germany.
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Ecke TH, Hallmann S, Gerullis H, Ruttloff J. Reconstruction of the urethra with a Surgisis® onlay patch in urethral reconstructive surgery: two case reports. J Med Case Rep 2009. [PMCID: PMC6512947 DOI: 10.1186/1752-1947-3-6542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction We present two case reports of patients with recurrent stricture of the urethra. We used Surgisis® for reconstruction. Case presentation In these two case reports, we show the positive results of reconstructive surgery with Surgisis® as an alternative surgical approach to common onlay patch surgery of the urethra performed on two Caucasian patients: a 48-year-old man and a 55-year-old man. Conclusion Compared to buccal mucosa flap or foreskin graft surgeries for urethral reconstruction, reconstructive surgery with Surgisis® is considered a relevant therapeutic alternative because of the shorter operation time and the preventable surgery of the buccal cavity or foreskin.
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