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Sterling J, Simhan J, Flynn BJ, Rusilko P, França WA, Ramirez EA, Angulo JC, Martins FE, Patel HV, Higgins M, Swerdloff D, Nikolavsky D. Reply by Authors. J Urol 2024; 211:607. [PMID: 38382012 DOI: 10.1097/ju.0000000000003888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Joshua Sterling
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
- Department of Urology, SUNY Upstate Medical University, Syracuse, New York
| | - Jay Simhan
- Department of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Brian J Flynn
- Division of Urology, University of Colorado School of Medicine, Aurora, Colorado
| | - Paul Rusilko
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Wagner A França
- Department of Urology, Hospital do Servidor Público Estadual de São Paulo, Sao Paulo, Brazil
| | | | - Javier C Angulo
- Department of Medical Clinic, Universidad Europea de Madrid, Madrid, Spain
| | - Francisco E Martins
- Department of Urology, University of Lisbon, Hospital of Santa Maria, Lisbon, Portugal
| | - Hiren V Patel
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Margaret Higgins
- Division of Urology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel Swerdloff
- Department of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Dmitriy Nikolavsky
- Department of Urology, SUNY Upstate Medical University, Syracuse, New York
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Sterling J, Simhan J, Flynn BJ, Rusilko P, França WA, Ramirez EA, Angulo JC, Martins FE, Patel HV, Higgins M, Swerdloff D, Nikolavsky D. Multi-Institutional Outcomes of Dorsal Onlay Buccal Mucosal Graft Urethroplasty in Patients With Postprostatectomy, Postradiation Anastomotic Stenosis. J Urol 2024; 211:596-604. [PMID: 38275201 DOI: 10.1097/ju.0000000000003848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE The treatment of urethral stenosis after a combination of prostatectomy and radiation therapy for prostate cancer is understudied. We evaluate the clinical and patient-related outcomes after dorsal onlay buccal mucosal graft urethroplasty (D-BMGU) in men who underwent prostatectomy and radiation therapy. MATERIALS AND METHODS A multi-institutional, retrospective review of men with vesicourethral anastomotic stenosis or bulbomembranous urethral stricture disease after radical prostatectomy and radiation therapy from 8 institutions between 2013 to 2021 was performed. The primary outcomes were stenosis recurrence and development of de novo stress urinary incontinence. Secondary outcomes were surgical complications, changes in voiding, and patient-reported satisfaction. RESULTS Forty-five men were treated with D-BMGU for stenosis following prostatectomy and radiation. There was a total of 7 recurrences. Median follow-up in patients without recurrence was 21 months (IQR 12-24). There were no incidents of de novo incontinence, 28 patients were incontinent pre- and postoperatively, and of the 6 patients managed with suprapubic catheter preoperatively, 4 were continent after repair. Following repair, men had significant improvement in postvoid residual, uroflow, International Prostate Symptom Score, and International Prostate Symptom Score quality-of-life domain. Overall satisfaction was +2 or better in 86.6% of men on the Global Response Assessment. CONCLUSIONS D-BMGU is a safe, feasible, and effective technique in patients with urethral stenosis after a combination of prostatectomy and radiation therapy. Although our findings suggest this technique may result in lower rates of de novo urinary incontinence compared to conventional urethral transection and excision techniques, head-to-head comparisons are needed.
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Affiliation(s)
- Joshua Sterling
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
- Department of Urology, SUNY Upstate Medical University, Syracuse, New York
| | - Jay Simhan
- Department of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Brian J Flynn
- Division of Urology, University of Colorado School of Medicine, Aurora, Colorado
| | - Paul Rusilko
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Wagner A França
- Department of Urology, Hospital do Servidor Público Estadual de São Paulo, Sao Paulo, Brazil
| | | | - Javier C Angulo
- Department of Medical Clinic, Universidad Europea de Madrid, Madrid, Spain
| | - Francisco E Martins
- Department of Urology, University of Lisbon, Hospital of Santa Maria, Lisbon, Portugal
| | - Hiren V Patel
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Margaret Higgins
- Division of Urology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel Swerdloff
- Department of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Dmitriy Nikolavsky
- Department of Urology, SUNY Upstate Medical University, Syracuse, New York
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Chua KJ, Kronstedt S, Kaldany A, Srivastava A, Doppalapudi SK, Liu H, Tarhini AA, Gatti‐Mays M, Gaughan E, Hu‐Lieskovan S, Aljumaily R, Nepple K, Schneider B, Sterling J, Singer EA. Comparing the rate of immunotherapy treatment change due to toxicity by sex. Cancer Rep (Hoboken) 2024; 7:e1932. [PMID: 38189893 PMCID: PMC10849926 DOI: 10.1002/cnr2.1932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 10/07/2023] [Accepted: 11/06/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Immuno-oncology therapy (IO) is associated with a variety of treatment-related toxicities. However, the impact of toxicity on the treatment discontinuation rate between males and females is unknown. We hypothesized that immune-related adverse events would lead to more frequent treatment changes in females since autoimmune diseases occur more frequently in females. AIMS Our aim was to determine if there was a difference in the rate of immunotherapy treatment change due to toxicity between males and females. METHODS AND RESULTS The Oncology Research Information Exchange Network Avatar Database collected clinical data from 10 United States cancer centers. Of 1035 patients receiving IO, 447 were analyzed, excluding those who did not have documentation noting if a patient changed treatment (n = 573). Fifteen patients with unknown or gender-specific cancer were excluded. All cancer types and stages were included. The primary endpoint was documented treatment change due to toxicity. Four hundred and forty-seven patients (281 males and 166 females) received IO treatment. The most common cancers treated were kidney, skin, and lung for 99, 84, and 54 patients, respectively. Females had a shorter IO course than males (median 3.7 vs. 5.1 months, respectively, p = .02). Fifty-four patients changed treatment due to toxicity. There was no significant difference between females and males on chi-square test (11.4% vs. 12.5%, respectively, p = 0.75) and multivariable logistic regression (OR 0.924, 95% CI 0.453-1.885, p = .827). Significantly more patients with chronic obstructive pulmonary disease (COPD) changed therapy due to toxicity (OR 2.491, 95% CI 1.025-6.054, p = .044). CONCLUSION Females received a shorter course of IO than males. However, there was no significant difference in the treatment discontinuation rate due to toxicity between males and females receiving IO. Toxicity-related treatment change was associated with COPD.
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Affiliation(s)
- Kevin J. Chua
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical SchoolSection of Urologic OncologyNew BrunswickNew JerseyUSA
- Rutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Shane Kronstedt
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical SchoolSection of Urologic OncologyNew BrunswickNew JerseyUSA
- Rutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Alain Kaldany
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical SchoolSection of Urologic OncologyNew BrunswickNew JerseyUSA
- Rutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Arnav Srivastava
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical SchoolSection of Urologic OncologyNew BrunswickNew JerseyUSA
- Rutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Sai Krishnaraya Doppalapudi
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical SchoolSection of Urologic OncologyNew BrunswickNew JerseyUSA
- Rutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Hao Liu
- Department of Biostatistics and EpidemiologyRutgers School of Public HealthPiscatawayNew JerseyUSA
| | - Ahmad A. Tarhini
- Departments of Cutaneous Oncology and ImmunologyMoffitt Cancer CenterTampaFloridaUSA
| | - Margaret Gatti‐Mays
- Division of Medical OncologyThe Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
| | - Elizabeth Gaughan
- Division of Hematology/OncologyThe University of Virginia Health SystemCharlottesvilleVirginiaUSA
| | - Siwen Hu‐Lieskovan
- Department of Internal Medicine Division of OncologyUniversity of Utah School of Medicine and Huntsman Cancer InstituteSalt Lake CityUtahUSA
| | - Raid Aljumaily
- Department of Hematology/Oncology Stephenson Cancer CenterUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahomaUSA
| | - Kenneth Nepple
- Department of UrologyUniversity of Iowa Holden Comprehensive Cancer CenterIowa CityIowaUSA
| | - Bryan Schneider
- Indiana University Melvin and Bren Simon Comprehensive Cancer CenterIndianapolisIndianaUSA
| | - Joshua Sterling
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical SchoolSection of Urologic OncologyNew BrunswickNew JerseyUSA
- Rutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Eric A. Singer
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical SchoolSection of Urologic OncologyNew BrunswickNew JerseyUSA
- Division of Urologic OncologyThe Ohio State University Comprehensive Cancer CenterColumbusOhioUSA
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Staniorski C, Myrga J, Hayden C, Sterling J, Rusilko P. Fasciocutaneous Flap Perineal Closure with Testicular Thigh Pouch for Scrotal Defects: Surgical Technique and Initial Experience. Urology 2023; 182:231-238. [PMID: 37708982 DOI: 10.1016/j.urology.2023.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To describe the surgical technique and evaluate the safety, feasibility, and preliminary outcomes of perineal closure with fasciocutaneous flaps as an alternative to scrotoplasty for large genital wounds. METHODS Cases of perineal closure with fasciocutaneous flaps and thigh pouch creation for patients having undergone scrotectomy from January 2015 until August 2022 were reviewed for operative details and surgical outcomes. RESULTS Twenty patients were identified undergoing this procedure. Patients had a median age of 64 (Inter-quartile range [IQR] 58-70), body mass index of 34 (IQR 29-40) and Charlson comorbidity index of 5 (IQR 4-8). Median total wound area was 443 cm2 (IQR 225-600). Operative technique in all cases included testicular thigh pouch and fasciocutaneous flap creation for perineal closure; these flaps were raised from the thigh in 18 patients and abdominal wall in 8. This technique resulted in 100% closure rate of the perineum with 3 patients required abdominal split thickness skin grafting (STSG) to complete closure. Complication occurred in 3 patients (15%) with 1 wound infection and 2 episodes of bleeding. Forty percent of patients were discharged home. Median follow-up was 9 months with only 1 patient reporting pain related to thigh pouches and none desiring elective scrotoplasty. CONCLUSIONS Despite large defects, perineal closure was completed in all patients with minimal use of STSG. Complication rates were comparable to other methods despite significant patient frailty and no patients desired staged scrotoplasty. This method of closure adds an option for the complex perineal reconstruction patient.
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Affiliation(s)
| | - John Myrga
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Christopher Hayden
- Department of Urology, Yale University School of Medicine, New Haven, CT
| | - Joshua Sterling
- Department of Urology, Yale University School of Medicine, New Haven, CT
| | - Paul Rusilko
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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Sterling J, Carbonella J, Jones T, Hanchuk S, Kelly P, Garcia MM. Cancer Screening for Transgender Individuals: Guidelines, Best Practices, and a Proposed Care Model. Urol Clin North Am 2023; 50:563-576. [PMID: 37775215 DOI: 10.1016/j.ucl.2023.06.014] [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: 10/01/2023]
Abstract
Few transgender-specific cancer screening recommendations exist. This review aims to cover current guidelines and practice patterns of cancer screening in transgender patients and, where evidence-based data are lacking, to draw from cisgender screening guidelines to suggest best practices for transgender patients based on anatomic inventory. Sufficient evidence does not exist to determine the long-term effects of gender-affirming hormone therapy on cancer risk. In the future, cancer screening and prevention should be focused on anatomic inventory and high-risk behaviors.
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Affiliation(s)
- Joshua Sterling
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | | | - Tashzna Jones
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | | | | | - Maurice M Garcia
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Urology, University of California San Francisco, San Francisco, CA, USA; Department of Anatomy, University of California San Francisco, San Francisco, CA, USA; Department of Urology, Cedars-Sinai Transgender Surgery and Health Program, Gender Affirming Genital Surgery and Sexual Medicine, Cedars-Sinai Medical Center, Los Angeles, 8631 West Third Street, Suite 1070W, Los Angeles, CA 90048, USA.
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Sterling J, Rahman SN, Varghese A, Angulo JC, Nikolavsky D. Complications after Prostate Cancer Treatment: Pathophysiology and Repair of Post-Radiation Urethral Stricture Disease. J Clin Med 2023; 12:3950. [PMID: 37373644 DOI: 10.3390/jcm12123950] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Radiation therapy (RT) in the management of pelvic cancers remains a clinical challenge to urologists given the sequelae of urethral stricture disease secondary to fibrosis and vascular insults. The objective of this review is to understand the physiology of radiation-induced stricture disease and to educate urologists in clinical practice regarding future prospective options clinicians have to deal with this condition. The management of post-radiation urethral stricture consists of conservative, endoscopic, and primary reconstructive options. Endoscopic approaches remain an option, but with limited long-term success. Despite concerns with graft take, reconstructive options such as urethroplasties in this population with buccal grafts have shown long-term success rates ranging from 70 to 100%. Robotic reconstruction is augmenting previous options with faster recovery times. Radiation-induced stricture disease is challenging with multiple interventions available, but with successful outcomes demonstrated in various cohorts including urethroplasties with buccal grafts and robotic reconstruction.
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Affiliation(s)
- Joshua Sterling
- Yale School of Medicine, 20 York Street, New Haven, CT 06511, USA
| | - Syed N Rahman
- Yale School of Medicine, 20 York Street, New Haven, CT 06511, USA
| | - Ajin Varghese
- New York College of Osteopathic Medicine, 8000 Old Westbury, Glen Head, NY 11545, USA
| | - Javier C Angulo
- Faculty of Biomedical Sciences, Universidad Europea, 28905 Madrid, Spain
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Sterling J, Daneshvar M, Nikolavsky D. Transurethral Ventral Buccal Mucosa Graft Inlay Urethroplasty: technique and intermediate outcomes. BJU Int 2023. [PMID: 36919248 DOI: 10.1111/bju.16007] [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]
Abstract
OBJECTIVE To outline our step-by-step surgical technique for a transurethral ventral buccal mucosa graft inlay urethroplasty to treat fossa navicularis and distal urethral strictures. METHODS The transurethral ventral inlay urethroplasty is accomplished in four steps. First, after obtaining proper exposure the cicatrice is excised via a transurethral ventral urethrotomy until the lumen is at least 24fr. Second, double arm 6-0 polydioxanone suture is used to deliver the triangular buccal mucosal graft to the proximal extent of the urethrotomy and secured externally. Third, the graft is secured to the meatus with 5-0 polyglactin sutures and additional 6-0 double arm polydioxanone sutures are used to quilt the graft for spread fixation. Finally, a 16fr silicone catheter is placed. Patients are discharged the same day and return for void trial after one week. A retrospective, single institution review was conducted to include all patients who underwent this procedure with a minimum of 1 year follow-up. Patients were analyzed for recurrences, and pre- and post-operative urine flow rates, post void residuals, and patient questionnaires were also reviewed. RESULTS 44 patients met our inclusion criteria. Median surgical time was 120 minutes. At a mean follow up of 36 months (IQR 22-50) 95% of patients are patent without additional interventions. The 2 patients that did have stricture recurrence were found to have urethral stenosis that extended more proximally, and both were successfully treated with a dorsal onlay buccal urethroplasty. There were significant improvements in urine flow rate, post void residuals, international prostate symptom score and quality of life scores post operatively. There was no difference in post operative sexual function scores. CONCLUSION This minimally invasive transurethral ventral urethroplasty has excellent intermediate term outcomes in terms of traditional objective measures of urethroplasty success and patient reported outcomes.
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Affiliation(s)
- Joshua Sterling
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Michael Daneshvar
- Department of Urology, University of California Irvine, Orange, CA, USA
| | - Dmitriy Nikolavsky
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA
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Sterling J, Policastro C, Elyaguov J, Simhan J, Nikolavsky D. How and why tobacco use affects reconstructive surgical practice: a contemporary narrative review. Transl Androl Urol 2023; 12:112-127. [PMID: 36760864 PMCID: PMC9906109 DOI: 10.21037/tau-22-427] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/24/2022] [Indexed: 01/05/2023] Open
Abstract
Background and Objective The overall negative impact of tobacco use on an individual's health has been well documented but the literature on tobacco's impact on post-surgical outcomes, specifically the outcomes after urologic surgery, is not as clear cut. The aim of this narrative review is to provide urologists with the information needed to have a nuanced pre-operative counseling conversation with patients about tobacco use. Here we combine publications on the histologic and physiologic changes induced by nicotine and tobacco use with publications from the wider surgical literature on post-operative outcomes in tobacco users. Methods A literature search of PubMed, Google Scholar and Medline was performed using iterations of the following terms: tobacco, nicotine, changes, physiologic, histology, post-operative, and surgical. Non-English publications and abstracts were excluded. Inclusion required agreement from all authors and preference was given to human specimens over animal models for the basic science manuscripts and large database and meta-analyses over single institution experiences. Key Content and Findings Tobacco use results in measurable changes in nearly every organ system in the body. While smokers have increased wound complications, there is no evidence that reconstructive surgery using grafts or flaps fail more frequently in tobacco users. Smokers have an increased risk of respiratory complications following endotracheal intubation. Conclusions Surgeries should not be canceled due to a patient's inability to cease tobacco use. Urologists and patients should engage in joint decision making regarding the timing and pursuit of elective operations.
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Affiliation(s)
- Joshua Sterling
- SUNY Upstate Medical University, Department of Urology, Syracuse, NY, USA;,Yale School of Medicine, Department of Urology, New Haven, CT, USA
| | - Connor Policastro
- SUNY Upstate Medical University, Department of Urology, Syracuse, NY, USA
| | - Jason Elyaguov
- SUNY Upstate Medical University, Department of Urology, Syracuse, NY, USA
| | - Jay Simhan
- Fox Chase Cancer Center, Division of Urologic Oncology and Urology, Philadelphia, PA, USA
| | - Dmitriy Nikolavsky
- SUNY Upstate Medical University, Department of Urology, Syracuse, NY, USA
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Nagaya N, Chua KJ, Sterling J, Horie S, Kim IY. Extended versus Standard Pelvic Lymph Node Dissection yields no difference in 3-year biochemical recurrence rates. Prostate Int 2022. [DOI: 10.1016/j.prnil.2022.12.005] [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: 12/24/2022] Open
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Chua KJ, Sterling J, Doppalapudi SK, Kaldany A, Kronstedt S, Srivastava A, Liu H, Singer EA. Comparing rate of immunotherapy treatment change due to toxicity by gender. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2656] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2656 Background: Immunotherapy (IO) is associated with a variety of treatment related toxicities. However, the impact of toxicity on the treatment discontinuation rate between males and females is unknown. We hypothesized that immune related adverse events would lead to more frequent treatment changes in females since autoimmune diseases occur more frequently in females Methods: The Oncology Research Information Exchange Network (ORIEN) Avatar Database collects clinical data from ten different United States cancer centers, where patients receive IO. Of 1,035 patients receiving IO, 447 patients were analyzed, excluding those (N = 573) who did not have documentation noting if a patient changed treatment. 15 additional patients with an unknown or gender-specific cancer were excluded. All cancer types and stages were included. Primary endpoint was documented treatment change due to toxicity. Significance was calculated with logistic regression, linear regression, chi-squared test for categorical variables and Mann-Whitney U test for continuous nonparametric variables. Results: 447 patients (281 males and 166 females) received IO treatment for cancer. The most common cancers treated were kidney, skin, and lung for 99, 84, and 54 patients, respectively. Females had a shorter IO course compared to males on Mann-Whitney U test (median 3.7 vs 5.1 months, respectively, p=0.02) and multivariable linear regression (Beta -3.87, 95% CI -6.591, -1.149, p=0.005). 54 patients changed IO treatment due to toxicity. There was no significant difference in the rate of treatment change due to toxicity between females and males on chi-square test (11.4% vs. 12.5%, respectively, p = 0.75) and logistic regression (Table). Pembrolizumab, Nivolumab, Ipilimumab/Nivolumab, Ipilimumab, Durvalumab, Avelumab, and Atezolizumab were given to 16, 14, 9, 9, 3, 2 and 1 patients who changed treatment due to toxicity, respectively. The median length of time for IO treatment prior to change for toxicity was 3 months (IQR 1.4 – 5.9 months). Significantly more patients with COPD changed treatment due to toxicity (Table). Conclusions: Females received a shorter course of IO than males. However, there was no significant difference in the treatment discontinuation rate due to toxicity between males and females receiving IO. Toxicity related treatment change was associated with COPD. Studies with larger sample sizes with more granular data (i.e., type of adverse effects) are needed to truly characterize if a difference between genders and IO toxicity exists. [Table: see text]
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Affiliation(s)
- Kevin Joseph Chua
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Sai Krishnaraya Doppalapudi
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alain Kaldany
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Shane Kronstedt
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Hao Liu
- Biostatistics Shared Resource, Rutgers Cancer Institute of New Jersey, and Department of Biostatistics and Epidemiology, Rutgers School of Public Health, New Brunswick, NJ
| | - Eric A. Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Kong J, Lichtbroun B, Sterling J, Wang Y, Wang Q, Singer EA, Jang TL, Ghodoussipour S, Kim IY. Comparison of perioperative complications for extended vs standard pelvic lymph node dissection in patients undergoing radical prostatectomy for prostate cancer: a meta-analysis. Am J Clin Exp Urol 2022; 10:73-81. [PMID: 35528467 PMCID: PMC9077149] [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] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/25/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Pelvic lymph node dissection (PLND) is widely performed for staging in men undergoing radical prostatectomy (RP) for prostate cancer. Our goal was to synthesize all available evidence and data to evaluate perioperative complications for two templates of PLND, standard (sPLND) vs extended (ePLND), at the time of RP in patients with prostate cancer. METHODS A meta-analysis was performed on relevant literature about complications during PLND. Pubmed, Scopus, WebofScience, and Cochrane Library were systematically searched through July 2021. Meta-analysis was conducted with both fixed-effects and random-effects models to estimate risk ratios (RRs) between treatments. A subgroup analysis was also conducted based on surgery type - open vs robotic. RESULTS 13 (1 randomized clinical trial and 12 observational studies) studies published between 1997 and 2019 with a total of 7,036 patients were analyzed. Pooled data showed complications in a random-effects model was lower in the sPLND group than the ePLND group (RR, 0.62; 95% CI 0.40-0.97). In a subgroup analysis, neither the open surgery subgroup nor the robotic surgery subgroup showed significant differences in complication rate between sPLND and ePLND. CONCLUSION ePLND is associated with a significantly greater risk of perioperative complication compared to sPLND, but not when comparing these templates performed via a robotic approach. Additional studies comparing the complication rates of sPLND and ePLND when utilizing a robotic approach should be conducted.
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Affiliation(s)
- Jerry Kong
- Section of Urologic Oncology, Rutgers Cancer Institute of New JerseyNew Jersey, USA
| | - Benjamin Lichtbroun
- Section of Urologic Oncology, Rutgers Cancer Institute of New JerseyNew Jersey, USA
- Division of Urology, Rutgers Robert Wood Johnson Medical SchoolNew Jersey, USA
| | - Joshua Sterling
- Department of Urology, SUNY Upstate Medical UniversityNew York, USA
| | - Yaqun Wang
- Biostatistics and Epidemiology, Rutgers School of Public HealthNew Jersey, USA
| | | | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New JerseyNew Jersey, USA
- Division of Urology, Rutgers Robert Wood Johnson Medical SchoolNew Jersey, USA
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New JerseyNew Jersey, USA
- Division of Urology, Rutgers Robert Wood Johnson Medical SchoolNew Jersey, USA
| | - Saum Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute of New JerseyNew Jersey, USA
- Division of Urology, Rutgers Robert Wood Johnson Medical SchoolNew Jersey, USA
| | - Isaac Yi Kim
- Department of Urology, Yale School of MedicineNew Haven, Connecticut, USA
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Policastro CG, Sterling J, Porter B, Zaccarini DJ, Li G, Bratslavksy G, Nikolavsky D. Evaluation of the Effect of Tobacco Use on Buccal Mucosa Graft Histology. Urology 2022; 166:264-270. [DOI: 10.1016/j.urology.2022.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 12/01/2022]
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Kim IY, Mitrofanova A, Panja S, Sterling J, Srivastava A, Kim J, Kim S, Singer EA, Jang TL, Ghodoussipour S, Saraiya B, Mayer T, Sabaawy HE, Yuh B, Byun SS, Kim WJ, Horie S. Genomic analysis and long-term outcomes of a phase 1 clinical trial on cytoreductive radical prostatectomy. Prostate Int 2022; 10:75-79. [PMID: 35510081 PMCID: PMC9035380 DOI: 10.1016/j.prnil.2022.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/27/2022] [Accepted: 03/01/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Approximately 7% of patients with newly diagnosed prostate cancer (PCa) in the US will have have metastatic disease. The dogma that there is no role for surgery in this population has been questioned recently. Here we report long-term outcomes of a phase 1 clinical trial on cytoreductive radical prostatectomy. Materials and methods This is a multicenter phase 1 trial. The major inclusion criterion was biopsy proven N1M0 or NxM1a/b PCa. Primary end point was the Clavien-Dindo-based major complication rate. Secondary outcomes were biochemical progression and overall survival. RNA-seq correlative study was conducted in nine select cases as a pilot study. Results Final accrual was 32 patients of which 25 and 7 were cNxM1 and cN1M0, respectively. With the median follow-up of 46 months (interquartile range 31.7 - 52.7 months), 25 out of the 32 patients (75%) were alive at the time of last contact. There were three disparate groups based on the oncologic outcome: favorable, intermediate, and poor. In seven men with favorable response, androgen deprivation therapy was switched to intermittent approach and five remain free of any evidence of disease after more than two years off all systemic therapy with the normalization of serum testosterone. Of these five patients, three had M1 disease. Long-term use of one pad or less per day was 80%. RNA-seq analysis revealed an enriched downregulation of tumor necrosis factor (TNF)-α signature in the favorable group. Conclusion Overall long-term oncologic outcome of cytoreductive radical prostatectomy was significantly higher than historical results. Importantly, the combination of surgery with systemic therapy may result in a long durable response in a minority of men who present with metastatic PCa.
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Patel HV, Kim S, Srivastava A, Shinder BM, Sterling J, Saraiya B, Mayer TM, Ghodoussipour S, Jang TL, Singer EA. Factors associated with palliative intervention utilization for metastatic renal cell carcinoma. Clin Genitourin Cancer 2022; 20:296-296.e9. [DOI: 10.1016/j.clgc.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/19/2021] [Accepted: 01/02/2022] [Indexed: 12/25/2022]
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Patel HV, Sterling J, Srivastava A, Saraiya B, Mayer TM, Kim IY, Ghodoussipour SB, Jang TL, Singer EA. Factors Associated with Palliative Care (PC) Utilization in Advanced and Metastatic Renal Cell Carcinoma (RCC). J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.623] [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: 10/20/2022]
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Patel HV, Sterling J, Srivastava A, Kim S, Saraiya B, Mayer TM, Kim IY, Ghodoussipour S, Jang TL, Singer EA. Factors associated with palliative care utilization in advanced and metastatic renal cell carcinoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
146 Background: Palliative care (PC) offers various benefits for patient with cancer that include, but are not limited to, decrease in disease-specific symptoms and improvement in functional status. Several oncological guidelines have adopted early integration of PC into oncologic care to improve quality of life among patients with advanced malignancies. However, PC utilization patterns and factors associated with its use in advanced renal cell carcinoma (RCC) remain poorly understood. Methods: Using the National Cancer Database (NCDB), we abstracted patients with Stage III and IV RCC from 2004-2014 and evaluated PC utilization amongst this cohort. Socioeconomic and clinical factors were compared for patient receiving and not receiving PC for advanced RCC. Multivariable logistic regression identified factors that were associated with receipt of PC among the overall cohort and treatment-based cohorts. Results: Among 20,122 and 42,014 patients with Stage III and IV RCC, 329 and 9,317 patients received PC, respectively. From 2004 to 2014, PC utilization was stable at ̃1% for Stage III RCC and minimally increased from 17% to 20% for Stage IV RCC. Multivariable analysis demonstrated that increased comorbidities, insurance status, higher education status, facility location, care at a comprehensive cancer program or integrated network, sarcomatoid histology, and prior treatments significantly increased likelihood of palliative care utilization. We uncover socioeconomic and clinical factors that are associated with receipt of palliative care use in a treatment-specific manner. Conclusions: While PC utilization has minimally increased for Stage IV RCC, there are several demographic, socioeconomic, and clinical factors that predict PC use, especially in a treatment-specific manner, among patients with advanced RCC. Taken together, this suggests the need for more equitable and systematic use of PC among patients with advanced RCC.
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Affiliation(s)
- Hiren V. Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, New Brunswick, NJ
| | - Sinae Kim
- Section of Biometrics, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Biren Saraiya
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Tina M. Mayer
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Isaac Yi Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Saum Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Thomas L. Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric A. Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Affiliation(s)
- Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, and Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Isaac Yi Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, and Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Patel H, Kim S, Srivastava A, Shinder B, Sterling J, Saraiya B, Mayer T, Kim I, Ghodoussipour S, Jang T, Singer E. PD38-09 FACTORS ASSOCIATED WITH PALLIATIVE CARE UTILIZATION IN ADVANCED AND METASTATIC RENAL CELL CARCINOMA. J Urol 2021. [DOI: 10.1097/ju.0000000000002048.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chua KJ, Mikhail M, Patel HV, Tabakin AL, Doppalapudi SK, Sterling J, SGR Tunuguntla H. Treatment of Urethral Stricture Disease in Women: Nonsystematic Review of Surgical Techniques and Intraoperative Considerations. Res Rep Urol 2021; 13:381-406. [PMID: 34189132 PMCID: PMC8232966 DOI: 10.2147/rru.s282651] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/02/2021] [Indexed: 11/23/2022] Open
Abstract
Female urethral strictures are rare, but underdiagnosed pathologies that can cause voiding dysfunction. These strictures are best managed with open reconstruction, as endoscopic treatments have high rates of failure. A flap urethroplasty can be performed with vaginal, labial or bladder tissue. Meanwhile, graft urethroplasties can utilize vaginal, labial, buccal or lingual tissue. It is important to consider the etiology and type of stricture, local vascularity, and prior attempts at repair when selecting the type of repair. Multiple different techniques have been described with theoretical advantages to each one. While some studies have reviewed a few of the reconstructive techniques to treat female urethral strictures, no single study has accounted for each individual technique. In this review, we discuss techniques captured by a number of systematic reviews and other articles. We will herein focus on reviewing and describing each unique technique of reconstruction in the setting of female urethral stricture.
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Affiliation(s)
- Kevin J Chua
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Mark Mikhail
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Hiren V Patel
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Alexandra L Tabakin
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Sai Krishnaraya Doppalapudi
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Joshua Sterling
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Hari SGR Tunuguntla
- Division of Urology, Department of Surgery, Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
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Gn M, Sterling J, Sinkin J, Cancian M, Elsamra S. The Expanding Use of Buccal Mucosal Grafts in Urologic Surgery. Urology 2021; 156:e58-e65. [PMID: 34097942 DOI: 10.1016/j.urology.2021.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/07/2021] [Accepted: 05/27/2021] [Indexed: 12/21/2022]
Abstract
The advent and success of buccal mucosal grafts as a substitution material in the urinary tract has changed the landscape of reconstructive urology. Due to its ease to harvest, low morbidity, and advantageous properties, there has been a growing number of applications for buccal mucosal grafts in upper and lower urinary tract reconstruction as well as genital reconstruction. In this article, we review the historical application and the evolution of buccal mucosal grafts and provide an up-to-date review on its utilization in urologic procedures.
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Affiliation(s)
- Martus Gn
- Department of Urology, Warren Alpert Medical School, Providence, RI.
| | - Joshua Sterling
- Department of Urology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jeremy Sinkin
- Department of Plastic Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Madeline Cancian
- Department of Urology, Warren Alpert Medical School, Providence, RI
| | - Sammy Elsamra
- Department of Urology, Robert Wood Johnson Medical School, New Brunswick, NJ
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Srivastava S, Tabakin AL, Chua KJ, Patel HV, Sterling J, Polotti CF, Srivastava A, Sinkin JC, Tunuguntla HSGR. Augmented anastomotic urethroplasty with buccal mucosa for post penile fracture urethral injury long segment bulbar urethral stricture review. Asian J Urol 2021; 8:337-339. [PMID: 34401342 PMCID: PMC8356034 DOI: 10.1016/j.ajur.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/14/2020] [Accepted: 07/27/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Shreya Srivastava
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Alexandra L Tabakin
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Kevin J Chua
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Hiren V Patel
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Joshua Sterling
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Charles F Polotti
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Arnav Srivastava
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jeremy C Sinkin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Hari S G R Tunuguntla
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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22
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Srivastava A, Patel HV, Kim S, Shinder B, Sterling J, Tabakin AL, Polotti C, Saraiya B, Mayer TM, Kim IY, Ghodoussipour S, Patel HD, Jang TL, Singer EA. Delaying surgery for clinical T1b-T2bN0M0 renal cell carcinoma: Oncologic implications in the COVID-19 era and beyond. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
283 Background: During COVID-19, many operating rooms were reserved exclusively for emergent cases. As a result, many elective surgeries for renal cell carcinoma (RCC) were deferred, with an unknown impact on outcomes. Since surveillance is commonplace for small renal masses, we focused on larger, organ-confined, RCCs. Our primary endpoint was pT3a upstaging and our secondary endpoint was overall survival (OS). Methods: We retrospectively abstracted cT1b-cT2bN0M0 RCC patients from the National Cancer Database (NCDB), stratifying them by clinical stage and time from diagnosis to surgery. We selected only those patients who underwent surgery. Patients were grouped by having surgery within <1 month, 1-3 months, or >3 months after diagnosis. Logistic regression models measured pT3a upstaging risk. Kaplan Meier curves and Cox proportional hazards models assessed OS. Results: 29,746 patients underwent partial or radical nephrectomy. Delaying surgery >3 months after diagnosis did not confer pT3a upstaging risk among cT1b (OR=0.90; 95%CI: 0.77–1.05, p = 0.170), cT2a (OR=0.90; 95%CI: 0.69–1.19, p=0.454), or cT2b (OR=0.96; 95%CI:0.62–1.51, p=0.873) masses (Table). In all clinical stage strata, non-clear cell RCCs were significantly less likely to be upstaged (p<0.001). A sensitivity analysis, performed for delays of <1, 1-3, 3-6, and >6 months, also showed no increase in upstaging risk. Conclusions: Delaying surgery up to, and even beyond, 3 months does not significantly increase risk of tumor progression in clinically localized RCC. However, if deciding to delay surgery due to COVID-19, tumor histology, growth kinetics, patient comorbidities, and hospital capacity/resources, should be considered. [Table: see text]
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Affiliation(s)
- Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, New Brunswick, NJ
| | - Hiren V. Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Sinae Kim
- Section of Biometrics, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Brian Shinder
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alexandra L. Tabakin
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Charles Polotti
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ, NJ
| | - Biren Saraiya
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Tina M. Mayer
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Isaac Yi Kim
- Rutgers Cancer Institute of New Jersey, Piscataway, NJ
| | - Saum Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric A. Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Patel HV, Sterling J, Srivastava A, Kim S, Saraiya B, Mayer TM, Jang TL, Singer EA. Factors associated with palliative care (PC) utilization in advanced and metastatic renal cell carcinoma (RCC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
297 Background: Palliative care (PC) offers various benefits for patient with cancer that include, but are not limited to, decrease in disease-specific symptoms and improvement in functional status. Several oncological guidelines have adopted early integration of PC into oncologic care to improve quality of life among patients with advanced malignancies. However, PC utilization patterns and factors associated with its use in advanced renal cell carcinoma (RCC) remain poorly understood. Methods: Using the National Cancer Database (NCDB), we abstracted patients with stage III and IV RCC from 2004-2014 and evaluated PC utilization amongst this cohort. Socioeconomic and clinical factors were compared for patient receiving and not receiving PC for advanced RCC. Multivariable logistic regression identified factors that were associated with receipt of PC. Results: We identified 20,122 and 42,014 patients with stage III and IV RCC, respectively. Among this cohort, 329 and 9,317 patients received PC for stage III and IV RCC, respectively. From 2004 to 2014, PC utilization has been stable at ~1% for stage III RCC and has significantly increased from 17% to 20% for stage IV RCC. Multivariable analysis demonstrated that Blacks, income >$48,000, regions outside of Northeast, stage III RCC, and patients that received surgery were less likely to receive PC. Patients that were female, with more comorbidities, uninsured or with government insurance, lower educational status, treated at academic or integrated cancer program, with sarcomatoid histology, receiving systemic therapy were more likely to receive PC. Conclusions: While PC utilization has significantly increased for stage IV RCC, there are several demographic, socioeconomic, and clinical factors that predict PC usage among patients with advanced RCC. Taken together, this suggests the need for more equitable and systematic use of PC among patients with advanced RCC.
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Affiliation(s)
- Hiren V. Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, New Brunswick, NJ
| | - Sinae Kim
- Section of Biometrics, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Biren Saraiya
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Tina M. Mayer
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric A. Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Sterling J, Garcia MM. Cancer screening in the transgender population: a review of current guidelines, best practices, and a proposed care model. Transl Androl Urol 2021; 9:2771-2785. [PMID: 33457249 PMCID: PMC7807311 DOI: 10.21037/tau-20-954] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [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] [Indexed: 12/27/2022] Open
Abstract
Over the last 50 years cancer mortality has decreased, the biggest contributor to this decrease has been the widespread adoption of cancer screening protocols. These guidelines are based on large population studies, which often do not capture the non-gender conforming portion of the population. The aim of this review is to cover current guidelines and practice patterns of cancer screening in transgender patients, and, where evidence-based data is lacking, to draw from cis-gender screening guidelines to suggest best-practice screening approaches for transgender patients. We performed a systematic search of PubMed, Google Scholar and Medline, using all iterations of the follow search terms: transgender, gender non-conforming, gender non-binary, cancer screening, breast cancer, ovarian cancer, uterine cancer, cervical cancer, prostate cancer, colorectal cancer, anal cancer, and all acceptable abbreviations. Given the limited amount of existing literature inclusion was broad. After eliminating duplicates and abstract, all queries yielded 85 unique publications. There are currently very few transgender specific cancer screening recommendations. All the guidelines discussed in this manuscript were designed for cis-gender patients and applied to the transgender community based on small case series. Currently, there is not sufficient to evidence to determine the long-term effects of gender-affirming hormone therapy on an individual’s cancer risk. Established guidelines for cisgender individuals and can reasonably followed for transgender patients based on what organs remain in situ. In the future comprehensive cancer screening and prevention initiatives centered on relevant anatomy and high-risk behaviors specific for transgender men and women are needed.
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Affiliation(s)
- Joshua Sterling
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Maurice M Garcia
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, Los Angeles, CA, USA.,Department of Urology, University of California San Francisco, San Francisco, CA, USA.,Department of Anatomy, University of California San Francisco, San Francisco, CA, USA
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Sterling J, Rivera-Núñez Z, Patel HV, Farber NJ, Kim S, Radadia KD, Modi PK, Goyal S, Parikh R, Weiss RE, Kim IY, Elsamra SE, Jang TL, Singer EA. Factors Associated With Receipt of Partial Nephrectomy or Minimally Invasive Surgery for Patients With Clinical T1a and T1b Renal Masses: Implications for Regionalization of Care. Clin Genitourin Cancer 2020; 18:e643-e650. [PMID: 32389458 PMCID: PMC7502425 DOI: 10.1016/j.clgc.2020.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/14/2020] [Accepted: 03/16/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE To identify factors associated with receipt of partial nephrectomy (PN) and minimally invasive surgery (MIS) in patients with clinical T1 renal cell carcinoma (RCC) using the National Cancer Data Base (NCDB). METHODS We queried the NCDB from 2010 to 2014 identifying patients treated surgically for cT1a-bN0M0 RCC. Logistic regression was used to examine associations between socioeconomic, clinical, and treatment factors, and receipt of MIS or PN within the T1 patient population. RESULTS Our cohort included 69,694 patients (cT1a, n = 44,043; cT1b, n = 25,651). For cT1a tumors, 70% of patients received PN and 65% underwent MIS. For cT1b tumors, 32% of patients received PN and 62% underwent MIS. cT1a and cT1b patients with household income < $62,000, without private insurance, and treated outside academic centers were less likely to receive MIS or PN. cT1a patients traveling > 31 miles were more likely to undergo MIS. For both cT1a/b, the farther a patient traveled for treatment, the more likely a PN was performed. CONCLUSION Data showed an increase in utilization of MIS and PN from 2010 to 2014. However, patients in the lowest socioeconomic groups were less likely to travel and were more likely to receive more invasive treatments. On the basis of these findings, additional research is needed into how regionalization of RCC surgery affects treatment disparities.
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Affiliation(s)
- Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Zorimar Rivera-Núñez
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Hiren V Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Nicholas J Farber
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sinae Kim
- Division of Biometrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Kushan D Radadia
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Parth K Modi
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Rahul Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Robert E Weiss
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Isaac Y Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sammy E Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
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Srivastava A, Patel HV, Kim S, Shinder B, Sterling J, Tabakin AL, Polotti CF, Saraiya B, Mayer T, Kim IY, Ghodoussipour S, Patel HD, Jang TL, Singer EA. Delaying surgery for clinical T1b-T2bN0M0 renal cell carcinoma: Oncologic implications in the COVID-19 era and beyond. Urol Oncol 2020; 39:247-257. [PMID: 33223368 PMCID: PMC7574787 DOI: 10.1016/j.urolonc.2020.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/31/2020] [Revised: 10/10/2020] [Accepted: 10/17/2020] [Indexed: 01/01/2023]
Abstract
Purpose During COVID-19, many operating rooms were reserved exclusively for emergent cases. As a result, many elective surgeries for renal cell carcinoma (RCC) were deferred, with an unknown impact on outcomes. Since surveillance is commonplace for small renal masses, we focused on larger, organ-confined RCCs. Our primary endpoint was pT3a upstaging and our secondary endpoint was overall survival. Materials and methods We retrospectively abstracted cT1b-T2bN0M0 RCC patients from the National Cancer Database, stratifying them by clinical stage and time from diagnosis to surgery. We selected only those patients who underwent surgery. Patients were grouped by having surgery within 1 month, 1–3 months, or >3 months after diagnosis. Logistic regression models measured pT3a upstaging risk. Kaplan Meier curves and Cox proportional hazards models assessed overall survival. Results A total of 29,746 patients underwent partial or radical nephrectomy. Delaying surgery >3 months after diagnosis did not confer pT3a upstaging risk among cT1b (OR = 0.90; 95% CI: 0.77–1.05, P = 0.170), cT2a (OR = 0.90; 95% CI: 0.69–1.19, P = 0.454), or cT2b (OR = 0.96; 95% CI: 0.62–1.51, P = 0.873). In all clinical stage strata, nonclear cell RCCs were significantly less likely to be upstaged (P <0.001). A sensitivity analysis, performed for delays of <1, 1–3, 3–6, and >6 months, also showed no increase in upstaging risk. Conclusion Delaying surgery up to, and even beyond, 3 months does not significantly increase risk of tumor progression in clinically localized RCC. However, if deciding to delay surgery due to COVID-19, tumor histology, growth kinetics, patient comorbidities, and hospital capacity/resources, should be considered.
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Affiliation(s)
- Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Hiren V Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sinae Kim
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Biometrics Shared Resource, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Brian Shinder
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Alexandra L Tabakin
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Charles F Polotti
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Biren Saraiya
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Tina Mayer
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Isaac Y Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Saum Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Hiten D Patel
- The James Buchanan Brady Urologic Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
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Sterling J, Smith K, Farber N, Nagaya N, Jang TL, Singer EA, Sadimin E, Kim IY. Fourteen-Core Systematic Biopsy That Includes Two Anterior Cores in Men With PI-RADS Lesion ≥ 3 is Comparable With Magnetic Resonance Imaging-ultrasound Fusion Biopsy in Detecting Clinically Significant Prostate Cancer: A Single-institution Experience. Clin Genitourin Cancer 2020; 19:275-279. [PMID: 33153920 DOI: 10.1016/j.clgc.2020.09.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/08/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Magnetic resonance imaging (MRI)-ultrasound fusion targeted prostate biopsy (FB) has been advocated by many experts as a replacement for the standard template biopsy. Herein, we compared pathology results and cancer detection rates of FB with our standard 14-core systematic prostate biopsy (SB) that includes 2 anterior cores. MATERIALS AND METHODS One hundred two men with elevated prostate-specific antigen and suspicious lesions on multiparametric MRI, Prostate Imaging Reporting And Data System (PI-RADS) v2 score ≥ 3, underwent FB. Each target lesion was biopsied 3 times; our SB was performed concurrently. Biopsy results were compared for overall and clinically significant (cs), defined as Gleason score ≥ 7, cancer detection. RESULTS Fifty-two percent of patients had positive biopsy results, and of those, 44 had cs prostate cancer (PCa). The overall detection rates for FB and SB were 39% and 50%, respectively, and there was no statistical difference in the detection rate of csPCa detection rate (P = .42). Of 17 patients diagnosed with a high-risk PCa, defined as Gleason score ≥ 8, SB identified 15, whereas FB identified 10. Within the SB group, 21 had positive anterior core biopsies, of which 11 were cs. CONCLUSION Expanding the standard template prostate biopsies to include 2 anterior horn sampling may be just as effective as FB in men with PI-RADS lesion ≥ 3, thereby mitigating the increased cost associated with FB.
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Affiliation(s)
- Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Kelsea Smith
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Nicholas Farber
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Naoya Nagaya
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Evita Sadimin
- Department of Pathology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Isaac Yi Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
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Sterling J, Pardini D, Pardini J, Docherty M, Mattis J. A-42 Incremental Utility of Visual Assessment in Predicting Concussion Recovery Time Among Adolescents. Arch Clin Neuropsychol 2020. [DOI: 10.1093/arclin/acaa036.42] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Sports-related concussions (SRC) often affect vision function and cognition, two components frequently assessed as part of a multimodal post-injury evaluation. The purpose of the study was to examine contributions of measures of vision function and cognition toward understanding recovery time.
Method
Participants were 593 (37.6% female) adolescents ages 10–18 (M = 14.7, SD = 1.7) who were evaluated and diagnosed with a concussion within 10 days of injury. Participants were administered the King-Devick (KD) test via KD cards to assess rapid number naming speed and the ImPACT test to assess post-concussion symptoms and neurocognitive test performance. The primary outcome was number of weeks (M = 3.2, SD = 1.9) until participants were cleared to return to play by the treating physician based on a standardized protocol.
Results
Poorer performance on the King-Devick test was significantly correlated with higher symptom severity (r = .41, p < .001), and poorer performance on ImPACT Verbal Memory (r = −.46, p < .001), Visual Memory (r = −.39, p < .001), Visual Motor Speed (r = −55, p < .001), and Reaction Time (r = .47, p < .001) composites. Poorer KD scores were also significantly correlated with a longer time to recovery (r = .23, p < .001). Importantly, poorer KD scores continued to significantly predict protracted recovery time after controlling for age, gender, time to initial physician evaluation, prior history of concussion, post-concussion symptom severity, and neurocognitive test performance (β = .12, p < .05).
Conclusions
Performance on King-Devick testing predicted recovery time, even after controlling for important demographic/injury characteristics and cognitive testing. Evaluation of vision function is an important component of post-injury assessment for SRC.
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Pardini J, Pardini D, Sterling J, Docherty M, Mattis J. A-30 Symptom Count Versus Symptom Severity: Which is a Better Predictor of Time to Recovery? Arch Clin Neuropsychol 2020. [DOI: 10.1093/arclin/acaa036.30] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Evaluation of self-reported symptoms is a key component of concussion management. This study examined whether symptom count, a more parsimonious method to gather symptom information, would predict recovery better than symptom severity.
Method
Participants were 1267 (39.3% female) adolescents ages 10–18 (M = 14.7, SD = 1.8) who were evaluated and diagnosed with a concussion by a physician within 10 days of injury. At their initial visit, participants completed the ImPACT computerized test and the included post-concussion symptom scale. The primary outcome was number of weeks (M = 3.2, SD = 1.8) until participants were cleared to return to play by the treating physician based on a standardized protocol.
Results
Symptom count and symptom severity were highly correlated (r = .89, p < .001). When examined in separate linear regression models, both symptom count (β = .28, p < .001) and symptom severity (β = .25, p < .001) predicted weeks until return to play after controlling for age, gender, prior history of concussion, and neurocognitive test performance. However, when symptom count and severity were both included in the same regression model, symptom count continued to predict weeks to recovery (β = .31, p < .001) and the effect of symptom severity was reduced to non-significance (β = −.03, p = .64).
Conclusions
Symptom count at initial clinic visit predicted recovery time, eliminating the predictive power of symptom severity when both were entered in the same regression model. Thus, symptom count may be a more robust and more parsimonious assessment than traditional severity ratings, which may save clinic time and allow for additional multimodal assessments.
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Srivastava A, Rivera-Núñez Z, Kim S, Sterling J, Farber NJ, Radadia KD, Patel HV, Modi PK, Goyal S, Parikh R, Mayer TM, Saraiya B, Sadimin ET, Weiss RE, Kim IY, Elsamra SE, Jang TL, Singer EA. Impact of pathologic lymph node-positive renal cell carcinoma on survival in patients without metastasis: Evidence in support of expanding the definition of stage IV kidney cancer. Cancer 2020; 126:2991-3001. [PMID: 32329899 DOI: 10.1002/cncr.32912] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/01/2020] [Accepted: 02/03/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Stage III renal cell carcinoma (RCC) encompasses both lymph node-positive (pT1-3N1M0) and lymph node-negative (pT3N0M0) disease. However, prior institutional studies have indicated that among patients with stage III disease, those with lymph node disease have worse oncologic outcomes and experience survival that is similar to that of patients with American Joint Committee on Cancer (AJCC) stage IV disease. The objective of the current study was to validate these findings using a large, nationally representative sample of patients with kidney cancer. METHODS Patients with AJCC stage III or stage IV RCC were identified using the National Cancer Data Base (NCDB). Patients were categorized as having lymph node-positive stage III (pT1-3N1M0), lymph node-negative stage III (pT3N0M0), or stage IV metastatic (pT1-3 N0M1) disease. Cox proportional hazards models compared outcomes while adjusting for comorbidities. Kaplan-Meier estimates illustrated relative survival when comparing staging groups. RESULTS A total of 8988 patients met the inclusion criteria, with 6587 patients classified as having lymph node-negative stage III disease, 2218 as having lymph node-positive stage III disease, and 183 as having stage IV disease. Superior survival was noted among patients with lymph node-negative stage III disease, but similar survival was noted between patients with lymph node-positive stage III and stage IV RCC, with 5-year survival rates of 61.9% (95% confidence interval [95% CI], 60.3%-63.4%), 22.7% (95% CI, 20.6%-24.9%), and 15.6% (95% CI, 11.1%-23.8%), respectively. CONCLUSIONS Current RCC staging systems group pT1-3N1M0 and pT3N0M0 disease as stage III disease. However, the results of the current validation study suggest the need for further stratification and even placement of patients with pT1-3N1M0 disease into the stage IV category. Staging that accurately reflects oncologic prognosis may help clinicians better counsel and select patients who might derive the most benefit from lymphadenectomy, adjuvant systemic therapy, more rigorous imaging surveillance, and clinical trial participation.
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Affiliation(s)
- Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Zorimar Rivera-Núñez
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Sinae Kim
- Division of Biometrics, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Nicholas J Farber
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Kushan D Radadia
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Hiren V Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Parth K Modi
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Rahul Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Tina M Mayer
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Biren Saraiya
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Evita T Sadimin
- Division of Genitourinary Pathology and Informatics, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Robert E Weiss
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Isaac Y Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Sammy E Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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Shinder BM, Patel HV, Sterling J, Tabakin AL, Kim IY, Jang TL, Singer EA. Urologic oncology surgery during COVID-19: a rapid review of current triage guidance documents. Urol Oncol 2020; 38:609-614. [PMID: 32507546 PMCID: PMC7260595 DOI: 10.1016/j.urolonc.2020.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/10/2020] [Indexed: 12/02/2022]
Abstract
The Coronavirus Disease 2019 pandemic placed urologic surgeons, and especially urologic oncologists, in an unprecedented situation. Providers and healthcare systems were forced to rapidly create triage schemas in order to preserve resources and reduce potential viral transmission while continuing to provide care for patients. We reviewed United States and international triage proposals from professional societies, peer-reviewed publications, and publicly available institutional guidelines to identify common themes and critical differences. To date, there are varying levels of agreement on the optimal triaging of urologic oncology cases. As the need to preserve resources and prevent viral transmission grows, prioritizing only high priority surgical cases is paramount. A similar approach to prioritization will also be needed as nonemergent cases are allowed to proceed in the coming weeks. While these decisions will often be made on a case-by-case basis, more nuanced surgeon-driven consensus guidelines are needed for the near future.
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Affiliation(s)
- Brian M Shinder
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Hiren V Patel
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Joshua Sterling
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alexandra L Tabakin
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Isaac Y Kim
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Thomas L Jang
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric A Singer
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
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Abstract
Gender affirming medical and surgical treatments affect the reproductive potential of transgender individuals. Prior to the development of assisted reproductive technologies (ART), genital gender-affirming surgery frequently eliminated a patient’s reproductive potential. Today, all patients should be counseled on their fertility preservation (FP) options before medical and surgical transition, yet this appears to seldom occur in practice. The following review is the result of a systematic literature search of PubMed, Medline and Google Scholar to identify current and future FP options, barriers to treatment patients face, practice patterns of transgender health care providers, and if there were any standardized counseling protocols. Options for transwomen at any point in their transition range from simply providing a semen sample to be used with assistive reproductive techniques to experimental techniques involving testicular cryopreservation followed by in vitro initiation of spermatogenesis. Transmen before and after starting hormone therapy can pursue any assistive reproductive techniques available for ciswomen. Future options currently under investigation include ovarian tissue cryopreservation (OTC) with in vitro oocyte maturation. In addition to counseling about their FP options, patients should be advised prospectively about the requirements, process details, the total costs associated with achieving pregnancy, and the inherent risks associated with using preserved genetic material including risk of failure, and maternal and fetal health risks. Transgender patients report using assistive reproductive services difficult, due to a lack of dialogue about fertility and the lack of information offered to them- presumably because their circumstances do not fit into a traditional narrative familiar to providers. Physicians and health care providers would benefit from better educational tools to help transgender patients make informed decisions and better training about transgender patients in general, and FP options available to them.
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Affiliation(s)
- Joshua Sterling
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Maurice M Garcia
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, Los Angeles, CA, USA.,Department of Urology, University of California San Francisco, San Francisco, CA, USA.,Department of Anatomy, University of California San Francisco, San Francisco, CA, USA
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Broderick C, Mahon CE, Sterling J. Urothelial carcinoma initially presenting as vulvodynia. Clin Exp Dermatol 2020; 45:667-668. [PMID: 32097492 DOI: 10.1111/ced.14185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2020] [Indexed: 11/28/2022]
Affiliation(s)
- C Broderick
- Dermatology Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - C E Mahon
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - J Sterling
- Dermatology Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Sterling J, Jang TL, Kim IY. EDITORIAL COMMENT. Urology 2020; 135:122. [PMID: 31895674 DOI: 10.1016/j.urology.2019.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/22/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Joshua Sterling
- Section of Urologic Oncology, Rutgers, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ
| | - Isaac Yi Kim
- Section of Urologic Oncology, Rutgers, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ
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Radadia KD, Rivera-Núñez Z, Kim S, Farber NJ, Sterling J, Falkiewicz M, Modi PK, Goyal S, Parikh R, Weiss RE, Kim IY, Elsamra SE, Jang TL, Singer EA. Accuracy of clinical nodal staging and factors associated with receipt of lymph node dissection at the time of surgery for nonmetastatic renal cell carcinoma. Urol Oncol 2019; 37:577.e17-577.e25. [PMID: 31280982 DOI: 10.1016/j.urolonc.2019.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/27/2019] [Accepted: 06/05/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The benefit of lymph node dissection (LND) in renal cell carcinoma (RCC) remains poorly defined. Despite this uncertainty, the American Urological Association (AUA) guideline on localized renal cancer recommends that LND be performed for staging purposes when there is suspicion of regional lymphadenopathy on imaging. Using the National Cancer Database (NCDB), we sought to determine how much of a departure the new AUA guideline is from current practice. We hypothesized that practice patterns would reflect the "Expert Opinion" recommendation and that patients who are clinical lymph node (cLN) positive would receive a LND more often than those who are cLN negative. Additionally, we sought to determine factors that would trigger a LND as well the accuracy of clinical staging by examining the relationship between cLN and pathologic lymph node (pLN) status of patients who received a LND. MATERIALS AND METHODS The NCDB was queried for patients with nonmetastatic RCC who underwent partial nephrectomy or nephrectomy from 2010 to 2014. Patient sociodemographic and clinical characteristics were extracted. Frequency distributions were calculated for patients with both cLN and pLN status available. Of patients who received a LND, sensitivity, specificity, and positive/negative predictive values (PPV/NPV) of cLN status for pLN positivity were calculated. Logistic regression models were used to examine association between clinical and socioeconomic factors and receipt of LND. Propensity score matching was used in sensitivity analyses to examine potential for reporting bias in NCDB data. RESULTS We identified 110,963 patients who underwent surgery for RCC, of whom 11,867 (11%) had LND performed at the time of surgery. cLN and pLN information were available in 11,300 patients, of which 1,725 were preoperatively staged as having positive cLN. More LNDs were performed per year for patients who were cLN negative than cLN positive. Of patients who received a LND, the majority of patients were cLN negative across all clinical T (cT) stages. Multivariable analysis showed that all patients who had care at an academic/research institution (odds ratio [OR]: 1.58, 95% confidence interval [CI]: 1.43-1.74) and had to travel >12.5 to 31.0 miles and >31.0 miles to a treatment center (OR: 1.08, 95%CI: 1.01-1.15 and OR: 1.28, 95%CI: 1.20-1.36, respectively) were more likely to get a LND. As cT stage increased from cT2-4, the risk of LND increased (OR range: 4.7-7.90, respectively). Patients who were cLN positive were more likely to receive a LND at the time of surgery (OR: 18.68, 95%CI: 16.62-21.00). Of the patients who received a LND, clinical staging was more specific than sensitive. CONCLUSION More patients received a LND who were cLN negative compared to patients who were cLN positive. Patients who were cLN positive were more likely to receive a LND. Treatment center type, distance to treatment center, cT stage, and cLN positivity were factors associated with LND receipt.
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Affiliation(s)
- Kushan D Radadia
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Zorimar Rivera-Núñez
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sinae Kim
- Division of Biometrics, Rutgers Cancer Institute of New Jersey and Rutgers School of Public Health, New Brunswick, NJ
| | - Nicholas J Farber
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Marissa Falkiewicz
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Parth K Modi
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Rahul Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Robert E Weiss
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Isaac Y Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Sammy E Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
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LeMaistre F, Sterling J, Miller C, Molony D. SAT-034 ESRD PATIENT MORTALITY INCREASED MAXIMALLY AT 90 DAYS AFTER HURRICANE HARVEY. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Sterling J, Farber N, Gupta NK. Comparing Outcomes of Medical Management and Minimally Invasive Surgical Techniques for Lower Urinary Tract Symptoms due to BPH. Curr Urol Rep 2019; 20:29. [PMID: 30989392 DOI: 10.1007/s11934-019-0896-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Compare outcomes of medical therapy as compared to minimally invasive surgical therapy (MIST) for treatment of bladder outlet obstruction RECENT FINDINGS: Treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) remains largely driven by patient symptomatology with medical therapy or watchful waiting as the first-line management strategies. However, most patients are not adherent to prescribed medical therapies and are hesitant to accept the risks associated with more invasive therapies. Minimally invasive surgical therapies are treatments providing short-term symptom relief superior to medical therapies without the sequela of more invasive procedures. Though there are few direct comparisons, MIST seems to relieve LUTS/BPH symptoms at least as well as medical therapy without the need for daily adherence.
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Affiliation(s)
- Joshua Sterling
- Division of Urology, Robert Wood Johnson Medical School, 125 Patterson St, MEB 584A, New Brunswick, NJ, 08901, USA
| | - Nicholas Farber
- Division of Urology, Robert Wood Johnson Medical School, 125 Patterson St, MEB 584A, New Brunswick, NJ, 08901, USA
| | - Nikhil K Gupta
- Division of Urology, Robert Wood Johnson Medical School, 125 Patterson St, MEB 584A, New Brunswick, NJ, 08901, USA.
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Radadia KD, Rivera-Nunez Z, Kim S, Farber N, Sterling J, Modi PK, Sharad G, Rahul P, Weiss RE, Kim I, Elsamra S, Jang T, Singer E. Factors linked with receiving a lymph node dissection during surgery for nonmetastatic renal cell carcinoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
672 Background: The benefit of a lymph node dissection (LND) in renal cell carcinoma (RCC) remains poorly defined. Despite this uncertainty, the American Urological Association (AUA) guideline on localized renal cancer recommends that LND be performed for staging purposes when there is suspicion of regional lymphadenopathy on imaging. Using the National Cancer Database (NCDB), we examined factors associated with the receipt of LND at the time of renal surgery. Methods: The NCDB was queried for non-metastatic patients who underwent partial nephrectomy or nephrectomy for RCC from 2010 to 2014. Patient socio-demographics, clinical characteristics, and treatment factors were extracted. Logistic regression models were used to examine factors associated with the receipt of LND. Results: We identified 110,963 patients who underwent surgery for RCC, of whom 11,867 (11%) had LND performed at the time of surgery. Clinical lymph node (cLN) and pathologic lymph node (pLN) information were available in 11,300 patients, of which 1,725 were preoperatively staged as having positive cLN. In the entire study population, patients who were cLN positive were approximately 19 times more likely to receive a LND at the time of surgery (OR: 18.68, 95%CI: 16.62-21.00). Factors associated with a LND in patients who are cLN negative (n = 106,370) were assessed. Clinical T (cT) stage was the strongest indicator of LND (cT2-4, OR range: 4.87-11.1). Among both cohorts, patients who received surgery at an academic/research institution or traveled farther ( > 31 miles) to a treatment center were more likely to undergo a LND. Patients from both cohorts who underwent robotic or laparoscopic surgery were less likely to receive a LND compared to open surgery. Conclusions: The greatest predictor of LND receipt is being cLN positive. Among patients who are cLN negative, the greatest predictor of LND is cT stage. Predictors of undergoing LND in all patients and those who are cLN negative include treatment center type and distance to the treatment center. Additional studies to determine the accuracy of clinical staging and assess novel preoperative imaging modalities that evaluate nodal involvement are indicated.
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Affiliation(s)
- Kushan Dilip Radadia
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ
| | - Zorimar Rivera-Nunez
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - Sinae Kim
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - Nicholas Farber
- Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Joshua Sterling
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Parth K. Modi
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Goyal Sharad
- Rutgers Cancer Institute of New Jersey, Division of Radiation Oncology, New Brunswick, NJ
| | - Parikh Rahul
- Rutgers Cancer Institute of New Jersey, Division of Radiation Oncology, New Brunswick, NJ
| | - Robert E. Weiss
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Isaac Kim
- Rutgers Cancer Institute of New Jersey, Piscataway, NJ
| | - Sammy Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Thomas Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Eric Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Sterling J, Rivera-Nunez Z, Farber N, Modi PK, Radadia KD, Kim S, Sharad G, Rahul P, Weiss RE, Kim I, Elsamra S, Jang T, Singer E. Treatment disparities among patients in the National Cancer Database (NCDB) with clinical TIa and TIb renal masses. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
648 Background: AUA guidelines on the management of renal cell carcinoma (RCC) recommend prioritizing partial nephrectomy (PN) for the treatment of clinical T1a (cT1a) tumors, using PN for clinical T1b (cT1b) tumors when feasible, and performing minimally invasive surgery (MIS) when possible. Since cT1 RCC is a heterogeneous disease, we evaluated patterns of care in this population to examine factors associated with receipt of PN and MIS. Methods: We queried the NCDB from 2010-2014 to identify patients treated surgically for cT1N0M0 RCC. Patient socio-demographics, clinical characteristics, and treatment parameters were compared between cT1a and cT1b patients. Logistic regression models examined factors associated with receiving MIS. Results: Our population included 69,694 patients (44,043 cT1a and 25,651 cT1b). For cT1a tumors, 70% of patients received PN, while 30% received RN; 35% of patients underwent an open procedure and 65% underwent MIS. For cT1b tumors, 32% of patients received PN and 68% received RN; 38% of patients underwent an open operation and 62% underwent MIS. In both cohorts, African Americans and those earning <$62,000 were less likely to have MIS. Distance to treatment was not significant in cT1b patients, but cT1a patients who traveled >31 miles were more likely to undergo MIS. Patients treated at a community hospital were less likely to receive MIS compared to those treated at academic centers (cT1a OR: 0.48, 95% CI: 0.44-0.53 and cT1b OR: 0.63, 95% CI: 0.56-0.7). cT1a patients without private insurance were less likely to receive MIS (OR range: 0.58-0.93). However, only uninsured cT1b patients were less likely to undergo MIS (OR: 0.74, 95% CI: 0.64-0.86). Conclusions: PN occurred more frequently for cT1a (70%) vs. cT1b (32%) tumors. Most cT1 tumors received MIS; 35% of cT1a patients and 38% of cT1b patients underwent an open procedure, presenting an opportunity for improvement. cT1a and cT1b patients with lower household income, without private insurance, and those treated outside academic centers were less likely to receive MIS. Based on these findings additional research on the impact of regionalization of RCC surgery on utilization of PN vs. RN, receipt of MIS, and outcomes is warranted.
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Affiliation(s)
- Joshua Sterling
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ
| | - Zorimar Rivera-Nunez
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - Nicholas Farber
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ
| | - Parth K. Modi
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Kushan Dilip Radadia
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ
| | - Sinae Kim
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - Goyal Sharad
- Rutgers Cancer Institute of New Jersey, Division of Radiation Oncology, New Brunswick, NJ
| | - Parikh Rahul
- Rutgers Cancer Institute of New Jersey, Division of Radiation Oncology, New Brunswick, NJ
| | - Robert E. Weiss
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Isaac Kim
- Rutgers Cancer Institute of New Jersey, Piscataway, NJ
| | - Sammy Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Thomas Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Eric Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Tabakin A, Kim S, Polotti C, Shinder B, Rivera-Nunez Z, Sterling J, Farber N, Radadia KD, Kim IY, Singer EA, Jang T. Survival rates after retroperitoneal lymph node dissection (RPLND) for testicular seminoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
534 Background: RPLND as first-line treatment for testicular seminoma is less well defined than for testicular nonseminomas. Furthermore, RPLND performed in the post-chemotherapy (PC) setting for seminoma patients with a PET avid residual mass > 3 cm can be technically challenging. We describe utilization of RPLND in the primary and PC settings and report on overall survival rates following surgery for these men. Methods: Using 2004-2014 data from the National Cancer Database, we identified 62,727 men with 1° testicular cancer, of which 31,068 men were diagnosed as having seminoma. After excluding men with benign, non-germ cell, and nonseminoma histologies, those who did not undergo RPLND, and those whose clinical stage (CS) or survival data were unavailable, 412 men comprised our final cohort. Men were further stratified according to whether they had 1° RPLND vs PC-RPLND, with 1° RPLND defined as RPLND performed for CS IA-IIB without prior chemotherapy, and PC-RPLND classified as RPLND performed for CS IIA-IIIC after chemotherapy. Descriptive statistics were used to summarize clinical and demographic factors. The Kaplan-Meier method was used to determine overall survival. Results: From 2004-2014, 412 men with testicular seminoma underwent RPLND, of which 89% and 11% were in the 1° and PC settings, respectively. There were no significant differences in clinical or demographic characteristics when comparing men in these 2 groups. The majority of men with testicular seminoma undergoing PC-RPLND were treated at an academic center (63.8%) or comprehensive community cancer program (21.3%). The median follow-up was 4.1 years. Of 372 patients with available survival data, five-year overall survival was 94.2% and 89.0% in the 1° RPLND and PC- RPLND groups, respectively. Conclusions: Though RPLND is rarely used as 1° therapy in testicular seminoma, overall survival rates appear to be excellent, as they do for men with testicular seminoma after PC-RPLND. Ongoing trials evaluating the use of RPLND for early metastatic, low-volume disease will clarify its role in the management of testicular seminoma.
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Affiliation(s)
- Alexandra Tabakin
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ
| | - Sinae Kim
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - Charles Polotti
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ, NJ
| | - Brian Shinder
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ
| | - Zorimar Rivera-Nunez
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - Joshua Sterling
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ
| | - Nicholas Farber
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ
| | - Kushan Dilip Radadia
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ
| | - Isaac Yi Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Eric A. Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Thomas Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Farber NJ, Chuchvara N, Modi PK, Sterling J, Elsamra SE. Urologists' estimations of the cost of commonly used disposable devices. Can J Urol 2019; 26:9660-9663. [PMID: 30797249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION To assess whether urologists are able to accurately estimate the cost of commonly used endourologic disposable devices. MATERIALS AND METHODS An anonymous questionnaire was presented to resident and attending urologists in one academic healthcare system. Respondents estimated the cost of 15 disposable devices commonly used in ureteroscopy. Twenty-five surgeons (9 resident and 16 attending urologists) participated for a response rate of 96.2%. Respondents' cost estimates were compared to actual institutional costs and considered accurate if the absolute percentage error was within 20%. Additional information obtained included: years in practice, participation in purchasing activities, practice setting, number of ureteroscopy procedures performed monthly, degree of confidence in ability to estimate cost, and the importance of cost in device selection for each respondent. RESULTS Of 375 total responses, 62 (16.5%) were accurate, 308 (82.1%) were inaccurate, and 5 (1.3%) were unanswered. The mean percentage error (MPE) for all responses was 178.8% (IQR 35.1%-211.4%). Overall, 73% of responses were overestimations and 27% were underestimations. Residents had an MPE of 128.4%, while attending urologists had an MPE of 207.8%. The most inaccurately estimated cost was for an endoscopic y-adapter, while the most accurate estimations were for a 1.5Fr nitinol ureteroscopic stone basket. CONCLUSIONS Neither attending nor resident urologists are able to accurately estimate the cost of commonly used disposable devices. Improving urologists' understanding of device costs is necessary for improved cost control and a reduction in healthcare expenditures.
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Affiliation(s)
- Nicholas J Farber
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Farber NJ, Rivera-Núñez Z, Kim S, Shinder B, Radadia K, Sterling J, Modi PK, Goyal S, Parikh R, Mayer TM, Weiss RE, Kim IY, Elsamra SE, Jang TL, Singer EA. Trends and outcomes of lymphadenectomy for nonmetastatic renal cell carcinoma: A propensity score-weighted analysis of the National Cancer Database. Urol Oncol 2018; 37:26-32. [PMID: 30446458 DOI: 10.1016/j.urolonc.2018.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/25/2018] [Accepted: 10/01/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE Lymph node (LN) involvement in renal cell carcinoma (RCC) is associated with a poor prognosis. While lymph node dissection (LND) may provide diagnostic information, its therapeutic benefit remains controversial. Thus, the aim of our study is to analyze survival outcomes after LND for nonmetastatic RCC and to characterize contemporary practice patterns. MATERIALS AND METHODS The National Cancer Database was queried for patients with nonmetastatic RCC who underwent either partial or radical nephrectomy from 2010 to 2014. A total of 11,867 underwent surgery and LND. Chi-square tests were used to examine differences in patient demographics. To minimize selection bias, propensity score matching (PSM) was used to select one control for each LND case (n = 19,500). Cox regression analyses were conducted to examine overall survival (OS) in patients who received LND compared to those who did not. RESULTS Of all patients undergoing LND for RCC (n = 11,867), 5%, 23%, 31%, 47% were performed for tumors of clinical T stage 1, 2, 3, and 4, respectively. Proportions of LND have not significantly changed from 2010 to 2014. No significant improvement in median OS for patients undergoing LND compared to no LND was shown (34.7 vs. 34.9 months, respectively; P = 0.98). Similarly, no significant improvement in median OS was found for clinically LN positive patients undergoing LND compared to no LND (P = 0.90). On Cox regression analysis, LND dissection was not associated with an OS benefit (hazard ratio: 1.00; 95% confidence interval 0.97 to 1.04). CONCLUSIONS Among all RCC patients, LNDs are often performed for low stage disease, suggesting a potential overutilization of LND. No OS benefit was seen in any subgroup of patients undergoing LND. Further investigation is needed to determine which patient populations may benefit most from LND.
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Affiliation(s)
- Nicholas J Farber
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Zorimar Rivera-Núñez
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sinae Kim
- Division of Biometrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Brian Shinder
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Kushan Radadia
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Parth K Modi
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Rahul Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Tina M Mayer
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Robert E Weiss
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Isaac Y Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sammy E Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
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Affiliation(s)
- C L Fleming
- Department of Dermatology, Cambridge University Hospitals Foundation Trust, Addenbrooke's Hospital Hills Road, Cambridge, CB2 0QQ, UK
| | - G Meligonis
- Department of Histopathology, Cambridge University Hospitals Foundation Trust, Addenbrooke's Hospital Hills Road, Cambridge, CB2 0QQ, UK
| | - J Sterling
- Department of Dermatology, Cambridge University Hospitals Foundation Trust, Addenbrooke's Hospital Hills Road, Cambridge, CB2 0QQ, UK
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Tabakin AL, Kim S, Polotti CF, Rivera-Núñez Z, Sterling J, Modi PK, Farber NJ, Radadia KD, Parikh R, Goyal S, Weiss RE, Kim IY, Elsamra SE, Singer EA, Jang TL. MP84-12 OUTCOMES AND FACTORS ASSOCIATED WITH RECEIPT OF OPEN VS MINIMALLY INVASIVE RETROPERITONEAL LYMPH NODE DISSECTION (RPLND) FOR TESTIS CANCER: ANALYZING THE NATIONAL CANCER DATABASE (NCDB) FROM 2010-2014. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Farber N, Sterling J, Elsamra S. 174 Financial Conflicts of Interest: A Link between Funding and Outcomes in Sexual Medicine. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2017.11.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Haka AS, Sue E, Zhang C, Bhardwaj P, Sterling J, Carpenter C, Leonard M, Manzoor M, Walker J, Aleman JO, Gareau D, Holt PR, Breslow JL, Zhou XK, Giri D, Morrow M, Iyengar N, Barman I, Hudis CA, Dannenberg AJ. Noninvasive Detection of Inflammatory Changes in White Adipose Tissue by Label-Free Raman Spectroscopy. Anal Chem 2016; 88:2140-8. [PMID: 26752499 DOI: 10.1021/acs.analchem.5b03696] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
White adipose tissue inflammation (WATi) has been linked to the pathogenesis of obesity-related diseases, including type 2 diabetes, cardiovascular disease, and cancer. In addition to the obese, a substantial number of normal and overweight individuals harbor WATi, putting them at increased risk for disease. We report the first technique that has the potential to detect WATi noninvasively. Here, we used Raman spectroscopy to detect WATi with excellent accuracy in both murine and human tissues. This is a potentially significant advance over current histopathological techniques for the detection of WATi, which rely on tissue excision and, therefore, are not practical for assessing disease risk in the absence of other identifying factors. Importantly, we show that noninvasive Raman spectroscopy can diagnose WATi in mice. Taken together, these results demonstrate the potential of Raman spectroscopy to provide objective risk assessment for future cardiometabolic complications in both normal weight and overweight/obese individuals.
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Affiliation(s)
- Abigail S Haka
- Department of Biochemistry, Weill Cornell Medical College , New York, New York 10065, United States
| | - Erika Sue
- Department of Medicine, Weill Cornell Medical College , New York, New York 10065, United States
| | - Chi Zhang
- Department of Mechanical Engineering, Johns Hopkins University , Baltimore, Maryland 21218, United States
| | - Priya Bhardwaj
- Department of Medicine, Weill Cornell Medical College , New York, New York 10065, United States
| | - Joshua Sterling
- Department of Medicine, Weill Cornell Medical College , New York, New York 10065, United States
| | - Cassidy Carpenter
- Department of Medicine, Weill Cornell Medical College , New York, New York 10065, United States
| | - Madeline Leonard
- Department of Medicine, Weill Cornell Medical College , New York, New York 10065, United States
| | - Maryem Manzoor
- Department of Biochemistry, Weill Cornell Medical College , New York, New York 10065, United States
| | - Jeanne Walker
- Laboratory of Biochemical Genetics and Metabolism, The Rockefeller University , New York, New York 10065, United States
| | - Jose O Aleman
- Laboratory of Biochemical Genetics and Metabolism, The Rockefeller University , New York, New York 10065, United States
| | - Daniel Gareau
- Department of Investigative Dermatology, The Rockefeller University , New York, New York 10065, United States
| | - Peter R Holt
- Laboratory of Biochemical Genetics and Metabolism, The Rockefeller University , New York, New York 10065, United States
| | - Jan L Breslow
- Laboratory of Biochemical Genetics and Metabolism, The Rockefeller University , New York, New York 10065, United States
| | - Xi Kathy Zhou
- Department of Healthcare Policy and Research, Weill Cornell Medical College , New York, New York 10065, United States
| | - Dilip Giri
- Department of Pathology, Memorial Sloan Kettering Cancer Center , New York, New York 10065, United States
| | - Monica Morrow
- Department of Surgery, Memorial Sloan Kettering Cancer Center , New York, New York 10065, United States
| | - Neil Iyengar
- Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, New York 10065, United States
| | - Ishan Barman
- Department of Mechanical Engineering, Johns Hopkins University , Baltimore, Maryland 21218, United States.,Department of Oncology, Johns Hopkins University , Baltimore, Maryland 21218, United States
| | - Clifford A Hudis
- Department of Medicine, Weill Cornell Medical College , New York, New York 10065, United States.,Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, New York 10065, United States
| | - Andrew J Dannenberg
- Department of Medicine, Weill Cornell Medical College , New York, New York 10065, United States
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Affiliation(s)
| | - Aaron M Bernie
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY
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Laudano MA, Osterberg EC, Sheth S, Ramasamy R, Sterling J, Mukherjee S, Robinson BD, Parekattil S, Goldstein M, Schlegel PN, Li PS. Microsurgical denervation of rat spermatic cord: safety and efficacy data. BJU Int 2014; 113:795-800. [PMID: 24053156 DOI: 10.1111/bju.12421] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe a microsurgical technique for denervation of the spermatic cord and use of multiphoton microscopy (MPM) laser to identify and ablate residual nerves after microsurgical denervation. To evaluate structural and functional changes in the rat testis and vas deferens after denervation. MATERIALS AND METHODS Nine Sprague-Dawley rats were divided into three experimental groups: sham, microsurgical denervation of the spermatic cord (MDSC), and MDSC immediately followed by laser ablation with MPM. At 2 months after surgery, we assessed testicular volume, functional circulation of the testicular artery with Doppler, patency of the vas deferens, and histology of the testis and vas deferens. RESULTS There was a significant decrease in the median number of nerves remaining around the vas deferens with MDSC alone (3.5 nerves) or MDSC with MPM (1.5 nerves) compared with sham rats (15.5 nerves) (P = 0.003). Although, MDSC with MPM resulted in the fewest remaining nerves, this result was similar to MDSC alone (P = 0.29). No deleterious effects on spermatogenesis or vas patency were seen in the experimental groups when compared with the sham rats. CONCLUSION A microsurgical approach can be used to effectively and safely denervate the rat spermatic cord with minimal changes to structure and function of the testis and vas deferens. MPM can be used as an adjunct to identify and ablate residual nerves after MDSC.
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Affiliation(s)
- Melissa A Laudano
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
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Osterberg EC, Laudano MA, Ramasamy R, Sterling J, Robinson BD, Goldstein M, Li PS, Haka AS, Schlegel PN. Identification of spermatogenesis in a rat sertoli-cell only model using Raman spectroscopy: a feasibility study. J Urol 2014; 192:607-12. [PMID: 24518766 DOI: 10.1016/j.juro.2014.01.106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE We determined whether Raman spectroscopy could identify spermatogenesis in a Sertoli-cell only rat model. MATERIALS AND METHODS A partial Sertoli-cell only model was created using a testicular hypothermia-ischemia technique. Bilateral testis biopsy was performed in 4 rats. Raman spectra were acquired with a probe in 1 mm3 samples of testicular tissue. India ink was used to mark the site of spectral acquisition. Comparative histopathology was applied to verify whether Raman spectra were obtained from Sertoli-cell only tubules or seminiferous tubules with spermatogenesis. Principal component analysis and logistic regression were used to develop a mathematical model to evaluate the predictive accuracy of identifying tubules with spermatogenesis vs Sertoli-cell only tubules. RESULTS Raman peak intensity changes were noted at 1,000 and 1,690 cm(-1) for tubules with spermatogenesis and Sertoli-cell only tubules, respectively. When principal components were used to predict whether seminferous tubules were Sertoli-cell only tubules or showed spermatogenesis, sensitivity and specificity were 96% and 100%, respectively. The ROC AUC to predict tubules with spermatogenesis with Raman spectroscopy was 0.98. CONCLUSIONS Raman spectroscopy is capable of identifying seminiferous tubules with spermatogenesis in a Sertoli-cell only ex vivo rat model. Future ex vivo studies of human testicular tissue are necessary to confirm whether these findings can be translated to the clinical setting.
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Affiliation(s)
- E Charles Osterberg
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Melissa A Laudano
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Ranjith Ramasamy
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Joshua Sterling
- Department of Biochemistry, Weill Cornell Medical College, New York, New York
| | - Brian D Robinson
- Department of Pathology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Marc Goldstein
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Philip S Li
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Abigail S Haka
- Department of Biochemistry, Weill Cornell Medical College, New York, New York
| | - Peter N Schlegel
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
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Goon P, Morrison V, Fearnhead N, Davies J, Wilson C, Jephcott C, Sterling J, Crawford R. High resolution anoscopy may be useful in achieving reductions in anal cancer local disease failure rates. Eur J Cancer Care (Engl) 2013; 24:411-6. [PMID: 24373061 DOI: 10.1111/ecc.12168] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2013] [Indexed: 11/29/2022]
Abstract
Anal cancer is uncommon, with an incidence rate of 0.5-1.0 per 100,000 of the population but incidence rates have been steadily increasing over the last 3 decades. Biological and epidemiological evidence have been mounting and demonstrate that anal cancer has many similarities to cervical cancer, especially in regard to its aetiology. High-resolution anoscopy (HRA) of the anal region – analogous to colposcopy of the cervix, is a technique that is not well-known in the medical and surgical fraternity. Evidence to support the use of HRA for detection and treatment in the surveillance of AIN exists and strongly suggests that it is beneficial, resulting in reduced rates of cancer progression. Pilot data from our study showed a local disease failure rate of 1.73 per 1000 patient-months compared with a published rate of 9.89 per 1000 patient-months. This demonstrates a 5.72-fold reduction in local disease failure rates of patients with T1-T3 tumours; the data therefore suggests that use of HRA for detection and treatment in surveillance of anal cancer patients will help prevent local regional relapse at the anal site. There is an urgent need for a large, randomised controlled clinical trial to definitively test this hypothesis.
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Affiliation(s)
- P Goon
- Division of Virology, Department of Pathology, University of Cambridge, Cambridge, UK; Department of GU and HIV Medicine, Addenbrooke's Hospital, Cambridge, UK
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