BackgroundSarcosine has been investigated as a prostate cancer biomarker with mixed results concerning its predictive power. We performed a case–control evaluation of the predictive value of serum sarcosine for early detection in a population-based cohort of men undergoing prostate-specific antigen (PSA) screening.MethodsFor analysis we used 251 cancer cases and 246 age-matched non-cancer cases from the San Antonio Biomarkers Of Risk (SABOR) screening study. For cancer cases, pre-diagnostic serum was utilized for sarcosine measurement. Controls were defined as men who had been followed at least for 5 years on study with no prostate cancer diagnosis; sarcosine was measured on the initial baseline serum. HPLC-electrospray ionization mass spectrometry was used for serum sarcosine quantification. The association of sarcosine with prostate cancer was assessed using area underneath the receiver-operating characteristic curve (AUC), and logistic regression adjusting for PSA, digital rectal exam, family history, age, race, and history of a prior negative biopsy. Among cancer cases, nominal logistic regression was used for the association of sarcosine with Gleason grade.ResultsSarcosine levels were overlapping between the prostate cancer cases (median 15.8 uM, range 6.2 to 42.5 uM) and controls (median 16.2 uM, range 6.4 to 53.6 uM). The AUC of sarcosine was not statistically different from random chance either for participants with any PSA value (52.2 %) or those with PSA values in the range of 2 to 10 ng/mL (54.3 %). Sarcosine was not predictive of Gleason score and added no independent predictive power to standard prostate cancer risk factors for detection of prostate cancer (all p-values > 0.05).ConclusionsSerum sarcosine should not be pursued further as a marker for the early detection of prostate cancer.
Introduction Cardiometabolic syndrome (CMS) is diabetes mellitus (or insulin resistance) plus any two of the following risk factors: hypertension, obesity, and hyperlipidemia. The correlation of metabolic syndrome with cardiovascular disease and the increase in the prevalence of patients with risk factors have solidified the importance of continued focus on metabolic syndrome. We retrospectively evaluated single‐center data to determine if there is an association between CMS and outcomes. Methods The local Society of Thoracic Surgeons Adult Cardiac Database was queried for consecutive coronary bypass (CABG) cases from 2002 to 2010. Short and long‐term outcomes were compared between groups of patients with CMS and then risk‐adjusted using multiple regression models with adjusted odds ratios and hazard ratios. Results Of 11 021 CABG cases, 3881 (35.2%) had CMS, with an annual prevalence that increased from 32% to 40% during the study. Patients with CMS were more likely to have prior cerebrovascular diseases, strokes, renal insufficiency, and worse New York Heart Association status. Unadjusted postoperative comparisons revealed that patients with CMS had higher rates of stroke, renal failure, dialysis, deep sternal wound infection, and longer intensive care unit and hospital length of stay. Risk‐adjusted odds ratios did not reveal a significant impact on short‐term outcomes, however, adjusted hazard ratios continued to demonstrate significant decreases in long‐term survival in patients with CMS. Conclusions Patients with CMS were more likely to present with increased comorbidities. Patients with CMS undergoing CABG were at risk for worse short‐term secondary postoperative outcomes and reduced long‐term survival. The data supports the need for further investigation for risk reduction surrounding operative revascularization.
Background:Renal cancer may invade the inferior vena cava (IVC) creating more complex surgical intervention. We investigate radiologic findings that may predict vascular reconstruction prior to surgery and future renal cancer-specific mortality.Materials and Methods:Radiologic findings included Mayo Clinic risk factors for vascular reconstruction: Right-sided tumor, anteroposterior diameter of the IVC at the ostium of the renal vein ≥24.0 mm, and radiologic identification of complete occlusion of the IVC. Additional factors included thrombus in the lumen of the hepatic veins and metastasis. Along with other demographic factors, analysis included Chi-squared analysis for vascular reconstruction and logistic regression for mortality. A Kaplan–Meier curve was created for the most significant radiologic factor.Results:Thirty-seven patients underwent IVC tumor thrombectomy at two institutions from April 2007 to February 2015. We found that Mayo risk factors of 0, 1, 2, and 3 and the proportions of vascular reconstruction of 0%, 0%, 12.5%, and 13.6%, respectively (P = 0.788). Hepatic vein involvement was the most significant determinate of renal cell carcinoma-specific mortality in multivariable analysis, controlling for the size of IVC at the hepatic veins, pulmonary metastasis, and Fuhrman grade (P = 0.02, Log-rank P = 0.002).Conclusion:Mayo risk factors did not predict vascular reconstruction in our small cohort of Level II–Level IV IVC thrombus undergoing IVC thrombectomy. Tumor thrombus traveling into the lumen of the hepatic veins was a significant risk factor for accelerated mortality.
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