Objectives:To investigate the association of lymphovascular invasion (LVI) in radical prostatectomy (RP) specimens with prostate-specific antigen (PSA) failure in patients with pT3aN0 prostate cancer (PCA). Methods: We retrospectively reviewed the clinical records of 94 patients with pT3aN0 PCA treated with RP alone. All of the 94 patients were prospectively observed without any treatment until PSA failure was confirmed. We investigated the association of LVI with the adverse pathological findings in RP specimens and the PSA failure-free survival rate. The Cox proportional hazard model was used to elucidate predictors of PSA failure. Results: Median follow up was 47.4 months (quartile range 9.1 to 146.8). LVI was found in 26 (27.7%) of the 94 patients. In a multivariate analysis, PSA (P = 0.0054) and LVI (P = 0.015) were significant and independent predictors of PSA failure. Stratifying patients into four risk groups by LVI status and PSA level, the PSA failure-free survival rate in patients with negative LVI and PSA Յ10 ng/mL was significantly better than any other groups (positive LVI and/or PSA >10 ng/mL). Conclusions: Adjuvant therapy would not be indicated to patients with pT3aN0 PCA with negative LVI and PSA Յ10 ng/mL.
OBJECTIVE
To investigate the rate of objective response and the skeletal‐related event (SRE)‐free survival after combined therapy with radiotherapy (RT) and zoledronate in patients with bone metastases from renal cell carcinoma (RCC).
PATIENTS AND METHODS
In all, 23 patients with RCC metastatic to bone were included in this retrospective study, of whom 13 had RT to bone metastases with no bisphosphonate therapy between 2000 and 2006, while the remaining 10 had combined therapy with RT and zoledronate (RT + Z) in 2006 and 2007. Significant calcifications of osteolytic metastases and/or shrinkage of bone lesions, as measured by computed tomography, were defined as a partial response. SREs were defined as any of pathological fracture, spinal cord compression, bone surgery, or additional RT to the bone.
RESULTS
In the RT + Z group, six patients had a partial response, showing evidence of calcification of their osteolytic bone metastases, while in the RT group, only one patient did (P = 0.019). One patient in the RT + Z group had an SRE, while 10 in the RT group had SREs (P = 0.003). The median SRE‐free survival time was not reached in the RT + Z group, but in the RT group it was 18.7 months (P = 0.046).
CONCLUSION
Combined therapy as RT + Z achieved a higher objective response rate (six of 10) and prolonged SRE‐free survival than RT alone in patients with bone metastases from RCC.
Objectives:The prognosis for upper urinary tract urothelial carcinoma is generally poorer than that for bladder cancer, and prognostic predictors with a high specificity for upper urinary tract urothelial carcinoma (UUT-UC) are needed to optimize treatment. In fact, the only preoperative predictor currently available is C-reactive protein. In the present study, we investigated the usefulness of pretreatment serum CYFRA 21-1 as a new prognostic predictor in UUT-UC. Methods: A total of 45 UUT-UC patients for whom serum CYFRA 21-1 was measured before treatment were included in this retrospective analysis. Patients were separated into high and low serum CYFRA 21-1 groups based on a cut-off value of 2.7 ng/mL determined from a receiver operating characteristic curve. Kaplan-Meier survival curves were calculated and the overall survival rate was statistically analyzed for the high and low pretreatment serum CYFRA 21-1 groups using the log-rank test. Multivariable analysis was carried out using the Cox proportional hazards analysis. Results: By the median follow-up period of 14.4 months, 20 patients (44.4%) had died. Of the 45 patients, 23 (51.1%) were in the high pretreatment serum CYFRA 21-1 group, and the overall survival rate of this group was significantly lower (P < 0.001). Multivariable analysis identified only distant metastasis (P < 0.001) and pretreatment serum CYFRA 21-1 (P = 0.039) as independent prognostic predictors. Distant metastasis did not significantly differ between the two groups or correlate with pretreatment serum CYFRA 21-1. Conclusion: These findings suggest that pretreatment serum CYFRA 21-1 values could serve as a prognostic predictor of UUT-UC.
Bisphosphonates (BP) are inhibitors of bone-resorption and have become the current standard of care for preventing skeletal complications associated with bone metastases. Although previous reports have also suggested potent antitumor, antiangiogenic and immunomodulatory properties of BP, there is debate about the clinical relevance of experimental in vitro and in vivo findings. We report a renal cell carcinoma case in which multiple lung and bone metastases displayed remarkable remission to BP therapy using 30 mg pamidronate once, 4 mg zoledronate once, and weekly 10 mg incadronate 10 times for 3 months. This is the first case report to demonstrate that BP therapy is effective to non-osseous visceral metastasis as well as bone metastases in the clinical setting.
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