Background: Various prediction tools have been developed to predict biochemical recurrence (BCR) after radical prostatectomy (RP), however, few of the previous prediction tools used serum prostate specific antigen (PSA) nadir after RP and maximum tumor diameter (MTD) at the same time. In this study, a nomogram incorporating MTD and PSA nadir was developed to predict BCR-free survival. Methods: 337 patients who underwent RP were retrospectively enrolled in this study. The maximum diameter of the index lesion was measured on magnetic resonance imaging (MRI). Cox regression analysis was performed to evaluate independent predictors of BCR. A nomogram was subsequently developed for the prediction of BCR-free survival at 3 and 5 years after RP. Time-dependent receiver operating characteristic (ROC) curve and decision curve analysis were performed to identify the advantage of the new nomogram in comparison with the CAPRA-S score. Results: A novel nomogram was developed to predict BCR by including PSA nadir, MTD, Gleason score, surgical margin (SM), and seminal vesicle invasion (SVI), since these variables were significantly associated with BCR in both univariate and multivariate analysis (p <0.05). In addition, a basic model including Gleason score, SM, and SVI was developed and used as a control to assess the incremental predictive power of the new model. The concordance index of our model was slightly higher than CAPRA-S model (0.76 vs. 0.70, p =0.02) and it was significantly higher than that of the basic model (0.76 vs. 0.66, p =0.001). Time-dependent ROC curves and decision curve analyses also demonstrated the advantages of the new nomogram.Conclusions: PSA nadir after RP and MTD based on MRI before surgery are independent predictors of BCR. By incorporating PSA nadir and MTD into the conventional predictive model, our newly developed nomogram significantly improved the accuracy in predicting BCR-free survival after RP.
Background: Germline pathogenic mutations associated with pheochromocytoma (PHEO) are present in most patients with hereditary bilateral PHEOs. Adenomatous polyposis coli (APC) gene has previously been identified as a tumor suppressor gene in familial adenomatous polyposis and colorectal cancers, but not PHEO. Methods: A father and a son from Tibet were clinically diagnosed with bilateral synchronous PHEOs. The son underwent staged retroperitoneal laparoscopic bilateral total adrenalectomy, and the father underwent retroperitoneal laparoscopic left adrenalectomy. A pedigree investigation was performed with a follow-up of 4 years. Whole-exome sequencing was performed to reveal the susceptibility genes in the pedigree. Results: The adrenal masses in the father and son were pathologically diagnosed as hereditary bilateral synchronous PHEOs. A pedigree investigation of 26 family members spanning 3 generations was performed. Multiple endocrine gland–related tumors, including PHEO, pancreatic neuroendocrine tumor, and pituitary adenoma, were diagnosed in the family. DNA sequencing identified a novel heterozygous germline missense mutation (c.896C>G) of the APC gene in the proband. The same heterozygous germline mutation of the APC gene was also present in the pedigree. Conclusions: We reported a pedigree from Tibet with hereditary bilateral synchronous PHEOs, which revealed a novel heterozygous germline missense mutation of the APC gene that may predispose to PHEO.
Background: To evaluate the association between pre- and postoperative parameters on magnetic resonance imaging (MRI) and continence recovery after laparoscopic radical prostatectomy (LRP). Methods: 73 patients who underwent LRP were retrospectively reviewed. Demographic characteristics, clinicopathologic outcomes and several MRI parameters before and after surgery were evaluated. Continence was defined as no pad per day. Early continence recovery was defined as continence recovery within 3 months. Kaplan-Meier analyses and log-rank test were used to compare time to continence recovery. Cox proportional-hazards regression analyses were performed to identify independent predictors of continence recovery after LRP.Results: Patients with smaller prostatic volume, shorter intravesical prostatic protrusion length (IPPL), longer preoperative membranous urethral length (MUL), lower MUL-removal rate, triangular vesicourethral anastomosis (VUA) and neurovascular bundle sparing experienced a faster continence recovery (All, p < 0.05). Multivariate analyses revealed IPPL (hazard ratio [HR]: 0.94, p = 0.044), preoperative MUL (HR: 1.10, p = 0.032), MUL-removal rate (HR: 0.91, p = 0.007) and shape of VUA (square vs. triangle, HR: 2.30, p = 0.012) were independent predictors of continence recovery after LRP.Conclusion: IPPL, preoperative MUL, MUL-removal rate and shape of VUA were promising parameters on MRI for predicting continence recovery after LRP.
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