Sarcopenia is a muscle loss syndrome known as a risk factor of various carcinomas. The impact of sarcopenia and sarcopenia-related inflammatory/nutritional markers in metastatic urothelial carcinoma (mUC) treated with pembrolizumab was unknown, so this retrospective study of 27 patients was performed. Psoas muscle mass index (PMI) was calculated by bilateral psoas major muscle area at the L3 with computed tomography. The cut-off PMI value for sarcopenia was defined as ≤6.36 cm2/m2 for men and ≤3.92 cm2/m2 for women. Neutrophil-to-lymphocyte ratio (NLR) ≥ 4.0 and sarcopenia correlated with significantly shorter progression-free survival (PFS) (hazard ratio (HR) 3.81, p = 0.020; and HR 2.99, p = 0.027, respectively). Multivariate analyses identified NLR ≥ 4.0 and sarcopenia as independent predictors for PFS (HR 2.89, p = 0.025; and HR 2.79, p = 0.030, respectively). Prognostic nutrition index < 45, NLR ≥ 4.0 and sarcopenia were correlated with significantly worse for overall survival (OS) (HR 3.44, p = 0.046; HR 4.26, p = 0.024; and HR 3.92, p = 0.012, respectively). Multivariate analyses identified sarcopenia as an independent predictor for OS (HR 4.00, p = 0.026). Furthermore, a decrease in PMI ≥ 5% in a month was an independent predictor of PFS and OS (HR 12.8, p = 0.008; and HR 6.21, p = 0.036, respectively). Evaluation of sarcopenia and inflammatory/nutritional markers may help in the management of mUC with pembrolizumab.
Aim To determine the urinary levels of nerve growth factor (NGF) and brain‐derived neurotrophic factor (BDNF) in children with monosymptomatic nocturnal enuresis (MNE) and evaluate whether these factors can be used as biomarkers for the treatment outcome. Methods NGF and BDNF levels were measured and compared in 38 children (28 boys and 10 girls) with MNE and 25 children (18 boys and 7 girls) with no urinary symptoms were assessed. The mean ages in the patient and control groups were 9 and 10 years, respectively (P = .49). The patients were treated with either alarm or desmopressin therapy. Results The urinary NGF/creatinine and BDNF/creatinine ratios were significantly higher in the patient group than in the control group (P = .0003 and P = .0095, respectively). NGF and BDNF levels showed a significant positive correlation (P = .0020, r = 0.40). With respect to the degree of response, 19 patients (50%) showed complete response (CR) or partial response (PR), and 19 patients (50%) showed nonresponse (NR). The urinary NGF/creatinine and BDNF/creatinine ratios were significantly higher in the NR group than in the CR and PR groups (P = .0003 and P = .0003, respectively). Conclusions Urinary NGF/creatinine and BDNF/creatinine ratios were significantly higher in children with MNE than in healthy controls. Urinary NGF/creatinine can be predictive factors of a poor treatment outcome in children with MNE.
Highlight Bone is one of major metastatic site in patients with genitourinary (GU) cancer. Accurately predicting survival of patients with bone metastasis (BM) is essential. This external validation study proved high predictive accuracy of B-FOM score. B-FOM score is a simple scoring model based on five prognostic factors. B-FOM score is higher accurate tool comparing to other previously reported scores.
Objectives To evaluate the clinical benefit of bone‐modifying agents and identify the risk factors of skeletal‐related events in patients with genitourinary cancer with newly diagnosed bone metastasis. Methods This was a multicenter retrospective study including a total of 650 patients with bone metastasis of the following cancer types: hormone‐sensitive prostate cancer (n = 443), castration‐resistant prostate cancer (n = 50), renal cell carcinoma (n = 80) and urothelial carcinoma (n = 77). Clinical factors at the time of diagnosis of bone metastasis were analyzed. Early treatment with bone‐modifying agents was defined as follows: administration of bone‐modifying agents before the development of skeletal‐related events and within 6 months from the diagnosis of bone metastasis. Results During the follow‐up period (median 19.0 months, interquartile range 6.0–43.8 months), skeletal‐related events were reported in 88 (20%) patients with hormone‐sensitive prostate cancer, 17 (34%) patients with castration‐resistant prostate cancer, 58 (73%) patients with renal cell carcinoma and 34 (44%) patients with urothelial carcinoma. Early treatment with bone‐modifying agents significantly prolonged the time to the first skeletal‐related event in castration‐resistant prostate cancer, renal cell carcinoma and urothelial carcinoma, but not in hormone‐sensitive prostate cancer. Bone pain and elevated alkaline phosphatase levels were independent predictive risk factors of the first skeletal‐related event. The subgroup analysis showed that early treatment with bone‐modifying agents was associated with prolonged time to the first skeletal‐related events in patients with bone pain or elevated alkaline phosphatase levels. Conclusions Early treatment with bone‐modifying agents should be considered, especially for patients with bone pain and elevated alkaline phosphatase levels, to prevent skeletal‐related events in patients with genitourinary cancer with bone metastasis.
Objectives: To assess the association between postoperative cystogram findings and subsequent outcomes on urinary continence after robot-assisted laparoscopic radical prostatectomy (RALP).Methods: A retrospective review of 250 consecutive patients who were observed for at least 12 months after RALP. The postoperative cystogram findings examined were: the location of the bladder neck, degree of bladder abnormalities, and presence of outflow of contrast medium into the urethra during the filling phase of cystography. The continence status based on pad usage was recorded. Those who required no pad or only a safety pad were defined as continent.Results: Patients with a bladder neck location above the middle of the pubic symphysis height exhibited significantly higher continence levels than those with a lower bladder neck location at both postoperative 3 and 12 months (P < 0.0001 and P = 0.0002, respectively). The higher a bladder neck was located, the earlier the urinary continence was achieved after RALP (P < 0.0001). Patients without contrast outflow into the urethra during cystogram demonstrated a significantly more favorable continence status at the 3-month follow-up (P = 0.004). Patients without bladder abnormalities on postoperative cystogram demonstrated a significantly more favorable continence status at the 12-month follow-up than those with bladder abnormalities (P = 0.01).Conclusions: Postoperative cystogram findings may predict recovery of urinary continence after RALP. K E Y W O R D S bladder neck, cystogram, prostatectomy, RALP, urinary incontinence 1 | INTRODUCTION The spread of prostate serum antigen (PSA) screening has increased the reported incidence of prostate cancer. Robot-assisted laparoscopic radical prostatectomy (RALP) has become the most common surgical management for prostate cancer. It was reported that 85% of prostatectomies were performed under robotic surgery in the USA in 2009. 1 Although surgical techniques have improved, urinary inconti-nence is one of the most common complications following prostatectomy and has a significant impact on the quality of life (QoL) of patients who undergo radical prostatectomy. The reported incidence of patients with urinary incontinence after radical prostatectomy ranges from 6% to 20%. 2,3 Although nearly 90% of patients achieved urinary continence at the 12-month follow-up following prostatectomy, the incidence of urinary incontinence did not improve remarkably later than 12 months after prostatectomy. 4The pathophysiology of urinary incontinence after RALP has been investigated, and multiple factors are associated with urinary incontinence after prostatectomy, including damage to the urinary sphincter, 5 bladder neck dysfunction, 6 and dysfunction of the pelvic diaphragm. 6In this study, we assessed the association between the postoperative cystogram findings and subsequent urinary continence outcomes to identify factors that predict postoperative urinary incontinence.
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