Percentage Of Tumor Volume Research Articles

Effective melanoma cancer suppression by iontophoretic co-delivery of STAT3 siRNA and imatinib using gold nanoparticles

Co-delivery of chemotherapeutic agents improve anti-tumor efficacy and reduce cancer resistance. Here, we report development of layer-by-layer assembled gold nanoparticles (LbL-AuNP) containing anti-STAT3 siRNA and imatinib mesylate (IM) to treat melanoma. The combination treatment with STAT3 siRNA and IM in B16F10 melanoma cells showed greater suppression of STAT3 protein, decreased cell viability and increased apoptotic events compared with LbL-AuNP containing either STAT3 siRNA or IM. In vivo efficacy studies in melanoma tumor bearing mice showed that non-invasive topical iontophoretic administration (0.5mA/cm2) of LbL-AuNP was comparable with intratumoral administration. Co-delivery of STAT3 siRNA and IM using LbL-AuNP showed significant (p<0.05) reduction in percentage tumor volume, tumor weight and suppressed STAT3 protein expression compared with either STAT3 siRNA or IM loaded LbL-AuNP. Taken together, LbL-AuNP can be developed as nanocarrier system for co-delivery of siRNA and small molecule drugs for topical iontophoretic delivery.

Significance of the correlation between serum-prostate specific antigen and the percentage of prostate cancer volume in postoperative biochemical progression

Introduction/Objective. Radical prostatectomy (RP) is the best form of treatment of patients with locally confined prostate cancer (PC). Biochemical progression (BP) of the disease occurs in 27?53% of patients after RP. The aim of our analysis was to assess the significance of the correlation of preoperative prostate-specific antigen (PSA) values and the percentage volume of PC in biochemical progression in patients with RP and the biopsy Gleason score of 6 and 7. Methods. The analysis included the results of treatment of 228 patients with the committed radical retropubic prostatectomy for localized PC in the 2007?2011 period. According to the Gleason grade system values, three groups were identified ? 6 (3 + 3), 7 (3 + 4) and 7 (4 + 3). According to the preoperative PSA values the following three groups were determined and monitored: ? 4 ng/ml, 4.1?10 ng/ml, and ? 10.1 ng/ml. Biochemical progression was defined as two consecutive increases of PSA values ? 0.2 ng/ml after RP. The percentage of tumor volume (PTV) is determined by a visual assessment of the percentage of PC in each microscopic sample. Four PTV groups were determined: 0?5%, 6?25%, 26?50%, and 51?100%. Results. Biochemical progression was registered in 19 patients. Most frequent PTV in the group of patients with BP and from biopsy and RP was 6?50%, an average of 30%. Conclusion. Our study showed predictive significant connections between preoperative PSA values and the values of PTV after operational treatment and that these are independent parameters in the assessment of treatment results.

Risk factors for Gleason Score upgrading following radical prostatectomy.

Gleason Score discordance can confound optimal treatment allocation of patients diagnosed with prostate cancer and place these patients at risk of worse oncological outcomes. Its prevalence remains endemic; its exact causation remains unknown. The objective of this review was to examine the observational studies of patient cohorts who have undergone radical prostatectomy with the aim of identifying any preoperative variables that may be associated with an upgrade in final prostatectomy Gleason Score. A non-systematic review of English articles from 2010 to present was performed through a MEDLINE search. Search terms included "Gleason Score," "pathological," "upgrade," and "radical prostatectomy." All studies included for review were retrospective analyses of radical prostatectomy series that examined factors associated with Gleason Score discordance. The various studies found that Gleason Score upgrading remains highly prevalent, and that some association can be seen with greater percent positive cores, longer biopsy core lengths, smaller prostate glands, higher percent tumor volume per gland, prostate-specific antigen density and visible lesions on multiparametric magnetic resonance imaging.

Metastatic Tumor Burden Does Not Predict Overall Survival Following Cytoreductive Nephrectomy for Renal Cell Carcinoma: a Novel 3-Dimensional Volumetric Analysis

To compare 1-dimensional (1D) and 3-dimensional (3D) volume measurements and determine whether primary tumor (PT) burden is predictive of overall survival (OS) following cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC). Records and imaging studies of patients with mRCC treated with CN from 2006 to 2015 were included, with tumor volumes measured by a faculty radiologist blinded to clinical outcomes using Advantage Workstation Volume Share (Ver 4.6, GE, Waukesha, WI). Complete PT and metastatic tumor volumes were measured for 67 patients. For 15 (22.3%) patients, 1D volume was within ±10% of the measured 3D volume. In 40 (59.7%) patients, the 1D calculated PT volume was >10% of the actual 3D volume. Fractional percentage of tumor volume (FPTV) removed during CN was calculated using the formula PT volume/(PT + met volume). FPTV was not associated with OS when analyzed as a continuous variable. Patients were divided into 2 groups based on previously published cut point of 90% FPTV. No differences between cohorts in age, gender, grade, subtype, number of metastatic sites, performance status, Memorial Sloan Kettering Cancer Center risk group, or International Metastatic Renal Cell Carcinoma Database Consortium risk group were identified. OS was not different between cohorts (P = .38). 1D measurements of PT diameter frequently overestimate mRCC PT volume. In patients with mRCC selected for CN, the ratio of primary to metastatic tumor does not predict OS.

Mechanism and Natural Course of Tumor Involution in Hepatocellular Carcinoma Following Transarterial Ethanol Ablation.

To evaluate the microvascular distribution of lipiodol-ethanol, the histological change of the tumor lesion, and the status of tumor involution over time in hepatocellular carcinoma (HCC) following transarterial ethanol ablation (TEA), in lesions that showed CT evidence of complete tumor response. Patients with unresectable HCC were treated (183 patients, 242 lesions) with TEA using lipiodol-ethanol mixture (LEM) mixed in 2:1 ratio by volume and followed with CT at 3-month intervals for a median of 14.1months. Liver tumors (n=131) that showed CT evidence of complete tumor response, defined as the absence of any enhancing tumor throughout the follow-up period, were included. The surgical specimens of five patients who subsequently received partial hepatectomy were available for histological assessment. The microvascular distribution of LEM and the degree of tumor necrosis were analyzed. Tumor involution over time was assessed with CT in lesions that showed complete response. Lipid stain revealed lipiodol infiltration throughout arterioles, intratumoral sinusoidal spaces, tumor capsule, and peritumoral portal venules. Complete tumor necrosis (100%) occurred in all 5 surgical specimens. The median (IQR) percentage tumor volume compared to baseline volumes at 12, 36, and 60months was 32% (23.5-52.5%), 22% (8-31%), and 13.5% (6-21.5%), respectively. Intrahepatic HCC lesion that showed CT evidence of complete tumor response following TEA is associated with histological evidence of LEM infiltration throughout the intratumoral and peritumoral vasculature and complete tumor necrosis, as well as sustained reduction in tumor volume over time.

S&T-60 THE INFLUENCE OF LENGTH, GRADE, AND LOCATION OF POSITIVE SURGICAL MARGIN (PSM) ON BIOCHEMICAL RECURRENCE IN ORGAN CONFINED PROSTATE CANCER

You have accessJournal of UrologyScience & Technology Posters1 Apr 2016S&T-60 THE INFLUENCE OF LENGTH, GRADE, AND LOCATION OF POSITIVE SURGICAL MARGIN (PSM) ON BIOCHEMICAL RECURRENCE IN ORGAN CONFINED PROSTATE CANCER Chanwoo Lee, Aram Kim, Myong Kim, Myung-Chan Park, Jaeyoon Jung, Hyun-Jung Go, Yang-Soon Park, Yong Mee Cho, In Gab Jeong, Cheryn Song, Jun-Hyuk Hong, Choung-Soo Kim, and Hanjong Ahn Chanwoo LeeChanwoo Lee More articles by this author , Aram KimAram Kim More articles by this author , Myong KimMyong Kim More articles by this author , Myung-Chan ParkMyung-Chan Park More articles by this author , Jaeyoon JungJaeyoon Jung More articles by this author , Hyun-Jung GoHyun-Jung Go More articles by this author , Yang-Soon ParkYang-Soon Park More articles by this author , Yong Mee ChoYong Mee Cho More articles by this author , In Gab JeongIn Gab Jeong More articles by this author , Cheryn SongCheryn Song More articles by this author , Jun-Hyuk HongJun-Hyuk Hong More articles by this author , Choung-Soo KimChoung-Soo Kim More articles by this author , and Hanjong AhnHanjong Ahn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2889AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The oncological significance of pathological variables associated with positive surgical margin (PSM) after radical prostatectomy (RP), including location, involved length and grade, is still under debate. We intended to evaluate the influence of PSM-associated pathological variables on biochemical recurrence (BCR). METHODS Data from 1,236 patients who underwent RP and were confirmed pathologically with organ confined (=pT2) prostate cancer was reviewed. The prognostic significance of pathologic Gleason score (GS), percentage tumor volume (PTV), and aforementioned length, grade and location of PSM on BCR were analyzed utilizing Cox regression analysis. RESULTS PSMs were observed in 215 (17.4%) prostatectomy specimens and median length of PSM is 2mm (IQR: 1-5). Among them, 110 margins (51.2%) were grade 3 and 53 margins (24.6%) were grade 4 or 5. Grade of 52 cases were unreported at pathological outcome. Location of PSM was reported in all patients, 87 margins (40.4%) were only at apex lesion, 77 margins (35.8%) were at both apex and other lesion, and 51 margins (23.7%) were not at apex lesion. Biochemical recurrence occurred in 120 (9.7%) patients, in median follow up of 49 months (IQR: 32-61), and the estimated 5-year BCR-free survival was 89.5%. On multivariable analysis, pathologic GS (=8; HR = 2.19, p=0.019) and presence of PSMs (HR= 2.62, p=0.005) were independent prognostic factors for BCR. However, involved length (p range: 0.207-0.678), and tumor grade at surgical margin (p range: 0.179-0.203) did not affected BCR. The location of PSM was the only pathologic variable associated with PSM affecting the BCR (single apical lesion, HR = 1.96, p > 0.05; multiple lesions including apex; HR = 2.83, p = 0.012; non-apical lesion; HR = 3.01, p = 0.003; compared to negative surgical margin). CONCLUSIONS Among the variables associated with PSM, non-apical PSM was significantly associated with biochemical recurrence in pT2 prostate cancer, while the length and grade of PSM did not affect BCR. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e333 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Chanwoo Lee More articles by this author Aram Kim More articles by this author Myong Kim More articles by this author Myung-Chan Park More articles by this author Jaeyoon Jung More articles by this author Hyun-Jung Go More articles by this author Yang-Soon Park More articles by this author Yong Mee Cho More articles by this author In Gab Jeong More articles by this author Cheryn Song More articles by this author Jun-Hyuk Hong More articles by this author Choung-Soo Kim More articles by this author Hanjong Ahn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Abstract P5-02-05: Prediction of response to neoadjuvant chemotherapy in ER+ breast cancer: Magee equation recurrence versus oncotype DX® recurrence score

Abstract Background and Aim: The Magee equation recurrence score (MS) based on tumor pathological characteristics can be used to estimate the actual Oncotype DX® recurrence score (RS). This study's aim was to test the correlation of MS with RS and their usefulness in predicting tumor response to neoadjuvant chemotherapy (NCT) in patients with estrogen receptor (ER) positive, HER2 negative invasive breast carcinoma (BC). Methods: Pathological data required for MS calculation such as Nottingham Score, H-scores for ER and PR, HER2, Ki 67 and tumor size were obtained via pre-therapy slide review or pathology/electronic medical record. Actual RS was measured (at Genomic Health) on core biopsies from 60 patients who received NCT. Pre-therapy tumor size was measured using imaging. Percentage tumor volume reduction (%TR) was measured. %TR was based on pre-therapy tumor size by MRI and US and detailed pathology evaluation of the resection specimen. Substantial %TR was defined as at least 50% reduction in tumor size (&amp;gt;50%TR). MS was calculated using Magee equation (http://path.upmc.edu/onlineTools/ptvr.html). MS and RS were categorized by score &amp;lt;18 (referred as MS18 and RS18, respectively) and ≥31 (referred as MS31 and RS31, respectively). Correlation between MS, RS and &amp;gt;50%TR were determined by using the Spearman's correlation coefficient. The mean levels of pathological parameters and score levels which had &amp;gt;50%TR or &amp;lt;50%TR were compared by ANOVA at a 2-sided α level of 0.05. The impact of the scoring systems for &amp;gt;50%TR by the scoring systems was assessed by calculating the area under (AUC) the receiver operating characteristic curve (ROC); AUC values between 0.7–0.8 represent considerable discrimination. Results: The mean patient age was 52 ±13 years. The mean pre-NCT tumor size was 48 ±36 mm.&amp;gt;50%TR was observed in 27 (45%) patients, but there was no pathological complete response. Low level of ER H-score (&amp;lt;100) was significantly associated with &amp;gt;50%TR (p=0.01). The Spearman's correlation coefficient (rs) for the MS and RS was 0.522 (p&amp;lt;0.001) with an average coefficient of determination (r2) of 0.298. Neither, MS nor RS correlated with &amp;gt;50%TR (p=0.08, p=0.2, respectively). The AUC values were calculated from the MS, RS, MS18, RS18, MS31 and RS31 (AUC=0.625, 0.602, 0.589, 0.572, 0.525 and 0.522, respectively).Conclusions: MS and Oncotype DX® RS have a good correlation in this small ER+ neoadjuvant cohort. However, neither MS nor RS correlated with %TR. Lower ER expression as a single variable is an excellent predictor of response to NCT and may be used alone in making therapy decisions in small number of cases. For moderate to strongly ER+ cases, the decision between primary surgery versus neoadjuvant systemic therapy may be difficult, but MS may be used in lieu of actual Oncotype DX® RS when it is not available. Citation Format: Soran A, Johnson R, Menekse E, Bhargava R, McGuire K, McAuliffe P, Ahrendt G, Dabbs D, Bonaventura M. Prediction of response to neoadjuvant chemotherapy in ER+ breast cancer: Magee equation recurrence versus oncotype DX® recurrence score. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-02-05.

Effect of serum testosterone and percent tumor volume on extra-prostatic extension and biochemical recurrence after laparoscopic radical prostatectomy.

Several studies have revealed that the preoperative serum testosterone and percent tumor volume (PTV) predict extra-prostatic extension (EPE) and biochemical recurrence (BCR) after radical prostatectomy. This study investigated the prognostic significance of serum testosterone and PTV in relation to EPE and BCR after laparoscopic radical prostatectomy (LRP). We reviewed 520 patients who underwent LRP between 2004 and 2012. PTV was determined as the sum of all visually estimated tumor foci in every section. BCR was defined as two consecutive increases in the postoperative prostate-specific antigen (PSA) >0.2 ng ml−1. The threshold for serum total testosterone was 3.0 ng ml−1. Multivariate logistic regression was used to define the effect of variables on the risk of EPE and BCR. A low serum testosterone (<3.0 ng ml−1) was associated with a high serum PSA, Gleason score, positive core percentage of the prostate biopsy, PTV, and all pathological variables. On multivariate analysis, similar to previous studies, the serum PSA, biopsy positive core percentage, Gleason score, and pathological variables predicted EPE and BCR. In addition, low serum testosterone (<3.0 ng ml−1, adjusted OR, 8.52; 95% CI, 5.04–14.4, P = 0.001) predicted EPE and PTV (adjusted OR, 1.02; 95% CI, 1.01–1.05, P = 0.046) predicted BCR. In addition to previous predictors of EPE and BCR, low serum testosterone and PTV are valuable predictors of EPE and BCR after LRP.

MRI kinetics with volumetric analysis in correlation with hormonal receptor subtypes and histologic grade of invasive breast cancers.

OBJECTIVE. The aim of this study was to assess whether computer-assisted detection-processed MRI kinetics data can provide further information on the biologic aggressiveness of breast tumors. MATERIALS AND METHODS. We identified 194 newly diagnosed invasive breast cancers presenting as masses on contrast-enhanced MRI by a HIPAA-compliant pathology database search. Computer-assisted detection-derived data for the mean and median peak signal intensity percentage increase, most suspicious kinetic curve patterns, and volumetric analysis of the different kinetic patterns by mean percentage tumor volume were compared against the different hormonal receptor (estrogen-receptor [ER], progesterone-receptor [PR], ERRB2 (HER2/neu), and triple-receptor expressivity) and histologic grade subgroups, which were used as indicators of tumor aggressiveness. RESULTS. The means and medians of the peak signal intensity percentage increase were higher in ER-negative, PR-negative, and triple-negative (all p ≤ 0.001), and grade 3 tumors (p = 0.011). Volumetric analysis showed higher mean percentage volume of rapid initial enhancement in biologically more aggressive ER-negative, PR-negative, and triple-negative tumors compared with ER-positive (64% vs 53.6%, p = 0.013), PR-positive (65.4% vs 52.5%, p = 0.001), and nontriple-negative tumors (65.3% vs 54.6%, p = 0.028), respectively. A higher mean percentage volume of rapid washout component was seen in ERRB2-positive tumors compared with ERRB2-negative tumors (27.5% vs 17.9%, p = 0.020). CONCLUSION. Peak signal intensity percentage increase and volume analysis of the different kinetic patterns of breast tumors showed correlation with hormonal receptor and histologic grade indicators of cancer aggressiveness. Computer-assisted detection-derived MRI kinetics data have the potential to further characterize the aggressiveness of an invasive cancer.

Diffusion-weighted MRI and MR- volumetry - in the evaluation of tumor response after preoperative chemoradiotherapy in patients with locally advanced rectal cancer

PurposeTo determine the diagnostic performance of diffusion-weighted MRI and MR volumetry for the assessment of tumor response after preoperative chemoradiotherapy (CRT) in patients with locally advanced rectal cancer. Materials and MethodsForty-three patients with rectal cancer who underwent preoperative CRT were prospectively examined for the study. This prospective study was approved by our institutional review board. DW- and high resolution T2-weighted imaging were performed before and after therapy. Two different diffusion gradients (b=0 and b=600, then separately b=0 and b=1000) were applied. The mean tumor volume and mean ADC values were measured before and after therapy. To evaluate the responders and nonresponders to neoadjuvant CRT, two criteria, ypT stage determined in the pathologic examination after treatment and histopathologic tumor regression grade (Ryan), were used as reference standards. The patients with a lower ypT stage than T stage in the first MRI before neoadjuvant CRT were evaluated as the responder group, while the patients with a higher or the same ypT stage relative to the first MRI T stage were evaluated as the nonresponder group. According to Ryan tumor regression grade, grade 1 was evaluated as the responders, whereas grades 2 and 3 were evaluated as the nonresponder group. The percentage ADC increase and percentage tumor volume regression were compared between the responders and nonresponders using two reference standards: T downstaging and tumor regression grade (TRG). ResultsBefore CRT, the mean tumor ADC in the responder group was significantly lower than that in the nonresponder group (p<0.001). At the end of CRT, the mean percentage of tumor ADC change in the responder group was significantly higher than that in the nonresponder group. The percentage tumor volume regression of the responders was significantly higher than that of the nonresponders (p=0.001). The cut-off ADC value for discriminating between the responders and nonresponders after treatment was determined to be (b=600) 1.03×10−3mm2/s and the sensitivity, 71%; specificity, 79%; accuracy, 74%; positive predictive value, 81%; negative predictive value, 68% respectively. The cut-off value for discriminating between the responders and the nonresponders after treatment was determined for b=1000 as 1.20×10−3mm2/s and the sensitivity, 42%; specificity, 84%; accuracy, 60%; positive predictive value, 77%; negative predictive value, 53%. ConclusionThe increase in the mean tumor ADC and percentage tumor volume regression in patients with rectal cancer treated with preoperative CRT was correlated with good response. DW MR imaging is a promising non-invasive technique that can help predict and monitor early therapeutic response in patients with rectal cancer who undergo CRT.

Radical prostatectomy and positive surgical margins: relationship with prostate cancer outcome.

Positive surgical margins (PSMs) are an adverse factor that may predict a worse outcome in patients submitted to radical prostatectomy (RP). However, not all of these cases will evolve to biochemical (BCR) or clinical (CR) recurrence, therefore relationship between PSMs and these recurrent events has to be correlated with other clinical and pathologic findings to indicate complementary treatment for selected patients. Of 1250 patients submitted to open retropubic radical prostatectomy (RRP), between March 1991 and June 2008, the outcome of 161 patients with PSMs and of 67 without PSMs as a control group, comprising a total of 228 cases were retrospectively reviewed. A minimum follow-up time of 2 years after surgery was considered. BCR was determined when PSA ≥ 0.2 ng/mL. CR was determined whenever there was clinical evidence of tumor. Chi-square test was used to correlate clinical and pathologic variables with PSMs. Time interval to biochemical recurrence was analyzed by the Kaplan-Meier product limit analysis using the log-rank test for comparison between groups. Univariate and multivariate Cox stepwise logistic regression models were used to identify significant predictors of risk of shorter intervals to BCR. Prostate circumference margin was the most common site with 78 cases (48.44%). Regarding the outcome of 228 cases from both groups, BCR occurred in 68 patients (29.82%), and CR in 10 (4.38%). Univariate analysis showed statistically significant associations (p < 0.001) between presence of PSMs with BCR, but not with CR (p = 0.05). At follow-up of the 161 patients with PSMs, only 61(37.8%) presented BCR, while 100 (62.8%) did not. BCR correlated with pathologic stage; Gleason score; preoperative PSA; tumor volume in the specimen; capsular and perineural invasion; presence and number of PSMs. CR correlated only with angiolymphatic invasion and Gleason score. Considering univariate analysis of clinical and pathologic factors predicting progression-free survival at 5 years, prostate weight; preoperative PSA; Gleason score; pathologic stage; tumor volume; PSMs; capsular and perineural invasion were correlated with BCR. At multivariate analysis, only Gleason score and percentage of tumor volume correlated as significant independent predictors of BCR. At univariate analysis, presence, number and location of PSMs have consistent correlation with BCR after RRP, but at follow-up BCR occurred only in 37.8% of patients with PSMs. However at multivariate analysis, the significant risk factors for BCR were percentage of tumor volume (p = 0.022) and Gleason score (p < 0.005) in the surgical specimen. Angiolymphatic invasion and Gleason score were significantly correlated with CR.

Percentage of high‐grade tumour volume does not meaningfully improve prediction of early biochemical recurrence after radical prostatectomy compared with Gleason score

To examine whether percentage of tumour volume (%TV) and percentage of high-grade tumour volume (%HGTV) help to better identify men at higher risk of early biochemical recurrence (BCR) after radical prostatectomy (RP) for non-metastatic high-risk prostate cancer, as early BCR after RP might be associated with higher risk of metastases and cancer-specific mortality. We examined the data of 595 men treated with RP for non-metastatic high-risk prostate cancer between 1992 and 2011 at two European tertiary care centres. Kaplan-Meier analyses were used to graphically depict 2-year BCR-free survival. Multivariable Cox regression models addressed early BCR. We tested whether addition of %TV and %HGTV to a multivariable Cox regression model helps to increase a model's predictive accuracy (PA) for prediction of early BCR. In all, 32 men (10%) with specimen-confined prostate cancer (pT2-pT3a, negative surgical margin, pN0) and 67 men (24%) with non-specimen-confined prostate cancer had early BCR. After stratification according to %HGTV (%HGTV threshold: ≤33.33 vs >33.33%), the 2-year BCR-free survival rates were respectively 93 vs 60% (log-rank P < 0.001). In multivariable Cox regression models %HGTV emerged as an independent predictor of early BCR (P < 0.001), whereas %TV did not (P > 0.05). However, adding %HGTV (regardless of its coding) to other covariates in multivariable Cox regression analysis did not increase the model's PA in a meaningful fashion compared with the use of the detailed Gleason grading system (6 vs 7a vs 7b vs 8 vs 9-10). In a large cohort of patients with high-risk prostate cancer, %HGTV and %TV did not improve prediction of early BCR after RP substantially, although %HGTV was an independent predictor of early BCR. Therefore, sophisticated TV/HGTV measurements do not seem to have additional benefit for early BCR prediction relative to the use of Gleason grading. However, these results need to be confirmed in larger, prospective studies.

Editorial Comment to High percent tumor volume predicts biochemical recurrence after radical prostatectomy in pathological stage T3a prostate cancer with a negative surgical margin

Editorial Comment to High percent tumor volume predicts biochemical recurrence after radical prostatectomy in pathological stage <scp>T</scp>3a prostate cancer with a negative surgical margin

High percent tumor volume predicts biochemical recurrence after radical prostatectomy in pathological stage T3a prostate cancer with a negative surgical margin

To evaluate the impact of percent tumor volume and surgical margin status on biochemical recurrence in pT3-T4 prostate cancer. A total of 397 patients who had pT3-T4N0 diseases and did not receive neoadjuvant or adjuvant therapy were included for analysis. In the entire cohort, prostate-specific antigen (per 1 ng/mL increase; hazard ratio 1.019; P = 0.002), pathological stage (T3b-T4 vs T3a; hazard ratio 2.283; P < 0.001), Gleason score (≥8 vs ≤6; hazard ratio 5.290; P = 0.005), surgical margin status (multiple positive vs negative; hazard ratio 1.839; P = 0.003) and lymphovascular invasion (present vs absent; hazard ratio 1.641; P = 0.008) were independent predictors of recurrence. Percent tumor volume was an independent predictor of recurrence in T3a diseases with negative surgical margins. In analysis using receiver operating characteristic curve, a threshold of 12% showed the best balance of sensitivity and specificity, 66% and 67%, respectively. The 5-year recurrence-free survival rates of pT3a diseases with negative surgical margin were 85.2% for percent tumor volume ≤12% and 57.7% for percent tumor volume >12% (P < 0.001). Patients with pT3a with negative surgical margins and percent tumor volume >12% showed comparable 5-year recurrence-free survival rate compared with those with pT3a with positive surgical margin (57.7% vs 57.6%; P = 0.763). Despite having less impact on recurrence than other clinicopathological variables in pT3-T4 prostate cancer, percent tumor volume can further improve recurrence risk stratification in pT3a diseases with negative surgical margins.

Quantitative Dosimetry for Yttrium-90 Radionuclide Therapy: Tumor Dose Predicts Fluorodeoxyglucose Positron Emission Tomography Response in Hepatic Metastatic Melanoma

PurposeTo assess a new method for generating patient-specific volumetric dose calculations and analyze the relationship between tumor dose and positron emission tomography (PET) response after radioembolization of hepatic melanoma metastases. Methods and MaterialsYttrium-90 (90Y) bremsstrahlung single photon emission computed tomography (SPECT)/computed tomography (CT) acquired after 90Y radioembolization was convolved with published 90Y Monte Carlo estimated dose deposition kernels to create a three-dimensional dose distribution. Dose-volume histograms were calculated for tumor volumes manually defined from magnetic resonance imaging or PET/CT imaging. Tumor response was assessed by absolute reduction in maximum standardized uptake value (SUVmax) and total lesion glycolysis (TLG). ResultsSeven patients with 30 tumors treated with 90Y for hepatic metastatic melanoma with available 90Y SPECT/CT and PET/CT before and after treatment were identified for analysis. The median (range) for minimum, mean, and maximum dose per tumor volume was 16.9 Gy (5.7–43.5 Gy), 28.6 Gy (13.8–65.6 Gy) and 36.6 Gy (20–124 Gy), respectively. Response was assessed by fluorodeoxyglucose PET/CT at a median time after treatment of 2.8 months (range, 1.2–7.9 months). Mean tumor dose (P = .03) and the percentage of tumor volume receiving ≥ 50 Gy (P < .01) significantly predicted for decrease in tumor SUVmax, whereas maximum tumor dose predicted for decrease in tumor TLG (P < .01). ConclusionsVolumetric dose calculations showed a statistically significant association with metabolic tumor response. The significant dose-response relationship points to the clinical utility of patient-specific absorbed dose calculations for radionuclide therapy.

1349 PREDICTORS OF UPGRADING AFTER RADICAL PROSTATECTOMY IN LOW-RISK PROSTATE CANCER: ROLE OF MRI

You have accessJournal of UrologyProstate Cancer: Localized (VI)1 Apr 20131349 PREDICTORS OF UPGRADING AFTER RADICAL PROSTATECTOMY IN LOW-RISK PROSTATE CANCER: ROLE OF MRI Sang Hoon Song, Sahyun Pak, Sejun Park, Cheryn Song, and Hanjong Ahn Sang Hoon SongSang Hoon Song Seoul, Korea, Republic of More articles by this author , Sahyun PakSahyun Pak Seoul, Korea, Republic of More articles by this author , Sejun ParkSejun Park Seoul, Korea, Republic of More articles by this author , Cheryn SongCheryn Song Seoul, Korea, Republic of More articles by this author , and Hanjong AhnHanjong Ahn Seoul, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.03.060AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We aimed to identify risk factors predicting Gleason sum upgrade after radical prostatectomy (RP) in low risk prostate cancer patients who are candidates for active surveillance, and to evaluate the role of MRI in upgrade prediction. METHODS We retrospectively reviewed the medical records of 1,262 patients who underwent twelve-core biopsy, preoperative MRI, and RP in a single center between September 2007 and June 2012. Finally, we included 382 patients with low risk prostate cancer (D'Amico criteria) in the analysis. Predictive factors for Gleason sum upgrading after surgery were analyzed by multivariate logistic regression method. RESULTS The mean age and preoperative PSA was 64.0 ± 7.6 years and 5.0 ± 1.8 ng/ml, respectively. Gleason sum upgrading was found in 212 (55.5%) patients (Table). The lesions of prostate cancer was identifiable on MRI in 249 patients (65.1%); they located in anterior (42.9%) or in posterior (57.0%) of the prostate. In univariate analysis, age, PSA density, number of positive core, percentage tumor volume of a positive core, and the ratio of anteriorly located index cancer on MRI were significantly higher in patients with Gleason sum upgrade. In multivariate analysis, higher age (OR=1.063, 95% CI 1.031-1.095, p<0.001), tumor percent in positive core (OR=1.021, 95% CI 1.004-1.040, p=0.028), and anterior location of cancer on MRI (OR=2.477, 95% CI 1.529-4.013, p<0.001) were remained significant for prediction of Gleason sum upgrade. When selecting patients with insignificant cancer based on Epstein criteria, anterior location of cancer on MRI (OR=4.359, 95% CI 1.172-16.210, p=0.028) was the only significant risk factor for upgrading in multivariate analysis. CONCLUSIONS MRI had a substantial role in predicting Gleason sum upgrade after RP in low risk prostate cancer patients who are candidates for active surveillance. We speculate that tumors in anterior side of the prostate are more difficult to be detected by the contemporary prostate biopsy method so that upgrade of cancer occurs more frequently. Table. Clinicopathologic characteristics according to Gleason sum upgrade Mean ± SD, or n (%) Upgrade (-) (n=170) Upgrade (+) (n=212) P value Age (years) 62.40 ± 7.17 62.36 ± 7.70 <0.001 PSA (ng/ml) 5.03 ± 1.93 5.10 ± 1.72 0.789 PSAD (ng/ml/cc) 0.152 ± 0.089 0.173 ± 0.085 0.025 Prostate volume (cc) 39.14 ± 17.76 35.35 ± 15.89 0.029 Positive biopsy core number 1.94 ± 1.33 2.43 ± 1.75 0.002 Percentage volume of positive core 16.41 ± 11.20 20.74 ± 14.70 0.001 Anterior tumor on MRI <0.001 No 136 (80.0) 129 (60.8) Yes 34 (20.0) 83 (39.2) Index tumor on MRI (coronal view) 0.053 No 71 (41.8) 62 (29.2) Apex 30 (17.6) 36 (17.0) Mid 62 (36.5) 102 (48.1) Base 7 (4.1) 12 (5.7) Index tumor on MRI (transverse view) <0.001 No 71 (41.8) 62 (29.2) Anterior 30 (17.6) 77 (36.3) Posterior 69 (40.6) 73 (34.4) Pathologic tumor volume (%) 5.98 ± 6.64 10.86 ± 8.64 <0.001 Op method 0.102 Retropubic radical prostatectomy 37 (21.8) 62 (29.2) Robot assisted radical prostatectomy 133 (78.2) 150 (70.8) Nerve sparing 0.706 None 7 (7.4) 11 (10.0) Unilateral 4 (4.2) 3 (2.7) Bilateral 84 (88.4) 96 (87.3) Anterior tumor on pathologic mapping 73 (34.3) 140 (65.7) <0.001 pT stage <0.001 2 160 (94.1) 170 (80.2) 3a 9 (5.3) 40 (18.9) 3b 0 (0) 2 (0.9) Pathologic Gleason sum <0.001 6 170 (100) 0 (0) 7 0 (0) 205 (96.7) 8 0 (0) 7 (3.3) Positive resection margin 7 (15.2) 10 (16.9) 1.000 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e551 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sang Hoon Song Seoul, Korea, Republic of More articles by this author Sahyun Pak Seoul, Korea, Republic of More articles by this author Sejun Park Seoul, Korea, Republic of More articles by this author Cheryn Song Seoul, Korea, Republic of More articles by this author Hanjong Ahn Seoul, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The degree of tumor volume reduction during the early phase of induction chemotherapy is an independent prognostic factor in patients with high‐risk neuroblastoma

In patients with high-risk neuroblastoma, the reduction in primary tumor volume was measured during the early phase of induction chemotherapy as an indicator of early tumor response, and the authors investigated whether the degree of tumor volume reduction could predict outcome in these patients. Primary tumor volumes were measured both at diagnosis and at the first tumor response evaluation (after 2 or 3 cycles of induction chemotherapy) in 90 patients with high-risk neuroblastoma who had volumetrically evaluable computed tomography or magnetic resonance scans. If the tumor volume at the first response evaluation was >40% of the initial tumor volume, then the patient was categorized as a poor responder; otherwise, the patient was categorized as a good responder. Outcomes were compared according to the degree of tumor volume reduction at the first response evaluation. The tumor volume reduction was greater in patients who remained relapse free than in patients who had a relapsed tumor (median percentage tumor volume, 21% vs 41.5%; P = .037). The 5-year relapse-free survival rate was higher in the good responders than in the poor responders (83% [95% confidence interval, 72%-94%] vs 51% [95% confidence interval, 31%-71%]; P = .002). In a multivariate analysis of relapse-free survival, a poor early response was identified as an independent, unfavorable prognostic factor (hazard ratio, 4.24; 95% confidence interval, 1.59-11.29; P = .004). A greater reduction in tumor volume reduction the early phase of induction chemotherapy was associated with a better outcome in patients with high-risk neuroblastoma. Tailoring treatment intensity according to the early tumor response to induction chemotherapy may improve patient outcomes.

Intrahepatic Cholangiocarcinoma Treated with Local-Regional Therapy: Quantitative Volumetric Apparent Diffusion Coefficient Maps for Assessment of Tumor Response

To evaluate volumetric changes in apparent diffusion coefficient (ADC) and contrast material enhancement on contrast-enhanced (CE) magnetic resonance (MR) images in hepatic arterial and portal venous phases for assessing early response in cholangiocarcinoma treated with transcatheter arterial chemoembolization (TACE). Twenty-nine patients with unresectable cholangiocarcinoma, including 11 men (mean age, 60 years; standard deviation, 16.8) and 18 women (mean age, 63 years; standard deviation, 11.5) were included in this retrospective institutional review board-approved, HIPAA-compliant study; informed consent was waived. Sixty-nine TACE procedures were performed during the observational time (range, one to five TACE sessions). No patients received another form of therapy after treatment with TACE. MR Imaging was performed before and 3-4 weeks after TACE, and images were analyzed with a semiautomatic volumetric software package. Patients were stratified as responders and nonresponders on the basis of overall survival (OS) as the primary end point. Differences between responders and nonresponders were analyzed with paired t tests, and OS was calculated with the Kaplan-Meier method. Significant differences were analyzed with the log-rank test. Mean volumetric ADC increased from 1.54×10(-3) mm2/sec to 1.92×10(-3) mm2/sec (P<.0001), with no significant decrease in mean volumetric enhancement in hepatic arterial (40.6% vs 37.5%, P=.546) and portal venous (79.0% vs 70.0%, P=.105) phases. Patients who demonstrated improved survival of 10 months or more had a significant increase in mean volumetric ADC and volumetric ADC above the threshold level of 1.60×10(-3) mm2/sec (P<.002). Patients with 45% or greater (n=21; log-rank test, P<.02) and 60% or greater (n=12; log-rank test, P<.009) ADC changes for the whole tumor volume demonstrated better OS compared with patients in whom these ADC changes were not achieved. Patients with percentage tumor volume increase in ADC of 45% or greater and 60% or greater above the threshold level of 1.60×10(-3) mm2/sec had favorable response to therapy and improved survival.

Post-prostatectomy PSA slope (ProsVue) in Gleason score ≥7 disease

e15113 Background: A case-cohort designed multicenter clinical study addressed the prognostic value of the linear slope of PSA in 304 men after radical prostatectomy (RP) – 64 with clinical recurrence and 240 with stable disease. PSA was measured with Nucleic Acid Detection Immunoassay (NADiA) technology having a limit of quantification of 0.00065 ng (0.65 pg) per mL. Least-squares linear PSA slope (ProsVue) was calculated using 3 serum samples drawn 1.5-20 months (mo) post-RP. Multivariate Cox proportional hazards regression analysis showed that a ProsVue cutpoint of ≤2.0 pg/mL/mo was an independent prognostic factor for identifying men at reduced risk for recurrence along with clinical evaluation (HR=9.824). Of traditional risk factors – pre-RP PSA, Gleason score (GS) and pathologic stage, only GS was an independent prognostic factor (HR=5.3). This study tested the prognostic performance of ProsVue in a 164-man subset with pathologic GS ≥7. Methods: Recurrence was documented by positive imaging, positive biopsy or prostate cancer death. The same ProsVue cutpoint dichotomized men “at reduced” or “not at reduced” recurrence risk compared to clinically recurrent or stable disease status. Uni- and multivariate Cox proportional hazards regression were employed. Results: Median age, pre-RP PSA and percent tumor volume in the subset were 62.6, 7.2 ng/mL, and 20%. Distributions of GS 7, 8, 9 were 76.8%, 14.6% and 8.5%, respectively. Pathologic stages were T0-T2, T3a, T3b and T4 in 41%, 57%, 29% and 7% of men, respectively. Median follow-up in stable and recurrent groups was 10.8 and 4.8 yr. The table compares results in the full cohort and the GS ≥7 subgroup. Conclusions: ProsVue prognostic performance is maintained with GS ≥7. Performance parameters, especially the multivariate hazard ratio (HR) are minimally attenuated vs. the full case-cohort. [Table: see text]

879 Impact of percent tumor volume and surgical margin status on biochemical recurrence in patients with extraprostatic disease following radical prostatectomy

879 Impact of percent tumor volume and surgical margin status on biochemical recurrence in patients with extraprostatic disease following radical prostatectomy