Objective
To evaluate the impact of year of surgery on clinical, pathological and oncological outcomes of patients with high‐risk prostate cancer.
Patients and Methods
We evaluated 1 033 patients ...with clinically high‐risk prostate cancer, defined as the presence of at least one of the following risk factors: preoperative prostate‐specific antigen (PSA) level >20 ng/mL, and/or clinical stage ≥T3, and/or biopsy Gleason score ≥8. Patients were treated between 1990 and 2013 at a single institution. The year‐by‐year trends in clinical and pathological characteristics were examined. Multivariable Cox regression analysis was used to test the relationship between year of surgery and oncological outcomes.
Results
We observed a decrease over time in the proportion of patients with high‐risk disease (preoperative PSA >20 ng/mL or clinical stage cT3). A trend in the opposite direction was seen for biopsy Gleason score ≥8 tumours. We observed a considerable increase in the median number of lymph nodes removed, which was associated with an increased rate of lymph node invasion (LNI). On multivariable Cox regression analysis, year of surgery was associated with a reduced risk of biochemical recurrence (hazard ratio HR per 5‐year interval 0.90, 95% confidence interval CI 0.84–0.96; P = 0.01) and distant metastasis (HR per 5‐year interval 0.91, 95% CI 0.83–0.99; P = 0.039), after adjusting for age, preoperative PSA, pathological stage, LNI, surgical margin status, and pathological Gleason score.
Conclusions
In this single‐centre study, an increased diagnosis of localized and less extensive high‐grade prostate cancer was observed over the last two decades. Patients with high‐risk disease who were selected for radical prostatectomy showed better cancer control over time. Better definitions of what constitutes high‐risk prostate cancer among contemporary patients are needed.
Anterior abdominal wall defects are rare anomalies that can affect multiple organ systems including gastrointestinal, genitourinary, musculoskeletal, and the neurospinal axis. The highly varied, ...complex anatomy in this patient population creates a challenging reconstruction scenario that merits careful surgical planning. We present an unusual female variant with an anorectal malformation as well as musculoskeletal and genital abnormalities consistent with classic bladder exstrophy in which the urinary bladder, sphincter, and urethra were largely uninvolved.
Objective
To assess the prognostic role of extranodal extension (ENE) and the size of the largest lymph node (LN) metastasis in predicting early biochemical relapse (eBCR) in patients with LN ...metastasis after radical prostatectomy (RP).
Patients and Methods
We evaluated BCR‐free survival in men with LN metastases after RP and pelvic LN dissection performed in six high‐volume centres.
Multivariable Cox regression tested the role of ENE and diameter of largest LN metastasis in predicting eBCR after adjusting for clinicopathological variables.
We compared the discrimination of multivariable models including ENE, the size of largest LN metastasis and the number of positive LNs.
Results
Overall, 484 patients were included. The median (interquartile range, IQR) follow‐up was 16.1 (6–27.5) months. The median (IQR) number of removed LNs was 10 (4–14), and the median (IQR) number of positive LNs was 1 (1–2). ENE was present in 280 (58%) patients, and 211 (44%) had their largest metastasis >10 mm. Patients with ENE and/or largest metastasis of >10 mm had significantly worse eBCR‐free survival (all P < 0.01).
On multivariable analysis, number of positive LNs (≤2 vs >2) and the diameter of LN metastasis (≤10 vs >10 mm), but not ENE, were significant predictors of eBCR (all P < 0.003).
ENE and diameter of LN metastasis increased the area under the curve of a baseline multivariable model (0.663) by 0.016 points.
Conclusions
The diameter of the largest LN metastasis and the number of positive LNs are independent predictors of eBCR.
Considered together, ENE and the diameter of the largest LN metastasis have less discrimination than the number of positive LNs.
Objective
To design a novel system of scoring prune belly syndrome (PBS) phenotypic severity at any presenting age and apply it to a large pilot cohort.
Patients and Methods
From 2000 to 2017, ...patients with PBS were recruited to our prospective PBS study and medical records were cross‐sectionally analysed, generating individualised RUBACE scores. We designed the pragmatic RUBACE‐scoring system based on six sub‐scores (R: renal, U: ureter, B: bladder/outlet, A: abdominal wall, C: cryptorchidism, E: extra‐genitourinary, generating the acronym RUBACE), yielding a potential summed score of 0–31. The ‘E’ score was used to segregate syndromic PBS and PBS‐plus variants. The cohort was scored per classic Woodard criteria and RUBACE scores compared to Woodard category.
Results
In all, 48 males and two females had a mean (range) RUBACE score of 13.8 (8–25) at a mean age of 7.3 years. Segregated by phenotypic categories, there were 39 isolated PBS (76%), six syndromic PBS (12%) and five PBS‐plus (10%) cases. The mean RUBACE scores for Woodard categories 1, 2, and 3 were 20.5 (eight patients), 13.8 (25), and 10.6 (17), respectively (P < 0.001).
Conclusions
RUBACE is a practical, organ/system level, phenotyping tool designed to grade PBS severity and categorise patients into isolated PBS, syndromic PBS, and PBS‐plus groups. This standardised system will facilitate genotype–phenotype correlations and future prospective multicentre studies assessing medical and surgical treatment outcomes.
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