•The prognostic significance of venous thrombus extent in RCC is controversial.•Most studies on this topic are limited by their inclusion of metastatic patients.•In this non-metastatic cohort, ...thrombus extent was not associated with RFS.•In this non-metastatic cohort, thrombus extent was not associated with CSS.•In this non-metastatic cohort, thrombus extent was not associated with OS.
The prognostic significance of level of venous tumor thrombus (VTT) extension in patients with non-metastatic renal cell carcinoma (RCC) has been controversial. The aim of this study was to examine the prognostic significance of VTT extent in patients who underwent surgery for non-metastatic RCC.
The Canadian Kidney Cancer information system database was used to identify patients who underwent surgery for non-metastatic RCC and VTT from January 2011 to December 2019. Association between VTT level and recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) was examined. Univariable and multivariable analyses were performed to estimate predictors of survival.
Out of 6,340 patients during the study period, 228 patients (3.6%) had VTT. VTT was level 0 in 84 (37%), level I to II in 112 (49%), and level III to IV in 33 (14%) patients as per the Mayo Clinic classification. Median age was 65.4 years (interquartile range IQR 57.6–72.2) and 169 (74.1%) were male. After a median follow-up of 21.2 months, VTT level did not significantly impact the RFS, CSS, or OS. For VTT level 0, I to II, and III to IV, there was no significant difference in estimated 5-year RFS (31%, 23%, and 30.5%; P > 0.05), CSS (70%, 69%, and 55%; P > 0.05) and OS (64%, 66%, and 50%; P > 0.05). Adjusting for known prognostic factors, thrombus level was not associated with risk of recurrence or death.
In a large, multi-institutional cohort of patients undergoing surgery for non-metastatic RCC with tumor thrombus, thrombus extent was not independently associated with recurrence or death.
To assess the impact of time between prostate cancer diagnosis on biopsy and definitive intervention with radical prostatectomy (RP) in regard to adverse pathologic outcomes using a large ...multi-surgeon database.
We retrospectively reviewed 2,728 patients who underwent RP between 2005 and 2014. Patients were stratified according to biopsy Grade Group (GG). Pathologic outcomes were evaluated for patients with <2 months between biopsy and surgery and then at monthly intervals of up to 6 months. Adverse pathological outcomes were defined as Gleason upgrading from biopsy, the presence of extraprostatic extension (EPE, pT3a) or seminal vesicle invasion (SVI, pT3b), positive surgical margins, and lymph node positivity. The chi-squared test was used for statistical analysis.
In total 2,310 patients met the inclusion criteria. Median time from biopsy to surgery was 83 days (range: 61-109 days). No difference was observed for patients in any risk category regarding the adverse pathologic outcomes, including GG upgrade from biopsy to prostatectomy, presence of EPE, SVI, positive surgical margins, and positive lymph node involvement, with delays of up to 6 months between biopsy and RP. Surgical margins were positive in 25% of cases with pT2 disease and 50.2% of cases with pT3 and greater disease. EPE and SVI were present in 24.5% and 7.5% of specimens, respectively.
Surgical delays of up to 6 months following prostate biopsy were not associated with an increased risk of GG upgrading, EPE, SVI, positive surgical margins, or lymph node involvement.
The prostate biopsy pathology report represents a critical document used for decision-making in patients diagnosed with prostate cancer, yet the content exceeds the health literacy of most patients. ...We sought to create and compare the effectiveness of a patient-centered prostate biopsy report compared with standard reports.
Using a modified Delphi approach, prostate cancer experts identified critical components of a prostate biopsy report. Patient focus groups provided input for syntax and formatting of patient-centered pathology reports. Ninety-four patients with recent prostate biopsies were block randomized to the standard report with or without the patient-centered report. We evaluated patient activation, self-efficacy, provider communication skills, and prostate cancer knowledge.
Experts selected primary and secondary Gleason score and the number of positive scores as the most important elements of the report. Patients prioritized a narrative design, non-threatening language and information on risk classification. Initial assessments were completed by 87% (40/46) in the standard report group and 81% (39/48) in the patient-centered report group. There were no differences in patient activation, self-efficacy, or provider communication skills between groups. Patients who received the patient-centered report had significantly improved ability to recall their Gleason score (100% vs. 85%, p = 0.026) and number of positive cores (90% vs. 65%, p = 0.014). In total, 86% of patients who received the patient-centered report felt that it helped them better understand their results and should always be provided.
Patient-centered pathology reports are associated with significantly higher knowledge about a prostate cancer diagnosis. These important health information documents may improve patient-provider communication and help facilitate shared decision-making among patients diagnosed with prostate cancer.
Prostate cancer is the most common cancer among men, but overall mortality rates remain low, due to the preponderance of low-risk disease. Over the last decade, there has been a shift toward more ...conservative management in low-risk prostate cancer, in order to minimize unnecessary intervention. This study aimed to evaluate the number of low-risk radical prostatectomies (RPs) being performed at the Southern Alberta Institute of Urology over a 10-year period.
We retrospectively reviewed all patients who underwent RP from 2005 to 2014 at our institution. Patients were stratified by D'Amico risk classification and grade group based on 12-core transrectal ultrasound-guided biopsy (TRUS-bx) results. RP findings are reported from February 2005 to October 2014 to describe concordance between TRUS-bx and RPs. Basic descriptive analyses were used for this study.
Over the study period, 2,310 RPs were performed in our institution. Overall, 35.2% of these were performed on men with low-risk prostate cancer. From 2005 to 2014, the proportion of RPs performed for low-risk prostate cancer dropped from 54.0% to 8.9%, and 49.8% of patients who underwent RP for low-risk disease experienced pathologic upgrading, though only 3.8% were upgraded to grade group 3 or greater. Other adverse pathological findings were uniformly low among the low-risk group.
The proportion of patients undergoing RP at our center for low-risk prostate cancer decreased significantly over the 10 years evaluated in this study, reflecting current global trends toward active surveillance in the management of low-risk prostate cancer.
Multiples Alt Går Bra; Baker, Malcolm; Bodenstein, Felicity ...
Perspective (Paris. 2006),
08/2019
Journal Article
Odprti dostop
À travers la notion de multiples, ce numéro thématique traitera de la question de la reproductibilité technique. Si la formulation renvoie immanquablement à Walter Benjamin et son célèbre essai de ...1936, ce volume n’entend pas se limiter à la reproduction de masse inhérente à l’avènement de la photographie et du cinéma, mais bien embrasser l’ensemble des moyens de reproduction dans une perspective transhistorique, des plus rudimentaires aux plus sophistiqués. Les contributions rassemblées ici s’intéressent ainsi tant aux techniques d’empreinte et de moulage et à leurs différents usages depuis l’Antiquité, qu’aux procédés photomécaniques du XIXe siècle, à la carte postale, en passant par l’estampe au siècle des Lumières, jusqu’aux livres et aux films d’artistes aujourd’hui. Il s’agira d’interroger les présupposés ontologiques qui opposent l’original à ses copies, aussi bien que les dynamiques commerciales et les visées politiques sous-tendues par la reproduction technique, de la simple copie à la reproduction en série. Si elles constituent un tournant dans la diffusion des œuvres, les techniques de reproduction de masse ont en retour influé sur leur production même, comme en témoigne la création contemporaine dans le champ musical ou chorégraphique, aussi bien que l’architecture et ses mutations à l’heure du numérique et du virtuel. Ce numéro est en vente sur le site du Comptoir des presses d'universités. Comité de rédaction du volume Pauline Chevalier, Ralph Dekoninck, Elitza Dulguerova, Caroline Fieschi, Rossella Froissart, Jérémie Koering, Sophie Maisonneuve, Marie-Anne Sarda, Michele Tomasi
PDF
