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  • 1
    Article
    Article
    Language: English
    In: The Journal of Urology, January 2017, Vol.197(1), pp.215-215
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 2
    Article
    Article
    Language: English
    In: Urology, March 2012, Vol.79(3), pp.625-625
    Keywords: Medicine
    ISSN: 0090-4295
    E-ISSN: 1527-9995
    Source: ScienceDirect Journals (Elsevier)
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  • 3
    Language: English
    In: The Journal of Urology, April 2012, Vol.187(4), pp.e476-e476
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
    Source: ScienceDirect Journals (Elsevier)
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  • 4
    Language: English
    In: The Journal of Urology, April 2011, Vol.185(4), pp.e643-e643
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
    Source: ScienceDirect Journals (Elsevier)
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  • 5
    In: BJU International, July 2012, Vol.110(2), pp.233-237
    Description: What's known on the subject? and What does the study add? Currently, prognostication of patients with invasive BC is hampered owing to the inadequacy of standard clinicopathological risk factors to predict accurately individual treatment outcomes. This review provides a comprehensive albeit brief overview on current studies elucidating the potential role of different molecular markers to close this gap of evidence. It focuses on biostatistical considerations in the interpretation of study results which are essential to provide meaningful clinical conclusions for an individual patient. • To improve prognostication and the management of patients with invasive bladder cancer (BC). • Standard clinicopathological risk factors are not reliably enough to accurately predict outcomes in patients after radical treatment and guide clinicians for recommending selectively the use of adjuvant therapies. • With detailed insights into the molecular pathology of BC, biomarkers have come to the fore of researchers as a potential tool to close this gap of evidence. • However, their definitive role in the diagnostic and therapeutic management of patients with invasive BC has not clearly been addressed so far. • Invasive BC are an extremely heterogenenous group of malignancies which are characterized by multiple genetic alterations involved in the carcinogenesis and development of metastatic spread. Thus, it is questionable whether any single marker will provide superior prognostication compared with a combination of markers. • Current studies evaluating the predictive value of a multitude of markers have used high-throughput technologies and investigated the gain in predictive accuracy within new nomograms which encompass well-established clinicopathological and novel putative molecular parameters. p53 overexpression was found to be associated with increased risk of recurrence in urothelial and non-urothelial cancer. In pT1 disease, the combination of p53, p21 and p16 as well as epigenetic alterations of myopodin expression has been shown to provide improved prognostication, and this might help to advocate more selectively the use of early radical treatment. • After the bladder-sparing approach, p53 and p21 overexpression indicate decreased probability of long-term bladder preservation. Additionally, altered retinoblastoma expression is associated with improved survival after adjuvant chemotherapy. • To provide meaningful conclusions for individual prognosis and the need of adjuvant treatment, biostatistical pitfalls in the analysis and interpretation of results have to be taken into account. • Different molecular markers have the potential to improve prognostication of patients with invasive BC and provide improved evidence for targeted therapy in the neoadjuvant, adjuvant and metastatic setting. • However, in order to advocate their routine clinical use on a sound scientific basis prospective data are still necessary.
    Keywords: Bladder Cancer ; Marker ; Molecular ; Outcome ; Prognostication ; Radical Cystectomy
    ISSN: 1464-4096
    E-ISSN: 1464-410X
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  • 6
    Language: English
    In: The Journal of Urology, April 2012, Vol.187(4), pp.e765-e766
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
    Source: ScienceDirect Journals (Elsevier)
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  • 7
    Language: English
    In: The Journal of Urology, April 2013, Vol.189(4), pp.e583-e583
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
    Source: ScienceDirect Journals (Elsevier)
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  • 8
    In: BJU International, December 2012, Vol.110(11b), pp.E533-E540
    Description: To purchase or authenticate to the full-text of this article, please visit this link: http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2012.11231.x/abstract Byline: Tilman Todenhofer(1), Markus Renninger(1), Christian Schwentner(1), Arnulf Stenzl(1), Georgios Gakis(1) Keywords: thrombocytosis; platelets; bladder cancer; risk factor; radical cystectomy Study Type - Prognosis (cohort series) Level of Evidence 2a What's known on the subject? and What does the study add? Preoperative thrombocytosis has been identified as a predictor of poor outcome in various cancer types. However, the prognostic role of platelet count in patients with invasive bladder cancer undergoing radical cystectomy is unknown. The present study demonstrates that preoperative thrombocytosis is an independent risk factor for decreased cancer-specific survival after radical treatment of invasive bladder cancer. We developed a new prognostic scoring model for cancer-specific outcomes after radical cystectomy including platelet count and established pathological risk factors. Consideration of platelet count in the final model increased its predictive accuracy significantly. Thrombocytosis may be a useful parameter to include within established international bladder cancer nomograms. OBJECTIVE To investigate the oncological significance of preoperative thrombocytosis in patients with invasive bladder cancer undergoing radical cystectomy, as it has been reported as a marker for aggressive tumour biology in a variety of solid tumours. PATIENTS AND METHODS The series comprised 258 patients undergoing radical cystectomy between 1999 and 2010 in whom different clinical and histopathological parameters were assessed. Elevated platelet count was defined as 〉450 x 10.sub.9/L. Based on regression estimates of significant parameters in multivariable analysis a new weighted scoring model was developed to predict cancer-specific outcomes. RESULTS The median follow-up was 30 months (6-116). Of the 258 patients, 26 (10.1%) had elevated and 232 (89.9%) had normal platelet count. The 3-year cancer-specific survival in patients with normal and elevated platelet count was 61.5% and 32.7%, respectively (P 0.001). In multivariable analysis, cancer-specific survival was significantly lower in patients with locally advanced disease (a[yen]pT3a) (relative risk 2.91, 1.54-5.65; P= 0.001), positive soft tissue surgical margins (4.03, 1.99-7.92; P= 0.001) and thrombocytosis (2.68, 1.26-5.14; P= 0.011). The 3-year cancer-specific survival in patients with a score 0 (low risk), 1-2 (intermediate risk) and 3-5 (high risk) was 81.0%, 54.8% and 8.2%, respectively (P 0.001). Consideration of preoperative platelet count in the final model increased its predictive accuracy by 1.8% with a concordance index of 0.745 (P= 0.040). CONCLUSIONS The presence of thrombocytosis at radical cystectomy portends unfavourable prognosis. We constructed a simple weighted prognostic model for cancer-specific outcomes after radical cystectomy based on pretreatment platelet count and established pathological risk factors. These data warrant external validation and may allow for tailored monitoring and selection of appropriate patients for neoadjuvant and adjuvant trials. Author Affiliation: (1)Department of Urology, Eberhard-Karls University, Tubingen, Germany Correspondence: (*) Georgios Gakis, Department of Urology, Eberhard-Karls University, Hoppe-Seyler Strasse 3, D-72076 Tubingen, Germany. e-mail: georgios.gakis@web.de Accepted for publication 29 February 2012 CAPTION(S): Supporting info item
    Keywords: Thrombocytosis ; Platelets ; Bladder Cancer ; Risk Factor ; Radical Cystectomy
    ISSN: 1464-4096
    E-ISSN: 1464-410X
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  • 9
    Language: English
    In: The Journal of Urology, 2012, Vol.187(1), pp.68-73
    Description: In hematuria cases urine based tests are used to detect bladder cancer, although the diagnostic yield remains insufficient due to influencing variables, including urinary tract infection. Many patients are elderly with renal insufficiency and have proteinuria as an additional influencing factor. To our knowledge no data are available on the accuracy of urine based bladder cancer tests in conjunction with renal function. Urine samples of 449 patients with hematuria and histology were included in analysis. Cytology, fluorescence in situ hybridization, immunocytology and nuclear matrix protein 22 assay were done. Renal function was classified as normal, impaired or severely impaired based on serum creatinine, the glomerular filtration rate and proteinuria. False-positive rates were statistically compared in regard to renal function. A total of 382 patients did not have bladder cancer. There was an increased false-positive rate for creatinine and the glomerular filtration rate. The nuclear matrix protein 22 test showed a 22.0% and 46.7% false-positive rate in the normal and limited function cohorts, respectively (p = 0.05). Similar trends were noted for proteinuria. Indeterminate significance was detected, separating those with severely impaired function for immunocytology and those in the normal group for fluorescence in situ hybridization (p = 0.08 and 0.06, respectively). Proteinuria was a significant factor for urine cytology with increased false-positive results in the absence of urinary tract infection (p = 0.0017 and 0.05, respectively). To our knowledge this is the first study of renal function and the accuracy of urine based bladder cancer markers. Renal function influences the diagnostic yield. A decreased glomerular filtration rate was associated with increased false-positive nuclear matrix protein 22 results while proteinuria decreased urine cytology specificity. Renal function should be considered when urine based bladder cancer tests are interpreted.
    Keywords: Urinary Bladder ; Urinary Bladder Neoplasms ; Kidney Function Tests ; Tumor Markers ; Biological ; False Positive Reactions ; Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 10
    Language: English
    In: The Journal of Urology, April 2011, Vol.185(4), pp.e394-e394
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
    Source: ScienceDirect Journals (Elsevier)
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