Hein Van Poppel - Academia.edu (original) (raw)

Papers by Hein Van Poppel

Research paper thumbnail of Correlations between age, Charlson score and outcome in clinical unilateral T3a prostate cancer

Asian J Androl, 2009

According to the European Association of Urology (EAU) guidelines, a life expectancy of &... more According to the European Association of Urology (EAU) guidelines, a life expectancy of > 10 years is considered an important factor in the treatment of prostate cancer. The Charlson score is used to predict mortality based on comorbidities. The purpose of this study was to investigate the relationship between age, Charlson score and outcome in patients with cT3a prostate cancer. Between 1987 and 2004, 200 patients, who were with clinical T3a prostate cancer and who underwent radical prostatectomy (RP), were previously detected by digital rectal examination (DRE). Patients were categorized into two age groups (< 65 and >or= 65 years old). Patients were also divided into two groups according to Charlson score ( = 0 and >or= 1). Both age and Charlson score were analyzed regarding their predictive power of patients' outcomes. The mean follow-up period was 70.6 months, and the mean age of patients was 63.3 years. In all, 106 patients were < 65 years old and 94 patients were >or= 65 years old. Age was a significant predictor of overall survival (OS). A Charlson score of 0 was found in 110 patients, and of >or= 1 in 90 patients. Charlson score was not a significant predictor of biochemical progression-free survival (BPFS), clinical progression-free survival (CPFS) or OS. Cox multivariate analysis showed that margin status was a significant independent factor in BPFS, and cancer volume was a significant independent factor in CPFS. Charlson score does not influence the outcome in patients with clinical locally advanced prostate cancer. Age may influence OS. RP can be performed in motivated healthy older patients. However, the patients need to be counseled regarding possible surgery-related side effects, such as urinary incontinence and erectile dysfunction, which are age- and comorbidity-dependent.

Research paper thumbnail of A patient support programme to improve quality of life in patients with prostate cancer treated with LH-RH agonists

Journal of Men S Health, 2009

Research paper thumbnail of Cytogenetic Investigation of Transitional Cell Carcinomas of the Upper Urinary Tract

Cancer Genetics and Cytogenetics, Oct 15, 1999

Cytogenetic investigation was attempted on 44 tumors from 44 patients with transitional cell carc... more Cytogenetic investigation was attempted on 44 tumors from 44 patients with transitional cell carcinoma (TCC) of the upper urinary tract (pelvis and ureter), and karyotypes were obtained in 27 tumors. Numerical changes prevailed, but are not specific for this type of tumor (trisomy 7, -Y, or both). In the light of previously reported data on TCC, the finding of a del(9q) as the only anomaly in one of the cases may be meaningful. Patients showing -Y and/or trisomy 7 had a poor prognosis.

Research paper thumbnail of 1790 OUTCOME OF MULTIMODALITY TREATMENT OF VERY HIGH-RISK T4-PROSTATE CANCER WITH RADICAL CYSTECTOMY AS INITIAL STEP

Research paper thumbnail of Assessing the Optimal Timing for Early Salvage Radiation Therapy in Patients with Prostate-specific Antigen Rise After Radical Prostatectomy

European urology, Jan 20, 2015

Early salvage radiation therapy (eSRT) represents a treatment option for patients who experience ... more Early salvage radiation therapy (eSRT) represents a treatment option for patients who experience a prostate-specific antigen (PSA) rise after radical prostatectomy (RP); however, the optimal PSA level for eSRT administration is still unclear. To test the impact of PSA level on cancer control after eSRT according to pathologic tumour characteristics. The study included 716 node-negative patients with undetectable postoperative PSA who experienced a PSA rise after RP. All patients received eSRT, defined as local radiation to the prostate and seminal vesicle bed, delivered at PSA ≤0.5 ng/ml. Biochemical recurrence (BCR) after eSRT was defined as two consecutive PSA values ≥0.2 ng/ml. Multivariable Cox regression analysis tested the association between pre-eSRT PSA level and BCR after eSRT. Covariates consisted of pathologic stage (pT2 vs pT3a vs pT3b or higher), pathologic Gleason score (≤6, 7, or ≥8), and surgical margin status (negative vs positive). We tested an interaction with PSA...

Research paper thumbnail of MP82-01 LONG-TERM OUTCOMES OF VERY HIGH RISK PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY WITH OR WITHOUT ADJUVANT TREATMENTS. RESULTS OF A COMPETING RISKS, MULTI INSTITUTIONAL ANALYSIS

The Journal of Urology, 2015

Research paper thumbnail of Open partial nephrectomy for complex tumours and >4 cm: Is it still the gold standard technique in the minimally invasive era?

Archivos españoles de urología

The objective of this paper is to discuss the role of open partial nephrectomy (OPN) for complex ... more The objective of this paper is to discuss the role of open partial nephrectomy (OPN) for complex renal tumours and large renal tumours > 4 cm in the minimally invasive era. The current status of OPN, laparoscopic partial nephrectomy (LPN) and robotic PN are reviewed. The literature search is done using the National Library of Medicine database (PubMed). The indication of OPN has been extended to T1b tumours (4-7 cm). PN and radical nephrectomy (RN) provide equivalent oncological outcomes for these tumours. In addition, there is a growing application of OPN for complex tumours (centrally located, hilar, multifocal). Despite the more challenging cohort of patients, there is no increase in the overall morbidity of OPN. In contemporary cohorts there is an increase in overweight patients and a higher incidence of central tumours treated with OPN. LPN has been extended to select patients with larger renal masses (4-7 cm) and centrally located tumours. LPN for tumours > 4 cm was in t...

Research paper thumbnail of Different angiogenic potential in low and high grade sporadic clear cell renal cell carcinoma is not related to alterations in the von Hippel-Lindau gene

Cellular oncology : the official journal of the International Society for Cellular Oncology, 2009

von Hippel-Lindau (VHL) inactivation is common in sporadic clear cell renal cell carcinomas (ccRC... more von Hippel-Lindau (VHL) inactivation is common in sporadic clear cell renal cell carcinomas (ccRCC). pVHL is part of the ubiquitin ligase complex that targets the alpha subunits of hypoxia-inducible transcription factor (HIF) for degradation under well-oxygenated conditions. In the absence of wild-type pVHL, as observed in VHL patients and most sporadic ccRCCs, constitutive upregulation of HIF results in transcriptional activation of angiogenesis-related genes, such as VEGF. Differences in angiogenic activity within the group of ccRCCs were reported and strong genotype-phenotype correlations were found in patients with VHL disease, raising a question about the importance of VHL inactivation status in angiogenic behaviour and tumour progression. To address this question, we investigated the influence of VHL mutation (direct sequencing)/hypermethylation (methylation-specific PCR) on angiogenesis/tumour parameters (immunohistochemistry) in 150 patients with sporadic ccRCC. We found no ...

Research paper thumbnail of Biodistribution of Evans blue in an orthotopic AY-27 rat bladder urothelial cell carcinoma model: implication for the improved diagnosis of non-muscle-invasive bladder cancer (NMIBC) using dye-guided white-light cystoscopy

BJU International, 2015

To investigate the possibility of using Evans blue (EB) as a novel diagnostic tool to detect blad... more To investigate the possibility of using Evans blue (EB) as a novel diagnostic tool to detect bladder tumors with white-light (WL) cystoscopy, in this preclinical study we examined the biodistribution of the compound in the different layers (urothelium, submucosa, muscle) of a normal rat bladder and a rat bladder bearing a malignant urothelium composed of syngeneic AY-27 tumor cells.

Research paper thumbnail of 772 SALVAGE LYMPH NODE DISSECTION FOR PATIENTS TREATED WITH RADICAL PROSTATECTOMY WITH BIOCHEMICAL RECURRENCE AND IMAGING-DETECTED NODAL METASTASES

Research paper thumbnail of Reply to Apostolos P. Labanaris et al's Letter to the Editor re: Ziya Kirkali and Hein Van Poppel. A Critical Analysis of Surgery for Kidney Cancer with Vena Cava Invasion. Eur Urol 2007;52:658–62

Research paper thumbnail of What Does the Urologist Expect from the Pathologist (and What Can the Pathologists Give) in Reporting on Adult Kidney Tumour Specimens?

e u r o p e a n u r o l o g y 5 1 ( 2 0 0 7 ) 1 1 9 4 -1 2 0 1 a v a i l a b l e a t w w w . s c ... more e u r o p e a n u r o l o g y 5 1 ( 2 0 0 7 ) 1 1 9 4 -1 2 0 1 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Abstract Objective: To identify the parameters required by the urologist to determine the prognosis and the treatment of renal cancer in adults, and to establish the potential therapeutic targets of the new treatments that started to show clinical efficacy. Methods: A literature search of the last 10 yr was done, paying specific attention to TNM 2002 (UICC staging) and Fuhrman's grading. Also, the main genetic characteristics of the different subtypes (according to the WHO 2004 classification) with potential therapeutic implications have been compiled. Results: After the review of the literature, the opinion of the joint meeting including urologists and pathologists is that some aspects of the TNM 2002 classification must be refined. Criteria for nuclear grading should be different for the subtypes of renal cell carcinoma, and the WHO 2004 histological classification is clinically useful. Conclusions: In the workshop held in Palermo, common opinion was achieved on a number of points. The TNM 2002 classification is useful, but some adjustments should be made, particularly as referred to the tumour size cut-off, assessment of the invasion of the renal sinus fat tissue, and invasion of the ipsilateral adrenal gland. The Fuhrman's grading system is useful in clear cell renal cell carcinoma (RCC), and probably also in papillary RCC, but a redefinition for chromophobe RCC is needed. Finally, the determination of certain markers, such as VEGF and HIF, could constitute good target markers for the new therapies, but they remain under investigation.

Research paper thumbnail of The Role of Nephron-Sparing Surgery (NSS) for Renal Tumours >4 cm

Chronic Kidney Disease, 2012

For many years, radical nephrectomy (RN) has been the gold standard treatment for renal tumours. ... more For many years, radical nephrectomy (RN) has been the gold standard treatment for renal tumours. However, at present the available evidence supports elective nephron-sparing surgery (NSS) as the standard surgical treatment for renal cortical tumours≤ 4 cm (clinical ...

Research paper thumbnail of Renal Cell Carcinoma with Synchronous Metastasis to the Calcaneus and Metachronous Metastases to the Ovary and Gallbladder

Case Reports in Medicine, 2011

Renal cell carcinomas (RCCs) are known for their unpredictable metastatic pattern. We present the... more Renal cell carcinomas (RCCs) are known for their unpredictable metastatic pattern. We present the case of a 63-year-old woman who initially presented in 1992 with a metastasis in the left calcaneus that led to the discovery of RCC. In 1998, a new metastasis was found in the ovary. In 2008, the diagnosis of a gallbladder metastasis was made. All metastases were surgically removed; no additional systemic therapies were used. Aggressive surgical treatment can prolong the survival of patients with resectable metastases. Patterns of metastasis are discussed, and a brief review of the literature is given regarding each localization.

Research paper thumbnail of Natural history of surgically treated high-risk prostate cancer

Urologic Oncology: Seminars and Original Investigations, 2015

Background: No data exist on the patterns of biochemical recurrence (BCR) and their effect on sur... more Background: No data exist on the patterns of biochemical recurrence (BCR) and their effect on survival in patients with high-risk prostate cancer (PCa) treated with surgery. The aim of our investigation was to evaluate the natural history of PCa in patients treated with radical prostatectomy (RP) alone.

Research paper thumbnail of Open surgery for localized RCC

Thescientificworldjournal, 2007

The only possibility for cure in localized renal cell carcinoma (RCC) is surgery. Open radical ne... more The only possibility for cure in localized renal cell carcinoma (RCC) is surgery. Open radical nephrectomy (RN), as described by Robson, has long been the gold standard. Nevertheless, as a consequence of the increased use of abdominal imaging modalities, a continuing stage migration towards small, low-grade RCC lesions has become evident during the last decades. Together with this stage migration, nephron-sparing surgery (NSS), less-invasive therapies (laparoscopic RN and NSS), and minimally invasive therapies (radiofrequency ablation [RFA], cryoablation) have been developed and are gaining popularity. The value of laparoscopic RN and open NSS are acknowledged worldwide, but the value of laparoscopic NSS, RFA, and cryoablation remains to be established. Despite this evolution, there is still a place for open surgery for localized RCC. Open NSS is, at present, considered the standard of care for localized RCC less than 4 cm, while open RN still has a place for larger lesions, certainly when an extended lymph node dissection or adrenalectomy is warranted, or when a tumor thrombus is extending into the inferior vena cava. This review provides the data that support open surgery in clear, selected cases of RCC. KEYWORDS: renal cell carcinoma, open surgery, nephron-sparing surgery Joniau et al.: Open Surgery for Localized RCC TheScientificWorldOURNAL (2007) 7, 742-752 743

Research paper thumbnail of How important are surgical margins in nephron-sparing surgery?

European Urology Supplements, 2007

Research paper thumbnail of A Giant Mucinous Adenocarcinoma Arising within a Villous Adenoma of the Urachus: Case Report and Review of the Literature

Case Reports in Medicine, 2009

We present an exceptional case of a giant urachal tumor, consisting of both villous adenoma and m... more We present an exceptional case of a giant urachal tumor, consisting of both villous adenoma and mucinous adenocarcinoma of the urachus. The tumor was incidentally discovered during investigations for renal failure. Initial transurethral biopsies showed only a villous adenoma of the urachus. Although the biopsies showed no malignancy, a radical cystoprostatectomy and broad excision of the urachus and umbilicus were performed. At the same time, a bilateral nephroureterectomy was performed because of reflux-nephropathy and renal failure. The indication for surgery was based on the typical imaging aspects, raising the suspicion of an underlying urachal adenocarcinoma (size and location). Indeed, at final histopathology a concomitant well-differentiated adenocarcinoma of the urachus confined to the urachal mucosa was found. The patient remained free of disease for 50 months of follow-up. Only three previous cases of urachal adenocarcinoma associated with villous adenoma have been described.

Research paper thumbnail of Technical Aspects of Focal Therapy in Localized Prostate Cancer: Follow-Up After Focal Therapy

Technical Aspects of Focal Therapy in Localized Prostate Cancer, 2014

Research paper thumbnail of Precancerous Lesions in the Kidney

Scandinavian Journal of Urology and Nephrology, 2000

Renal cell carcinoma (RCC), although occurring less frequently than prostate and bladder cancer, ... more Renal cell carcinoma (RCC), although occurring less frequently than prostate and bladder cancer, is actually the most malignant urologic disease, killing >35% of affected patients. Therefore, investigation of the nature of premalignant lesions of the kidney is a relevant issue. Following the most recent histological classification RCC can be subdivided into four categories: conventional RCC; papillary RCC; chromophobe RCC; and collecting duct carcinoma. In contrast to many genitourinary malignancies, premalignant alterations in the kidney are scarcely described. Intratubular epithelial dysplasia has been recognized as the most common precursor of RCC. In analogy to prostatic intraepithelial neoplasia (PIN), the premalignant lesions of the kidney are described as high or low-grade renal intratubular neoplasia. In contrast, precancerous lesions have been described as part of the von Hippel-Lindau syndrome (VHL) where the evolution from a simple cyst to an atypical cyst with epithelial hyperplasia to cystic or solid conventional-type RCC is well documented. Finally, in the genesis of papillary RCC an adenoma-carcinoma sequence has been recognized with specific genetic changes. There are no data on the epidemiology of premalignant lesions of the kidney, but research into the etiology of RCC has been extended substantially. Familial and genetic factors are well documented in VHL disease, in hereditary papillary RCC, in the tuberous sclerosis complex and in familial RCC. Cigarette smoking and obesity are established risk factors for RCC. Hypertension or its medication has also been associated with an increased risk. Among dietary factors an inverse relation between risk and consumption of vegetables and fruit has been found. Occupational exposure to substances such as asbestos and solvents has been linked to an increased risk of RCC. Specific RCC variants have distinctive chromosome alterations and several genes have been implicated in the development of RCC. Loss of material from the 3p chromosome characterizes conventional RCC and the deletion of the VHL suppressor gene plays an important role in the genesis of this RCC variant. In contrast, numerical changes with trisomy of chromosomes 7 and 17 and loss of the sex chromosome are typical changes in papillary tumors, whereas papillary RCC have additional trisomies. Chromophobe RCC is characterized by loss of chromosomes with a combination of monosomies. Less consistent genetic alterations are associated with collecting duct carcinoma. The traditional treatment of RCC is surgery by radical or partial nephrectomy. The latter approach carries a risk of tumor recurrence as a result of unrecognized satellite lesions or premalignant lesions that might have been present at the time of surgery. However, the reported recurrence rates after partial nephrectomy are <1% and therefore the possible presence of premalignant disease does not alter the actual treatment strategy advocated. Although multifocality and bilateral occurrence of RCC are much more likely in cases of papillary RCC, biopsy of the renal remnant or contralateral kidney is not justified even in patients with this tumor type. Conversely, patients with RIN in a partial or radical nephrectomy specimen or in a renal biopsy taken for whatever reason should be subjected to closer follow-up with regularly repeated ultrasound. When an effective chemopreventive regimen becomes available it might be useful for patients with an inherited risk of RCC as well as in those who are at risk of tumor recurrence after intervention. Mass screening with the purpose of detecting RCC at its earliest stage is not recommended at the present time, but screening focused on certain risk groups can be advocated. Further research is needed to identify avoidable risks, develop effective chemoprevention and recognize patients at risk.

Research paper thumbnail of Correlations between age, Charlson score and outcome in clinical unilateral T3a prostate cancer

Asian J Androl, 2009

According to the European Association of Urology (EAU) guidelines, a life expectancy of &amp;... more According to the European Association of Urology (EAU) guidelines, a life expectancy of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 10 years is considered an important factor in the treatment of prostate cancer. The Charlson score is used to predict mortality based on comorbidities. The purpose of this study was to investigate the relationship between age, Charlson score and outcome in patients with cT3a prostate cancer. Between 1987 and 2004, 200 patients, who were with clinical T3a prostate cancer and who underwent radical prostatectomy (RP), were previously detected by digital rectal examination (DRE). Patients were categorized into two age groups (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 65 and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or= 65 years old). Patients were also divided into two groups according to Charlson score ( = 0 and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or= 1). Both age and Charlson score were analyzed regarding their predictive power of patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; outcomes. The mean follow-up period was 70.6 months, and the mean age of patients was 63.3 years. In all, 106 patients were &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 65 years old and 94 patients were &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or= 65 years old. Age was a significant predictor of overall survival (OS). A Charlson score of 0 was found in 110 patients, and of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or= 1 in 90 patients. Charlson score was not a significant predictor of biochemical progression-free survival (BPFS), clinical progression-free survival (CPFS) or OS. Cox multivariate analysis showed that margin status was a significant independent factor in BPFS, and cancer volume was a significant independent factor in CPFS. Charlson score does not influence the outcome in patients with clinical locally advanced prostate cancer. Age may influence OS. RP can be performed in motivated healthy older patients. However, the patients need to be counseled regarding possible surgery-related side effects, such as urinary incontinence and erectile dysfunction, which are age- and comorbidity-dependent.

Research paper thumbnail of A patient support programme to improve quality of life in patients with prostate cancer treated with LH-RH agonists

Journal of Men S Health, 2009

Research paper thumbnail of Cytogenetic Investigation of Transitional Cell Carcinomas of the Upper Urinary Tract

Cancer Genetics and Cytogenetics, Oct 15, 1999

Cytogenetic investigation was attempted on 44 tumors from 44 patients with transitional cell carc... more Cytogenetic investigation was attempted on 44 tumors from 44 patients with transitional cell carcinoma (TCC) of the upper urinary tract (pelvis and ureter), and karyotypes were obtained in 27 tumors. Numerical changes prevailed, but are not specific for this type of tumor (trisomy 7, -Y, or both). In the light of previously reported data on TCC, the finding of a del(9q) as the only anomaly in one of the cases may be meaningful. Patients showing -Y and/or trisomy 7 had a poor prognosis.

Research paper thumbnail of 1790 OUTCOME OF MULTIMODALITY TREATMENT OF VERY HIGH-RISK T4-PROSTATE CANCER WITH RADICAL CYSTECTOMY AS INITIAL STEP

Research paper thumbnail of Assessing the Optimal Timing for Early Salvage Radiation Therapy in Patients with Prostate-specific Antigen Rise After Radical Prostatectomy

European urology, Jan 20, 2015

Early salvage radiation therapy (eSRT) represents a treatment option for patients who experience ... more Early salvage radiation therapy (eSRT) represents a treatment option for patients who experience a prostate-specific antigen (PSA) rise after radical prostatectomy (RP); however, the optimal PSA level for eSRT administration is still unclear. To test the impact of PSA level on cancer control after eSRT according to pathologic tumour characteristics. The study included 716 node-negative patients with undetectable postoperative PSA who experienced a PSA rise after RP. All patients received eSRT, defined as local radiation to the prostate and seminal vesicle bed, delivered at PSA ≤0.5 ng/ml. Biochemical recurrence (BCR) after eSRT was defined as two consecutive PSA values ≥0.2 ng/ml. Multivariable Cox regression analysis tested the association between pre-eSRT PSA level and BCR after eSRT. Covariates consisted of pathologic stage (pT2 vs pT3a vs pT3b or higher), pathologic Gleason score (≤6, 7, or ≥8), and surgical margin status (negative vs positive). We tested an interaction with PSA...

Research paper thumbnail of MP82-01 LONG-TERM OUTCOMES OF VERY HIGH RISK PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY WITH OR WITHOUT ADJUVANT TREATMENTS. RESULTS OF A COMPETING RISKS, MULTI INSTITUTIONAL ANALYSIS

The Journal of Urology, 2015

Research paper thumbnail of Open partial nephrectomy for complex tumours and >4 cm: Is it still the gold standard technique in the minimally invasive era?

Archivos españoles de urología

The objective of this paper is to discuss the role of open partial nephrectomy (OPN) for complex ... more The objective of this paper is to discuss the role of open partial nephrectomy (OPN) for complex renal tumours and large renal tumours > 4 cm in the minimally invasive era. The current status of OPN, laparoscopic partial nephrectomy (LPN) and robotic PN are reviewed. The literature search is done using the National Library of Medicine database (PubMed). The indication of OPN has been extended to T1b tumours (4-7 cm). PN and radical nephrectomy (RN) provide equivalent oncological outcomes for these tumours. In addition, there is a growing application of OPN for complex tumours (centrally located, hilar, multifocal). Despite the more challenging cohort of patients, there is no increase in the overall morbidity of OPN. In contemporary cohorts there is an increase in overweight patients and a higher incidence of central tumours treated with OPN. LPN has been extended to select patients with larger renal masses (4-7 cm) and centrally located tumours. LPN for tumours > 4 cm was in t...

Research paper thumbnail of Different angiogenic potential in low and high grade sporadic clear cell renal cell carcinoma is not related to alterations in the von Hippel-Lindau gene

Cellular oncology : the official journal of the International Society for Cellular Oncology, 2009

von Hippel-Lindau (VHL) inactivation is common in sporadic clear cell renal cell carcinomas (ccRC... more von Hippel-Lindau (VHL) inactivation is common in sporadic clear cell renal cell carcinomas (ccRCC). pVHL is part of the ubiquitin ligase complex that targets the alpha subunits of hypoxia-inducible transcription factor (HIF) for degradation under well-oxygenated conditions. In the absence of wild-type pVHL, as observed in VHL patients and most sporadic ccRCCs, constitutive upregulation of HIF results in transcriptional activation of angiogenesis-related genes, such as VEGF. Differences in angiogenic activity within the group of ccRCCs were reported and strong genotype-phenotype correlations were found in patients with VHL disease, raising a question about the importance of VHL inactivation status in angiogenic behaviour and tumour progression. To address this question, we investigated the influence of VHL mutation (direct sequencing)/hypermethylation (methylation-specific PCR) on angiogenesis/tumour parameters (immunohistochemistry) in 150 patients with sporadic ccRCC. We found no ...

Research paper thumbnail of Biodistribution of Evans blue in an orthotopic AY-27 rat bladder urothelial cell carcinoma model: implication for the improved diagnosis of non-muscle-invasive bladder cancer (NMIBC) using dye-guided white-light cystoscopy

BJU International, 2015

To investigate the possibility of using Evans blue (EB) as a novel diagnostic tool to detect blad... more To investigate the possibility of using Evans blue (EB) as a novel diagnostic tool to detect bladder tumors with white-light (WL) cystoscopy, in this preclinical study we examined the biodistribution of the compound in the different layers (urothelium, submucosa, muscle) of a normal rat bladder and a rat bladder bearing a malignant urothelium composed of syngeneic AY-27 tumor cells.

Research paper thumbnail of 772 SALVAGE LYMPH NODE DISSECTION FOR PATIENTS TREATED WITH RADICAL PROSTATECTOMY WITH BIOCHEMICAL RECURRENCE AND IMAGING-DETECTED NODAL METASTASES

Research paper thumbnail of Reply to Apostolos P. Labanaris et al's Letter to the Editor re: Ziya Kirkali and Hein Van Poppel. A Critical Analysis of Surgery for Kidney Cancer with Vena Cava Invasion. Eur Urol 2007;52:658–62

Research paper thumbnail of What Does the Urologist Expect from the Pathologist (and What Can the Pathologists Give) in Reporting on Adult Kidney Tumour Specimens?

e u r o p e a n u r o l o g y 5 1 ( 2 0 0 7 ) 1 1 9 4 -1 2 0 1 a v a i l a b l e a t w w w . s c ... more e u r o p e a n u r o l o g y 5 1 ( 2 0 0 7 ) 1 1 9 4 -1 2 0 1 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Abstract Objective: To identify the parameters required by the urologist to determine the prognosis and the treatment of renal cancer in adults, and to establish the potential therapeutic targets of the new treatments that started to show clinical efficacy. Methods: A literature search of the last 10 yr was done, paying specific attention to TNM 2002 (UICC staging) and Fuhrman's grading. Also, the main genetic characteristics of the different subtypes (according to the WHO 2004 classification) with potential therapeutic implications have been compiled. Results: After the review of the literature, the opinion of the joint meeting including urologists and pathologists is that some aspects of the TNM 2002 classification must be refined. Criteria for nuclear grading should be different for the subtypes of renal cell carcinoma, and the WHO 2004 histological classification is clinically useful. Conclusions: In the workshop held in Palermo, common opinion was achieved on a number of points. The TNM 2002 classification is useful, but some adjustments should be made, particularly as referred to the tumour size cut-off, assessment of the invasion of the renal sinus fat tissue, and invasion of the ipsilateral adrenal gland. The Fuhrman's grading system is useful in clear cell renal cell carcinoma (RCC), and probably also in papillary RCC, but a redefinition for chromophobe RCC is needed. Finally, the determination of certain markers, such as VEGF and HIF, could constitute good target markers for the new therapies, but they remain under investigation.

Research paper thumbnail of The Role of Nephron-Sparing Surgery (NSS) for Renal Tumours >4 cm

Chronic Kidney Disease, 2012

For many years, radical nephrectomy (RN) has been the gold standard treatment for renal tumours. ... more For many years, radical nephrectomy (RN) has been the gold standard treatment for renal tumours. However, at present the available evidence supports elective nephron-sparing surgery (NSS) as the standard surgical treatment for renal cortical tumours≤ 4 cm (clinical ...

Research paper thumbnail of Renal Cell Carcinoma with Synchronous Metastasis to the Calcaneus and Metachronous Metastases to the Ovary and Gallbladder

Case Reports in Medicine, 2011

Renal cell carcinomas (RCCs) are known for their unpredictable metastatic pattern. We present the... more Renal cell carcinomas (RCCs) are known for their unpredictable metastatic pattern. We present the case of a 63-year-old woman who initially presented in 1992 with a metastasis in the left calcaneus that led to the discovery of RCC. In 1998, a new metastasis was found in the ovary. In 2008, the diagnosis of a gallbladder metastasis was made. All metastases were surgically removed; no additional systemic therapies were used. Aggressive surgical treatment can prolong the survival of patients with resectable metastases. Patterns of metastasis are discussed, and a brief review of the literature is given regarding each localization.

Research paper thumbnail of Natural history of surgically treated high-risk prostate cancer

Urologic Oncology: Seminars and Original Investigations, 2015

Background: No data exist on the patterns of biochemical recurrence (BCR) and their effect on sur... more Background: No data exist on the patterns of biochemical recurrence (BCR) and their effect on survival in patients with high-risk prostate cancer (PCa) treated with surgery. The aim of our investigation was to evaluate the natural history of PCa in patients treated with radical prostatectomy (RP) alone.

Research paper thumbnail of Open surgery for localized RCC

Thescientificworldjournal, 2007

The only possibility for cure in localized renal cell carcinoma (RCC) is surgery. Open radical ne... more The only possibility for cure in localized renal cell carcinoma (RCC) is surgery. Open radical nephrectomy (RN), as described by Robson, has long been the gold standard. Nevertheless, as a consequence of the increased use of abdominal imaging modalities, a continuing stage migration towards small, low-grade RCC lesions has become evident during the last decades. Together with this stage migration, nephron-sparing surgery (NSS), less-invasive therapies (laparoscopic RN and NSS), and minimally invasive therapies (radiofrequency ablation [RFA], cryoablation) have been developed and are gaining popularity. The value of laparoscopic RN and open NSS are acknowledged worldwide, but the value of laparoscopic NSS, RFA, and cryoablation remains to be established. Despite this evolution, there is still a place for open surgery for localized RCC. Open NSS is, at present, considered the standard of care for localized RCC less than 4 cm, while open RN still has a place for larger lesions, certainly when an extended lymph node dissection or adrenalectomy is warranted, or when a tumor thrombus is extending into the inferior vena cava. This review provides the data that support open surgery in clear, selected cases of RCC. KEYWORDS: renal cell carcinoma, open surgery, nephron-sparing surgery Joniau et al.: Open Surgery for Localized RCC TheScientificWorldOURNAL (2007) 7, 742-752 743

Research paper thumbnail of How important are surgical margins in nephron-sparing surgery?

European Urology Supplements, 2007

Research paper thumbnail of A Giant Mucinous Adenocarcinoma Arising within a Villous Adenoma of the Urachus: Case Report and Review of the Literature

Case Reports in Medicine, 2009

We present an exceptional case of a giant urachal tumor, consisting of both villous adenoma and m... more We present an exceptional case of a giant urachal tumor, consisting of both villous adenoma and mucinous adenocarcinoma of the urachus. The tumor was incidentally discovered during investigations for renal failure. Initial transurethral biopsies showed only a villous adenoma of the urachus. Although the biopsies showed no malignancy, a radical cystoprostatectomy and broad excision of the urachus and umbilicus were performed. At the same time, a bilateral nephroureterectomy was performed because of reflux-nephropathy and renal failure. The indication for surgery was based on the typical imaging aspects, raising the suspicion of an underlying urachal adenocarcinoma (size and location). Indeed, at final histopathology a concomitant well-differentiated adenocarcinoma of the urachus confined to the urachal mucosa was found. The patient remained free of disease for 50 months of follow-up. Only three previous cases of urachal adenocarcinoma associated with villous adenoma have been described.

Research paper thumbnail of Technical Aspects of Focal Therapy in Localized Prostate Cancer: Follow-Up After Focal Therapy

Technical Aspects of Focal Therapy in Localized Prostate Cancer, 2014

Research paper thumbnail of Precancerous Lesions in the Kidney

Scandinavian Journal of Urology and Nephrology, 2000

Renal cell carcinoma (RCC), although occurring less frequently than prostate and bladder cancer, ... more Renal cell carcinoma (RCC), although occurring less frequently than prostate and bladder cancer, is actually the most malignant urologic disease, killing >35% of affected patients. Therefore, investigation of the nature of premalignant lesions of the kidney is a relevant issue. Following the most recent histological classification RCC can be subdivided into four categories: conventional RCC; papillary RCC; chromophobe RCC; and collecting duct carcinoma. In contrast to many genitourinary malignancies, premalignant alterations in the kidney are scarcely described. Intratubular epithelial dysplasia has been recognized as the most common precursor of RCC. In analogy to prostatic intraepithelial neoplasia (PIN), the premalignant lesions of the kidney are described as high or low-grade renal intratubular neoplasia. In contrast, precancerous lesions have been described as part of the von Hippel-Lindau syndrome (VHL) where the evolution from a simple cyst to an atypical cyst with epithelial hyperplasia to cystic or solid conventional-type RCC is well documented. Finally, in the genesis of papillary RCC an adenoma-carcinoma sequence has been recognized with specific genetic changes. There are no data on the epidemiology of premalignant lesions of the kidney, but research into the etiology of RCC has been extended substantially. Familial and genetic factors are well documented in VHL disease, in hereditary papillary RCC, in the tuberous sclerosis complex and in familial RCC. Cigarette smoking and obesity are established risk factors for RCC. Hypertension or its medication has also been associated with an increased risk. Among dietary factors an inverse relation between risk and consumption of vegetables and fruit has been found. Occupational exposure to substances such as asbestos and solvents has been linked to an increased risk of RCC. Specific RCC variants have distinctive chromosome alterations and several genes have been implicated in the development of RCC. Loss of material from the 3p chromosome characterizes conventional RCC and the deletion of the VHL suppressor gene plays an important role in the genesis of this RCC variant. In contrast, numerical changes with trisomy of chromosomes 7 and 17 and loss of the sex chromosome are typical changes in papillary tumors, whereas papillary RCC have additional trisomies. Chromophobe RCC is characterized by loss of chromosomes with a combination of monosomies. Less consistent genetic alterations are associated with collecting duct carcinoma. The traditional treatment of RCC is surgery by radical or partial nephrectomy. The latter approach carries a risk of tumor recurrence as a result of unrecognized satellite lesions or premalignant lesions that might have been present at the time of surgery. However, the reported recurrence rates after partial nephrectomy are <1% and therefore the possible presence of premalignant disease does not alter the actual treatment strategy advocated. Although multifocality and bilateral occurrence of RCC are much more likely in cases of papillary RCC, biopsy of the renal remnant or contralateral kidney is not justified even in patients with this tumor type. Conversely, patients with RIN in a partial or radical nephrectomy specimen or in a renal biopsy taken for whatever reason should be subjected to closer follow-up with regularly repeated ultrasound. When an effective chemopreventive regimen becomes available it might be useful for patients with an inherited risk of RCC as well as in those who are at risk of tumor recurrence after intervention. Mass screening with the purpose of detecting RCC at its earliest stage is not recommended at the present time, but screening focused on certain risk groups can be advocated. Further research is needed to identify avoidable risks, develop effective chemoprevention and recognize patients at risk.