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Andrea Fandella

Publications and source records attributed to Andrea Fandella.

8 recordsLinked to original sources
PubMed2006

Nomogram predictive of pathological inguinal lymph node involvement in patients with squamous cell carcinoma of the penis.

PURPOSE: In penile cancer the therapeutic benefits of early inguinal lymphadenectomy must be counterbalanced by the high rates of morbidity, postoperative complications and mortality. A relevant aim is optimizing the selection of the patients who could really have the highest survival advantage from inguinal lymphadenectomy, limiting the cases in which this surgery might be considered over treatment with a risk of severe complications. We generated a nomogram estimating the risk of pathological inguinal lymph node involvement according to clinical lymph node stage and pathological findings of the primary tumor. MATERIALS AND METHODS: We retrospectively collected the clinical and pathological data of 175 patients who had undergone surgical therapy for squamous cell carcinoma of the penis from 1980 to 2002 at 11 urological centers in northeastern Italy. A logistic regression model was used to construct the nomogram. RESULTS: The presence of palpable groin lymph nodes and the histological findings of vascular and/or lymphatic embolization were important predictors of metastatic inguinal lymph node involvement. The nomogram predicting the risk of metastatic lymph node involvement showed a good concordance index (0.876) and good calibration. CONCLUSIONS: The clinical stage of groin lymph nodes and pathological findings of penectomy specimens allowed us to generate a nomogram to predict the probability of metastatic lymph node involvement in patients with squamous cell carcinoma of the penis. The statistical model showed an excellent ability to identify the patients with lymph node metastases and good calibration.

Aged↗
PubMed2006

Nomogram predictive of cancer specific survival in patients undergoing partial or total amputation for squamous cell carcinoma of the penis.

PURPOSE: We created the first nomograms to predict cancer specific survival probabilities of patients with squamous cell carcinoma of the penis, clustering prognostic information from the most commonly used clinical and pathological variables. MATERIALS AND METHODS: We retrospectively collected clinical and pathological data from 175 patients who had undergone surgery for squamous cell carcinoma of the penis from 1980 to 2002 at 11 urological centers in northeastern Italy. A logistic regression model was used to construct the nomogram. RESULTS: At a median followup of 24 months, 101 patients (57.7%) were alive and disease-free while 74 (42.3%) died of penile cancer. According to multivariate analyses, 2 models predictive of cancer specific survival probability were generated. The first model was based on the pathological findings of the primary tumor after penectomy and on the clinical stage of groin lymph nodes, while the second model included the pathological data of the primary tumor and groin lymph nodes. The concordance index was 0.728 for the first model and 0.747 for the second. Calibration appeared to be good in both models. CONCLUSIONS: In this article we propose 2 models to predict the 5-year cancer specific survival probabilities of patients with squamous cell carcinoma of the penis. Both models showed good discriminating power and calibration in predicting patient 5-year cancer specific survival. These nomograms could improve the quality of prognostic data provided to patients and support physicians in planning treatment.

Aged↗
PubMed2006

The effects of renal ischemia on kidney function in renal cancer conservative surgery.

Over the past ten years nephron sparing surgery for renal cancer has been compared to radical nephrectomy for what concern oncological results, even in elective situations but it is necessary to consider functional results (renal function) as well. Clamping renal artery, inducing a temporary renal ischemia that might represent the major known cause of permanent renal damage, is advised for both open and laparoscopic conservative approach. Data from literature show that before the clamping, the patient should be adequately hydrated and receive mannitol. Ischemia should last preferentially less than 30 minutes and kidney cooling should be advised in case of more prolonged ischemia. Artery reclamping should be avoided. Both in warm and cold ischemia, the renal tissue should be perfused by mannitol once the circulation is resumed.

Cold Ischemia↗
PubMed2005

Lymphatic and vascular embolizations are independent predictive variables of inguinal lymph node involvement in patients with squamous cell carcinoma of the penis: Gruppo Uro-Oncologico del Nord Est (Northeast Uro-Oncological Group) Penile Cancer data base data.

BACKGROUND: The objective of the current study was to identify independent clinical and pathologic variables that were predictive of lymph node involvement in patients with squamous cell carcinoma of the penis in a multicenter series with the intent to select patients who were suitable to undergo immediate inguinal lymphadenectomy. METHODS: Data were analyzed from 175 patients who underwent surgery for penile carcinoma in 11 urologic centers participating in the Gruppo Uro-Oncologico del Nord-Est (Northeast Uro-Oncological Group) Penile Cancer Data Base. Pathologically positive lymph nodes were defined as the presence of histologically confirmed lymph node metastasis in patients who underwent either immediate or delayed inguinal and/or pelvic lymphadenectomy. Patients who had clinically positive lymph nodes with cytologically positive fine-needle aspiration results and who had not undergone lymphadenectomy were censored. RESULTS: Overall, lymph-node involvement was observed in 71 of 175 patients (40.6%) included in the analyses. After analyzing the whole group of patients, the following variables were identified as independent predictors of pathologic lymph node metastasis: clinical lymph node status, pathologic stage of the primary tumor, venous and lymphatic embolizations, and histologic grade. In the subgroup of patients with clinically negative lymph nodes, tumor thickness, histologic grade, lymphatic and venous embolizations, infiltration of both corpus spongiosum and urethra, and pathologic stage of the primary tumor (according to the 1997 TNM classification system) were predictive of lymph node involvement on univariate analysis. The generated logistic regression model showed that venous and/or lymphatic embolizations and infiltration of the corpus spongiosum and/or urethra were independent predictors of pathologic lymph node metastasis in patients with clinically negative lymph nodes. CONCLUSIONS: Venous and/or lymphatic embolizations played relevant roles as predictors of pathologic lymph node involvement in patients with penile neoplasia and should be considered important parameters in determining which patients with clinically negative lymph nodes should undergo immediate lymphadenectomy.

Adult↗
PubMed2004

New experimental models for the in vitro reconstitution of human bladder mucosa.

This study describes two experimental models for the in vitro reconstitution of the human bladder mucosa (neo-bladder): human urothelial stabilized cell lines were cultured on three-dimensional matrices, collagen or platelet-fibrin gels, containing murine fibroblast 3T3-J2 cells. Low-density seeding (2x10(4) cells/ml) of both normal (TCA-48) and neoplastic cell lines (TCA-47) on collagen matrix gave rise to isolated papillar colonies, while high-density seeding (3.75x10(6) cells/ml) led to the formation of wide pluristratified epithelial sheets, resembling the normal transitional epithelium. In contrast, high-density seeding (5x10(5) cells/ml) on platelet-fibrin matrix did not allow the formation of epithelial sheets: only isolated voluminous colonies of normal TCA-48 cells, and sparse and small colonies of neoplastic TCA-47 could be observed. Growth assays and cytotoxicity reduction tests showed that the growth inhibitory effect of platelet-fibrin gel on urothelial cells was probably due to the aspecific activation of the complement contained in the plasmatic fraction, whose precipitation forms fibrin-glue. Collectively, these findings allow us to draw the following conclusions: i) neobladders obtained by culturing urothelial cells on collagen matrix reproduce normal bladder mucosa and could be utilized in pharmacological studies; and ii) platelet-fibrin gels, that specifically inhibit neoplastic urothelial cell growth, could be used as scaffolds in surgical bladder reconstitution.

3T3 Cells↗
PubMed2002

[Response to a cognitive questionnaire on the guideline project of prostatic biopsy of the SIEUN--GUONE--SIUrO--SIBioC].

Ultrasound guided systemic sextant needle biopsy of the prostate is the procedure of choice for the diagnosis of prostate cancer. During the past 50 years, the techniques, indications, and pathologic interpretation of prostate biopsies have evolved. Moreover, the indications for prostate biopsy have become more refined. This paper provides the results of an interactive questionnaire on ultrasound guided biopsy of the prostate. 14 questions have been selected. A range of 102-109 answers have been collected for every questions at Castrocaro (Fo) during the 14th National Congress of the Italian Society of Urological, Andrological and Nephrological Ultrasound on May 3rd 2002.

Biopsy↗
PubMed2002

[Prostatic tumor: how many biopsies?].

INTRODUCTION: Ultrasound-guided prostatic biopsy is usually performed by sextants according to Hodge, but the authors feel that 6 biopsies are insufficient. It has been suggested that the number of prostatic biopsies be increased and the mapped areas extended, but this causes discomfort to patients and increases effective costs. The authors suggest repetition of biopsies in "risk" cases, routinely selecting patients taking into account the best cost-benefit ratio. MATERIALS AND METHODS: From January 2000 to December 2001, 682 first series biopsies were performed on as many patients. A Stamey modified sextant technique was used: 6 biopsies, 3 on each side carried out more posterolaterally than the original technique. The biopsy procedure was repeated within 4 months in 11 patients with high risk clinical parameters (PSA > 10 or high PSA and prostatic nodule). During the period of observation, 25 patients had over 0.75 ng/year increase in their PSA and so biopsies were repeated. RESULTS: After the first biopsy series, 277 were positive. Of the 11 repeated biopsies, 3 were positive. Of the 25 patients with altered PSA velocity, 9 were positive. DISCUSSION AND CONCLUSIONS: It has been shown that only 10-12% of biopsies are false negative in the sextant biopsy series when taken posterolaterally. The techniques that increase the number of biopsies have around 3-5% false negatives, but this involves more discomfort for the patient, local anaesthesia and a possible increase in complications. The procedure whereby biopsies were only repeated in patients with high risk clinical elements, saved 3852 biopsies from being carried out, with an economic saving (just on the histological exam that was not carried out) assessed at 59.681,80 Euro (115,560,000 Lire) for our Local Health Service.

Biopsy↗