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Biomedical subjects

R R Hall

Publications and source records attributed to R R Hall.

At least 19 recordsLinked to original sources
PubMed1991

Systemic chemotherapy for urothelial cancer in patients with ureteric obstruction.

The aims of this study were to document the toxicity of systemic chemotherapy and response rates in patients with ureteric obstruction caused by urothelial cancer. The study group included 91 patients who received cisplatin and methotrexate; 36 (40%) had upper tract dilatation, 9 of whom had drainage by stenting or nephrostomy and 55 (60%) had normal upper tracts. The response rate was documented in 65 patients (71%) who had measurable primary or metastatic disease. No significant differences were found between the dilated/drained group, the dilated/undrained group and the normal group in biochemical measurements of renal function during or after the courses of chemotherapy. Serious haematological toxicity occurred in 10% (10/104 cycles) of the dilated/undrained group and in 6% (12/200 cycles) of the normal group. The complete response rate in the dilated group was 15% compared with 41% in the normal group. No increased chemotherapy toxicity was observed in patients with upper tract dilatation and a significant complete response rate was found in patients with upper tract dilatation without renal impairment.

Acute Kidney Injury↗
PubMed1991

Interpretation of biopsies of "normal" urothelium in patients with superficial bladder cancer. MRC Superficial Bladder Cancer Sub Group.

In the course of a Medical Research Council trial of intravesical chemotherapy, biopsies were taken from apparently normal bladder urothelium near to newly diagnosed superficial bladder cancers in 417 patients. Differences were noted in the rates at which histological features were described in different centres. To gain more information about the reproducibility of the pathological findings, a group of 6 pathologists (5 from the UK and 1 from the USA), all having a special interest in urological pathology, were asked to examine a representative sample of 92 slides. They were then asked to re-examine 30 of them after an interval of at least 6 months. At first examination and at re-examination the slides were assessed using a standard proforma. However, the definitions of the categories were left unspecified for the pathologists to use their own criteria. The 5 UK pathologists then met to establish a consensus view of each slide. The results indicated that: (1) The reporting of non-dysplastic changes varied so much between pathologists as to render it of little value to clinical practice. (2) There were wide variations between different pathologists in the reported incidence of dysplastic change. (3) On a second review the pathologists reproduced their own assessment on only 62% of occasions. (4) Even after discussion between pathologists there was no consensus on the diagnosis of mild as opposed to moderate dysplasia. Consensus was reached on all biopsies which showed either severe dysplasia or carcinoma in situ. (5) In adopting a policy of taking urothelial biopsies, urologists should be aware of the imprecision and lack of reproducibility in the interpretation of such biopsies. (6) Biopsies of cystoscopically normal urothelium may not be a useful guide in defining therapy.

Biopsy↗
PubMed1990

The epidermal growth factor receptor and the prognosis of bladder cancer.

Epidermal growth factor is found in high concentrations in urine, and its receptor (EGFr) has been identified in certain bladder tumors. This study was performed to determine whether receptor positivity in the tumor was associated with a poor clinical outcome. One hundred one patients with newly diagnosed bladder cancer were studied prospectively by immunohistochemical staining for the EGFr. There were 76 men and 25 women, with a mean follow-up of 30 months; 49 had tumors invading muscle: 18 were pTl (tumor invading lamina propia) and 34 were pTa (tumor confined to urothelium). Strong staining for the EGFr was found in 48% of tumors and was associated with high stage (P less than 0.001). Death of bladder cancer (40 of 101) was associated independently with high stage (P less than 0.0001) and EGFr positivity (P less than 0.001). In patients with pTa and pTl tumors, EGFr positivity was associated with multiplicity (P less than 0.01), time to recurrence (P less than 0.03), and recurrence rate (P less than 0.004). Tumor progression was associated with EGFr positivity (P less than 0.0001) and multiplicity (P less than 0.05). EGFr were found on a significant proportion of bladder tumors: such tumors were more likely to result in death, recurrence, and progression.

Aged↗
PubMed1989

Characterization and quantitation of the epidermal growth factor receptor in invasive and superficial bladder tumors.

Epidermal growth factor receptors (EGFr) have been measured on primary human bladder tumor membranes by 125I-EGF ligand binding. High affinity receptors were detected on both superficial (Kd 0.2-1.45 nM; mean, 0.86 nM; median, 0.88 nM) and invasive tumors (Kd 0.19-2.38 nM; mean, 0.9 nM, median, 0.79 nM). There was one class of binding sites and EGFr concentration was quantified by competitive binding and Scatchard analysis. The EGFr was further characterized and shown to be cleaved at the major autophosphorylation site by a calcium-activated mechanism. Thus the EGFr from primary bladder tumors exhibits similar biochemical characteristics to those in established cell lines. Tumors classified as invasive on the basis of muscle invasion had higher EGFr levels [EGF binding, 99 +/- 252 (SD) fmol/mg protein; median, 21; n = 24] than superficial tumors (12 +/- 12 fmol/mg protein; median, 11; n = 23) or normal bladder mucosa (9 +/- 12 fmol/mg protein; median, 6; n = 6) (P = 0.05). When the two largest subgroups of superficial and invasive tumors were compared (15 pTa, 16 T3), the invasive tumors had significantly higher EGFr levels (P less than 0.05). EGFr may therefore be involved in mechanisms of tumor progression. EGFr may be a target for selective therapy with EGF-linked drugs in a subset of invasive bladder cancers.

Aged↗
PubMed1989

Epidermal growth factor receptor in human bladder cancer: a comparison of immunohistochemistry and ligand binding.

Epidermal growth factor receptors were measured in biopsies from patients with newly diagnosed bladder cancer. Two methods to detect these receptors were compared: immunohistochemical staining of frozen sections, and a ligand binding study using radiolabeled epidermal growth factor and tumor cell membranes. We studied 101 patients by immunohistochemistry and 47 patients by both methods. An association was found between immunohistochemical positivity for epidermal growth factor receptors and high tumor stage (p less than 0.001). Thus, most of the muscle invasive tumors were positive (35 of 49, 71 per cent) and more stage pT1 tumors were positive (8 of 18, 44 per cent) than were stage pTa tumors (5 of 34, 15 per cent, p less than 0.05). The ligand binding study was slightly more sensitive in detecting receptors than immunohistochemistry (30 of 47, 64 per cent and 25 of 47, 53 per cent, respectively). Greater amounts of receptors were found in muscle invasive tumors compared to tumors not invading muscle (p less than 0.05). A significant association was found between the 2 methods in the detection of receptors (p less than 0.001) and no discrepancies were found between the 2 methods in tumors containing high levels of receptors. Immunohistochemistry provides a satisfactory method to detect receptors in tumors with high levels of receptors, although ligand binding is more sensitive in tumors with low levels of receptors.

Adult↗
PubMed1988

Should pT1 transitional cell cancers of the bladder still be classified as superficial?

Of 171 patients consecutively presenting with newly diagnosed transitional cell cancer (TCC) of the bladder, 107 were "superficial"; 98 have been followed up for 2 years and 84 for 3 years. No patient with pTa TCC developed muscle infiltrating recurrences, although 15% progressed to pT1 category by 3 years. At 2 and 3 years respectively, 33 and 46% of the pT1 TCC had progressed to infiltrate muscle. The use of the term "superficial" to describe pTa and pT1 category TCC together in one grouping should be reconsidered.

Adult↗
PubMed1988

Deferred treatment for prostate cancer.

The clinical outcome of 278 prostate cancer patients managed by a deferred treatment policy was analysed retrospectively. Following TURP or biopsy, all patients were asymptomatic and deemed suitable for management by a deferred treatment policy, i.e. hormone therapy or other forms of treatment were only initiated if and when symptomatic progression occurred. The overall 5-year survival rate was 30%; 18% of patients died from other causes without needing treatment for their prostate cancer; 11% were alive and untreated after 5 years' follow-up; 17% died from prostate cancer without further treatment. Poor tumour grade, anaemia, metastatic disease, a short history, presentation with retention, and a raised serum creatinine at presentation were associated with a poor prognosis.

Aged↗
PubMed1988

Differing interpretations by pathologists of the pT category and grade of transitional cell cancer of the bladder.

The UICC pT category for transitional cell cancer (TCC) of the bladder was recorded as assigned from the routine service of a pathology laboratory. All reports had been passed for release after review by pathologists of the status of senior registrar or above. After 99 cases had been collected, the slides available to the original pathologist were reviewed by one dedicated pathologist in continuous session who was ignorant of the original report. No new sections were cut. There was disagreement with the original report of pT category in 14 cases: 13 were downstaged (including 6 from invasive to superficial) and 1 upstaged. There was disagreement with the original differentiation grade in 13 cases: 10 TCC were considered to be more differentiated and 3 less differentiated than the original report. A second pathologist reviewed the pT category only of 13 of the 14 cases, disagreeing with the original pT category on 8 occasions and with the pT category assigned by the dedicated pathologist on 7 occasions. These findings have important implications for advising patients on prognosis and clinical management and in the design and reporting of therapeutic trials.

Carcinoma, Transitional Cell↗