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Vincenzo Ficarra

Publications and source records attributed to Vincenzo Ficarra.

At least 19 recordsLinked to original sources
PubMed2007

Grading systems in renal cell carcinoma.

PURPOSE: We reviewed updated literature data concerning several issues of renal cell carcinoma grading systems. MATERIALS AND METHODS: We performed a nonsystematic review of the literature. Data were identified by a MEDLINE search using a strategy including MeSH and free text protocols. From the MEDLINE search we collected 184 records. RESULTS: Although the original study was published in 1982, the independent predictive value of nuclear grades was only revealed in 2000 by the team from University of California-Los Angeles. Subsequently further data from our group and the group at the Mayo Clinic reconfirmed those findings, although similar cancer specific survival probabilities were noted among different grades. The prognostic relevance of nuclear grade justified the inclusion of that variable in algorithms and nomograms predictive of cancer specific survival, such as those provided by University of California-Los Angeles, the Mayo Clinic and Memorial Sloan-Kettering Cancer Center. Despite the routine clinical use of nuclear grade, several drawbacks have affected grading systems, such as interobserver and intra-observer reproducibility, and variability of the cancer specific survival probabilities stratified by grade. Several studies showed that intra-observer and interobserver agreement with regard to grade are only moderate with up shifting in all series. That issue might be due to the heterogeneity of renal cell carcinoma as well as to the lack of consensus about the minimal size of high grade tumor to be considered significant. Moreover, recent data underscore the role of histological subtypes. CONCLUSIONS: Grade is one of the most powerful prognostic factors in patients with renal cell carcinoma. The Fuhrman grading system is currently most widely used by pathologists in Europe and the United States. However, there is still a need for better standardization of nuclear criteria to improve interobserver reproducibility and a major consensus should be achieved by uropathologists.

Carcinoma, Renal Cell↗
PubMed2006

Renal cell carcinoma with nodal metastases in the absence of distant metastatic disease: prognostic indicators of disease-specific survival.

OBJECTIVES: Outcome of patients with exclusive renal cell carcinoma (RCC) nodal metastases without distant metastases is not extensively described. We explored the ability of standard risk factors such as tumour size, Fuhrman grade, histologic subtype and symptom classification to predict renal cell carcinoma-specific survival (RCC-SS). METHODS: Analyses targeted 171 patients with RCC nodal metastases and absence of distant metastases. Univariable, multivariable, and predictive accuracy analyses addressed RCC-SS with the intent of identifying independent and most informative predictors of RCC-SS in this cohort of patients. RESULTS: Median RCC-SS was 2.3 yr. Symptom classification (61.3%, p<0.001) demonstrated the highest univariable accuracy. In multivariable analyses, symptom classification contributed the most to the combined predictive accuracy of all variables (+4.2%, p<0.001), followed by Fuhrman grade (+2.3%) and histologic subtype (+1.0%). CONCLUSIONS: Renal cell carcinoma-specific survival of patients with exclusive nodal metastases may show important variability. In presence of systemic symptoms, survival is extremely poor. Substantially better survival may be expected in patients with local or no symptoms. This observation has important implications when adjuvant therapies are considered.

Adolescent↗
PubMed2006

Relationship between age at diagnosis and clinicopathologic features of renal cell carcinoma.

OBJECTIVES: To analyse the influence of age at diagnosis on tumour characteristics and cancer-specific survival in renal cell carcinoma (RCC). METHODS: Data on age, tumour characteristics, and survival for 4774 patients from 12 European RCC databases were recorded. Patients were divided into four groups according to age at diagnosis: < or =40, >40 and <60, > or =60 and <80, and > or =80 yr. The following variables were analysed: TNM stage, Fuhrman grade, tumour size, symptoms at diagnosis, ECOG performance status (PS), and cancer-specific survival. The groups were compared for usual clinical and pathologic variables, and cancer-specific survival. RESULTS: The four groups accounted for 288 (6%), 1839 (38.5%), 2499 (52.3%), and 148 cases (3.2%), respectively. Differences were found among groups for tumour stage, symptoms at diagnosis, ECOG PS, Fuhrman grade (p<0.001), tumour size, M stage, and histologic subtype (p: 0.02). Patients < or =40 yr were more likely to have papillary or chromophobe RCCs and less likely to have clear-cell RCCs. No significant difference was found among groups for N stage (p: 0.15). The 5-yr cancer-specific survival rates for the four age categories were 85%, 74%, 70%, and 69%, respectively. In multivariate analysis age category remained an independent prognostic parameter (p<0.001). CONCLUSIONS: Renal tumours diagnosed in younger age are characterized by lower tumour stages and grades as well as favourable histologic patterns compared with tumours in older patients. Basic research is required for explaining such a relationship between age, tumour aggressiveness, and therefore tumour biology.

Adult↗
PubMed2006

Anticholinergic drugs in patients with bladder outlet obstruction and lower urinary tract symptoms: A systematic review.

OBJECTIVES: To review the available evidence concerning the use of anticholinergic drugs, alone or in combination with alpha-blockers, in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and concomitant overactive bladder syndrome, to assess whether the currently available evidence suggests a role for antimuscarinic drugs in patients with BPH. METHODS: A systematic review of the literature was performed using Embase, MEDLINE, and Web of Science through a complex search strategy including "free text" and "MeSH" protocols. Moreover, the Cochrane database of systematic review was browsed for records regarding BPH and the abstract books of the American Urological Association, European Association of Urology, and International Continence Society annual meetings from 2000 to 2005 were hand-searched for studies concerning the topic of the review. RESULTS: From the literature search, we identified four randomised controlled trials (RCTs), two prospective case series, and a few congress abstracts. For methodologic issues, the best RCT was based on urodynamic data, but did not provide any clinical insight on the patients' symptoms. The other papers were affected by significant methodologic or clinical drawbacks. CONCLUSION: The available data may be considered promising in terms of safety and efficacy. The evidence of the limited number of RCTs available, considering their methodologic or clinical shortcomings, is not sufficient to support the clinical use of combination therapy with alpha-blockers and anticholinergic drugs in patients with associated storage and voiding symptoms. Well-designed, large, double-blind, placebo-controlled, long-term RCTs are needed to assess the long-term safety and efficacy of antimuscarinic drugs, alone or in combination with alpha-blockers, in this category of patients.

Cholinergic Antagonists↗
PubMed2006

Proposal for reclassification of the TNM staging system in patients with locally advanced (pT3-4) renal cell carcinoma according to the cancer-related outcome.

OBJECTIVES: The optimal stratification of locally advanced renal cell carcinoma (RCC) is controversial, with the prognostic relevance of ipsilateral adrenal gland invasion and cranial extension of vena cava thrombosis being the most debatable issues. We evaluated the prognosis of patients with locally advanced RCC and identified a new model to stratify their outcome. MATERIALS AND METHODS: We analyzed the data of 227 patients who had undergone partial or radical nephrectomy for pT3-4 RCC at two academic centers between 1986 and 2002. The log-rank test and Cox proportional hazards model were used for univariate and multivariate analysis, respectively. RESULTS: At a median follow-up of 29 mo, we censored 108 (47.6%) cancer-related deaths. On univariate analysis, the 2002 T stage was not statistically significant. According to cancer-related outcome, we identified three subgroups of patients with different prognoses: pT3a(n): tumors with perirenal fat invasion or renal vein thrombosis or thrombosis within the vena cava below the diaphragm; pT3b(n): tumors with renal vein thrombosis or thrombosis within the vena cava below the diaphragm and concomitant perirenal fat invasion; pT4(n): adrenal gland or Gerota fascia invasion or thrombosis within the vena cava above the diaphragm. The three subgroups had significantly different prognoses. The new reclassification was an independent predictive variable on multivariate analysis, as well as the pathologic lymph node stage. CONCLUSIONS: The 2002 version of TNM of locally advanced RCC did not stratify patient outcome. The present study suggests the possibility of reclassifying pT3-4 RCC into three categories capable of predicting cancer-specific survival, regardless of all other prognostic factors.

Aged↗
PubMed2006

Evidence from robot-assisted laparoscopic radical prostatectomy: a systematic review.

OBJECTIVE: To review the literature available on robot-assisted laparoscopic radical prostatectomy (RALP). METHODS: A literature search was performed using EMBASE, MEDLINE, and Web Science databases through a "free text" protocol, including the following terms: robotic radical prostatectomy, da Vinci, and radical prostatectomy. Three of the authors separately reviewed the records to select the papers relevant for the topic of the review, with any discrepancies solved by open discussion. The selected articles were recorded in an electronic database and analysed by version 13.0 SPSS software. RESULTS: We identified 71 manuscripts. Eleven papers focused on surgical technique, and 35 manuscripts reported clinical, pathologic, and/or follow-up data. Seven studies included clinical data concerning surgical series with fewer than 10 patients, whereas the remaining 26 series reported larger surgical series of RALP. RALP turned out to be a feasible procedure, with limited blood loss, favourable complication rates, and short hospital stays. Positive surgical margin rates decreased with the surgeon's experience and technique improving, reaching percentages similar to those of retropubic and laparoscopic series. The available oncologic data are only preliminary. Especially interesting are the data on postoperative continence rates, whereas results on potency, although promising, are based only on a limited number of patients and have to be considered as incomplete and premature. CONCLUSION: Literature showed that RALP had a short learning curve and interesting postoperative results, especially with regard to continence recovery. The available data on recovery of erectile function and oncologic follow-up are still incomplete.

Humans↗
PubMed2006

Prognostic role of the histologic subtypes of renal cell carcinoma after slide revision.

OBJECTIVES: To evaluate concordance, using the kappa statistic, between tumour histotypes assigned at initial diagnosis and those after slide revision, and to assess the independent predictive value of reviewed tumour histotype. MATERIALS AND METHODS: We analysed records of 491 patients who had undergone partial or radical nephrectomy for renal cell carcinoma (RCC) in our department from 1986 to 2000. Pathologic slides were reviewed by one uropathologist blinded to original diagnoses and follow-up data, who reassigned histologic subtype and nuclear grades. RESULTS: Concordance between original and reviewed histotypes was substantial (kappa = 0.52). Data were affected by the year of initial diagnosis: Concordance was moderate (kappa = 0.43) in patients treated from 1986 to 1997 and substantial (kappa = 0.73) in those observed thereafter. The original histotype did not stratify the cancer-related outcome. According to the reviewed histotypes, the 5-year cancer-specific survival probabilities of conventional, papillary and chromophobe RCC patients were 81.3%, 90.1% and 100%, respectively (p = 0.009). Patients with conventional RCC showed significantly lower cancer-specific survival than those with papillary or chromophobe RCC, even in the cases with locally advanced (p = 0.04) or high-grade (p = 0.02) neoplasms. The reviewed histologic subtype was not an independent prediction of cancer-specific survival on multivariate analysis. CONCLUSION: Concordance between histologic subtype assigned before 1997 and after slide revision was only moderate. In univariate analysis, reviewed tumour histotype stratified cancer-related outcome, but the data of multivariate analysis were strongly influenced by the prevalent number of conventional RCC.

Carcinoma, Renal Cell↗
PubMed2006

Tumor size improves the accuracy of TNM predictions in patients with renal cancer.

OBJECTIVES: Current staging for renal cancer (RC) does not directly rely on tumor size. We examined the increment in accuracy related to inclusion of pathologically determined tumor size in prediction of nodal metastases (N+), distant metastases (M+), and cancer-specific survival (CSS). METHODS: Partial or radical nephrectomy was performed in 2245 patients with clear cell histology. Pathologic stages were T1a in 566, T1b in 490, T2 in 303, T3 in 831, and T4 in 55 patients. Tumor size was 0.5-25 cm (mean, 6.8). Multivariate models relied on 1997 and 2002 TNM variables and addressed N+, M+ disease, and CCS. Their accuracy was compared according to either the presence or absence of tumor size. RESULTS: In all univariate and multivariate models, tumor size was a statistically significant predictor of all outcomes (p< or =0.001). In all multivariate models, tumor size added between 3.7% and 0.8% to predictive accuracy of either 1997 or 2002 TNM categories. CONCLUSIONS: Tumor size represents a highly significant, multivariate, and informative predictor of RC outcomes and may warrant inclusion in future TNM revisions.

Carcinoma, Renal Cell↗
PubMed2006

Needle core length is a quality indicator of systematic transperineal prostate biopsy.

OBJECTIVE: To analyse the length of needle cores sampled as a quality indicator in systematic transperineal prostate biopsy. We assessed the correlation of core length with the other clinical and topographic parameters. MATERIAL AND METHODS: We prospectively evaluated data from 509 consecutive patients who underwent a first set of transrectal ultrasound-guided transperineal prostate biopsy for suspected prostate cancer. Fourteen cores were sampled from each patient. Needle cores were stretched and placed in tissue cassettes between two nylon meshes according to the pre-embedding methods of prostate needle biopsy specimens. For single biopsy core, the measurement of length (in millimetres) and any percentage of cancer in the biopsy specimen were reported. RESULTS: The mean length of 7,126 analysed cores was 14.14+/-4.35mm. All cores were longer than 10mm. The mean length of needle cores sampled did not correlate with patient age, total prostate-specific antigen value, digital rectal examination, and prostate volume. The whole mean length of the six samples from the peripheral zone of the right lobe was higher than the mean corresponding value of the six samples from the left lobe peripheral zone (p<0.001). The transperineal approach allows a greater sampling of the prostate apex than of the midgland and prostate base (p<0.001). CONCLUSIONS: The length of the needle cores sampled during transperineal prostate biopsy fulfils the parameters of quality required by pathologists for an appropriate evaluation of the biopsy specimen.

Aged↗
PubMed2006

Treatment of varicocele in subfertile men: The Cochrane Review--a contrary opinion.

OBJECTIVE: A recent Cochrane meta-analysis of randomised clinical trials (RCTs) concluded that surgical or radiological treatment of varicocele in men from couples with otherwise unexplained subfertility cannot be recommended. The aim of the present study is to address criticisms of this review carrying out a critical analysis of all available RCTs. MATERIALS AND METHODS: The eight randomised clinical trials selected in the last Cochrane Library systematic review have been evaluated. All RCTs including patients either with normal semen analysis or subclinical varicocele have been excluded. Inclusion criteria, number and clinical characteristics of randomised patients, and outcomes reported in terms of pregnancy rate one year after randomisation have been described in the remaining studies. RESULTS: Only 3/8 RCTs included patients with abnormal semen analysis and palpable varicocele. Overall 120 patients in the treatment group and 117 in the control group were randomised. The studies turned out to be heterogeneous in terms of inclusion criteria and clinical characteristics of the analysed patients. Their methodological quality and statistical power have to be considered poor. Moreover, the "as treated" cumulative analysis showed a significant increase in pregnancy rate in patients who underwent varicocele treatment (36.4%) compared with the control group (20%) (p = 0.009). CONCLUSIONS: The RCTs included in the last Cochrane review concerning the efficacy of varicocele treatment in subfertile couples were heterogeneous and methodologically poor. The pooling of these studies cannot result in a good quality meta-analysis. The Cochrane meta-analysis conclusions should not support guidelines recommendation against varicocele treatment in subfertile patients. Data from ongoing studies should provide more information in this topic.

Adult↗
PubMed2006

External validation of the Mayo Clinic Stage, Size, Grade and Necrosis (SSIGN) score to predict cancer specific survival using a European series of conventional renal cell carcinoma.

PURPOSE: We validated the Mayo Clinic SSIGN score in an independent European sample of patients who were surgically treated for conventional RCC. MATERIALS AND METHODS: In our kidney cancer database we identified 388 patients who were treated with radical or partial nephrectomy for conventional RCC between 1986 and 2000. Associations of the pathological features studied with death from RCC were evaluated using the log rank test and Cox proportional hazards regression model. The predictive ability of competing models was evaluated using the c index. RESULTS: Median followup in the 290 patients who were alive at last followup was 5 years (range 5 months to 17 years). The estimated cancer specific survival rate 5 years following surgery was 81.3%. All features that comprise the SSIGN score except tumor size were significantly associated with death from RCC in a multivariate setting, resulting in a c index of 0.90. The median SSIGN score in the 388 patients studied was 3 (range 0 to 15). The c index in a model containing the clear cell SSIGN score was 0.88. Five-year cancer specific survival rates in patients with a score of 0 to 2, 3 to 4, 5 to 6, 7 to 9 and 10 or more were 100.0%, 90.5%, 63.6%, 46.8% and 0%, respectively. CONCLUSIONS: We provide the first external validation of the Mayo Clinic SSIGN score for conventional RCC. This simple algorithm resulted in a high degree of prognostic accuracy.

Adult↗
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

Twelve-month self-reported quality of life after retropubic radical prostatectomy: a prospective study with Rand 36-Item Health Survey (Short Form-36).

OBJECTIVES: To evaluate the health-related quality of life (HRQoL) in patients undergoing retropubic radical prostatectomy (RRP) for clinically localized prostate cancer. PATIENTS AND METHODS: From February 2002 to September 2003 all patients undergoing RRP in our department were invited to participate in the study; the data from 75 of them comprised the present analysis. For evaluating HRQoL the RAND 36-Item Health Survey (SF-36) was used. RESULTS: Comparing the baseline scores of the SF-36 domains to those at 3, 6 and 12 months, there was a statistically significant difference in 'physical function', 'role limitations due to physical health problems', 'role limitations due to emotional problems', and 'energy/fatigue'. There were no statistically significant changes in the follow-up values for the other scales of the questionnaire. However, the baseline scores overlapped the 12-month follow-up values for all the SF-36 scales. The mean SF-36 scores reported by incontinent patients were lower than those of the continent patients, although this trend was not statistically significant. At the 12-month follow-up some variables were independent predictors of lower mean scores of some SF-36 scales, i.e. age >65 years, education level less than secondary school, pathological extracapsular extension of cancer and erectile dysfunction. CONCLUSION: At 1 year after RRP, HRQoL levels in each of the SF-36 domains overlapped those of the baseline in >80% of patients. The age, educational level of patients, local extension of the tumour, and erectile dysfunction could significantly affect the HRQoL scores.

Aged↗
PubMed2006

Short-term outcome after high-intensity focused ultrasound in the treatment of patients with high-risk prostate cancer.

OBJECTIVE: To assess the short-term outcome in patients with high-risk prostate cancer treated by transrectal high-intensity focused ultrasound (HIFU). PATIENTS AND METHODS: From April 2003 to November 2004, 30 patients with high-risk prostate cancer were enrolled in this prospective study; all had transurethral resection of the prostate before transrectal HIFU treatment, using the Ablatherm device (EDAP, Lyon, France) during the same session, associated with hormonal therapy with luteinizing hormone-releasing hormone analogues. After the procedure, all the patients were evaluated every 3 months by physical examination, prostate-specific antigen (PSA) assay and a continence questionnaire. The follow-up schedule also included a transperineal prostate biopsy 6 months after the treatment. All the patients had a minimum follow-up of 12 months. RESULTS: The HIFU treatment took a median (interquartile range, IQR) of 140 (100-160) min. No complications were reported during treatment. The mean (IQR) hospitalization was 2.2 (1-4) days, and the suprapubic drainage tube was removed after 12 (7-18) days. The complications after treatment were: urinary tract infections in five patients (16%), stenosis of the intraprostatic and membranous urethra in three (10%), and secondary infravesical obstruction in four (13%). At 12 months after the procedure, 28 patients (93%) were continent. Seven of the 30 men (23%) had a positive prostate biopsy. At the 1-year follow-up only three of the 30 patients with high-risk prostate cancer had a PSA level of >0.3 ng/mL. CONCLUSIONS: HIFU is a modern, minimally invasive therapy for prostate cancer, often used in selected patients with localized disease. The present results show that HIFU was also feasible in patients with high-risk prostate cancer. The low complication rates and favourable functional outcome support the planning of further larger studies in such patients. The oncological efficacy of HIFU should be assessed in further studies with a longer follow-up.

Aged↗
PubMed2006

An unusual inguino-scrotal presentation of disseminated peritoneal adenomucinosis.

We report a rare case of disseminated peritoneal adenomucinosis presenting as an inguino-scrotal mass. Imaging studies showed the presence of a mass, with liquid content, expanding from right colon into the retrovesical space and downward into the right inguinal canal. Intraoperatively, we observed and removed an appendiceal gelatinous mass. The inguinal-scrotal mass consisted of a hernial sac filled with mucinous material. Histological examination allowed the diagnosis of peritoneal adenomucinosis.

Adult↗