Publications by authors named "Pia Paffenholz"

46 Publications

Levels of Circulating PD-L1 Are Decreased in Patients with Resectable Cholangiocarcinoma.

Int J Mol Sci 2021 Jun 18;22(12). Epub 2021 Jun 18.

Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany.

Tumor resection represents the only curative treatment option for patients with biliary tract cancers (BTCs), including intrahepatic cholangiocarcinoma (CCA), perihilar and extrahepatic CCA and gallbladder cancer. However, many patients develop early tumor recurrence and are unlikely to benefit from surgery. Therefore, markers to identify ideal surgical candidates are urgently needed. Circulating programmed cell death 1 ligand 1 (PD-L1) has recently been associated with different malignancies, including pancreatic cancer which closely resembles BTC in terms of patients' prognosis and tumor biology. Here, we aim at evaluating a potential role of circulating PD-L1 as a novel biomarker for resectable BTC.

Methods: Serum levels of PD-L1 were analyzed by ELISA in 73 BTC patients and 42 healthy controls.

Results: Circulating levels of preoperative PD-L1 were significantly lower in patients with BTC compared to controls. Patients with low PD-L1 levels displayed a strong trend towards an impaired prognosis, and circulating PD-L1 was negatively correlated with experimental markers of promalignant tumor characteristics such as CCL1, CCL21, CCL25 and CCL26. For 37 out of 73 patients, postoperative PD-L1 levels were available. Interestingly, after tumor resection, circulating PD-L1 raised to almost normal levels. Notably, patients with further decreasing PD-L1 concentrations after surgery showed a trend towards an impaired postoperative outcome.

Conclusion: Circulating PD-L1 levels were decreased in patients with resectable BTC. Lack of normalization of PD-L1 levels after surgery might identify patients at high risk for tumor recurrence or adverse outcome.
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http://dx.doi.org/10.3390/ijms22126569DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233871PMC
June 2021

Teratomatous Elements in Orchiectomy Specimens Are Associated with a Reduced Relapse-Free Survival in Metastasized Testicular Germ Cell Tumors.

Urol Int 2021 Jun 15:1-7. Epub 2021 Jun 15.

Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany.

Introduction: The impact of teratomatous elements in orchiectomy specimens of metastasized testicular germ cell tumors (TGCT) regarding oncological outcome is still unclear.

Methods: We performed a retrospective analysis including 146 patients with metastasized TGCT analysing patient characteristics.

Results: Twenty-six (18%) of all patients showed teratomatous elements in the orchiectomy specimens. TGCT with teratomatous elements showed a significantly higher frequency of clinical-stage 2C-3 disease (73 vs. 49%, p = 0.031), visceral metastases (58 vs. 32%, p = 0.015), and poor prognosis (p = 0.011) than TGCT without teratomatous elements. Teratoma-containing TGCT revealed a significantly higher rate of post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND, 54 vs. 32%, p = 0.041), with teratomatous elements being more often present in the PC-RPLND specimens (43 vs. 11%, p = 0.020) than nonteratoma-containing primaries. In the Kaplan-Meier estimates, the presence of teratomatous elements in orchiectomy specimens was associated with a significantly reduced relapse-free survival (RFS) (p = 0.049) during a median follow-up of 36 months (10-115.5).

Conclusions: The presence of teratomatous elements in orchiectomy specimens is associated with an advanced tumor stage, worse treatment response as well as a reduced RFS in metastasized TGCT. Consequently, the presence of teratomatous elements might act as a reliable stratification tool for treatment decision in TGCT patients.
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http://dx.doi.org/10.1159/000515715DOI Listing
June 2021

The combination of microRNA-371a-3p and 375-5p can distinguish viable germ cell tumor and teratoma from necrosis in postchemotherapy retroperitoneal lymph node dissection specimens.

Transl Androl Urol 2021 Apr;10(4):1647-1655

Department of Urology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.

Background: To identify a combination of microRNAs (miRNA) to differentiate between viable tumor (V) or teratoma (T) and necrosis/fibrosis (N) in pcRPLND specimens of metastatic germ cell tumor (GCT) patients with residual masses ≥1 cm after chemotherapy. Biomarker guided therapy could reduce overtreatment with pcRPLND in patients with only N.

Methods: We selected 48 metastatic GCT patients who had undergone pcRPLND. V, pure T and N was shown in the resected tissue of 16 patients, respectively. Of these areas total RNA was isolated and miRNA expression was analyzed for miR-371a-3p, 375-3p, and 375-5p using qPCR. ROC analysis was performed for each miRNA and for all combinations in order to determine the discriminatory capacity of V and T . N.

Results: On comparing V . N miR-371a-3p achieved the highest fold change (FC) of 31.1 (P=0.023) while for T . N miR-375-5p performed best (FC 64.2; P<0.001). Likewise, the most accurate AUC for V was 0.75 using miR-371a-3p, for T 0.80 using miR-375-5p. Combining the best performing miRNAs for V and T resulted in an AUC of 0.94 with a sensitivity of 93.75, specificity of 93.75, PPV of 96.8 and NPV of 83.3.

Conclusions: By combining miR-371a-3p and miR-375-5p in pcRPLND tissue samples V and T could be distinguished from necrosis/fibrosis with great accuracy. This combination of miRNAs might serve as new biomarker in the future, in order to spare miRNA-negative patients from pcRPLND. However, further studies analyzing patient's serum are needed to confirm the clinical impact of these biomarkers.
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http://dx.doi.org/10.21037/tau-20-1349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100847PMC
April 2021

Diverticular disease is associated with an increased incidence rate of depression and anxiety disorders.

Int J Colorectal Dis 2021 May 3. Epub 2021 May 3.

Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.

Background: Diverticular disease represents a gastrointestinal disorder of high prevalence in developed countries that often leads to psychological distress. Here, we aimed at evaluating a potential association between diverticular disease and depression or anxiety disorders in outpatients in Germany.

Methods: Using the Disease Analyzer database featuring data of over 8 million patients treated in German general practices, we identified 61.556 patients with diverticular disease (ICD-10: K57) who were 1:1 matched by age, sex, index year, and the Charlson Comorbidity Index to 61.556 patients without diverticular disease. The association between diverticular disease and depression or anxiety disorders was evaluated in Cox regression models.

Results: Within 5 years after the initial diagnosis of diverticular disease, 14.0% of patients with and 10.6% of individuals without diverticular disease were diagnosed with depression (HR 1.34, 95%CI 1.29-1.39, p < 0.001). Similarly, the incidence of anxiety disorder was significantly higher in patients with diverticular disease (HR 1.55, 95%CI 1.46-1.64, p < 0.001). Finally, the prescription rate for antidepressant drugs was significantly higher in diverticular disease patients compared to individuals without diverticular disease (9.4% vs. 6.1%, HR 1.56, 95%CI 1.49-1.62, p < 0.001). These associations were confirmed for different age groups and both sexes.

Conclusion: Our data provide evidence that diverticular disease is associated with an increased incidence of depression and anxiety disorders. Despite that fact that confounding factors such as deprivation and patient personality have to be taken into account, we suggest that patients with diverticular disease are regularly screened for symptoms of depression and anxiety disorders.
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http://dx.doi.org/10.1007/s00384-021-03937-3DOI Listing
May 2021

CT-based determination of excessive visceral adipose tissue is associated with an impaired survival in critically ill patients.

PLoS One 2021 16;16(4):e0250321. Epub 2021 Apr 16.

Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany.

Objective: Obesity is a negative prognostic factor for various clinical conditions. In this observational cohort study, we evaluated a CT-based assessment of the adipose tissue distribution as a potential non-invasive prognostic parameter in critical illness.

Methods: Routine CT-scans upon admission to the intensive care unit (ICU) were used to analyze the visceral and subcutaneous adipose tissue areas at the 3rd lumbar vertebra in 155 patients. Results were correlated with various prognostic markers and both short-term- and overall survival. Multiple statistical tools were used for data analysis.

Results: We observed a significantly larger visceral adipose tissue area in septic patients compared to non-sepsis patients. Interestingly, patients requiring mechanical ventilation had a significantly higher amount of visceral adipose tissue correlating with the duration of mechanical ventilation. Moreover, both visceral and subcutaneous adipose tissue area significantly correlated with several laboratory markers. While neither the visceral nor the subcutaneous adipose tissue area was predictive for short-term ICU survival, patients with a visceral adipose tissue area above the optimal cut-off (241.4 cm2) had a significantly impaired overall survival compared to patients with a lower visceral adipose tissue area.

Conclusions: Our study supports a prognostic role of the individual adipose tissue distribution in critically ill patients. However, additional investigations need to confirm our suggestion that routine CT-based assessment of adipose tissue distribution can be used to yield further information on the patients' clinical course. Moreover, future studies should address functional and metabolic analysis of different adipose tissue compartments in critical illness.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250321PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051769PMC
April 2021

Salvage management of patients with relapsing testicular germ cell tumors.

Curr Opin Urol 2021 05;31(3):206-213

Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Germany.

Purpose Of Review: This review aims to summarize the latest evidence of medical and surgical treatment options for patients with relapsing testicular germ cell tumors.

Recent Findings: Depending on International Germ Cell Cancer Classification Group risk classification 10-50% of patients with metastatic TGCT develop relapse which needs further multimodality treatment. With regard to therapy, early relapses are stratified according to their prognostic risk profile which results in a 3-year overall survival between 6% in the very high to 77% in the very low risk group. Prognostic risk score dictates systemic therapy which might be second line chemotherapy (TIP, PEI) or high dose chemotherapy. Any residual masses following salvage chemotherapy need to be completely resected due the presence of viable cancer and/or teratoma in more than 50% of cases. Targeted therapy in men with druggable mutations is for individualized cases only. Patients with late relapses developing more than 2 years after first-line chemotherapy are best managed by surgery. Desperation surgery is reserved for those patients with rising markers during or immediately after chemotherapy and good risk factors such as rising alpha-fetoprotein, <3 metastatic sites and complete resectability. Multimodality treatment will result in long-term cure of 25% to 60%. Due to the complexity of treatment, chemotherapy as well as surgery should be performed in highly experienced centres only.

Summary: Multimodality treatment to salvage relapsing patients with metastatic testis cancer requires extensive experience for both systemic therapy and surgery. If done properly, it will result in moderate to high cure rates. Personalized therapeutic options are currently evaluated in clinical trials.
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http://dx.doi.org/10.1097/MOU.0000000000000875DOI Listing
May 2021

Elevated soluble urokinase plasminogen activator receptor serum levels indicate poor survival following transarterial chemoembolization therapy for hepatic malignancies: An exploratory analysis.

JGH Open 2021 Mar 1;5(3):356-363. Epub 2021 Feb 1.

Department of Hepatology and Gastroenterology Charité University Medicine Berlin Berlin Germany.

Background And Aim: Transarterial chemoembolization (TACE) represents a standard of care for patients with intermediate-stage hepatocellular carcinoma (HCC) or liver metastases. However, identification of the ideal candidates for TACE therapy remains challenging. The soluble urokinase plasminogen activator receptor (suPAR) has recently evolved as a prognostic marker in patients with cancer; however no data on suPAR in the context of TACE exists.

Methods: Serum levels of suPAR were measured by an enzyme-linked immunosorbent assay in = 48 TACE patients (HCC: = 38, liver metastases: = 10) before intervention and 1 day after TACE, as well as in 20 healthy controls.

Results: Serum levels of suPAR were significantly elevated in patients with liver cancer compared to healthy controls. Patients with or without an objective tumor response to TACE therapy had comparable levels of circulating suPAR. Importantly, baseline suPARs above the ideal prognostic cut-off value (5.39 ng/mL) were a significant prognostic marker for reduced overall survival (OS) following TACE. As such, patients with initial suPAR levels >5.39 ng/mL showed a significantly reduced median OS of only 256 days compared to patients with suPAR serum levels below the cut-off value (median OS: 611 days). In line with previous data, suPAR serum concentrations correlated with those of creatinine but were independent of tumor entity, leukocyte count, and C-reactive protein in multivariate analysis.

Conclusion: Baseline suPAR serum levels provide important information on the postinterventional outcome of liver cancer patients receiving TACE.
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http://dx.doi.org/10.1002/jgh3.12501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7936623PMC
March 2021

Targeted Therapy in Patients with Metastatic Male Germ Cell Tumors.

Urol Int 2021 17;105(7-8):720-723. Epub 2021 Mar 17.

Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany.

Ten to fifteen percent of patients with metastatic testis cancer (mGCT) will develop chemorefractory disease of which about 50% will die. We report on the integration of next generation sequencing in daily clinical practice to identify druggable mutations in metastatic lesions of 3 patients with mGCT. Mutational analysis revealed KIT D820G, TP53, and NPM1 mutations as well as mismatch repair deficiency with loss of MSH2 and MSH6 proteins so that targeted therapy with sunitinib (n = 2) or pembrolizumab (n = 1) was initiated resulting in remarkable partial remissions for 9, 12+, and 15 months.
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http://dx.doi.org/10.1159/000510717DOI Listing
March 2021

The prognostic significance of lactate dehydrogenase levels in seminoma patients with advanced disease: an analysis by the Global Germ Cell Tumor Collaborative Group (G3).

World J Urol 2021 Mar 8. Epub 2021 Mar 8.

SWENOTECA, Trondheim, Norway.

Purpose: The prognostic significance of lactate dehydrogenase (LDH) in patients with metastatic seminoma is not defined. We investigated the prognostic impact of LDH levels prior to first-line systemic treatment and other clinical characteristics in this subset of patients.

Methods: Files from two registry studies and one single-institution database were analyzed retrospectively. Uni- and multivariate analyses were conducted to identify patient characteristics associated with recurrence free survival (RFS), overall survival (OS), and complete response rate (CRR).

Results: The dataset included 351 metastatic seminoma patients with a median follow-up of 5.36 years. Five-year RFS, OS and CRR were 82%, 89% and 52%, respectively. Explorative analysis revealed a cut-off LDH level of < 2.5 upper limit of normal (ULN) (n = 228) vs. ≥ 2.5 ULN (n = 123) to be associated with a significant difference concerning OS associated with 5-years OS rates of 93% vs. 83% (p = 0.001) which was confirmed in multivariate analysis (HR 2.87; p = 0.004). Furthermore, the cut-off LDH < 2.5 ULN vs. ≥ 2.5 ULN correlated with RFS and CRR associated with a 5-years RFS rate and CRR of 76% vs. 86% (p = 0.012) and 32% vs. 59% (p  ≤  0.001), respectively.

Conclusions: LDH levels correlate with treatment response and survival in metastatic seminoma patients and should be considered for their prognostic stratification.
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http://dx.doi.org/10.1007/s00345-021-03635-3DOI Listing
March 2021

Modern surgical strategies in the management of complex ureteral strictures.

Curr Opin Urol 2021 03;31(2):170-176

Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany.

Purpose Of Review: The purpose of this article is to outline the various therapeutic options of ureteral strictures.

Recent Findings: Ureteral strictures with consecutive hydronephrosis can be due to endourological and surgical procedures, inflammatory processes, radiation therapy as well as spontaneous passage of ureteral calculi. When planning surgical correction, stricture length, anatomical location as well as patients' characteristics like age, comorbidities and previous treatment in the peritoneal cavity, retroperitoneum or pelvis should be taken into consideration. Treatment options include not only surgical reconstruction techniques like simple stricture excision, end-to-end anastomosis, ureterolysis with omental wrapping, ureteroneoimplantation, renal autotransplantation and ureter-ileum replacement, but also minimally invasive procedures such as self-expandable thermostents and pyelovesical bypass prosthesis.

Summary: Various therapeutic options can be offered in the treatment of ureteral strictures, potentially leading to long-term success rate of more than 90% and a rate of significant complications < 5%.
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http://dx.doi.org/10.1097/MOU.0000000000000849DOI Listing
March 2021

[Using preorchiectomy tumor marker serum concentrations for International Germ Cell Consensus Classification (IGCCCG) risk group assignment results in significant numbers of up- and downstaging].

Urologe A 2021 Mar 11;60(3):337-343. Epub 2021 Jan 11.

Klinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.

Background: The prognostic classification system of the International Germ Cell Cancer Cooperative Group (IGCCCG) for testicular germ cell tumors is based on the histological subtype, location of the primary tumor, extent of metastatic spread and prechemotherapy tumor marker serum concentrations.

Objectives: In this study, we aim to identify whether the use of preorchiectomy instead of prechemotherapy tumor marker serum concentration has an impact on IGCCCG risk group assignment.

Materials And Methods: We performed a retrospective analysis including 135 patients with metastasized testicular germ cell tumors. Analysis of the clinical information with a focus on the tumor marker serum concentration preorchiectomy and prechemotherapy was performed, thus leading to the grouping of patients according to IGCCCG risk group assignment.

Results: Using preorchiectomy instead of prechemotherapy tumor markers led to an incorrect IGCCCG risk group classification in 8% (11/135) of all patients, and consequently to a non-guideline concordant treatment. Up-staging was observed in 8 of 11 patients, representing 6% (8/135) of the total patient cohort. Three of the 11 misclassified patients showed a down-staging and thus describe 2% (3/135) of the total patient cohort.

Conclusions: Using preorchiectomy tumor markers instead of prechemotherapy serum concentration might lead to an incorrect IGCCCG risk group assignment as well as non-guideline concordant treatment. Consequently, prechemotherapy tumor marker serum concentration should be applied for guideline concordant staging of patients.
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http://dx.doi.org/10.1007/s00120-020-01432-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7979643PMC
March 2021

Mxi-2 Dependent Regulation of p53 in Prostate Cancer.

Anticancer Res 2020 Oct;40(10):5539-5544

Department of Urology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany

Background/aim: Endothelin-1 (ET-1) is overexpressed in many types of cancer, inhibiting the release of the microRNA 15a (miR-15a) and inducing the production of Mxi-2. Our aim was to identify a molecular complex regulating p53 activity in prostate cancer (PCa).

Materials And Methods: DU145 cells were treated with ET-1, MAPK p38 inhibitor, Endothelin A receptor inhibitor (ETAR inhibitor) and Endothelin B receptor inhibitor (ETBR inhibitor). Extracts were analysed using Western Blot, immunoprecipitation and qRT-PCR. Furthermore, prostate cancer patient samples were analysed using qRT-PCR and ELISA.

Results: The hypothesised molecular complex was identified, with miR-15a, microRNA 1285 (miR-1285) and Mxi-2 levels up-regulated in patients in relation to increasing aggressiveness of PCa.

Conclusion: A complex composed of Argonaut 2 (Ago2)/Mxi-2/miR-1285 is involved in PCa. The expression of Mxi-2 correlates with increasing PCa aggressiveness and might be used as a non-invasive marker for the diagnosis and progression of PCa.
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http://dx.doi.org/10.21873/anticanres.14566DOI Listing
October 2020

Circulating levels of microRNA193a-5p predict outcome in early stage hepatocellular carcinoma.

PLoS One 2020 22;15(9):e0239386. Epub 2020 Sep 22.

Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany.

While tumor resection and liver transplantation (LT) represent potentially curative therapeutic options for patients with early-stage hepatocellular carcinoma (HCC), the identification of the ideal surgical candidates has remained challenging. Just recently, miRNA-193a-5p was described as a tumor suppressor in murine and human HCC but only little is known about circulating miRNA-193a-5p in HCC patients. Here, we evaluated serum levels of miR-193a-5p by qPCR in 41 HCC patients undergoing tumor resection (n = 33) or LT (n = 8) and 20 controls. Circulating relative miR-193a-5p levels were significantly elevated in HCC patients compared to healthy controls. While relative miR-193a-5p levels were comparable between patients of different underlying disease etiology and tumor size, high relative miR-193a-5p levels were predictive for the patients' postoperative outcome, which was confirmed in uni- and multivariate Cox-regression analysis. As such, HCC patients with a preoperative relative miR-193a-5p level above the ideal cut-off value (3.57) had a median overall survival (OS) of only 451 days compared to 1158 days in patients with a relative miR-193a-5p level below this cut-off value. Our data support a novel function of miR-193a-5p as a biomarker in early-stage HCC patients that might help to identify the best surgical candidates in terms of postoperative outcome.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239386PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508360PMC
November 2020

Skeletal Muscle Composition Predicts Outcome in Critically Ill Patients.

Crit Care Explor 2020 Aug 5;2(8):e0171. Epub 2020 Aug 5.

Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany.

Parameters of patients' body composition have been suggested as prognostic markers in several clinical conditions including cancer and liver transplantation, but only limited data on its value in critical illness exist to date. In this study, we aimed at evaluating a potential prognostic value of the skeletal muscle mass and skeletal muscle myosteatosis of critically ill patients at admission to the ICU.

Design: Exploratory observational cohort study.

Setting: An urban, academic medical institution.

Patients: One-hundred fifty-five patients treated for critical illness on a medical ICU.

Interventions: None.

Measurements And Main Results: We used routine CT scans to assess the patients' individual body composition. The skeletal muscle index as a surrogate for sarcopenia was defined as the total skeletal muscle area at the level of the third lumbar vertebra on axial CT scan, normalized for the patient's height. Myosteatosis was evaluated by assessing the mean skeletal muscle attenuation measured in Hounsfield unit at the same sectional plane. The skeletal muscle index and mean skeletal muscle attenuation at admission to the ICU were significantly higher in patients with long-term survival (180-day or 1-year mortality), while both parameters were comparable between short-term survivors and nonsurvivors (ICU mortality or 30-d mortality). Patients with a skeletal muscle index or mean skeletal muscle attenuation below our established ideal cutoff values (74.95 mm/cm and 29 Hounsfield unit) showed a significantly reduced overall survival. These findings were confirmed in univariate and multivariate Cox regression analyses. Furthermore, myosteatosis significantly correlated with the time of mechanical ventilation, the duration of hospital stay, and the presence of sepsis.

Conclusions: Our data suggest that sarcopenia and myosteatosis represent important prognostic factors in critically ill patients that can be easily obtained from routine CT scans. Both parameters at admission to the ICU yield important information on the patients' long-term outcome and might be used for early clinical decision-making in these patients.
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http://dx.doi.org/10.1097/CCE.0000000000000171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7418902PMC
August 2020

[Complication management for TUR of the bladder].

Aktuelle Urol 2020 Sep 12;51(5):450-455. Epub 2020 Aug 12.

Universitätsklinikum Köln, Klinik für Urologie, Köln.

Transurethral resection of bladder cancer is a standard procedure in urology which requires complete resection. Knowledge of the possible complications and their management is essential for practicing urologists. The most common complications are catheter related bladder symptoms, bleeding, infections and perforation of the bladder. Resection of the orifice and positional damage are seldom but severe complications which need immediate treatment. In this review, we summarise the above mentioned complications as well as their management.
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http://dx.doi.org/10.1055/a-1210-2163DOI Listing
September 2020

Impact of the COVID-19 Pandemic on Urologists in Germany.

Eur Urol Focus 2020 Sep 8;6(5):1111-1119. Epub 2020 Jun 8.

Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany.

Background: In order to contain the coronavirus disease 2019 (COVID-19) pandemic, Germany has implemented drastic restrictions on public or social life, while health institutions are invoked to postpone elective procedures. Although urologists are less involved in the direct treatment of COVID-19 patients, the current situation strongly affects the urological work routine.

Objective: To analyze the impact of the COVID-19 pandemic on various aspects of work and personal life among urologists in Germany.

Design, Setting, And Participants: A total of 589 urologists in Germany participated in an online survey between March 27 and April 11, 2020.

Outcome Measurements And Statistical Analysis: Participants were stratified into subgroups according to professional characteristics.

Results And Limitations: Most urologists rated Germany as "well prepared" and the increasing restrictions of social life as "very positive." Routine operation was more restricted in hospitals than in the outpatient sector (p = 0.046). Moreover, urologists from the outpatient sector felt significantly less prepared for the COVID-19 pandemic (p = 0.001), reported a higher shortage of protective medical equipment (p < 0.001), and described a tendency toward a higher level of threat (p = 0.054). Although restrictions regarding telemedicine approaches were reported by 60% of participants, the outpatient sector used telehealth more frequently than hospitals (25.5% vs 17.0%, p < 0.001). Limitations include the national design and the restricted survey period.

Conclusions: This survey systematically evaluates the impact of the COVID-19 pandemic on personal and professional aspects of German urologists. We identified several issues, such as a higher shortage of medical protective equipment in the outpatient sector that could trigger specific measures to further improve the quality of urological care in Germany.

Patient Summary: We evaluated a potential impact of the coronavirus disease 2019 (COVID-19) pandemic on professional and personal aspects of the urologists in Germany. Our results suggest that the outpatient sector should receive specific attention as, for example, shortage of protective equipment was more common.
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http://dx.doi.org/10.1016/j.euf.2020.06.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834409PMC
September 2020

Perception of the 2020 SARS-CoV-2 pandemic among medical professionals in Germany: results from a nationwide online survey.

Emerg Microbes Infect 2020 Dec;9(1):1590-1599

Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany.

The COVID-19 pandemic represents an unprecedented global challenge and implicates a wide range of burden on medical professionals. Here, we evaluated the perception of the COVID-19 pandemic among medical professionals in Germany. A total of  = 2827 medical professionals participated in an online survey between 27 March and 11 April. While most participants stated that Germany was well prepared and rated the measures taken by their employer as positive, subgroup analyses revealed decisive differences. The preventive measures were rated significantly worse by nurses compared to doctors ( < 0.001) and by participants from ambulatory healthcare centres compared to participants from maximum-care hospitals ( < 0.001). Importantly, shortage of protective medical equipment was reported more commonly in the ambulatory sector ( < 0.001) and in East German federal states ( = 0.004). Moreover, the majority of health care professionals (72.4%) reported significant restrictions of daily work routine. Finally, over 60% of medical professionals had concerns regarding their own health, which were more pronounced among female participants ( = 0.024). This survey may indicate starting points on how medical professionals could be supported in carrying out their important activities during the ongoing and future healthcare challenges.
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http://dx.doi.org/10.1080/22221751.2020.1785951DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473195PMC
December 2020

Telemedicine in Germany During the COVID-19 Pandemic: Multi-Professional National Survey.

J Med Internet Res 2020 08 5;22(8):e19745. Epub 2020 Aug 5.

Department of Medicine III, University Hospital Aachen, Aachen, Germany.

Background: In an effort to contain the effects of the coronavirus disease (COVID-19) pandemic, health care systems worldwide implemented telemedical solutions to overcome staffing, technical, and infrastructural limitations. In Germany, a multitude of telemedical systems are already being used, while new approaches are rapidly being developed in response to the crisis. However, the extent of the current implementation within different health care settings, the user's acceptance and perception, as well as the hindering technical and regulatory obstacles remain unclear.

Objective: The aim of this paper is to assess the current status quo of the availability and routine use of telemedical solutions, user acceptance, and the subjectively perceived burdens on telemedical approaches. Furthermore, we seek to assess the perception of public information quality among professional groups and their preferred communication channels.

Methods: A national online survey was conducted on 14 consecutive days in March and April 2020, and distributed to doctors, nurses, and other medical professionals in the German language.

Results: A total of 2827 medical professionals participated in the study. Doctors accounted for 65.6% (n=1855) of the professionals, 29.5% (n=833) were nursing staff, and 4.9% (n=139) were identified as others such as therapeutic staff. A majority of participants rated the significance of telemedicine within the crisis as high (1065/2730, 39%) or neutral (n=720, 26.4%); however, there were significant differences between doctors and nurses (P=.01) as well as between the stationary sector compared to the ambulatory sector (P<.001). Telemedicine was already in routine use for 19.6% (532/2711) of German health care providers and in partial use for 40.2% (n=1090). Participants working in private practices (239/594, 40.2%) or private clinics (23/59, 39.0%) experienced less regulatory or technical obstacles compared to university hospitals (586/1190, 49.2%). A majority of doctors rated the public information quality on COVID-19 as good (942/1855, 50.8%) or very good (213/1855, 11.5%); nurses rated the quality of public information significantly lower (P<.001). Participant's age negatively correlated with the perception of telemedicine's significance (ρ=-0.23; P<.001).

Conclusions: Telemedicine has a broad acceptance among German medical professionals. However, to establish telemedical structures within routine care, technical and regulatory burdens must be overcome.
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http://dx.doi.org/10.2196/19745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409912PMC
August 2020

Human chorionic gonadotropin-positive seminoma patients: A registry compiled by the global germ cell tumor collaborative group (G3).

Eur J Cancer 2020 06 29;132:127-135. Epub 2020 Apr 29.

Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Background: The prognostic role of human chorionic gonadotropin (hCG) and lactate dehydrogenase (LDH) serum levels in seminoma patients remains uncertain. This observational study evaluates the prognostic impact of tumour marker levels, and other clinicopathological findings, in hCG-positive seminoma patients.

Methods: Seminoma patients with serum hCG levels above normal at first diagnosis were eligible for recruitment. Statistical analysis, including multivariate regression, was performed to identify risk factors. Primary end-points were overall survival (OS) and recurrence-free survival (RFS).

Results: We recruited 1031 hCG-positive patients (stage I: n = 586; stage II + III: n = 427) diagnosed between 1981 and 2018. In metastatic disease, LDH levels ≥3 above upper normal limit (UNL) pre- (n = 109) or post-orchiectomy (n = 73) and patients aged ≥40 years (n = 187) were associated with poor prognosis: 5-year OS rates of 84% (LDH ≥3 UNL pre-orchiectomy) versus 92% (<3 UNL pre-orchiectomy) (hazard ratio [HR]: 3.155, [95% confidence interval {CI}: 1.28-7.75], P = 0.012), 82% (≥3 UNL post-orchiectomy) versus 92% (<3 UNL post-orchiectomy) (HR: 6.877, [95% CI: 1.61-29.34]; P = 0.009) and 86% (≥40 years) versus 91% (<40 years) (HR: 6.870, [95% CI: 1.45-13.37], P = 0.009), respectively. A subset of patients with hCG levels ≥2000 IU/l pre-orchiectomy (n = 17) exhibited a poor prognosis, with 5-year OS rates of 73% (≥2000 IU/l) versus 94% (<2000 IU/l) (HR: 3.936, [95% CI: 1.02-12.61], P = 0.047).

Conclusions: Age and LDH levels are significantly associated with poor prognosis in hCG-positive seminoma patients. A small number of patients, with levels of hCG ≥2000 IU/l, may represent a separate prognostic subgroup associated with impaired survival rates.
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http://dx.doi.org/10.1016/j.ejca.2020.03.022DOI Listing
June 2020

Circulating levels of soluble urokinase plasminogen activator receptor predict outcome after resection of biliary tract cancer.

JHEP Rep 2020 Apr 31;2(2):100080. Epub 2020 Jan 31.

Department of Medicine III, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.

Background & Aims: Surgical resection is the only potentially curative therapy for patients with biliary tract cancer (BTC), but 5-year survival rates after tumor resection have remained below 30%, corroborating the need for better stratification tools to identify the ideal surgical candidates. The soluble urokinase plasminogen activator receptor (suPAR) represents a mediator of inflammation and has been associated with distinct types of cancer. In this study, we evaluated a potential role of suPAR as a novel biomarker in patients undergoing BTC resection.

Methods: Tumor expression of uPAR was analyzed by immunohistochemistry in 108 BTC samples. Serum levels of suPAR were analyzed by ELISA in a training and validation cohort comprising a total of 117 patients with BTC and 76 healthy controls.

Results: High tumoral uPAR expression was associated with an adverse outcome after BTC resection. Accordingly, circulating levels of suPAR were significantly elevated in patients with BTC compared to healthy controls, as well as in patients with primary sclerosing cholangitis. Using a small training set, we established an optimal prognostic suPAR cut-off value of 3.72 ng/ml for patients with BTC. Importantly, preoperative suPAR serum levels above this cut-off value were associated with significantly impaired overall survival in both the training and validation cohort. Multivariate Cox-regression analysis including various clinicopathological parameters such as tumor stage, markers of inflammation and organ dysfunction, as well as tumor markers, revealed circulating suPAR levels as an independent prognostic marker following BTC resection. Finally, high preoperative suPAR levels were indicative of acute kidney injury after tumor resection.

Conclusion: Circulating suPAR represents a previously unrecognized biomarker in patients with resectable BTC, which might help to preoperatively identify the ideal candidates for liver surgery.

Lay Summary: Surgical resection represents the only curative treatment option for patients with biliary tract cancer, but not all patients benefit to the same extent in terms of overall survival. Here, we provide evidence that serum levels of an inflammatory mediator (suPAR) are indicative of a patient's postoperative outcome and might thus help to identify the ideal surgical candidates.
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http://dx.doi.org/10.1016/j.jhepr.2020.100080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7049662PMC
April 2020

Testis-preserving strategies in testicular germ cell tumors and germ cell neoplasia .

Transl Androl Urol 2020 Jan;9(Suppl 1):S24-S30

Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital of Cologne, Cologne, Germany.

Testicular germ cell tumors (TGCT) are rare malignancies which affect young adults and adolescents between the ages of 15 and 40 years. In suspected malignant TGCT, the treatment of choice is radical orchiectomy. However, in specific cases this routine surgical approach has been challenged in favor of an organ-preserving approach with comparable oncological outcome. Thus, testis-preserving strategies should be considered in unilateral or bilateral synchronous or metachronous TGCT as well as incidentally found small testicular masses, which are mostly benign lesions including Sertoli cell tumors, Leydig cell tumors, adenomatoid tumors or epidermoid cysts. In case of a testis-preserving surgery, adjuvant postoperative radiation therapy (20 Gy) is recommended. The rational for this approach is that the remaining parenchyma harbors germ cell neoplasia in situ (GCNIS), which might lead to locally recurrent TGCT in 50% in the next following 5 years. However, testicular radiotherapy might result in infertility and 'Sertoli-cell only' syndrome because of radiation-induced destruction of germ cells as well as Leydig cell insufficiency in 20% of all patients leading to life-long androgen substitution. Therefore, radiation therapy should be delay or sperm banking be should performed in fertile patients wish to have children. This review provides an overview on literature regarding testis-preserving strategies in TGCT as well as GCNIS.
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http://dx.doi.org/10.21037/tau.2019.07.22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995842PMC
January 2020

Role of primary retroperitoneal lymph node dissection in stage I and low-volume metastatic germ cell tumors.

Curr Opin Urol 2020 03;30(2):251-257

Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA.

Purpose Of Review: Early-stage testicular cancers are highly curable. Following orchidectomy, management options for stage I disease include active surveillance, nerve-sparing retroperitoneal lymph node dissection (nsRPLND) and primary chemotherapy as recommended by the current guidelines. Primary RPLND has for decades played an integral part of treatment in patients with early-stage testicular germ cell tumors (TGCT), particularly in nonseminomatous germ cell tumors (NSGCT) with focus on reducing the long-term morbidity. We review the role of RPLND in stage I NSCGT as well as stage II A/B NSGCT and as seminoma.

Recent Findings: Radiation therapy and systemic chemotherapy are established treatments for seminoma; however, long-term data has demonstrated the association of such therapies with late toxicity including secondary malignancies, hearing loss, cardiovascular disease as well as metabolic syndromes. Given the well established role of RPLND in NSGCTs, clinicians have developed an interest in utilization of surgery for low-volume retroperitoneal metastatic disease. Two prospective clinical trials (SEMS and PRIMETEST) are underway to determine the role of RPLND alone in low volume metastatic seminoma.

Summary: RPLND is a highly effective treatment for early-stage germ cell tumors but represents overtreatment in low-volume stage I disease where active surveillance is recommended. RPLND has shown a promising role in low-volume stage II seminomas. Two phase II clinical trials are underway to further determine the curative potential of this approach.
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http://dx.doi.org/10.1097/MOU.0000000000000736DOI Listing
March 2020

Vimentin 3 Allows Differentiation between Normozoospermia and Oligoasthenoteratozoospermia.

Dis Markers 2019 10;2019:9803498. Epub 2019 Dec 10.

Department of Urology, University Hospital of Cologne, Germany.

Vimentin is a structural protein predominantly located in the head of sperms. The function and localization of the previously identified truncated version, Vimentin 3 (Vim3), are still unknown. To investigate whether the expression of Vim3 can be used as a reliable marker for the differentiation of sperm quality, we analyzed ejaculates from patients with oligoasthenoteratozoospermia (OAT) syndrome and normozoospermia. We identified sperms with head, neck, and tail changes, which were less positive for Vim3 in OAT syndrome compared to normozoospermia. The expression of Vim3 was significantly downregulated in patients with OAT syndrome compared to sperms from patients with normozoospermia ( < 0.01). The ELISA analysis showed similar results as ejaculates from normozoospermic patients showed a significantly higher Vim3 concentration than patients with OAT syndrome ( < 0.001). This study demonstrates that Vim3 is more highly expressed in ejaculates from patients with normozoospermia compared to ejaculates from patients with OAT syndrome. Therefore, we postulate that Vim3 can be used to determine ejaculate quality. Furthermore, we identified the marker, Vim3, to differentiate between mature sperms with no morphological changes and sperms with head, neck, and tail changes. A lateral flow assay that allows quick analysis is currently under development.
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http://dx.doi.org/10.1155/2019/9803498DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925920PMC
May 2020

Radiomics allows for detection of benign and malignant histopathology in patients with metastatic testicular germ cell tumors prior to post-chemotherapy retroperitoneal lymph node dissection.

Eur Radiol 2020 Apr 11;30(4):2334-2345. Epub 2019 Dec 11.

Department of Urology, University Hospital of Cologne, Cologne, Germany.

Objectives: To evaluate whether a computed tomography (CT) radiomics-based machine learning classifier can predict histopathology of lymph nodes (LNs) after post-chemotherapy LN dissection (pcRPLND) in patients with metastatic non-seminomatous testicular germ cell tumors (NSTGCTs).

Methods: Eighty patients with retroperitoneal LN metastases and contrast-enhanced CT were included into this retrospective study. Resected LNs were histopathologically classified into "benign" (necrosis/fibrosis) or "malignant" (viable tumor/teratoma). On CT imaging, 204 corresponding LNs were segmented and 97 radiomic features per LN were extracted after standardized image processing. The dataset was split into training, test, and validation sets. After stepwise feature reduction based on reproducibility, variable importance, and correlation analyses, a gradient-boosted tree was trained and tuned on the selected most important features using the training and test datasets. Model validation was performed on the independent validation dataset.

Results: The trained machine learning classifier achieved a classification accuracy of 0.81 in the validation dataset with a misclassification of 8 of 36 benign LNs as malignant and 4 of 25 malignant LNs as benign (sensitivity 88%, specificity 72%, negative predictive value 88%). In contrast, a model containing only the LN volume resulted in a classification accuracy of 0.68 with 64% sensitivity and 68% specificity.

Conclusions: CT radiomics represents an exciting new tool for improved prediction of the presence of malignant histopathology in retroperitoneal LN metastases from NSTGCTs, aiming at reducing overtreatment in this group of young patients. Thus, the presented approach should be combined with established clinical biomarkers and further validated in larger, prospective clinical trials.

Key Points: • Patients with metastatic non-seminomatous testicular germ cell tumors undergoing post-chemotherapy retroperitoneal lymph node dissection of residual lesions show overtreatment in up to 50%. • We assessed whether a CT radiomics-based machine learning classifier can predict histopathology of lymph nodes after post-chemotherapy lymph node dissection. • The trained machine learning classifier achieved a classification accuracy of 0.81 in the validation dataset with a sensitivity of 88% and a specificity of 78%, thus allowing for prediction of the presence of viable tumor or teratoma in retroperitoneal lymph node metastases.
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http://dx.doi.org/10.1007/s00330-019-06495-zDOI Listing
April 2020

Serum Levels of Kisspeptin Are Elevated in Patients with Pancreatic Cancer.

Dis Markers 2019 20;2019:5603474. Epub 2019 Oct 20.

Department of Medicine III, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.

Pancreatic adenocarcinoma (PDAC) still represents a devastating disease associated with a very limited survival. Novel biomarkers allowing an early diagnosis as well as an optimal selection of suitable treatment options for individual patients are urgently needed to improve the dismal outcome of PDAC patients. Recently, alterations of Kisspeptin serum levels, a member of the adipokine family, were described in various types of cancers. However, the role of circulating Kisspeptin as a biomarker in PDAC patients is poorly defined. In this study, we measured Kisspeptin serum levels in a cohort of 128 prospectively enrolled PDAC patients undergoing surgical resection as well as 36 healthy controls. Kisspeptin concentrations were elevated in PDAC patients compared to control samples. Nevertheless, Kisspeptin serum levels were independent of tumor-related factors such as the tumor grading, TNM stage, or clinical features such as the ECOG performance status. Finally, in our analysis, neither preoperative nor postoperative Kisspeptin levels turned out as a significant predictor of overall survival after tumor resection. In conclusion, our data suggest that Kisspeptin concentrations are altered in PDAC patients but do not allow to predict patients' outcome after resection of PDAC.
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http://dx.doi.org/10.1155/2019/5603474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6854939PMC
April 2020

Comprehensive analysis of Twitter activity on #Incontinence.

Neurourol Urodyn 2020 01 20;39(1):440-446. Epub 2019 Nov 20.

Department of Urology, University of Munich (LMU), Munich, Germany.

Aim: The aim of this study is comprehensive analysis of the Twitter activity on #Incontinence.

Material And Methods: The following six functional-urology hashtags on Twitter were analyzed from 2015 to 2018 to gain a comprehensive insight into the topic: #Incontinence, #InterstitialCystitis, #OAB, #FPMRS, #BPH, and #UroBPH. For the Twitter analysis, Symplur Signals was used, which is a health care social media analytics tool.

Results: In total 191 383 tweets by 54 094 users in 2015 through 2018 were analyzed. A rise in the number of tweets could be identified for all six analyzed hashtags on functional urology, in summary, the numbers raised from 25 629 tweets in 2015 to 66 551 tweets in 2018. For the hashtag incontinence (#Incontinence), the number of tweets raised from 13 823 in 2015 to 19 996 in 2018 (+44.7%). Main influencers on functional urology topics identified by the Symplur algorithm were individuals from the health care sector in 44.6% of the cases and health care organizations in 36.5% of the cases, whereas for #Incontinence, only 7% of influencers were patients in 2018. The ten most common words connected to #Incontinence were Incontinence, Urinary, Women, Help, New, Bladder, Stress, Treatment, Pelvic, and Sex. Of the tweets, 66% were categorized as positive statements and 34% were categorized as negative.

Conclusion: Social media is an emerging tool of communication in urology, whereas discussions on #Incontinence are underrepresented compared to the high prevalence of urinary incontinence. In addition, patients' activity is low.
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http://dx.doi.org/10.1002/nau.24227DOI Listing
January 2020

External validation of 2 models to predict necrosis/fibrosis in postchemotherapy residual retroperitoneal masses of patients with advanced testicular cancer.

Urol Oncol 2019 11 17;37(11):809.e9-809.e18. Epub 2019 Sep 17.

Department of Urology, University Hospital Cologne, Cologne, Germany; Department of Urology, Medical University Vienna, Austria. Electronic address:

Objectives: Nonseminomatous testicular germ cell tumors with residual retroperitoneal lesions >1 cm are treated with postchemotherapy retroperitoneal lymph node dissection (pcRPLND). However, up to 50% of patients are overtreated since the histology shows only residual necrosis/fibrosis. We aim to validate the 2 currently best performing prediction models (Vergouwe and Leao) for postchemotherapy residual mass histology.

Methods And Materials: We performed a retrospective analysis including 402 patients who underwent a pcRPLND from 2008 to 2015. The study cohort was used to validate the 2 prediction models by Vergouwe and Leao using the published formulas and thresholds.

Results: Using our validation cohort, the Vergouwe model reached a significantly better area under the curve compared to the Leao model (0.760 (confidence interval 0.713-0.807) vs. 0.692 (0.640-0.744), P = 0.002) in the prediction of benign histology. At a threshold of >70% for the predicted probability of benign disease, the Leao model revealed that pcRPLND would be avoided in 10.2% of patients with benign disease with an error rate of 3.8% for viable tumor, while the Vergouwe model would avoid pcRPLND in 27.4% of all patients with benign disease with an error rate of 10.1% for viable tumor and 2.9% for teratoma. Adjusting the models to our data had no significant improvement. Limitations include the retrospective design.

Conclusions: The discriminatory accuracy of both models is not sufficient to safely select patients for surveillance strategy instead of pcRPLND. Therefore, further studies including new biomarkers are needed to optimize the accuracy of potential prediction models and to minimize pcRPLND overtreatment.
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http://dx.doi.org/10.1016/j.urolonc.2019.07.021DOI Listing
November 2019

[Personalised medicine in prostate cancer].

Aktuelle Urol 2019 Sep 29;50(5):509-512. Epub 2019 Aug 29.

Universitätsklinikum Köln, Urologie, Köln.

Prostate cancer is the most common cancer in men. Its incidence increases with age. New treatment options have been introduced and there is a clear trend to more aggressive treatment in newly diagnosed metastatic disease. While prolonged survival of patients has been achieved, the new expensive drugs are associated with an increased burden on the healthcare system. Meanwhile, similarly to other tumour entities, there is a pool of different drugs available with comparable oncologic efficacy, but different side-effects. Effective diagnostic investigation and treatment decisions require additional factors, above and beyond clinical parameters, for a more individual treatment approach. In castration-resistant prostate cancer (CRPCA), there are promising molecular markers for treatment decisions. In metastatic disease, liquid biopsies and next generation sequencing of metastatic biopsies allow for genetic analysis. These will provide more insight into tumour dynamics and allow for patient selection. This review concentrates on molecular markers in CRPCA.
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http://dx.doi.org/10.1055/a-0972-0824DOI Listing
September 2019

European Association of Urology Guidelines on Testis Cancer: Important Take Home Messages.

Eur Urol Focus 2019 Sep 16;5(5):742-744. Epub 2019 Aug 16.

Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany.

Testicular germ-cell tumors represent the most common solid neoplasms among young men aged 20-40 yr. Owing to interdisciplinary management and high chemosensitivity, cure rates are high even among patients with poor risk. Although the diagnostic and therapeutic approaches for organ-confined disease and low-volume and high-volume metastatic disease are well standardized and reported in numerous national and international guidelines, guidelines, high frequency of guideline noncompliance has recently been observed, resulting in poorer long-term outcomes. This article underlines the clinically most important messages that should be adhered to in the management of testis cancer patients to avoid patient harm and achieve the best therapeutic outcomes. These recommendations include: (1) a detailed pathology report by an experienced uropathologist; (2) organ-sparing surgery or frozen section analysis for patients with bilateral testis cancer or testicular masses of uncertain identity; (3) risk-adapted therapy for clinical stage I seminomas and nonseminomas; and (4) interdisciplinary management of patients with advanced testis cancer in high-volume centers. PATIENT SUMMARY: Management of testis cancer has been standardized but lack of compliance with guidelines is increasing, resulting in inferior oncological outcomes. Close adherence to guidelines and early referral of complex cases are of utmost importance for high cure rates.
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http://dx.doi.org/10.1016/j.euf.2019.08.002DOI Listing
September 2019

Primary Retroperitoneal Lymph Node Dissection or Chemotherapy in Nonseminomas with Low-Volume Metastatic Disease: Experience Matters.

Eur Urol Oncol 2020 04 2;3(2):207-208. Epub 2019 Aug 2.

Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Köln, Germany.

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http://dx.doi.org/10.1016/j.euo.2019.07.003DOI Listing
April 2020
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