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Bernard Lobel

Publications and source records attributed to Bernard Lobel.

At least 19 recordsLinked to original sources
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

Interest of pentoxifylline in ICSI with frozen-thawed testicular spermatozoa from patients with non-obstructive azoospermia.

Selection for intracytoplasmic sperm injection (ICSI) of viable frozen-thawed testicular spermatozoa obtained from patients suffering from non-obstructive azoospermia is very often long, difficult and sometimes impossible. The purpose of this study was to determine if the use of pentoxifylline (PF) could facilitate this selection in stimulating sperm motility. From January 2000 to December 2004, 108 ICSI cycles with non-obstructive azoospermia were performed. From these 108 cycles, in 64 cycles where no motile spermatozoa were observed or when the time search per spermatozoa was above 20 min, 1.5 mmol/l PF was used for 10 min, whereas the 44 other ICSI cycles were performed using spontaneously motile spermatozoa (control group). In all cases, PF either initiated the motility when no motile spermatozoa were observed, or stimulated the motility, reducing dramatically the time search per spermatozoa. The total fertilization rate was 54.2% versus 66.7% in the control group (P < 0.02). Twenty-nine pregnancies out of the 64 PF cycles (45.3% per cycle) occurred, including 20 deliveries of 23 healthy children and eight ongoing pregnancies, whereas 12 pregnancies were obtained in the control group (27.3% per cycle), including nine deliveries of 13 healthy children. In conclusion, in 100% of cycles pentoxifylline allows the selection of viable frozen-thawed testicular spermatozoa with the same outcome after ICSI as that observed with fresh ejaculated spermatozoa.

Adult↗
PubMed2006

Laparoscopic management of a transitional cell carcinoma arising in a right ectopic ureter.

Ectopic ureter is a rare abnormality, so presenting a transitional cell carcinoma (TCC) arising from an ectopic ureter is extremely rare. We report here a case of a man with an invasive transitional cell carcinoma arising from a right ectopic ureter and managed by laparoscopy. To our knowledge, this is the fourth case described in the literature, and the second case of a TCC arising in a right ectopic ureter.

Carcinoma, Transitional Cell↗
PubMed2005

Comparison of predictive accuracy of four prognostic models for nonmetastatic renal cell carcinoma after nephrectomy: a multicenter European study.

BACKGROUND: The objective of the current study was to compare, in a large multicenter study, the discriminating accuracy of four prognostic models developed to predict the survival of patients undergoing nephrectomy for nonmetastatic renal cell carcinoma (RCC). METHODS: A total of 2404 records of patients from 6 European centers were retrospectively reviewed. For each patient, prognostic scores were calculated according to four models: the Kattan model, the University of California at Los Angeles integrated staging system (UISS) model, the Yaycioglu model, and the Cindolo model. Survival curves were estimated by the Kaplan-Meier method and compared by the log-rank test. Discriminating ability was assessed by the Harrell c-index for censored data. The primary end point was overall survival (OS), and the secondary end points were cancer-specific survival (CSS) and disease recurrence-free survival (RFS). RESULTS: At last follow-up, 541 subjects had died of any causes, with a 5-year OS rate of 80%. The 5-year CSS and RFS rates were 85% and 78%, respectively. All models discriminated well (P < 0.0001). The c-indexes for OS were 0.706 for the Kattan nomogram, 0.683 for the UISS model, and 0.589 and 0.615 for the Yaycioglu and Cindolo models, respectively. The Kattan nomogram was found to improve discrimination substantially in the UISS intermediate-risk patients. CONCLUSIONS: The current study appears to better define the general applicability of prognostic models for predicting survival in patients with nonmetastatic RCC treated with nephrectomy. The results suggest that postoperative models discriminate substantially better than preoperative ones. The Kattan model was consistently found to be the most accurate, although the UISS model was only slightly less well performing. The Kattan model can be useful in the UISS intermediate-risk patients.

Adolescent↗
PubMed2005

Prognostic value of histologic subtypes in renal cell carcinoma: a multicenter experience.

PURPOSE: To analyze to what extent histologic subtype is of prognostic importance in renal cell carcinoma based on a large, international, multicenter experience. PATIENTS AND METHODS: Four thousand sixty-three patients from eight international centers were included in this retrospective study. Histologic subtype (1997 International Union Against Cancer [UICC] criteria of tumor response), age, sex, TNM stage, Fuhrman grade, tumor size, Eastern Cooperative Oncology Goup performance status (ECOG PS), and overall survival were determined in all cases. The prognostic values of clear cell, papillary, and chromophobe histologic features were assessed by uni- and multivariate analysis using the Kaplan-Meier method and Cox model, respectively. RESULTS: Clear cell, papillary, and chromophobe carcinomas accounted for 3,564 (87.7%), 396 (9.7%) and 103 (2.5%) cases, respectively. In univariate analysis, a trend toward a better survival was observed when clear cell, papillary, and chromophobe histologies were considered prognostic categories (log-rank P = .0007). However, in multivariate analysis, TNM stage, Fuhrman grade and ECOG PS, but not histology, were retained as independent prognostic variables (P < .001). CONCLUSION: The stratification in three main renal cell carcinoma histologic subtypes as defined by the 1997 UICC-American Joint Committee on Cancer consensus should not be considered a major prognostic variable comparable to TNM stage, Fuhrman grade and ECOG PS.

Adolescent↗
PubMed2005

EAU guidelines for the management of genitourinary tuberculosis.

Nearly one third of the world's population is estimated to be infected with Mycobacterium tuberculosis. Moreover, tuberculosis is the most common opportunistic infection in AIDS patients. Genitourinary tuberculosis is not very common but it is considered as a severe form of extra-pulmonary tuberculosis The diagnosis of genitourinary tuberculosis is made based on culture studies by isolation of the causative organism; however, biopsy material on conventional solid media may occasionally be required. Drug treatment is the first line therapy in genitourinary tuberculosis. Treatment regimens of 6 months are effective in most of the patients. Although chemotherapy is the mainstay of treatment, surgery in the form of ablation or reconstruction may be unavoidable. Both radical and reconstructive surgery should be carried out in the first 2 months of intensive chemotherapy.

Antitubercular Agents↗
PubMed2005

EAU guidelines on the diagnosis and treatment of urothelial carcinoma in situ.

OBJECTIVES: On behalf of the European Association of Urology (EAU), guidelines for the diagnosis, therapy and follow-up of patients with urothelial carcinoma in situ (CIS) have been established. METHOD: The recommendations in these guidelines are based on a recent comprehensive overview and meta-analysis in which two panel members have been involved (RS and AVDM). A systematic literature search was conducted using Medline, the US Physicians' Data Query (PDQ), the Cochrane Central Register of Controlled Trials, and reference lists in trial publications and review articles. RESULTS: Recommendations are provided for the diagnosis, conservative and radical surgical treatment, and follow-up of patients with CIS. Levels of evidence are influenced by the lack of large randomized trials in the treatment of CIS.

Carcinoma in Situ↗
PubMed2005

The utility of Ki-67 expression in the differential diagnosis of prostatic intraepithelial neoplasia and ductal adenocarcinoma.

Cribriform and/or papillary prostatic lesions observed on limited tissue, such as needle biopsy, can pose diagnostic dilemmas. One such area of difficulty is the distinction between papillary and/or cribriform prostatic high-grade prostatic intraepithelial neoplasia (HG-PIN) and ductal adenocarcinoma. Over 48 months, we identified 17 cases of ductal adenocarcinoma and 17 cases of HG-PIN from radical retropubic prostatectomy specimens. The HG-PIN lesions were in all cases associated with an acinar prostatic adenocarcinoma component. For each case, we evaluated the proliferative activity, assessed by Ki-67 immunohistochemistry. The majority (82%) of ductal adenocarcinomas were composed of mixed papillary and cribriform patterns, with the remaining demonstrating pure papillary or cribriform patterns. The HG-PIN lesions showed a papillary, cribriform, or mixed papillary/cribriform architecture. The proliferative activity, defined as Ki-67 labeling index, was statistically higher in ductal adenocarcinoma (mean 33%, range 21%-66%) as compared with HG-PIN (mean 6%, range 2%-15%), with no overlap in the Ki-67 indices (P = 0001). A combination of histological features and measurements of cellular proliferation may be helpful to distinguish HG-PIN from ductal adenocarcinoma in limited prostatic tissue samples.

Adenocarcinoma↗
PubMed2005

[Management of acute prostatitis, based on a series of 100 cases].

OBJECTIVES: To evaluate the current diagnostic and therapeutic management of acute prostatitis. MATERIAL AND METHODS: The authors report a series of 100 consecutive patients with a diagnosis of acute prostatitis managed between January 1999 and December 2003. They analysed the clinical and laboratory data and imaging findings leading to the diagnosis of acute prostatitis and then the modalities of treatment and follow-up of these patients. RESULTS: The median age was 56.5 years (range: 19-86 years). In 77% of cases, the initial septic syndrome was considered to be severe. Prostatic tenderness was detected on digital rectal examination in 68% of cases. In 76% of cases, the micro-organism responsible was Escherichia coli. 8% of patients had positive blood cultures. All patients presented laboratory signs of inflammatory syndrome, with elevated C Reactive Protein (CRP) in most cases. Renal and bladder ultrasound was performed in 49% of cases and CT was performed in 16% of cases. 92% of patients were treated with fluoroquinolones, as monotherapy in 34% of cases. The duration of prescription ranged from 2 weeks to 6 weeks. No aetiology was detected in 48% of cases, 8% were considered to be iatrogenic and 44% were associated with incomplete bladder emptying. CONCLUSION: Acute prostatitis, rapidly treated by aggressive and adapted antibiotics has a rapidly favourable outcome. Elevation of CRP and the presence of leukocyturia on urine dipsticks are almost constant and, when they are normal, the diagnosis of acute prostatitis should be questioned. Imaging is not required in the absence of diagnostic doubt and any suspicion of progression to abscess. The duration of antibiotic therapy varies from prescriber to prescriber reflecting the various guidelines. Guidelines on this subject are contradictory and further effort is required to achieve homogenization and application of these guidelines.

Acute Disease↗
PubMed2005

[Risks and benefits of total nephrectomy in elderly patients over the age of 80].

OBJECTIVE: There is currently no consensus concerning the age limit for the surgical management of kidney tumours and very limited data are available in the literature. The objective of this study was to evaluate the morbidity of renal cancer surgery in elderly patients in order to determine the benefit/risk balance. MATERIAL AND METHODS: A retrospective study was conducted in 157 patients operated for kidney tumour in our department. Two groups were defined: one group of 40 patients over the age of 80 years and another group of 117 patients under the age of 80 years at the time of surgery. The following elements were compared in the 2 groups: presence or absence of symptoms, general state (evaluated by the Eastern Cooperative Oncology Group score), associated comorbidities (evaluated by the American Society of Anesthesiologists score), preoperative haemoglobin and serum creatinine, histological examination of the tumour, medical and surgical complication rate, postoperative mortality, length of hospital stay and specific survival. RESULTS: Tumour characteristics were identical in each group except for the presence of distant metastases which were more frequent in the group of patients young than 80. Older patients had a significantly higher preoperative serum creatinine (p = 0.01), a higher ASA score (p = 0.001), a higher medical complication rate (p < 0.00001) and a higher mortality (p = 0.04). At the end of follow-up, the specific survival was comparable in the two groups (32.5% versus 40%). CONCLUSION: Tumour characteristics and specific survival after surgical management of kidney tumours are comparable in elderly patients and younger patients. The risks of complications and impaired renal function were higher in elderly patients undergoing total nephrectomy. Close surveillance as well as minimally invasive alternatives will probably have an increasingly important place in the future, especially in patients presenting a major surgical risk.

Adult↗
PubMed2005

[Treatment of benign prostatic hyperplasia (BPH) by transurethral needle ablation (TUNA) and 36-month follow-up of the retreatment rate].

OBJECTIVE: Benign prostatic hyperplasia (BPH) is a disease affecting about 25% of men over the age of 40. One half of these men report symptoms that interfere with their daily activities. MATERIAL AND METHODS: In this multicentre study, 102 patients with BPH were treated by transurethral needle ablation (TUNA). The efficacy of treatment was evaluated for 12 months after the operation by means of Madsen and IPSS (International Prostate Symptom Score) scores. The course of uroflowmetry and quality of life (International Score) and sexual function were also assessed for one year. The safety of treatment was evaluated according to the type and frequency of complications. The results show an immediate and significant improvement of symptoms (p < 0.0001 for Madsen and IPSS scores and maximum flow rate between M0 and M12) demonstrating the efficacy of the TUNA system. A very positive impact of TUNA was demonstrated on quality of life. No negative impact was reported on sexual function and the operation had very few repercussions with a low adverse event rate. The retreatment rate (surgical and/or drug) was evaluated 36 months after the operation by means of an optional follow-up questionnaire subsequently completed by the investigators. RESULTS: After 3 years, based on the 80 questionnaires returned, 43 patients (53.8%) were stable and did not need any other medical or surgical treatment for BPH. Thirty-seven (37) patients (46.3%) required retreatment: 21 were treated with drugs (26%), 17 were treated surgically (21.25%) including 1 patient who was also retreated with drugs. This study demonstrates the significant and lasting improvement of BPH symptoms by TUNA, which constitutes an alternative attractive to surgery in young patients and/or patients worried about their sexuality.

Catheter Ablation↗
PubMed2004

Use of the University of California Los Angeles integrated staging system to predict survival in renal cell carcinoma: an international multicenter study.

PURPOSE: To evaluate ability of the University of California Los Angeles Integrated Staging System (UISS) to stratify patients with localized and metastatic renal cell carcinoma (RCC) into risk groups in an international multicenter study. PATIENTS AND METHODS: 4,202 patients from eight international academic centers were classified according to the UISS, which combines TNM stage, Fuhrman grade, and Eastern Cooperative Oncology Group performance status. Distribution of the UISS categories was assessed in the overall population and in each center. RESULTS: The UISS stratified both localized and metastatic RCC into three different risk groups (P <.001). For localized RCC, the 5-year survival rates were 92%, 67%, and 44% for low-, intermediate-, and high-risk groups, respectively. A trend toward a higher risk of death was observed in all centers for increasing UISS risk category. For metastatic RCC, the 3-year survival rates were 37%, 23%, and 12% for low-, intermediate-, and high-risk groups, respectively; in 6 of 8 centers, a trend toward a higher risk of death was observed for increasing UISS risk category. A greater variability in survival rates among centers was observed for high-risk patients. CONCLUSION: This study defines the general applicability of the UISS for predicting survival in patients with RCC. The UISS is an accurate predictor of survival for patients with localized RCC applicable to external databases. Although the UISS may be useful for patients with metastatic RCC, it may be less accurate in this subset of patients due to the heterogeneity of patients and treatments.

Adult↗
PubMed2004

Frequency, clinical presentation and evolution of renal oncocytomas: multicentric experience from a European database.

OBJECTIVES: To understand the clinical behavior of renal oncocytoma in a retrospective analysis of a European multicentric nephrectomies database. METHODS: The records of 891 patients who underwent surgical resection of renal neoplasm were reviewed. Relevant clinical and pathological data for each patient were retrieved in a database. RESULTS: Thirty-two (3.6%) cases of renal oncocytoma were identified. Twenty patients (62.5%) were asymptomatic. No case of lymphatic invasion or metastatic disease, nor any evidence of vascular or fat tissue invasion was found. Thirty-one cases (96%) exhibited low mitotic activity. In one case the presence of renal clear cell carcinoma (diameter: 1.5cm) was found. After a median follow-up of 42 months, 87.5% of patients were alive with no evidence of tumor, while 9.3% of patients had died for non-malignant causes. One patient had not treated the tumor surgically and was disease-free at a 27-month follow-up. CONCLUSIONS: Renal oncocytoma is a benign neoplasm, characterized by slow growth and excellent prognosis after surgery. Nephron sparing techniques may be adequate for tumor removal.

Adenocarcinoma, Clear Cell↗
PubMed2004

The changing evolution of renal tumours: a single center experience over a two-decade period.

OBJECTIVES: To study the evolution of renal tumours treated in a single institution over a 2-decade period. MATERIAL AND METHODS: 729 patients surgically treated due to a renal tumour were included in this study. Age at diagnosis, gender, tumour size, TNM stage, percentage (%) of benign tumours, type of treatment, histologic subtype and mode of presentation were compared over 3 periods (1984-1992, 1993-1997, and 1998-2003). RESULTS: During the period of the study, the median tumour size decreased from 7.5 to 6 cm while the rate of nephron-sparing surgery (NSS) increased from 1.6 to 19.6% and from 3.1 to 46.9% in all tumours and in tumours measuring less than 4 cm respectively. In this former group, the percentage of benign tumours increased from 6.3 to 15.2% while the percentage of radical nephrectomies decreased from 100% to 54.2%. CONCLUSION: We are treating today a great amount of small good prognosis renal tumors as well as an increasing percentage of benign tumours. In both cases, expanding the role of NSS will significantly reduce the rate of useless radical nephrectomies.

Adolescent↗
PubMed2004

Immunohistochemical analysis of tumor polyamines discriminates high-risk patients undergoing nephrectomy for renal cell carcinoma.

Renal cell carcinoma (RCC) is known to display a wide variation in biological behavior and clinical outcome. Although usual bioclinical prognostic parameters (eg, nuclear grade, tumor stage) are to a certain extent useful in predicting the outcome of RCC after radical nephrectomy, they now appear to be insufficient. The polyamines (spermidine, spermine, and putrescine) are ubiquitous polycations that are essential for cell proliferation. To support their excessive proliferation, cancer cells have high rates of polyamine metabolism. Indeed, malignant cells typically have higher polyamine levels than their normal counterparts. Before this report, antipolyamine antibodies that are potentially valuable tools for the in situ observation of polyamines had not been exploited in clinical conditions. In the present study, tumor tissues obtained from radical nephrectomy performed for RCC (n = 73) were immunostained with the anti-spermine monoclonal antibody Spm8-2, and the immunoreactivity was evaluated as a prognostic tool. RCC cells displayed various reactivity to the antibody Spm8-2 that translated into a heterogeneous cytoplasmic staining. The prognostic value of the labeling index (LI) on clinical outcome was correlated with the usual clinicopathologic parameters, and the cell proliferation rate was evaluated using Ki-67 labeling. Multiple correspondence analysis and ascending hierarchical classification were performed to determine significant prognostic factors. Univariate statistical survival analysis demonstrated that tumor size (P < .001), nuclear grade (P < .01), necrosis (P < .007), tumor stage (P < .004), metastasis (P < .001), Ki-67 LI (P < .0003), and Spm8-2 immunoreactivity (P < .0001) were predictors of tumor-related death. A positive correlation was found between Ki-67 LI and Spm8-2 immunoreactivity (r' = .53). Multivariate analysis revealed that only Ki-67 LI and Spm8-2 immunoreactivity were significant independent factors in patients with metastases (P < .04 and <.001, respectively) and in patients without metastases (P < .006 and <.001, respectively). Moreover, 100% of the patients with Spm8-2 immunoreactivity <10% were alive at the end of the follow-up. In terms of predictive values, Spm8-2 immunoreactivity had the highest predictive values (sensitivity, 89; specificity, 75; risk ratio, 11) of all clinicopathologic parameters. This study demonstrates that the anti-spermine monoclonal antibody Spm8-2 may be used at the time of radical nephrectomy as a reliable prognostic marker for defining RCC patients at high risk for progression.

Adult↗
PubMed2004

Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience.

PURPOSE: We compared cancer specific survival of patients undergoing partial and radical nephrectomies for T1N0M0 renal tumors according to tumor size in a large multicenter series. MATERIALS AND METHODS: A retrospective analysis of 1454 patients undergoing partial or radical nephrectomy for T1N0M0 renal tumors from 7 international academic centers was performed. Data were obtained for each patient including TNM stage (determined according to the 2002 TNM criteria), tumor size, type of surgery (partial versus radical nephrectomy) and cancer specific survival. Recurrence events were recorded when available. RESULTS: Partial and radical nephrectomies were performed in 379 (26.1%) and 1075 (73.9%) cases, respectively. Mean followup +/- SD was 62.5 +/- 51.8 months. Recurrence data were available on 544 patients. There were no significant differences in local or distant recurrence rates between patients undergoing partial or radical nephrectomy for either T1a (p = 0.6) or T1b tumors (p = 0.5). For patients with T1a tumors, there was no significant difference in the rate of cancer specific deaths between the partial (314) and radical (499) nephrectomy groups (2.2% versus 2.6%, respectively, p = 0.8). For patients with T1b tumors there was also no significant difference in the rate of cancer specific deaths between patients undergoing partial (65) and patients undergoing radical (576) nephrectomy (6.2% versus 9%, respectively, p = 0.6). CONCLUSIONS: Partial nephrectomy is becoming the gold standard for renal tumors less than 4 cm but this treatment is much more controversial for larger T1 tumors. This large multicenter study suggests that it is safe to expand the indications of partial nephrectomy to include patients with T1N0M0 tumors up to 7 cm. However, careful patient selection remains necessary.

Carcinoma, Renal Cell↗
PubMed2004

Multi-institutional validation of a symptom based classification for renal cell carcinoma.

PURPOSE: We validate the prognostic value of a symptom based classification (S classification) in a multi-institutional study. MATERIALS AND METHODS: A total of 2,242 patients from 5 European centers were included in this study. Based on symptoms at diagnosis, patients were stratified into 3 groups of S1-asymptomatic tumors, S2-tumors with local symptoms and S3-tumors with systemic symptoms. Variables such as age, gender, tumor size, TNM stage, Fuhrman grade, Eastern Cooperative Oncology Group (ECOG) performance status, perinephric fat, renal vein and adrenal invasion were also considered for prognostic value. The end point of the study was cancer specific survival. Survival assessment was made with univariate and multivariate analyses using the Kaplan-Meier method and Cox regression analysis. RESULTS: Of the patients 1,018 (45.4%) were classified as S1, 865 (38.6%) S2 and 339 (16.0%) S3. The S classification correlated to tumor stage, grade and ECOG (p <0.001). On univariate analysis ECOG performance status, S classification, tumor size, TNM stage, Fuhrman grade, and adrenal, perinephric fat or vein invasion were significant prognostic factors (p <0.001). The S classification provided a significant prognostic stratification in the aggregate as well at each of the 5 centers. On multivariate analysis the S classification, TNM stage, Fuhrman grade, and perinephric fat and renal vein invasion remained independent prognostic factors (p <0.001). CONCLUSIONS: This study confirms that it is possible to graduate symptoms for a prognostic purpose. The proposed symptom score should be evaluated for its integration in prognostic algorithms.

Adolescent↗