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Bernard Lobel

Publications and source records attributed to Bernard Lobel.

At least 37 records · Page 2Linked to original sources
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↗
PubMed2004

Symptoms as well as tumor size provide prognostic information on patients with localized renal tumors.

PURPOSE: T stage stratification of organ confined renal tumors is based only on tumor size. Currently T1a and T1b are defined as tumors less or greater than 4 cm. However, to our knowledge the validity of this stratification has not been determined. We determined whether symptoms could add additional prognostic information when integrated with tumor size into the TNM classification. MATERIALS AND METHODS: Patients with T1-T2N0M0 renal tumors at 6 academic centers in Europe and the United States were included in this study. T stage was defined according to the 2002 TNM classification. Age, gender, T stage, tumor size, symptoms at presentation, Fuhrman grade and cancer specific survival were determined in all cases. Survival estimates were compared using the Kaplan-Meier method and multivariate analysis of the data were performed with the Cox model. RESULTS: A total of 1,771 patients with pT1-T2N0M0 renal tumors were included in this study. There were 1,148 males and 623 females. Mean age was 59.6 years. Median tumor size was 5 cm. Of the tumors 781 (44.1%), 616 (34.8%) and 374 (21.1%) were stages T1a, T1b and T2, respectively. In 825 patients (46.6%) symptoms were related to renal cancer. T stage and symptoms strongly correlated, in that 67%, 51% and 29% of patients with T1a, T1b and T2 tumors, respectively, were asymptomatic. Symptoms increased the risk of cause specific death for each T stage level. On multivariate analysis Fuhrman grade (HR 1.46), T stage (HR 1.81) and symptoms (HR 2.98) were independent predictors of survival. Based on these results 4 groups resulting from combinations of 2002 TNM stage and symptoms with significantly different risks of death were defined, namely 1) T1a-4 cm or less without symptoms, 2) T1b-4 cm or less with symptoms and greater than 4 cm without symptoms, 3) T2a-greater than 4 cm and 7 cm or less with symptoms, and 4) T2b-greater than 7 cm with symptoms CONCLUSIONS: In this study we noted that a system combining tumor size and symptoms can accurately stratify patients for predicting survival in those with organ confined renal tumors. Our data support the idea that symptoms should be integrated in further modifications of the TNM system.

Adolescent↗
PubMed2004

[Clinical and histological prognostic factors of renal cancer with caval thrombus].

OBJECTIVES: The objective of this study was to determine the clinical and histological factors influencing survival of patients with renal cancer and caval thrombus. MATERIAL AND METHODS: The clinical and pathological data of 46 patients operated for renal cancer with caval thrombus were reviewed. The following prognostic factors were studied: tumour stage and grade, tumour diameter, invasion of the perirenal fat or adrenal gland, presence of lymph node involvement or distant metastases, level of the thrombus, invasion of the wall of the vena cava, partial or complete nature of the resection. Survival was determined by the Kaplan-Meier method and multivariate analysis was performed with the Cox test. RESULTS: The study population comprised 30 males and 16 females with a mean age of 64.4 years. The mean tumour diameter was 10.6 cm. Twelve thrombi were perirenal (26.1%), 15 were infrahepatic (32.6%), 12 were retrohepatic (26.1%), and 7 were supradiaphragmatic (15.2%). Forty four tumours were stage T3 and 2 were stage T4. Fifteen tumours were N1-2 or M1 (32.6%). The median disease-specific survival was 22 months and the 5-year survival rate was 25%. On univariate analysis, complete resection, lymph node invasion and metastases and adrenal gland invasion had an impact on survival. On multivariate analysis, only the presence of metastases had an independent prognostic value. CONCLUSION: This study confirms the prognostic value of certain factors (lymph node invasion and metastases, complete tumour resection) and raises the question of the prognostic significance of adrenal gland invasion. On the basis of these data, the authors recommend that surgery should only be performed in patients with a good general status, without metastases and in whom complete resection of the tumour mass appears to be possible.

Adult↗
PubMed2003

Prospective study comparing two methods of anaesthesia for prostate biopsies: apex periprostatic nerve block versus intrarectal lidocaine gel: review of the literature.

INTRODUCTION: Studies have demonstrated the need for pain control during multiple transrectal prostate biopsies. Due to encountered published results on periprostatic nerve block, we prospectively evaluated the efficacy and safety of periprostatic local anaesthesia at the apex in comparison to intrarectal lidocaine gel. METHODS: From January 2001 to January 2002 110 patients underwent prostate biopsy. Patients were randomized to receive 10 cc of either 2% lidocaine gel intrarectally (Group 1) or 10 cc of 1% lidocaine solution injected under ultrasound guidance for bilateral periprostatic nerve block at the apex (Group 2). Pain during biopsy was assessed using a 10-point linear visual analog pain scale and a 5-point digital visual pain scale (continuous variables). Statistical analysis of pain scores was performed using the Student t-test. RESULTS: 96 patients fitted the inclusion and presented no exclusion criteria. 43 patients composed group 1, and 53 patients group 2. The mean pain score was 2.76+/-1.69 and 1.73+/-1.26 for group 1 and 2, respectively for the 10-point linear visual analog pain scale (p=0.001). The mean pain score was 2.26+/-0.82 and 1.62+/-0.56 for groups 1 and 2, respectively for the 5-point digital visual pain scale (p<0.001). There was no difference in mean patient age (p=0.348), prostate size (p=0.899), serum PSA (p=0.932), and complications when comparing both groups. The number of biopsies per patient was significantly higher in group 2 (p=0.006), but pain scores in each scale were significantly less. CONCLUSIONS: Periprostatic nerve block at the apex is superior to intrarectal lidocaine gel for controlling pain during transrectal prostate biopsy, with no increased complications. This technique should be recommended for those patients without anal or rectal inflammatory diseases.

Administration, Rectal↗
PubMed2003

Correlation between symptom graduation, tumor characteristics and survival in renal cell carcinoma.

OBJECTIVES: To compare renal tumors with respect to initial clinical presentation and assess the prognostic value of a symptom based classification. MATERIAL AND METHODS: Based on symptoms at diagnosis, 388 renal tumors were stratified into three groups: (1) asymptomatic tumors; (2) tumors with local symptoms (3) tumors with systemic symptoms. The three groups were compared for usual clinical and pathological variables using chi(2)-tests and Anova regression, for qualitative and quantitative variables, respectively. Survival assessment was made with univariate and multivariate analysis using the Kaplan-Meier method and Cox regression analysis. RESULTS: The three defined groups were significantly different for all analysed variables except for age, sex ratio and pathological subtype. In univariate analysis: ECOG performance status, symptom classification, tumour size, TNM stage and grade, adrenal, perinephric fat or vein invasion were significant prognostic factors (p<0.001). In multivariate analysis, symptom classification, TNM stage, Fuhrman grade and perinephric fat invasion remained independent prognostic factors (p<0.001). CONCLUSION: The proposed classification merits further validation through multi-institutional studies before integrating it in further prognosis algorithms.

Adult↗
PubMed2003

The current status of intravesical therapy for superficial bladder cancer.

PURPOSE OF REVIEW: To analyse recent advances in intravesical instillation therapy for superficial bladder cancer. RECENT FINDINGS: Although intravesical bacillus Calmette-Guérin has been used for many years in the treatment of superficial bladder cancer, its mechanism of action remains unclear, its poor tolerance remains a problem, the prediction of its efficacy has still to be validated, and its long-term effects on progression and survival are controversial. The exact timing and place of intravesical chemotherapy needs to be better defined, as well as the place of some new molecules. Finally, new approaches need to be explored for overcoming the limitations of the usual intravesical agents. SUMMARY: No dramatic advances have been made in understanding the mechanisms of action of bacillus Calmette-Guérin during the past year. However, a careful dissection of this complex immunological pathway continues and immunological criteria are promising for predicting the response to bacillus Calmette-Guérin. Evidence has been accumulating to suggest that a dose reduction during the initial treatment remains effective and reduces side-effects. In addition, bacillus Calmette-Guérin maintenance therapy is useful for high-risk patients. However, long-term tolerance remains an important issue, and the optimal protocol has not yet been defined. On the other hand, it has been proved that intravesical chemotherapy, when administered early after transurethral resection, is effective in preventing frequent recurrences, whereas maintenance chemotherapy is ineffective. Finally, new approaches, including instillations of activated immune cells or targeted gene therapy, are being explored.

Adjuvants, Immunologic↗
PubMed2003

[Correlation between the mode of presentation of renal tumors and patient survival].

OBJECTIVES: To establish a symptom score and to test its prognostic value in comparison with the usual histological prognostic criteria. MATERIAL AND METHODS: 388 renal tumours were classified into three symptomatic grades according to the circumstances of discovery: S1: incidental discovery, S2; patient presenting with haematuria or low back pain, S3: patient presenting with alteration of general state or symptomatic metastasis. The following prognostic criteria were studied: age, gender, tumour volume, symptom score, ECOG (0 vs 1 or more), stage (TNM 1997), Fuhrman grade, venous and adrenal invasion. Survival rates were compared by the Kaplan-Meier method (Log rank test). Multivariate analysis was performed according to the Cox model. RESULTS: Tumours were classified as T1, T2, T3, T4 in 140 (36.1%), 73 (18.80%), 162 (41.8%) and 13 (3.4%) cases, respectively. 31 tumours were graded as G1 (8%), 167 as G2 (43%), 152 as G3 (39.2%) and 38 as G4 (9.8%), 143 tumours were classified as S1 (36.9%), 159 as S2 (41%) and 86 as S3 (22.10%). 45 patients were N+ (11.6%) and 54 were M+ (13.9%), The mean follow-up was 73 months. The significant parameters on univariate analysis were: ECOG, symptom score, TNM stage, grade, venous and adrenal invasion and tumour volume (p < 0.001), while symptom score, TNM stage and Fuhrman grade were significant on multivariate analysis (p < 0.001). CONCLUSION: The symptom score is an independent prognostic factor in the same way as tumour stage and grade. This score could be used in a mathematical algorithm predictive of survival of patients with renal cancer.

Carcinoma, Renal Cell↗
PubMed2003

[Complications of TVT].

Surgical repair of stress urinary incontinence by TVT was first performed in France in 1998, without any real evaluation of the morbidity related to this product before its release onto the market. In the context of the Necker 2002 report, a review of the literature and a multicentre study were performed to clarify this point. Bladder perforation, frequent during the early part of the learning curve, requires repositioning of the TVT and bladder catheterization for 48 hours, but does not cause any increase in postoperative morbidity. Urethral perforation, much less common, is a contraindication to maintenance of the TVT. Postoperative obstruction occurs in 5% to 12% of cases, and initially requires self-catheterization, as early section of TVT must be avoided. De novo instability is observed in 6% to 12% of cases, especially in the case of incomplete obstruction or a gaping bladder neck. Erosions due to TVT appear to be uncommon and are essentially vaginal.

Humans↗
PubMed2003

[PSA: the difficult position of general practitioners between patients and urologists].

OBJECTIVE: To determine the reasons for ordering PSA assay and delayed referral to an urologist following detection of elevated PSA in general practice. MATERIAL AND METHOD: Retrospective study of 200 patients referred to the department by general practitioners for elevated PSA from September 2000 to April 2001. RESULTS: The median age was 67 years (range: 52 to 87). The median PSA was 7.9 ng/ml (range: 4.1 to 897). Patients were referred after 1 to 5 PSA assays (mean: 1.6) with a median interval after discovery of elevated PSA of 1.7 months. The referral time was greater than 6 months for 52 patients (26%) and 31 patients (15.6%) were referred after more than two PSA assays were found to be elevated. PSA assay was ordered in the absence of symptoms or abnormal digital rectal examination in 43% of patients over the age of 70 years. CONCLUSION: Prostate cancer screening is regularly performed in general practice. The information given to general practitioners, faced with a well informed population, appears to be insufficiently clear, as PSA assay is sometimes incorrectly ordered or interpreted.

Aged↗
PubMed2003

[Intraperitoneal bladder rupture during transurethral resection of the prostate].

Bladder explosions are a rare complication of endoscopic surgery caused by massive cellular hydrolysis during electrocoagulation, releasing a mixture of gases that becomes explosive in contact with oxygen. Oxygen may enter the bladder as a result of manipulation of the resector, incorrect use of the Ellick evacuator bulb or introduction of air bubbles via the irrigation tubing. This risk can therefore be limited by taking certain precautions. The authors report a new case of intraperitoneal bladder rupture during transurethral resection of the prostate.

Adenoma↗
PubMed2003

[Neuroendocrine differentiation of bladder tumors].

Neuroendocrine bladder tumours (NET) constitute a group of various tumours with a common neuroendocrine phenotype. This is a very well defined entity (morphological, immunohistochemical, and ultrastructural). The great majority of bladder NETs reported in the literature are high-grade small cell carcinomas, but large cell carcinoma are probably underestimated due to the lack of systematic investigation. This paper reviews these rare, poorly known tumours, which require specific management. All bladder NETs are described. The frequency and diagnostic and therapeutic strategy of neuroendocrine bladder tumours are described.

Humans↗
PubMed2002

Guidelines on bladder cancer.

OBJECTIVES: On behalf of the European Association of Urology (EAU) guidelines for diagnosis, therapy and follow-up of bladder cancer patients were established. Criteria for recommendations were evidence based, and included aspects of cost-effectiveness and clinical feasibility. METHOD: A systematic literature research using Medline Services was conducted. References were weighted by a panel of experts. RESULTS: TNM 1997 classification and WHO grading 1998 are recommended. Recommendations are developed for diagnosis for bladder cancer in general, treatment of superficial and infiltrative bladder cancer, and follow-up after different types of treatment modalities, such as intravesical instillations, radical cystectomy, urinary diversions, radiotherapy and chemotherapy.

Follow-Up Studies↗
PubMed2002

Intravesical Bacillus Calmette-Guerin treatment improves patient survival in T1G3 bladder tumours.

OBJECTIVE: To study the clinical and pathological factors that affect recurrence, progression and survival in pT1G3 bladder tumours treated conservatively. MATERIAL AND METHODS: From January 1979 to December 1996, 80 patients were conservatively treated for pT1G3 bladder tumours. All patients were studied for potential prognostic factors such as: age, sex, previous tumour recurrence, tumour size, multiple tumours, carcinoma in situ, and intravesical instillations. A longitudinal, retrospective, observational and analytical study was conducted to evaluate four different types of events: recurrence, progression, overall survival, and disease-specific survival. The chi(2) (Fischer exact test) and student t tests were used to assess the prognostic value of the qualitative and quantitative variables. Estimations of the survival distributions were calculated according to the Kaplan-Meier method and compared with the Log rank test. Multivariate analysis of the data was performed with Cox proportional hazard models. RESULTS: Among the 80 patients, 67 (84%) were men and 13 (16%) were women, with median age of 65.5 years. The median tumour size was 20 mm, most had single tumour (58.8%) and carcinoma in situ was found in six patients (7.5%). Thirty patients were treated with transurethral resection (TUR) of the bladder tumour and 50 patients were treated with TUR followed by BCG. The two groups of patients were comparable and followed up during a median time of 61 and 65 months, respectively (p=0.454). Kaplan-Meier estimators and Log rank tests demonstrated that patients with TUR alone recurred (p<0.0001), progressed (p<0.040) and died (overall survival: p<0.009; disease-specific p<0.040) earlier than patients who received intravesical instillations of BCG. The results were confirmed with Cox models and odds-ratios are presented. CONCLUSION: In this study, BCG adjuvant immunotherapy was the only factor affecting recurrence, progression and survival. Conservative treatment using TUR followed by BCG may improve disease-specific survival.

Adjuvants, Immunologic↗
PubMed2002

Management of vascular access for hemodialysis after successful kidney transplantation.

OBJECTIVE: There is a lack of data concerning the fate of arterio-venous fistulas (AVF) after successful kidney transplantation. The objective of this study was to assess the evolution of AVF in transplanted patients and to discuss the management of such vascular access once dialysis has been stopped. MATERIAL AND METHODS: We reviewed 160 renal transplant patients who had undergone an AVF 0 to 312 months (mean 29) before transplantation. 136 (85%) of AVF were created in the forearm/wrist region and 21 (13%) at the elbow. RESULTS: The mean follow-up was 69 months from renal transplantation and 95 months from constitution of the AVF. Vascular access had to be closed in 7.5% of cases. Thrombosis occurred in 31% of cases, mainly in distal fistulas (85%). AVF was still functional in 61% of patients at the end of follow-up. CONCLUSION: AVF remains functional in the majority of patients after renal transplantation and is not usually associated with any significant morbidity. Systematic closure of AVF does not seem warranted as it would deprive patients of a useful vascular access should dialysis become again necessary in the long term.

Adolescent↗
PubMed2002

[Local immune tolerance mechanisms in kidney cancer].

Many arguments suggest that renal tumours are immunogenic. However, the immune cells present around or within the tumour are unable to induce tumour rejection and the results of immunotherapy in metastatic renal cancer remain disappointing regardless of the protocols used. The objective of this study was to review the main mechanisms by which a renal tumour can escape immune destruction. These mechanisms can concern: tumour antigens, antigen-presenting molecules on the cell surface or defects of the cell machinery leading to the preparation of these molecules. Defects may also concern intercellular communications, especially adhesion and co-stimulation molecules. The immune cells present may also be defective, presenting qualitative or quantitative deficits, abnormalities of the T receptor, defect of cytokine production and these defects may concern both effector cells and antigen-presenting cells. The capacity of tumour cells to release anergic substances, i.e. substances which paralyze the immune system, also constitutes another very powerful immunosuppressive mechanism. These substances are cytokines, especially TGF-b. This anergy can also be mediated by intercellular contacts between tumour cells and lymphocytes, especially via the Fas system. It is important to study these mechanisms for several reasons: 1/Understanding of anergy mechanisms in order to discover new therapeutic targets or to short-circuit these mechanisms in vitro; 2/Definition of an "immune phenotype" of the tumour which should be evaluated as a prognostic marker both for survival after radical surgery of localized tumours as a prognostic factor for response to immunotherapy in metastatic forms.

Antigen Presentation↗