- Email: [email protected]
36 OUTCOME PREDICTION IN PATIENTS WITH BLADDER CANCER AFTER CYSTECTOMY USING ARTIFICIAL NEURAL NETWORKS
VXJJHVWVLPSRUWDQWELRORJLFDOGLᚎHUHQFHVEHWZHHQVXEVHWVRIQRGDOSRVLWLYHEODGGHU FDQFHUVWKDWDUHQRWDGHTXDWHO\UHSUHVHQWHGLQWKHFXUUHQW710FODVVLᚏFDWLRQ
35
CONCOMITANT CARCINOMA IN SITU IS NOT ASSOCIATED WITH CLINICAL OUTCOMES AFTER RADICAL CYSTECTOMY
1XKQ3%DVWLDQ3-6YDWHN56.DUDNLHZLF]3,6NLQQHU( )UDGHW<,]DZD-,.DVVRXI:1RYDUD*0RQWRUVL) )ULWVFKH+0 7LONL',VEDUQ+)LFDUUD9 'LQQH\&36KDULDW6) 1 Ludwig-Maximilians-University Munich, Dept. of Urology, Munich, Germany, 2 University of Texas, Dept. of M.D. Anderson Cancer Center, Houston, United States of America, 3University of Montréal, Dept. of Cancer Prognostics and Health Outcomes, Montréal, Canada, 4University of Southern California, Dept. of Urology, Los Angeles, United States of America, 5Laval University, Dept. of Urology, Québec, Canada, 6University of Western Ontario, Dept. of Surgery, London, Canada, 7McGill University, Health Centre, Montréal, Canada, 8University of Padua, Dept. of Oncological and Surgical Sciences, Padua, Italy, 9University Vita-Salute San Raffaele, Dept. of Urology, Milan, Italy, 10University Regensburg, Caritas St. Josef Medical Center, Dept. of Urology, Regensburg, Germany, 11 University of Texas Southwestern Medical Center, Dept. of Urology, Dallas, United States of America Introduction & Objectives: 8URWKHOLDO FDUFLQRPD LQ VLWX &,6 LV D KLJKJUDGH QRQSDSLOODU\ PDQLIHVWDWLRQ RI XURWKHOLDO FDUFLQRPD RI WKH EODGGHU 8&% ZLWK SRWHQWLDOO\ DJJUHVVLYH DQG XQSUHGLFWDEOH EHKDYLRXU ,Q D UHODWLYHO\ VPDOO VWXG\ FRQFRPLWDQW&,6LQWKHUDGLFDOF\VWHFWRP\ 5& VSHFLPHQVKDVEHHQUHSRUWHGWR EHDQLQGHSHQGHQWSUHGLFWRURIRXWFRPHLQRUJDQFRQᚏQHG8&%7KHDLPRIWKLV VWXG\ZDVWRH[WHUQDOO\YDOLGDWHWKHSURJQRVWLFYDOXHRIFRQFRPLWDQW&,6XVLQJD ODUJHLQWHUQDWLRQDOFRKRUWRISDWLHQWVZLWKORQJWHUPIROORZXS Material & Methods: 7KHUHFRUGVRI SDWLHQWVWUHDWHGZLWK5&DQGELODWHUDO O\PSKDGHQHFWRP\IRU8&%DWQLQHFHQWUHVZRUOGZLGHZHUHUHYLHZHG Results: 7KRXVDQGVHYHQKXQGUHGIRUW\RQH KDGFRQFRPLWDQW&,6LQWKHLU 5&VSHFLPHQ&RQFRPLWDQW&,6ZDVPRUHFRPPRQO\LQRUJDQFRQᚏQHG8&%DQG ZDVDVVRFLDWHGZLWKO\PSKRYDVFXODULQYDVLRQ S &RQFRPLWDQW&,6ZDVQRW DVVRFLDWHGZLWKHLWKHUGLVHDVHUHFXUUHQFHRUFDQFHUVSHFLᚏFGHDWKUHJDUGOHVVRI SDWKRORJLF VWDJH VXEJURXS DQDO\VHV LQ S7 S7 S7 RUJDQFRQᚏQHG RU QRQ RUJDQ FRQᚏQHG QRQPXVFOHLQYDVLYH RU PXVFOHLQYDVLYH 8&% ,Q SDWLHQWV ZLWK S7 GLVHDVH SDWLHQWV ZLWK FRQFRPLWDQW &,6 ZHUH DW LQFUHDVHG ULVN RI GLVHDVH UHFXUUHQFHDQGFDQFHUVSHFLᚏFGHDWKFRPSDUHGWRWKRVHZLWKRXWFRQFRPLWDQW&,6 S S +RZHYHUZKHQDGMXVWHGIRUWKHHᚎHFWVRISDWKRORJLFJUDGH VXUJLFDO PDUJLQ VWDWXV O\PSKRYDVFXODU LQYDVLRQ DQG O\PSK QRGH PHWDVWDVLV WKH GLᚎHUHQFHV GLG QRW UHPDLQ VLJQLᚏFDQW 7KH SUHVHQFH RI FRQFRPLWDQW &,6 GLG QRW LPSURYH WKH SUHGLFWLYH DFFXUDF\ RI VWDQGDUG SUHGLFWRUV IRU HLWKHU GLVHDVH UHFXUUHQFHRUFDQFHUVSHFLᚏFGHDWKLQDQ\RIWKHVXEJURXSV Conclusions: :H FRXOG QRW FRQᚏUP WKH SURJQRVWLF YDOXH RI FRQFRPLWDQW &,6 LQ 5& VSHFLPHQV 7KLV WRJHWKHU ZLWK WKH GLVFUHSDQF\ EHWZHHQ SDWKRORJLVWV LQ GHWHUPLQLQJWKHSUHVHQFHRIFRQFRPLWDQW&,6DWWKHPRUSKRORJLFOHYHOOLPLWVWKH FOLQLFDOXWLOLW\RIFRQFRPLWDQW&,6LQFOLQLFDOGHFLVLRQPDNLQJ
36
OUTCOME PREDICTION IN PATIENTS WITH BLADDER CANCER AFTER CYSTECTOMY USING ARTIFICIAL NEURAL NETWORKS
%XFKQHU$%ROHQ]&+HUUPDQQ(7LONL'.DUO$+¸IQHU7 )ULWVFKH+:¾OᚏQJ&%XUJHU07URMDQ/7LHPDQQ$+DIHUNDPS$ 0LFKHO0+RKHQIHOOQHU0:LHODQG:0¾OOHU66WLHI&*%DVWLDQ3 1 Ludwig-Maximilians-University, Dept. of Urology, Munich, Germany, 2University Hospital Mannheim, Dept. of Urology, Mannheim, Germany, 3University of Münster, Dept. of Urology, Münster, Germany, 4University of Heidelberg, Dept. of Urology, Heidelberg, Germany, 5University of Regensburg, Dept. of Urology, Regensburg, Germany, 6University of Bonn, Dept. of Urology, Bonn, Germany Introduction & Objectives: 7KH RQFRORJLFDO RXWFRPH RI SDWLHQWV ZLWK EODGGHU FDQFHUWKDWXQGHUJRUDGLFDOF\VWHFWRP\VKRZVUHPDUNDEOHYDULDELOLW\DQGWKHUHLVD QHHGWRLGHQWLI\SURJQRVWLFSDUDPHWHUVWKDWDOORZLQGLYLGXDOSURJQRVWLFVWUDWLᚏFDWLRQ $UWLᚏFLDOQHXUDOQHWZRUNV $11 DUHVRIWZDUHV\VWHPVWKDWFDQOHDUQDQGUHFRJQLVH FRPSOH[ SDWWHUQV RI LQSXW GDWD $ WUDLQHG $11 LV DEOH WR FODVVLI\ QHZ GDWD VHWV DFFRUGLQJ WR WKHLU W\SLFDO SDWWHUQV ,Q UHFHQW \HDUV $11 KDYH EHHQ LQFUHDVLQJO\ DSSOLHG WR PHGLFDO DQG HVSHFLDOO\ RQFRORJLFDO TXHVWLRQV ,Q WKLV VWXG\ ZH XVHG $11WRLGHQWLI\KLJKULVNEODGGHUFDQFHUSDWLHQWVEDVHGRQFRPPRQFOLQLFDODQG KLVWRSDWKRORJLFDOSDUDPHWHUV Material & Methods: )URPDPXOWLFHQWHUGDWDEDVH VL[8QLYHUVLW\KRVSLWDOV ZLWK !EODGGHUFDQFHUSDWLHQWVWKDWXQGHUZHQWUDGLFDOF\VWHFWRP\FRPSOHWH GDWDVHWVZLWKIROORZXSGDWDZHUHDYDLODEOHIRUDQDO\VLV7KHPHGLDQIROORZXSWLPH ZDVPRQWKV$JHJHQGHUWXPRXUVWDJHDQGJUDGH LQ785%DQGF\VWHFWRP\ FDUFLQRPDLQVLWX &,6 LQ785%DQGF\VWHFWRP\ DQG QHR DGMXYDQWFKHPRRU UDGLRWKHUDS\ ZHUH XVHG DV LQSXW GDWD IRU WKH DUWLᚏFLDO QHXUDO QHWZRUN PXOWLOD\HU SHUFHSWURQ DUFKLWHFWXUH 6WDW6RIW 7XOVD 2. RI WKH FDVHV ZHUH XVHG IRU WKH WUDLQLQJ SURFHVV DQG WKH UHPDLQLQJ VHUYHG DV LQGHSHQGHQW YDOLGDWLRQ GDWDVHW7DUJHWYDULDEOHVZHUHWXPRXUVSHFLᚏFVXUYLYDODQGWXPRXUSURJUHVVLRQ UHFXUUHQFHUHVSHFWLYHO\$11SHUIRUPDQFHZDVDVVHVVHGE\FODVVLᚏFDWLRQHUURU
DQG52& UHFHLYHURSHUDWRUFKDUDFWHULVWLF DQDO\VLV Results: $IWHU WUDLQLQJ ZDV FRPSOHWHG WKH $11 FRUUHFWO\ DVVLJQHG WKH VXUYLYDO VWDWXV WR RI SDWLHQWV LQ WKH WUDLQLQJ VHW DQG WR LQ WKH YDOLGDWLRQ VHW UHVSHFWLYHO\ ,Q 52& DQDO\VLV WKH DUHD XQGHU FXUYH $8& ZDV :LWK SURJUHVVLRQUHFXUUHQFHDVWDUJHWSDUDPHWHUIRU$11WUDLQLQJLQVWHDGRIVXUYLYDOWKH FRUUHFWFODVVLᚏFDWLRQUDWHZDVLQWKHWUDLQLQJVHWDQGLQWKHYDOLGDWLRQVHW UHVSHFWLYHO\7KH$8&IRUSUHGLFWLRQRIWXPRXUUHODSVHZDV 7KHSDUDPHWHUV &,6DQGS7KDGWKHKLJKHVWLPSDFWRQWKHQHWZRUNಬVGHFLVLRQDVGHWHUPLQHGE\ WKHVRFDOOHGVHQVLWLYLW\LQGH[ Conclusions: ,QWKLVVWXG\$11FRXOGFRUUHFWO\SUHGLFWWKHWXPRXUUHODSVHRIXS WRRIEODGGHUFDQFHUSDWLHQWVDIWHUF\VWHFWRP\$UWLᚏFLDOQHXUDOQHWZRUNVDUH DSURPLVLQJDSSURDFKIRULQGLYLGXDORXWFRPHSUHGLFWLRQRIEODGGHUFDQFHUSDWLHQWV EDVHG RQ VRPH FRPPRQ SDUDPHWHUV $11 FDQ KHOS WR RSWLPLVH WKH WKHUDSHXWLF VWUDWHJ\ H J E\ VHOHFWLQJ KLJKULVN SDWLHQWV IRU DGMXYDQW WKHUDS\ $Q LPSURYHG SUHGLFWLRQRIWXPRXUVSHFLᚏFVXUYLYDOFDQSUREDEO\EHDFKLHYHGE\LQFOXGLQJGDWD DERXWWKHSRVWUHFXUUHQFHWKHUDS\LQWKHQHWZRUNPRGHO
37
VALIDATION OF TUMOUR ARCHITECTURE IS AN INDEPENDENT PREDICTOR OF OUTCOMES AFTER RADICAL NEPHROURETERECTOMY
)ULWVFKH+01RYDUD**XSWD$0DWVXPRWR..DVVRXI: :DOWRQ7%XUJHU07ULWVFKOHU6%DED6%DVWLDQ3-&DUEDOOLGR- 6HLW]& 2WWR:.DUDNLHZLF]3,)LFDUUD96KDULDW6) 1 Caritas St. Josef Medical Center, University of Regensburg, Dept. of Urology, Regensburg, Germany, 2University of Padua, Dept. of Urology, Padua, Italy, 3 University of Texas South-western Medical Center, Dept. of Urology, Dallas, United States of America, 4Kitasato University School of Medicine, Dept. of Urology, Sagamihara, Japan, 5McGill University Health Centre, Dept. of Urology, Montréal, Canada, 6Nottingham City Hospital, Dept. of Urology, Nottingham, United Kingdom, 7Ludwig-Maximilians-University, Dept. of Urology, Munich, Germany, 8Hospital Universitario Puerta de Hierro-Majadahonda, Dept. of Urology, Madrid, Spain, 9General Hospital Bolzano, Dept. of Urology, Bolzano, Italy, 10University of Montréal, Dept. of Cancer Prognostics and Health Outcomes, Montréal, Canada Introduction & Objectives: 6HVVLOH WXPRXU DUFKLWHFWXUH KDV EHHQ DVVRFLDWHG DGYHUVHRXWFRPHVDIWHUUDGLFDOQHSKURXUHWHUHFWRP\ 518 IRUXSSHUWUDFWXURWKHOLDO FDUFLQRPD 878& %HIRUH LQFOXVLRQ LQ GDLO\ FOLQLFDO GHFLVLRQPDNLQJ WR WKH SURJQRVWLFYDOXHRIWXPRXUDUFKLWHFWXUHQHHGVWREHYDOLGDWHGLQDQLQGHSHQGHQW H[WHUQDO GDWDVHW 7KHUHIRUH ZH WHVWHG ZKHWKHU WXPRXU DUFKLWHFWXUH LPSURYHV RXWFRPHSUHGLFWLRQLQDQLQWHUQDWLRQDOFRKRUWRISDWLHQWVZLWK878& Material & Methods: :H UHWURVSHFWLYHO\ VWXGLHG SDWLHQWV ZKR XQGHUZHQW 518 IRU 878& ZLWKRXW QHRDGMXYDQW FKHPRWKHUDS\ DW FHQWUHV ORFDWHG LQ $VLD &DQDGDDQG(XURSH$SDWKRORJLFDOUHYLHZRIWKHVOLGHVZDVQRWSHUIRUPHGLQRUGHU WRUHᚐHFWUHDOZRUOGSUDFWLFH3DWLHQWVCFKDUDFWHULVWLFVUHFXUUHQFHIUHH 5)6 DQG FDQFHUVSHFLᚏFVXUYLYDO &66 ZHUHDQDO\VHG Results: 6HVVLOHDUFKLWHFWXUHZDVSUHVHQWLQ SDWLHQWV7KHSUHYDOHQFH RIVHVVLOHDUFKLWHFWXUHLQFUHDVHGZLWKDGYDQFLQJSDWKRORJLFVWDJH DQG IRU 7 7 DQG QRQRUJDQ FRQᚏQHG UHVSHFWLYHO\ 3 6HVVLOH DUFKLWHFWXUH ZDV DVVRFLDWHG ZLWK HVWDEOLVKHG IHDWXUHV RI ELRORJLFDOO\ DJJUHVVLYH 878& VXFK DV KLJKHU WXPRXU JUDGH O\PSK QRGH PHWDVWDVLV O\PSKRYDVFXODU LQYDVLRQWXPRXUQHFURVLVDQGFRQFRPLWDQW&,6 SYDOXHV :LWKLQDPHGLDQ IROORZXSRIPRQWKV H[SHULHQFHGGLVHDVHUHFXUUHQFHDQGGLHGRI878& 2QXQLYDULDEOH&R[UHJUHVVLRQDQDO\VHVVHVVLOHDUFKLWHFWXUHZDVDVVRFLDWHGZLWK ERWK GLVHDVH UHFXUUHQFH DQG FDQFHU VSHFLᚏFGHDWK 7ZR\HDU 5)6 DQG &66 IRU SDSLOODU\DUFKLWHFWXUHZHUH 6( DQG 6( UHVSHFWLYHO\FRPSDUHG ZLWK 6( DQG 6( IRU VHVVLOH DUFKLWHFWXUH UHVSHFWLYHO\ 2Q PXOWLYDULDEOH&R[UHJUHVVLRQDQDO\VHVWKDWDGMXVWHGIRUWKHHᚎHFWVRIDJHVWDJH JUDGHO\PSKQRGHVWDWXVDQGDGMXYDQWFKHPRWKHUDS\VHVVLOHDUFKLWHFWXUHZDVDQ LQGHSHQGHQWSUHGLFWRURI5)6 +D]DUGUDWLR +5 &, ದS DQG&66 +5 &, ದS Conclusions: :HFRQᚏUPHGWKHLQGHSHQGHQWSRZHUIXOSURJQRVWLFYDOXHRIWXPRXU DUFKLWHFWXUH LQ D ODUJH LQGHSHQGHQW PXOWLFHQWHU DQG UHDOZRUOG 878& FRKRUW 7XPRXU DUFKLWHFWXUH RI 518 VSHFLPHQV VKRXOG EH UHSRUWHG LQ HYHU\ SDWKRORJ\ UHSRUWDQGLQFOXGHGLQSRVW518SUHGLFWLYHPRGHOVLQRUGHUWRUHᚏQHFXUUHQWFOLQLFDO GHFLVLRQPDNLQJUHJDUGLQJIROORZXSSURWRFRODQGDGMXYDQWWKHUDS\
Eur Urol Suppl 2010;9(2):45
35
CONCOMITANT CARCINOMA IN SITU IS NOT ASSOCIATED WITH CLINICAL OUTCOMES AFTER RADICAL CYSTECTOMY
1XKQ3%DVWLDQ3-6YDWHN56.DUDNLHZLF]3,6NLQQHU( )UDGHW<,]DZD-,.DVVRXI:1RYDUD*0RQWRUVL) )ULWVFKH+0 7LONL',VEDUQ+)LFDUUD9 'LQQH\&36KDULDW6) 1 Ludwig-Maximilians-University Munich, Dept. of Urology, Munich, Germany, 2 University of Texas, Dept. of M.D. Anderson Cancer Center, Houston, United States of America, 3University of Montréal, Dept. of Cancer Prognostics and Health Outcomes, Montréal, Canada, 4University of Southern California, Dept. of Urology, Los Angeles, United States of America, 5Laval University, Dept. of Urology, Québec, Canada, 6University of Western Ontario, Dept. of Surgery, London, Canada, 7McGill University, Health Centre, Montréal, Canada, 8University of Padua, Dept. of Oncological and Surgical Sciences, Padua, Italy, 9University Vita-Salute San Raffaele, Dept. of Urology, Milan, Italy, 10University Regensburg, Caritas St. Josef Medical Center, Dept. of Urology, Regensburg, Germany, 11 University of Texas Southwestern Medical Center, Dept. of Urology, Dallas, United States of America Introduction & Objectives: 8URWKHOLDO FDUFLQRPD LQ VLWX &,6 LV D KLJKJUDGH QRQSDSLOODU\ PDQLIHVWDWLRQ RI XURWKHOLDO FDUFLQRPD RI WKH EODGGHU 8&% ZLWK SRWHQWLDOO\ DJJUHVVLYH DQG XQSUHGLFWDEOH EHKDYLRXU ,Q D UHODWLYHO\ VPDOO VWXG\ FRQFRPLWDQW&,6LQWKHUDGLFDOF\VWHFWRP\ 5& VSHFLPHQVKDVEHHQUHSRUWHGWR EHDQLQGHSHQGHQWSUHGLFWRURIRXWFRPHLQRUJDQFRQᚏQHG8&%7KHDLPRIWKLV VWXG\ZDVWRH[WHUQDOO\YDOLGDWHWKHSURJQRVWLFYDOXHRIFRQFRPLWDQW&,6XVLQJD ODUJHLQWHUQDWLRQDOFRKRUWRISDWLHQWVZLWKORQJWHUPIROORZXS Material & Methods: 7KHUHFRUGVRI SDWLHQWVWUHDWHGZLWK5&DQGELODWHUDO O\PSKDGHQHFWRP\IRU8&%DWQLQHFHQWUHVZRUOGZLGHZHUHUHYLHZHG Results: 7KRXVDQGVHYHQKXQGUHGIRUW\RQH KDGFRQFRPLWDQW&,6LQWKHLU 5&VSHFLPHQ&RQFRPLWDQW&,6ZDVPRUHFRPPRQO\LQRUJDQFRQᚏQHG8&%DQG ZDVDVVRFLDWHGZLWKO\PSKRYDVFXODULQYDVLRQ S &RQFRPLWDQW&,6ZDVQRW DVVRFLDWHGZLWKHLWKHUGLVHDVHUHFXUUHQFHRUFDQFHUVSHFLᚏFGHDWKUHJDUGOHVVRI SDWKRORJLF VWDJH VXEJURXS DQDO\VHV LQ S7 S7 S7 RUJDQFRQᚏQHG RU QRQ RUJDQ FRQᚏQHG QRQPXVFOHLQYDVLYH RU PXVFOHLQYDVLYH 8&% ,Q SDWLHQWV ZLWK S7 GLVHDVH SDWLHQWV ZLWK FRQFRPLWDQW &,6 ZHUH DW LQFUHDVHG ULVN RI GLVHDVH UHFXUUHQFHDQGFDQFHUVSHFLᚏFGHDWKFRPSDUHGWRWKRVHZLWKRXWFRQFRPLWDQW&,6 S S +RZHYHUZKHQDGMXVWHGIRUWKHHᚎHFWVRISDWKRORJLFJUDGH VXUJLFDO PDUJLQ VWDWXV O\PSKRYDVFXODU LQYDVLRQ DQG O\PSK QRGH PHWDVWDVLV WKH GLᚎHUHQFHV GLG QRW UHPDLQ VLJQLᚏFDQW 7KH SUHVHQFH RI FRQFRPLWDQW &,6 GLG QRW LPSURYH WKH SUHGLFWLYH DFFXUDF\ RI VWDQGDUG SUHGLFWRUV IRU HLWKHU GLVHDVH UHFXUUHQFHRUFDQFHUVSHFLᚏFGHDWKLQDQ\RIWKHVXEJURXSV Conclusions: :H FRXOG QRW FRQᚏUP WKH SURJQRVWLF YDOXH RI FRQFRPLWDQW &,6 LQ 5& VSHFLPHQV 7KLV WRJHWKHU ZLWK WKH GLVFUHSDQF\ EHWZHHQ SDWKRORJLVWV LQ GHWHUPLQLQJWKHSUHVHQFHRIFRQFRPLWDQW&,6DWWKHPRUSKRORJLFOHYHOOLPLWVWKH FOLQLFDOXWLOLW\RIFRQFRPLWDQW&,6LQFOLQLFDOGHFLVLRQPDNLQJ
36
OUTCOME PREDICTION IN PATIENTS WITH BLADDER CANCER AFTER CYSTECTOMY USING ARTIFICIAL NEURAL NETWORKS
%XFKQHU$%ROHQ]&+HUUPDQQ(7LONL'.DUO$+¸IQHU7 )ULWVFKH+:¾OᚏQJ&%XUJHU07URMDQ/7LHPDQQ$+DIHUNDPS$ 0LFKHO0+RKHQIHOOQHU0:LHODQG:0¾OOHU66WLHI&*%DVWLDQ3 1 Ludwig-Maximilians-University, Dept. of Urology, Munich, Germany, 2University Hospital Mannheim, Dept. of Urology, Mannheim, Germany, 3University of Münster, Dept. of Urology, Münster, Germany, 4University of Heidelberg, Dept. of Urology, Heidelberg, Germany, 5University of Regensburg, Dept. of Urology, Regensburg, Germany, 6University of Bonn, Dept. of Urology, Bonn, Germany Introduction & Objectives: 7KH RQFRORJLFDO RXWFRPH RI SDWLHQWV ZLWK EODGGHU FDQFHUWKDWXQGHUJRUDGLFDOF\VWHFWRP\VKRZVUHPDUNDEOHYDULDELOLW\DQGWKHUHLVD QHHGWRLGHQWLI\SURJQRVWLFSDUDPHWHUVWKDWDOORZLQGLYLGXDOSURJQRVWLFVWUDWLᚏFDWLRQ $UWLᚏFLDOQHXUDOQHWZRUNV $11 DUHVRIWZDUHV\VWHPVWKDWFDQOHDUQDQGUHFRJQLVH FRPSOH[ SDWWHUQV RI LQSXW GDWD $ WUDLQHG $11 LV DEOH WR FODVVLI\ QHZ GDWD VHWV DFFRUGLQJ WR WKHLU W\SLFDO SDWWHUQV ,Q UHFHQW \HDUV $11 KDYH EHHQ LQFUHDVLQJO\ DSSOLHG WR PHGLFDO DQG HVSHFLDOO\ RQFRORJLFDO TXHVWLRQV ,Q WKLV VWXG\ ZH XVHG $11WRLGHQWLI\KLJKULVNEODGGHUFDQFHUSDWLHQWVEDVHGRQFRPPRQFOLQLFDODQG KLVWRSDWKRORJLFDOSDUDPHWHUV Material & Methods: )URPDPXOWLFHQWHUGDWDEDVH VL[8QLYHUVLW\KRVSLWDOV ZLWK !EODGGHUFDQFHUSDWLHQWVWKDWXQGHUZHQWUDGLFDOF\VWHFWRP\FRPSOHWH GDWDVHWVZLWKIROORZXSGDWDZHUHDYDLODEOHIRUDQDO\VLV7KHPHGLDQIROORZXSWLPH ZDVPRQWKV$JHJHQGHUWXPRXUVWDJHDQGJUDGH LQ785%DQGF\VWHFWRP\ FDUFLQRPDLQVLWX &,6 LQ785%DQGF\VWHFWRP\ DQG QHR DGMXYDQWFKHPRRU UDGLRWKHUDS\ ZHUH XVHG DV LQSXW GDWD IRU WKH DUWLᚏFLDO QHXUDO QHWZRUN PXOWLOD\HU SHUFHSWURQ DUFKLWHFWXUH 6WDW6RIW 7XOVD 2. RI WKH FDVHV ZHUH XVHG IRU WKH WUDLQLQJ SURFHVV DQG WKH UHPDLQLQJ VHUYHG DV LQGHSHQGHQW YDOLGDWLRQ GDWDVHW7DUJHWYDULDEOHVZHUHWXPRXUVSHFLᚏFVXUYLYDODQGWXPRXUSURJUHVVLRQ UHFXUUHQFHUHVSHFWLYHO\$11SHUIRUPDQFHZDVDVVHVVHGE\FODVVLᚏFDWLRQHUURU
DQG52& UHFHLYHURSHUDWRUFKDUDFWHULVWLF DQDO\VLV Results: $IWHU WUDLQLQJ ZDV FRPSOHWHG WKH $11 FRUUHFWO\ DVVLJQHG WKH VXUYLYDO VWDWXV WR RI SDWLHQWV LQ WKH WUDLQLQJ VHW DQG WR LQ WKH YDOLGDWLRQ VHW UHVSHFWLYHO\ ,Q 52& DQDO\VLV WKH DUHD XQGHU FXUYH $8& ZDV :LWK SURJUHVVLRQUHFXUUHQFHDVWDUJHWSDUDPHWHUIRU$11WUDLQLQJLQVWHDGRIVXUYLYDOWKH FRUUHFWFODVVLᚏFDWLRQUDWHZDVLQWKHWUDLQLQJVHWDQGLQWKHYDOLGDWLRQVHW UHVSHFWLYHO\7KH$8&IRUSUHGLFWLRQRIWXPRXUUHODSVHZDV 7KHSDUDPHWHUV &,6DQGS7KDGWKHKLJKHVWLPSDFWRQWKHQHWZRUNಬVGHFLVLRQDVGHWHUPLQHGE\ WKHVRFDOOHGVHQVLWLYLW\LQGH[ Conclusions: ,QWKLVVWXG\$11FRXOGFRUUHFWO\SUHGLFWWKHWXPRXUUHODSVHRIXS WRRIEODGGHUFDQFHUSDWLHQWVDIWHUF\VWHFWRP\$UWLᚏFLDOQHXUDOQHWZRUNVDUH DSURPLVLQJDSSURDFKIRULQGLYLGXDORXWFRPHSUHGLFWLRQRIEODGGHUFDQFHUSDWLHQWV EDVHG RQ VRPH FRPPRQ SDUDPHWHUV $11 FDQ KHOS WR RSWLPLVH WKH WKHUDSHXWLF VWUDWHJ\ H J E\ VHOHFWLQJ KLJKULVN SDWLHQWV IRU DGMXYDQW WKHUDS\ $Q LPSURYHG SUHGLFWLRQRIWXPRXUVSHFLᚏFVXUYLYDOFDQSUREDEO\EHDFKLHYHGE\LQFOXGLQJGDWD DERXWWKHSRVWUHFXUUHQFHWKHUDS\LQWKHQHWZRUNPRGHO
37
VALIDATION OF TUMOUR ARCHITECTURE IS AN INDEPENDENT PREDICTOR OF OUTCOMES AFTER RADICAL NEPHROURETERECTOMY
)ULWVFKH+01RYDUD**XSWD$0DWVXPRWR..DVVRXI: :DOWRQ7%XUJHU07ULWVFKOHU6%DED6%DVWLDQ3-&DUEDOOLGR- 6HLW]& 2WWR:.DUDNLHZLF]3,)LFDUUD96KDULDW6) 1 Caritas St. Josef Medical Center, University of Regensburg, Dept. of Urology, Regensburg, Germany, 2University of Padua, Dept. of Urology, Padua, Italy, 3 University of Texas South-western Medical Center, Dept. of Urology, Dallas, United States of America, 4Kitasato University School of Medicine, Dept. of Urology, Sagamihara, Japan, 5McGill University Health Centre, Dept. of Urology, Montréal, Canada, 6Nottingham City Hospital, Dept. of Urology, Nottingham, United Kingdom, 7Ludwig-Maximilians-University, Dept. of Urology, Munich, Germany, 8Hospital Universitario Puerta de Hierro-Majadahonda, Dept. of Urology, Madrid, Spain, 9General Hospital Bolzano, Dept. of Urology, Bolzano, Italy, 10University of Montréal, Dept. of Cancer Prognostics and Health Outcomes, Montréal, Canada Introduction & Objectives: 6HVVLOH WXPRXU DUFKLWHFWXUH KDV EHHQ DVVRFLDWHG DGYHUVHRXWFRPHVDIWHUUDGLFDOQHSKURXUHWHUHFWRP\ 518 IRUXSSHUWUDFWXURWKHOLDO FDUFLQRPD 878& %HIRUH LQFOXVLRQ LQ GDLO\ FOLQLFDO GHFLVLRQPDNLQJ WR WKH SURJQRVWLFYDOXHRIWXPRXUDUFKLWHFWXUHQHHGVWREHYDOLGDWHGLQDQLQGHSHQGHQW H[WHUQDO GDWDVHW 7KHUHIRUH ZH WHVWHG ZKHWKHU WXPRXU DUFKLWHFWXUH LPSURYHV RXWFRPHSUHGLFWLRQLQDQLQWHUQDWLRQDOFRKRUWRISDWLHQWVZLWK878& Material & Methods: :H UHWURVSHFWLYHO\ VWXGLHG SDWLHQWV ZKR XQGHUZHQW 518 IRU 878& ZLWKRXW QHRDGMXYDQW FKHPRWKHUDS\ DW FHQWUHV ORFDWHG LQ $VLD &DQDGDDQG(XURSH$SDWKRORJLFDOUHYLHZRIWKHVOLGHVZDVQRWSHUIRUPHGLQRUGHU WRUHᚐHFWUHDOZRUOGSUDFWLFH3DWLHQWVCFKDUDFWHULVWLFVUHFXUUHQFHIUHH 5)6 DQG FDQFHUVSHFLᚏFVXUYLYDO &66 ZHUHDQDO\VHG Results: 6HVVLOHDUFKLWHFWXUHZDVSUHVHQWLQ SDWLHQWV7KHSUHYDOHQFH RIVHVVLOHDUFKLWHFWXUHLQFUHDVHGZLWKDGYDQFLQJSDWKRORJLFVWDJH DQG IRU 7 7 DQG QRQRUJDQ FRQᚏQHG UHVSHFWLYHO\ 3 6HVVLOH DUFKLWHFWXUH ZDV DVVRFLDWHG ZLWK HVWDEOLVKHG IHDWXUHV RI ELRORJLFDOO\ DJJUHVVLYH 878& VXFK DV KLJKHU WXPRXU JUDGH O\PSK QRGH PHWDVWDVLV O\PSKRYDVFXODU LQYDVLRQWXPRXUQHFURVLVDQGFRQFRPLWDQW&,6 SYDOXHV :LWKLQDPHGLDQ IROORZXSRIPRQWKV H[SHULHQFHGGLVHDVHUHFXUUHQFHDQGGLHGRI878& 2QXQLYDULDEOH&R[UHJUHVVLRQDQDO\VHVVHVVLOHDUFKLWHFWXUHZDVDVVRFLDWHGZLWK ERWK GLVHDVH UHFXUUHQFH DQG FDQFHU VSHFLᚏFGHDWK 7ZR\HDU 5)6 DQG &66 IRU SDSLOODU\DUFKLWHFWXUHZHUH 6( DQG 6( UHVSHFWLYHO\FRPSDUHG ZLWK 6( DQG 6( IRU VHVVLOH DUFKLWHFWXUH UHVSHFWLYHO\ 2Q PXOWLYDULDEOH&R[UHJUHVVLRQDQDO\VHVWKDWDGMXVWHGIRUWKHHᚎHFWVRIDJHVWDJH JUDGHO\PSKQRGHVWDWXVDQGDGMXYDQWFKHPRWKHUDS\VHVVLOHDUFKLWHFWXUHZDVDQ LQGHSHQGHQWSUHGLFWRURI5)6 +D]DUGUDWLR +5 &, ದS DQG&66 +5 &, ದS Conclusions: :HFRQᚏUPHGWKHLQGHSHQGHQWSRZHUIXOSURJQRVWLFYDOXHRIWXPRXU DUFKLWHFWXUH LQ D ODUJH LQGHSHQGHQW PXOWLFHQWHU DQG UHDOZRUOG 878& FRKRUW 7XPRXU DUFKLWHFWXUH RI 518 VSHFLPHQV VKRXOG EH UHSRUWHG LQ HYHU\ SDWKRORJ\ UHSRUWDQGLQFOXGHGLQSRVW518SUHGLFWLYHPRGHOVLQRUGHUWRUHᚏQHFXUUHQWFOLQLFDO GHFLVLRQPDNLQJUHJDUGLQJIROORZXSSURWRFRODQGDGMXYDQWWKHUDS\
Eur Urol Suppl 2010;9(2):45