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Objectives: This study aimed at investigating the prognostic impact of tumor necrosis and preoperative monocyte-to-lymphocyte ratio (MLR) in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods: A total of 521 patients with UTUC treated with RNU from January 2008 to June 2019 at our institution were enrolled. Histological tumor necrosis was defined as the presence of microscopic coagulative necrosis. The optimal value of MLR was determined as 0.4 by receiver operating characteristic (ROC) analysis based on cancer-specific mortality. The Kaplan–Meier method with log-rank test and Cox proportional hazards regression models were performed to evaluate the impact of tumor necrosis and MLR on overall (OS), cancer-specific (CSS), and recurrence-free survival (RFS). Furthermore, ROC analysis was used to estimate the predictive ability of potential prognostic factors for oncological outcomes. Results: Tumor necrosis was present in 106 patients (20%), which was significantly associated with tumor location, high pathological tumor stage, lymph node metastasis, high tumor grade, lymphovascular invasion, tumor size, and increased monocyte counts. On multivariate analysis, the combination of tumor necrosis and preoperative MLR was an independent prognosticator of OS, CSS, and RFS (all p< 0.05). Moreover, ROC analyses revealed the predictive accuracy of a combination of tumor necrosis and preoperative MLR for OS, CSS, and RFS with the area under the ROC curve of 0.745, 0.810, and 0.782, respectively (all p< 0.001). Conclusions: The combination of tumor necrosis and preoperative MLR can be used as an independent prognosticator in patients with UTUC after RNU. The identification of this combination could help physicians to recognize high-risk patients with unfavorable outcomes and devise more appropriate postoperative treatment plans.
Kun-Che Lin; Hau-Chern Jan; Che-Yuan Hu; Yin-Chien Ou; Yao-Lin Kao; Wen-Horng Yang; Chien-Hui Ou. Tumor Necrosis with Adjunction of Preoperative Monocyte-to-Lymphocyte Ratio as a New Risk Stratification Marker Can Independently Predict Poor Outcomes in Upper Tract Urothelial Carcinoma. Journal of Clinical Medicine 2021, 10, 2983 .
AMA StyleKun-Che Lin, Hau-Chern Jan, Che-Yuan Hu, Yin-Chien Ou, Yao-Lin Kao, Wen-Horng Yang, Chien-Hui Ou. Tumor Necrosis with Adjunction of Preoperative Monocyte-to-Lymphocyte Ratio as a New Risk Stratification Marker Can Independently Predict Poor Outcomes in Upper Tract Urothelial Carcinoma. Journal of Clinical Medicine. 2021; 10 (13):2983.
Chicago/Turabian StyleKun-Che Lin; Hau-Chern Jan; Che-Yuan Hu; Yin-Chien Ou; Yao-Lin Kao; Wen-Horng Yang; Chien-Hui Ou. 2021. "Tumor Necrosis with Adjunction of Preoperative Monocyte-to-Lymphocyte Ratio as a New Risk Stratification Marker Can Independently Predict Poor Outcomes in Upper Tract Urothelial Carcinoma." Journal of Clinical Medicine 10, no. 13: 2983.
External urethral sphincter (EUS) dysfunction is a common, bothersome female voiding dysfunction. This study aims to analyze the characteristics of different types of female EUS dysfunction, as well as to determine the outcome predictors of sphincteric botulinum toxin A (BoNT-A) injection. Women receiving sphincteric BoNT-A injections for refractory EUS dysfunction were retrospectively reviewed. A comparison of the baseline clinical, urodynamic parameters and the treatment responses were made for patients with different EUS dysfunctions. A total of 106 females were included. Significantly increased detrusor overactivity, detrusor contracting pressure and the bladder outlet obstruction index with decreased urge sensation were noted in patients diagnosed with dysfunctional voiding or detrusor sphincter dyssynergia comparing to those diagnosed with poor relaxation of the external urethral sphincter. The average subjective improvement rate was 67% for the injection. The therapeutic effect was not affected by the type of EUS dysfunction. The multivariate analysis revealed that bladder neck narrowing and catheterization history were predictive of negative outcomes. There is a distinct urodynamic presentation for each type of female EUS dysfunction. Sphincteric BoNT-A injection provides a good therapeutic outcome for refractory EUS dysfunction. A narrowing bladder neck and a history of catheterization suggest poor therapeutic outcomes.
Yin-Chien Ou; Kuan-Hsun Huang; Hau-Chern Jan; Hann-Chorng Kuo; Yao-Lin Kao; Kuen-Jer Tsai. Therapeutic Efficacy of Urethral Sphincteric Botulinum Toxin Injections for Female Sphincter Dysfunctions and a Search for Predictive Factors. Toxins 2021, 13, 398 .
AMA StyleYin-Chien Ou, Kuan-Hsun Huang, Hau-Chern Jan, Hann-Chorng Kuo, Yao-Lin Kao, Kuen-Jer Tsai. Therapeutic Efficacy of Urethral Sphincteric Botulinum Toxin Injections for Female Sphincter Dysfunctions and a Search for Predictive Factors. Toxins. 2021; 13 (6):398.
Chicago/Turabian StyleYin-Chien Ou; Kuan-Hsun Huang; Hau-Chern Jan; Hann-Chorng Kuo; Yao-Lin Kao; Kuen-Jer Tsai. 2021. "Therapeutic Efficacy of Urethral Sphincteric Botulinum Toxin Injections for Female Sphincter Dysfunctions and a Search for Predictive Factors." Toxins 13, no. 6: 398.
Generic quality of life (QoL) is an important issue in decision making related to the primary treatment of localized prostate cancer (PC). This study assessed the dynamic changes of QoL in patients with localized PC under different treatment modalities. From 2013 to 2018, we prospectively assessed QoL scores in patients with localized PC under unitary treatment using the World Health Organization Quality of Life (WHOQOL) BREF version. The trajectories of the QoL scores after different treatments were estimated using a kernel-smoothing method. Dynamic changes in the major determinants were analyzed using a mixed effects model. The clinical features of the participants in our institute were compared with PC patients in Taiwan’s cancer registry. A total of 196 patients were enrolled with 491 repeated assessments. The participants shared similar clinical characteristics with the PC patients in Taiwan as a whole. Patients with lower household incomes showed statistically significant lower scores on all four domains and related facets, while PC survivors with comorbidities of anxiety and/or diabetes appeared to be affected on the physical domain and related facets. After controlling for these determinants, patients under active surveillance or observation demonstrated significantly higher QoL scores in the physical and social domains, as well as several facets belonging to these domains, in mixed models compared with patients undergoing radical prostatectomy or radiotherapy within the first year. The generic QoL scores were higher within the first year in patients receiving active surveillance or observation after controlling other significant factors. The difference diminished after one year of post management. More studies are needed to corroborate our findings.
Yao-Lin Kao; Chien-Hui Ou; Sheng-Hsiang Lin; Sheng-Mao Chang; Jung-Der Wang; Yuh-Shyan Tsai. Dynamic Changes of Generic Quality of Life after Different Treatments for Localized Prostate Cancer. Journal of Clinical Medicine 2021, 10, 158 .
AMA StyleYao-Lin Kao, Chien-Hui Ou, Sheng-Hsiang Lin, Sheng-Mao Chang, Jung-Der Wang, Yuh-Shyan Tsai. Dynamic Changes of Generic Quality of Life after Different Treatments for Localized Prostate Cancer. Journal of Clinical Medicine. 2021; 10 (1):158.
Chicago/Turabian StyleYao-Lin Kao; Chien-Hui Ou; Sheng-Hsiang Lin; Sheng-Mao Chang; Jung-Der Wang; Yuh-Shyan Tsai. 2021. "Dynamic Changes of Generic Quality of Life after Different Treatments for Localized Prostate Cancer." Journal of Clinical Medicine 10, no. 1: 158.
Neurogenic and non-neurogenic urethral sphincter dysfunction are common causes of voiding dysfunction. Injections of botulinum toxin A (BoNT-A) into the urethral sphincter have been used to treat urethral sphincter dysfunction (USD) refractory to conventional treatment. Since its first use for patients with detrusor sphincter dyssynergia in 1988, BoNT-A has been applied to various causes of USD, including dysfunctional voiding, Fowler’s syndrome, and poor relaxation of the external urethral sphincter. BoNT-A is believed to decrease urethral resistance via paralysis of the striated sphincter muscle through inhibition of acetylcholine release in the neuromuscular junction. Recovery of detrusor function in patients with detrusor underactivity combined with a hyperactive sphincter also suggested the potential neuromodulation effect of sphincteric BoNT-A injection. A large proportion of patients with different causes of USD report significant improvement in voiding after sphincteric BoNT-A injections. However, patient satisfaction might not increase with an improvement in the symptoms because of concomitant side effects including exacerbated incontinence, urinary urgency, and over-expectation. Nonetheless, in terms of efficacy and safety, BoNT-A is still a reasonable option for refractory voiding function. To date, studies focusing on urethral sphincter BoNT-A injections have been limited to the heterogeneous etiologies of USD. Further well-designed studies are thus needed.
Yao-Lin Kao; Kuan-Hsun Huang; Hann-Chorng Kuo; Yin-Chien Ou. The Therapeutic Effects and Pathophysiology of Botulinum Toxin A on Voiding Dysfunction Due to Urethral Sphincter Dysfunction. Toxins 2019, 11, 728 .
AMA StyleYao-Lin Kao, Kuan-Hsun Huang, Hann-Chorng Kuo, Yin-Chien Ou. The Therapeutic Effects and Pathophysiology of Botulinum Toxin A on Voiding Dysfunction Due to Urethral Sphincter Dysfunction. Toxins. 2019; 11 (12):728.
Chicago/Turabian StyleYao-Lin Kao; Kuan-Hsun Huang; Hann-Chorng Kuo; Yin-Chien Ou. 2019. "The Therapeutic Effects and Pathophysiology of Botulinum Toxin A on Voiding Dysfunction Due to Urethral Sphincter Dysfunction." Toxins 11, no. 12: 728.
ObjectiveTo determine factors that influence quality of life in prostate cancer patients.Patients and methodsPatients with pathologically verified prostate cancer and treated at the National Cheng Kung University Hospital were invited to fill out the World Health Organization Quality of Life-BREF questionnaires at the outpatient clinic. We explored the determinants of quality of life including age, education, income, marital status, disease stage, and treatment modality using a mixed-effects model.ResultsFrom January 2013 to July 2014, a total of 248 patients were investigated and 404 measurements were performed. Among them, there were 110 patients, 48 patients, and 90 patients with localized, locally advanced, and metastatic disease, respectively. After adjustment for comorbidities and other confounders, patients who were married showed a significantly higher score in the domains of physical health, social relationships including sexual satisfaction, and opportunities to obtain information and leisure activities. A higher income was associated with a higher score in physical, psychological, and environment domains. Patients with metastatic disease showed lower scores in the physical domain.ConclusionOur data demonstrated that marital status is an important determinant of quality of life in prostate cancer patients besides other sociodemographic factors. Clinicians are advised to provide more social support recourses for patients who do not have a partner
Yao-Lin Kao; Yuh-Shyan Tsai; Fat-Ya Ou; Ya-Jhu Syu; Chien-Hui Ou; Wen-Horng Yang; Hong-Lin Cheng; Tzong-Shin Tzai; Jung-Der Wang. Determinants of quality of life in prostate cancer patients: A single institute analysis. Urological Science 2015, 26, 254 -258.
AMA StyleYao-Lin Kao, Yuh-Shyan Tsai, Fat-Ya Ou, Ya-Jhu Syu, Chien-Hui Ou, Wen-Horng Yang, Hong-Lin Cheng, Tzong-Shin Tzai, Jung-Der Wang. Determinants of quality of life in prostate cancer patients: A single institute analysis. Urological Science. 2015; 26 (4):254-258.
Chicago/Turabian StyleYao-Lin Kao; Yuh-Shyan Tsai; Fat-Ya Ou; Ya-Jhu Syu; Chien-Hui Ou; Wen-Horng Yang; Hong-Lin Cheng; Tzong-Shin Tzai; Jung-Der Wang. 2015. "Determinants of quality of life in prostate cancer patients: A single institute analysis." Urological Science 26, no. 4: 254-258.