Purpose: Germline mutations in DNA damage repair (DDR) genes such as BRCA2 have been associated with prostate cancer (PC) risk but has not been thoroughly evaluated for metastatic prostate cancer (mPC) in Asian men. This study attempts to evaluate frequency of DDR mutations in the largest cohort of Koreans. Materials and Methods: We recruited 340 patients with mPC unselected for family history of cancer and compared to 495 controls. Whole genome sequencing was applied to assess germline pathogenic/likely pathogenic variants (PV/LPVs) in 26 DDR genes and HOXB13, including 7 genes (ATM, BRCA1/2, CHEK2, BRIP1, PALB2, and NBN) associated with hereditary PC. Comparisons to published Caucasian and Japanese cohorts were performed. Results: Total of 28 PV/LPVs were identified in 30 (8.8%) patients; mutations were found in 13 genes, including BRCA2 (15 men [4.41%]), ATM (2 men [0.59%]), NBN (2 men [0.59%], and BRIP1 (2 men [0.59%]). Only one patient had HOXB13 mutation (0.29%). A lower rate of overall germline variant frequency was observed in Korean mPC compared to Caucasians (8.8% vs. 11.8%), but individual variants notably differed from Caucasian and geographically similar Japanese cohorts. PV/LPVs in DDR genes tended to increase gradually with higher Gleason scores (GS 7, 7.1%; GS 8, 7.5%; GS 9–10, 9.9%). Conclusions BRCA2 was the most frequently mutated gene common to different cohorts supporting its importance, but differences in variant distribution in Korean mPC underscore the need for ethnic-specific genetic models. Future ethnic-specific analyses are warranted to verify our findings.

Purpose: To investigate the impact of preoperative underlying hypertension (HTN) and body mass index (BMI) on oncologic outcomes in patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNUx). Materials and Methods: From May 2003 to December 2018, 453 UTUC patients who underwent RNUx at a single institution were enrolled in the study. All patients were divided into 2 groups according to preoperative HTN and BMI (cutoff 24 kg/m2) and perioperative parameters and recurrence outcomes were compared. Multivariate Cox proportional hazard analysis was performed to identify the significance of HTN and BMI regarding UTUC recurrence. Results: Among a total 453 UTUC patients, 233 (51.4%) had HTN, and 222 (49.0%) had BMI ≥24 kg/m2. The HTN versus no-HTN group had similar perioperative outcomes, except for the rate of diabetes (p<0.001). The high-BMI versus low-BMI group had similar outcomes, except for the prevalence of HTN (p=0.026). During median follow-up of 23 months, 5-year recurrence-free survival rates were 76.2% in the HTN group and 79.9% in the non-HTN group (p=0.002), and 77.3% in the low-BMI group and 79.0% in the high-BMI group (p=0.007). Multivariate analysis showed that BMI (hazard ratio [HR], 0.740; p=0.046), and HTN (HR, 1.687; p=0.005) were significant predictors of cancer recurrence. Conclusions Among UTUC patients who underwent RNUx, patients with HTN and low-BMI showed worse prognosis regarding cancer recurrence. To validate our results, the mechanisms of association between HTN, BMI, and UTUC should be investigated in further prospective studies.

Purpose: To investigate the impact of preoperative underlying hypertension (HTN) and body mass index (BMI) on oncologic outcomes in patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNUx). Materials and Methods: From May 2003 to December 2018, 453 UTUC patients who underwent RNUx at a single institution were enrolled in the study. All patients were divided into 2 groups according to preoperative HTN and BMI (cutoff 24 kg/m2) and perioperative parameters and recurrence outcomes were compared. Multivariate Cox proportional hazard analysis was performed to identify the significance of HTN and BMI regarding UTUC recurrence. Results: Among a total 453 UTUC patients, 233 (51.4%) had HTN, and 222 (49.0%) had BMI ≥24 kg/m2. The HTN versus no-HTN group had similar perioperative outcomes, except for the rate of diabetes (p<0.001). The high-BMI versus low-BMI group had similar outcomes, except for the prevalence of HTN (p=0.026). During median follow-up of 23 months, 5-year recurrence-free survival rates were 76.2% in the HTN group and 79.9% in the non-HTN group (p=0.002), and 77.3% in the low-BMI group and 79.0% in the high-BMI group (p=0.007). Multivariate analysis showed that BMI (hazard ratio [HR], 0.740; p=0.046), and HTN (HR, 1.687; p=0.005) were significant predictors of cancer recurrence. Conclusions Among UTUC patients who underwent RNUx, patients with HTN and low-BMI showed worse prognosis regarding cancer recurrence. To validate our results, the mechanisms of association between HTN, BMI, and UTUC should be investigated in further prospective studies.

Insulin-like growth factor-I (IGF-I) plays a pivotal role in the diagnosis and treatment of growth hormone (GH) excess or deficiency. The GH study group of the Korean Endocrine Society aims to establish the Korean reference ranges of serum IGF-I and insulin-like growth factor binding protein-3 (IGFBP-3) and assess the relationship between IGF-I and IGFBP-3 and clinical parameters. Fasting serum was collected from healthy Korean adults at health promotion centers of five hospitals nationwide. Serum IGF-I and IGFBP-3 were measured via an immunoradiometric assay using a DSL kit (Diagnostic Systems Laboratories). Serum samples from 354 subjects (180 male, 174 female) were analyzed based on sex at 10-year intervals from 21 to 70 years. IGF-I levels were inversely correlated with age. After adjustment of age, the IGF-I/IGFBP-3 ratio was significantly negatively associated with blood pressure and free thyroxine and positively associated with weight, hemoglobin, creatinine, alanine transferase, fasting glucose, and thyroid stimulating hormone. Therefore, age- and sex-specific reference ranges of serum IGF-I and IGFBP-3 can be efficient in evaluating GH excess or deficiency in Korean population.

Ischemic colitis primarily affects the elderly with underlying disease, but it rarely occurs in young adults with risk factors, such as coagulopathy or vascular disorder. Moreover, it is extremely rare in the very young without risk factors. This paper presents a patient with ischemic colitis associated with heat stroke and rhabdomyolysis after intense exercise under high-temperature conditions. A 20-year-old man presented with mental deterioration after a vigorous soccer game for more than 30 minutes in sweltering weather. He also presented with hematochezia with abdominal pain. The laboratory tests revealed the following: AST 515 U/L, ALT 269 U/L, creatine kinase 23,181 U/L, BUN 29.1 mg/dL, creatinine 1.55 mg/dL, and red blood cell >50/high-power field in urine analysis. Sigmoidoscopy showed ischemic changes at the rectum and rectosigmoid junction. A diagnosis of ischemic colitis and rhabdomyolysis was made, and the patient recovered after conservative and fluid therapy. This case showed that a diagnosis of ischemic colitis should be considered in patients who present with abdominal pain and bloody diarrhea after intense exercise, and appropriate treatment should be initiated immediately.
Abdominal Pain ; Aged ; Colitis, Ischemic ; Creatine Kinase ; Creatinine ; Diagnosis ; Diarrhea ; Erythrocytes ; Fluid Therapy ; Gastrointestinal Hemorrhage ; Heat Stroke ; Hot Temperature ; Humans ; Rectum ; Rhabdomyolysis ; Risk Factors ; Sigmoidoscopy ; Soccer ; Weather ; Young Adult

Ischemic colitis primarily affects the elderly with underlying disease, but it rarely occurs in young adults with risk factors, such as coagulopathy or vascular disorder. Moreover, it is extremely rare in the very young without risk factors. This paper presents a patient with ischemic colitis associated with heat stroke and rhabdomyolysis after intense exercise under high-temperature conditions. A 20-year-old man presented with mental deterioration after a vigorous soccer game for more than 30 minutes in sweltering weather. He also presented with hematochezia with abdominal pain. The laboratory tests revealed the following: AST 515 U/L, ALT 269 U/L, creatine kinase 23,181 U/L, BUN 29.1 mg/dL, creatinine 1.55 mg/dL, and red blood cell >50/high-power field in urine analysis. Sigmoidoscopy showed ischemic changes at the rectum and rectosigmoid junction. A diagnosis of ischemic colitis and rhabdomyolysis was made, and the patient recovered after conservative and fluid therapy. This case showed that a diagnosis of ischemic colitis should be considered in patients who present with abdominal pain and bloody diarrhea after intense exercise, and appropriate treatment should be initiated immediately.
Abdominal Pain ; Aged ; Colitis, Ischemic ; Creatine Kinase ; Creatinine ; Diagnosis ; Diarrhea ; Erythrocytes ; Fluid Therapy ; Gastrointestinal Hemorrhage ; Heat Stroke ; Hot Temperature ; Humans ; Rectum ; Rhabdomyolysis ; Risk Factors ; Sigmoidoscopy ; Soccer ; Weather ; Young Adult

PURPOSE: Preoperative aspects and dimensions used for an anatomical (PADUA) classification is useful to predict perioperative complications and warm ischemia time. However, it remains uncertain whether PADUA classification can predict intraoperative conversion from partial nephrectomy (PN) to radical nephrectomy (RN). We evaluate whether PADUA classification parameters can predict conversion to RN during PN. MATERIALS AND METHODS: We retrospectively assessed data of 593 patients who underwent open PN and robotic PN for renal tumors by a single surgeon at a single tertiary center between December 2003 and September 2017. Intraoperative conversion to RN was performed in 17 of 593 patients who initially underwent PN. We evaluated the factors influencing the surgical modalities including PN and radical conversion cases. Then, the factors significantly associated with conversion to RN were further analyzed. RESULTS: There were no significant differences between the 2 groups in age, longitudinal location, exophytic rate, and rim or face locations of renal masses. Renal sinus involvement, urinary collecting system involvement, and renal mass size were variables that predicted radical conversion, using univariate analysis. Renal sinus involvement (odds ratio [OR], 9.075; p=0.049) and urinary collecting system involvement (OR, 3.944; p=0.029) were independent predictors of intraoperative radical conversion, using multivariate analysis. CONCLUSIONS: The PADUA classification is a useful tool to predict intraoperative conversion from PN to RN. Renal sinus involvement and urinary collecting system involvement are the best predictors of intraoperative conversion from PN to RN.
Classification ; Factor Analysis, Statistical* ; Humans ; Multivariate Analysis ; Nephrectomy* ; Retrospective Studies ; Surgical Procedures, Operative ; Warm Ischemia

PURPOSE: We tried to investigate the clinical impact of Ki-67 (MIB-1) expression on the oncological and survival outcomes in patients with bladder cancer (BCa) after the radical cystectomy. MATERIALS AND METHODS: We retrospectively analyzed the data of 230 patients who were treated by radical cystectomy for BCa. Multivariate Cox-proportional hazards models and logistic regression tests were performed to evaluate the prognostic value of each variable. RESULTS: The patients with positive Ki-67 expression showed significant worse clinical characteristics and pathologic outcomes than negative Ki-67 group. Furthermore, the patients with Ki-67 expression showed significant worse recurrence (p=0.018) and cancer-specific mortality free survival (p=0.019) than negative Ki-67 group. The overall survival was also revealed to be inferior in Ki-67 positive group than Ki-67 negative group but the statistical significance was marginal (p=0.062). Subsequent multivariate Cox analyses showed that Ki-67 was independent predictor for disease recurrence after surgery (hazard ratio, 3.142; 95% CI, 1.287–7.671; p=0.012). CONCLUSIONS: In our study, high Ki-67 expression was significantly related with worse clinical outcomes after radical cystectomy in the patients with BCa. Further prospective and basic researches are needed to validate the true prognostic value of Ki-67.
Cystectomy* ; Humans ; Logistic Models ; Mortality ; Prognosis* ; Proportional Hazards Models ; Prospective Studies ; Recurrence ; Retrospective Studies ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: The purpose of this study was to analyze the detection rate of prostate cancers from targeted biopsy specimens of midline focal lesions and to investigate the ultrasonographic findings to reduce unnecessary additional targeted biopsies. METHODS: Ninety-eight men with midline focal lesions detected on transrectal ultrasonography were enrolled. Additional targeted biopsies for midline focal lesions were performed after 12-core random systematic biopsies. Correlations between the ultrasonographic characteristics of midline focal lesions and the pathologic results were analyzed. RESULTS: Twenty of 98 targeted biopsy cores (20.4%) were positive for malignancy. In a univariate analysis, midline focal lesions without bulging contours (P=0.023), with involved margins (P=0.001), without hypoechoic perilesional rims (P=0.005), and with longer diameters (P=0.005) were statistically significant for cancer detection. In a multivariate analysis, involved margin (P=0.027), having longer diameter (P=0.011) or absence of hypoechoic perilesional rim (P=0.025) made a statistically significant contribution to cancer detection. CONCLUSION: Biopsy of midline focal lesions was not always non-significant in the detection of prostate cancer. Additional targeted biopsies should be considered in cases of midline focal lesions with involved margins but without hypoechoic perilesional rims.
Biopsy ; Humans ; Image-Guided Biopsy ; Male ; Multivariate Analysis ; Prostate* ; Prostatic Neoplasms ; Ultrasonography*

PURPOSE: To compare outcomes of robotic adrenalectomy with conventional laparoscopic adrenalectomy. MATERIALS AND METHODS: This retrospective study included 63 patients who underwent robotic or laparoscopic adrenalectomy between March 2005 and April 2016, with all operations performed using a transperitoneal approach. Outcomes were compared in the 29 patients who underwent robotic adrenalectomy and the 34 who underwent conventional laparoscopic adrenalectomy. RESULTS: Mean age (53.1±12.2 years vs. 51.4±15.1 years, p=0.631) and body mass index (25.9±3.8 kg/m2 vs. 25.2±3.5 kg/m2, p=0.461) were similar in the robotic and laparoscopic groups. A significant percentage of patients in the robotic group had undergone prior abdominal surgery (38% vs. 12%, p=0.015). Mean tumor sizes (3.0±1.5 cm vs. 3.7±2.7 cm, p=0.134) and the percentage of incidentalomas (75.9% vs. 73.5%, p=0.354) were similar in the robotic and laparoscopic groups. There were no statistical significance between-group differences in tumor size, operative time, estimated blood loss, perioperative hemoglobin change, length of hospital stay, and complication rates. Pathologic diagnosis showed that pheochromocytoma (21% vs. 3%) and metastatic tumor (24% vs. 6%) were more frequent in the robotic than in the laparoscopic group (p=0.019). Subgroup analysis of patients with low tumor volume (≤6.8 cm3) showed that operation time was significantly shorter in the robotic than in the laparoscopic group (p=0.045). CONCLUSIONS: Robotic adrenalectomy is feasible, with outcomes comparable to those of laparoscopic adrenalectomy.
Adrenal Glands ; Adrenalectomy* ; Body Mass Index ; Diagnosis ; Humans ; Length of Stay ; Operative Time ; Pheochromocytoma ; Retrospective Studies ; Tumor Burden