Background:There are no validated markers that predict response in metastatic renal cell cancer (RCC) patients treated with sunitinib. We aim to study the impact of single-nucleotide polymorphisms (SNPs) that have recently been proposed as predictors of outcome to anti-VEGF-targeted therapy in metastatic RCC in an independent cohort of patients.Methods:We genotyped 16 key SNPs in 10 genes involved in sunitinib pharmacokinetics, pharmacodynamics and VEGF-independent angiogenesis in patients with metastatic clear-cell RCC treated with sunitinib as the first-line targeted therapy. Association between SNPs, progression-free survival (PFS) and overall survival (OS) were studied by multivariate Cox regression using relevant clinical factors associated with PFS and OS as covariates.Results:In a series of 88 patients, both PFS and OS were associated significantly with SNP rs1128503 in ABCB1 (P=0.027 and P=0.025), rs4073054 in NR1/3 (P=0.025 and P=0.035) and rs307821 in VEGFR3 (P=0.032 and P=0.011). Progression-free survival alone was associated with rs2981582 in FGFR2 (P=0.031) and rs2276707 in NR1/2 (P=0.047), whereas OS alone was associated with rs2307424 in NR1/3 (P=0.048) and rs307826 in VEGFR3 (P=0.013).Conclusion:Our results confirm former communications regarding the association between SNPs in ABCB1, NR1/2, NR1/3 and VEGFR3 and sunitinib outcome in clear-cell RCC. Prospective validation of these SNPs is now required.
Objective To determine the in¯uence of radiotherapy on the outcome of arti®cial urinary sphincter implantation. Patients and methods A series of 72 men who had an arti®cial urinary sphincter inserted were reviewed retrospectively, analysing in detail the information from 15 patients with a past history of pelvic radiotherapy. Results In those who had undergone radiotherapy, the complication rate was higher, both for re-operation (eight of 15) and infection (three); 11 of the 15 patients were continent after surgery, compared with 51 (89%) of the 57 in the unirradiated group. Conclusions An arti®cial sphincter can be inserted after pelvic radiotherapy reasonably successfully, but at the cost of a high complication and re-operation rate.Patients with a previous history of radiotherapy should be informed of the higher risk of surgical revision associated with insertion of the prosthesis.
This paper presents a three-dimensional (3-D) shape reconstruction/intrapatient rigid registration technique used to establish a Nephron-Sparing Surgery preoperative planning. The usual preoperative imaging system is the Spiral CT Urography, which provides successive 3-D acquisitions of complementary information on kidney anatomy. Because the kidney is difficult to demarcate from the liver or from the spleen only limited information on its volume or surface is available. In this paper, we propose a methodology allowing a global kidney spatial representation on a spherical harmonics basis. The spherical harmonics are exploited to recover the kidney 3-D shape and also to perform intrapatient 3-D rigid registration. An evaluation performed on synthetic data showed that this technique presented lower performance then expected for the 3-D shape recovering but exhibited registration results slightly more accurate as the iterative closest point technique with faster computation time.
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