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  • 251. Powles, Thomas
    et al.
    Staehler, Michael
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Bensalah, Karim
    Canfield, Steven E.
    Dabestani, Saeed
    Giles, Rachel
    Hofmann, Fabian
    Hora, Milan
    Kuczyk, Markus A.
    Lam, Thomas
    Marconi, Lorenzo
    Merseburger, Axel S.
    Volpe, Alessandro
    Bex, Axel
    Updated EAU Guidelines for Clear Cell Renal Cancer Patients Who Fail VEGF Targeted Therapy2016Inngår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 69, nr 1, s. 4-6Artikkel i tidsskrift (Annet vitenskapelig)
  • 252. Price, Alison J
    et al.
    Travis, Ruth C
    Appleby, Paul N
    Albanes, Demetrius
    Barricarte Gurrea, Aurelio
    Bjørge, Tone
    Bueno-de-Mesquita, H Bas
    Chen, Chu
    Donovan, Jenny
    Gislefoss, Randi
    Goodman, Gary
    Gunter, Marc
    Hamdy, Freddie C
    Johansson, Mattias
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning. International Agency for Research on Cancer, Lyon, France.
    King, Irena B
    Kühn, Tilman
    Männistö, Satu
    Martin, Richard M
    Meyer, Klaus
    Neal, David E
    Neuhouser, Marian L
    Nygård, Ottar
    Stattin, Pär
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Tell, Grethe S
    Trichopoulou, Antonia
    Tumino, Rosario
    Ueland, Per Magne
    Ulvik, Arve
    de Vogel, Stefan
    Vollset, Stein Emil
    Weinstein, Stephanie J
    Key, Timothy J
    Allen, Naomi E
    Circulating Folate and Vitamin B12 and Risk of Prostate Cancer: A Collaborative Analysis of Individual Participant Data from Six Cohorts Including 6875 Cases and 8104 Controls2016Inngår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 70, nr 6, s. 941-951Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Folate and vitamin B12 are essential for maintaining DNA integrity and may influence prostate cancer (PCa) risk, but the association with clinically relevant, advanced stage, and high-grade disease is unclear.

    OBJECTIVE: To investigate the associations between circulating folate and vitamin B12 concentrations and risk of PCa overall and by disease stage and grade.

    DESIGN, SETTING, AND PARTICIPANTS: A study was performed with a nested case-control design based on individual participant data from six cohort studies including 6875 cases and 8104 controls; blood collection from 1981 to 2008, and an average follow-up of 8.9 yr (standard deviation 7.3). Odds ratios (ORs) of incident PCa by study-specific fifths of circulating folate and vitamin B12 were calculated using multivariable adjusted conditional logistic regression.

    OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Incident PCa and subtype by stage and grade.

    RESULTS AND LIMITATIONS: Higher folate and vitamin B12 concentrations were associated with a small increase in risk of PCa (ORs for the top vs bottom fifths were 1.13 [95% confidence interval (CI), 1.02-1.26], ptrend=0.018, for folate and 1.12 [95% CI, 1.01-1.25], ptrend=0.017, for vitamin B12), with no evidence of heterogeneity between studies. The association with folate varied by tumour grade (pheterogeneity<0.001); higher folate concentration was associated with an elevated risk of high-grade disease (OR for the top vs bottom fifth: 2.30 [95% CI, 1.28-4.12]; ptrend=0.001), with no association for low-grade disease. There was no evidence of heterogeneity in the association of folate with risk by stage or of vitamin B12 with risk by stage or grade of disease (pheterogeneity>0.05). Use of single blood-sample measurements of folate and B12 concentrations is a limitation.

    CONCLUSIONS: The association between higher folate concentration and risk of high-grade disease, not evident for low-grade disease, suggests a possible role for folate in the progression of clinically relevant PCa and warrants further investigation.

    PATIENT SUMMARY: Folate, a vitamin obtained from foods and supplements, is important for maintaining cell health. In this study, however, men with higher blood folate levels were at greater risk of high-grade (more aggressive) prostate cancer compared with men with lower folate levels. Further research is needed to investigate the possible role of folate in the progression of this disease.

  • 253.
    Prytz, Isak
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    A quality report on the Swedish patient-flow model for macroscopic haematuria  - SVF (standardized care process)-macrohematuria for Norrlands university hospital (NUS)2018Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 254.
    Ramsauer, Bernd
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Glucose degradation products in patients on hemodialysis: interventional studies2016Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Hemodialysis (HD) is the most frequently used treatment for end-stage renal disease. Despite all efforts to improve the outcomes, the mortality of patients on HD is still high, and this especially is related to cardiovascular diseases (CVD). Glucose degradation products accumulate in plasma and tissue as a result of oxidative stress in these patients. Such accumulation is strongly related to the risk of developing CVD. Tissue deposits of advanced glycation end products (AGE) can be easily assessed by a skin autofluorescence (SAF) technique. SAF is one of the strongest prognostic markers of mortality in HD patients. The aim of this thesis is to examine whether intervention on HD treatment can reduce the load of AGE of these patients.

    The aim of the first study was to investigate whether changes in SAF appear after a single HD session and if they might be related to changes in plasma AF. Skin and plasma AF (PAF) were measured before and after HD in 35 patients on maintenance HD therapy. Median dialysis time was 4 h (range 3-5.5). SAF was measured noninvasively with an AGE Reader, and plasma AF was measured before and after HD. The HD patients had on average a 65% higher SAF value than age-matched healthy persons (P < 0.001). PAF was reduced by 14% (P < 0.001), whereas SAF was not changed after a single HD treatment. No significant influence of the reduced PAF on SAF levels was found. This suggests that the measurement of SAF can be performed during the whole dialysis period and is not directly influenced by the changes in plasma AF during HD.

    In study 2 different dialysis filters were compared to clarify whether using a high-flux (HF) dialyzer favors plasma or SAF removal compared to low-flux (LF) dialyzer. Twenty-eight patients were treated with either an HF-HD or LF-HD but otherwise unchanged conditions in a cross-over design. SAF was measured non-invasively with an AGE reader before and after HD. PAF was determined as total and non-protein-bound fractions. Corrections for hemoconcentrations by volume changes were made using the change in serum albumin. Paired and non-paired statistical analyses were used. The different treatments did not change SAF after LF- and HF-dialysis. Total, free, and protein-bound PAF were reduced after a single LF-HD by 21%, 28%, and 17%, respectively (P<.001). After HF-HD total and free PAF was reduced by 5% and 15%, respectively (P<.001), while protein-bound values were unchanged. The LF-HD resulted in a more pronounced reduction of PAF than did HF-HD (P<.001). Serum albumin correlated inversely with PAF in HF-HD. There was no significant change in SAF after dialysis, either with LF or with HF dialysis. Although only limited reductions in PAF were observed, these were more pronounced when performing LF dialysis. These data are not in overwhelming support of the use of HF dialysis in the setting used in this study.

    In the third study the effect on SAF was investigated using either glucose-containing or glucose-free dialysate. SAF and PAF were measured in patients on HD during standard treatment with a glucose-containing dialysate (n=24). After that, the patients were switched to a glucose-free dialysate for a 2 week period, and new measurements were performed on PAF and SAF.

    There was an increase of pre-dialysis SAF measured at the beginning of the study compared with the values one month later (as in study 4). By comparing pre- and post-dialysis values there was a significant decrease of SAF only when using glucose-free dialysate. Free PAF decreased independently whether glucose-containing or glucose-free dialysate was used. The important finding was that increase in SAF seemed possible to slow down using glucose-free dialysate.

    Study 4 was performed to investigate whether there are seasonal variations in SAF on a HD population. SAF was measured non-invasively with an AGE Reader in patients on HD at different seasonal periods during one year such as February-May (N=31), May–August (N=28), August–March (N=25). SAF was measured before HD. Paired statistical analyses were performed between each two periods.  Unexpectedly there was at a median 6% increase in SAF during the winter (p=0.004) and a 11% decrease from 4.0 to 3.5 arbitrary units of the SAF during the summer (p<0.001). The study concluded that SAF shows seasonal variation. The cause of these changes could not be clarified. A beneficial effect may be due to extended exposure to sunlight during the summer and/or to different dietary intakes during the seasons.

    In conclusion, these interventional studies confirmed that PAF is lowered by dialysis. SAF was only decreased by HD when using glucose-free dialysate. SAF was not influenced by a single HD, with glucose-containing dialysate, independent of using HF or LF filters. These data favor glucose-free dialysate as a possible measure to slow down the progress of tissue AGE compared to glucose-containing dialysate. Longitudinal studies will help to clarify this issue further.

  • 255.
    Ramsauer, Bernd
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Department of Nephrology, Skaraborgs Hospital, 541 58 Skövde, Sweden.
    Engels, Gerwin Erik
    Graaff, Reindert
    Sikole, Aleksandar
    Arsov, Stefan
    Stegmayr, Bernd
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Skin- and Plasmaautofluorescence in hemodialysis with glucose-free or glucose-containing dialysate2017Inngår i: BMC Nephrology, ISSN 1471-2369, E-ISSN 1471-2369, Vol. 18, artikkel-id 5Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Haemodialysis (HD) patients suffer from an increased risk of cardiovascular disease (CVD). Skinautofluorescence (SAF) is a strong marker for CVD. SAF indirectly measures tissue advanced glycation end products(AGE) being cumulative metabolites of oxidative stress and cytokine-driven inflammatory reactions. The dialysatesoften contain glucose.

    Methods: Autofluorescence of skin and plasma (PAF) were measured in patients on HD during standard treatment(ST) with a glucose-containing dialysate (n = 24). After that the patients were switched to a glucose-free dialysate(GFD) for a 2-week period. New measurements were performed on PAF and SAF after 1 week (M1) and 2 weeks(M2) using GFD. Nonparametric paired statistical analyses were performed between each two periods.

    Results: SAF after HD increased non-significantly by 1.2% while when a GFD was used during HD at M1, a decreaseof SAF by 5.2% (p = 0.002) was found. One week later (M2) the reduction of 1.6% after the HD was not significant(p = 0.33). PAF was significantly reduced during all HD sessions. Free and protein-bound PAF decreased similarlywhether glucose containing or GFD was used. The HD resulted in a reduction of the total PAF of approximately15%, the free compound of 20% and the protein bound of 10%. The protein bound part of PAF correspondedto approximately 56% of the total reduction. The protein bound concentrations after each HD showed thelowest value after 2 weeks using glucose-free dialysate (p < 0.05). The change in SAF could not be related to achange in PAF.

    Conclusions: When changing to a GFD, SAF was reduced by HD indicating that such measure may hamperthe accumulation and progression of deposits of AGEs to protein in tissue, and thereby also the developmentof CVD. Glucose-free dialysate needs further attention. Protein binding seems firm but not irreversible.

  • 256.
    Ramsauer, Bernd
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Graaff, Reindert
    Sikole, Aleksandar
    Trajceska, Lada
    Arsov, Stefan
    Hadimeri, Henrik
    Stegmayr, Bernd
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Skin Autofluorescence, a Measure of Cumulative Metabolic stress and Advanced Glycation End Products, shows seasonal variations in dialysis patientsManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Abstract

    Tissue advanced glycation end products (AGE) are a measure of cumulative metabolic and oxidative stress and cytokine driven inflammatory reactions. AGEs are thought to contribute to the cardiovascular complications of hemodialysis patients. Skin autofluorescence (AF) is related to the tissue accumulation of AGE, and is one of the strongest prognostic markers on mortality in these patients. The content of AGE is high in barbecue food. Since the barbecue season in northern Sweden is between June and August a longitudinal study was performed to investigate whether there are seasonal variations in skin-AF on a hemodialysis (HD) in this population. Skin-AF was measured non-invasively with an AGE Reader (Diagnoptics Technologies BV, Groningen, The Netherlands) in patients on HD at different seasonal periods during one year such as February-May (N=29, 21 men/8 women), May – August (N=26, 19 m/7 w), August  – March  (N=24, 18 m/6 w). Skin-AF was measured before and after dialyses. Paired statistical analyses were performed between each two periods. A second analysis was performed including only the patients with measurements at all 4 points of time (n=23, 17m/6w).

    There was at a median 5.6% increase in skin-AF during the winter period (p=0.004) and a 10.6% decrease of the skin-AF during the summer (p<0.001). The study concluded that skin-AF shows seasonal variation. The cause of these changes could not be clarified. A beneficial effect may be due to extended exposure to sunlight during the summer and/or to different dietary intake during the seasons.

  • 257.
    Ramsauer, Bernd
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Department of Nephrology, Skaraborgs Hospital, Skövde.
    Graaff, Reindert
    Sikole, Aleksandar
    Trajceska, Lada
    Lundström, Sara
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Arsov, Stefan
    Hadimeri, Henrik
    Stegmayr, Bernd
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Skin Autofluorescence, a Measure of Cumulative Metabolic Stress and Advanced Glycation End Products, Decreases During the Summer in Dialysis Patients2019Inngår i: Artificial Organs, ISSN 0160-564X, E-ISSN 1525-1594, Vol. 43, nr 2, s. 173-180Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Tissue advanced glycation end products (AGEs) are a measure of cumulative metabolic and oxidative stress and cytokine-driven inflammatory reactions. AGEs are thought to contribute to the cardiovascular complications of hemodialysis (HD) patients. Skin autofluorescence (SAF) is related to the tissue accumulation of AGEs and rises with age. SAF is one of the strongest prognostic markers of mortality in these patients. The content of AGEs is high in barbecue food. Due to the location in northern Sweden, there is a short intense barbecue season between June and August. The aim of this study was to investigate if seasonal variations in SAF exist in HD patients, especially during the barbecue season. SAF was measured noninvasively with an AGE Reader in 34 HD-patients (15 of those with diabetes mellitus, DM). Each time the median of three measures were used. Skin-AF was measured before and after each one HD at the end of February and May in 31 patients (22 men/9 women); the end of May and August in 28 (20 m/8 w); the end of August and March in 25 (19 m/6 w). Paired statistical analyses were performed during all four periods (n = 23, 17 m/6 w); as was HbA1c of those with DM. There was at a median 5.6% increase in skin-AF during the winter period (February-May, P = 0.004) and a 10.6% decrease in the skin-AF during the summer (May-August, P < 0.001). HbA1c in the DM rose during the summer (P = 0.013). In conclusion, skin-AF decreased significantly during the summer. Future studies should look for favorable factors that prevent skin-AF and subsequently cardiovascular diseases.

  • 258. Ravaud, Alain
    et al.
    Motzer, Robert J
    Pandha, Hardev S
    George, Daniel J
    Pantuck, Allan J
    Patel, Anup
    Chang, Yen-Hwa
    Escudier, Bernard
    Donskov, Frede
    Magheli, Ahmed
    Carteni, Giacomo
    Laguerre, Brigitte
    Tomczak, Piotr
    Breza, Jan
    Gerletti, Paola
    Lechuga, Mariajose
    Lin, Xun
    Martini, Jean-Francois
    Ramaswamy, Krishnan
    Casey, Michelle
    Staehler, Michael
    Patard, Jean-Jacques
    Ljungberg, Börje
    Adjuvant Sunitinib in High-Risk Renal-Cell Carcinoma after Nephrectomy.2016Inngår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 375, nr 23, s. 2246-2254Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Sunitinib, a vascular endothelial growth factor pathway inhibitor, is an effective treatment for metastatic renal-cell carcinoma. We sought to determine the efficacy and safety of sunitinib in patients with locoregional renal-cell carcinoma at high risk for tumor recurrence after nephrectomy.

    METHODS: In this randomized, double-blind, phase 3 trial, we assigned 615 patients with locoregional, high-risk clear-cell renal-cell carcinoma to receive either sunitinib (50 mg per day) or placebo on a 4-weeks-on, 2-weeks-off schedule for 1 year or until disease recurrence, unacceptable toxicity, or consent withdrawal. The primary end point was disease-free survival, according to blinded independent central review. Secondary end points included investigator-assessed disease-free survival, overall survival, and safety.

    RESULTS: The median duration of disease-free survival was 6.8 years (95% confidence interval [CI], 5.8 to not reached) in the sunitinib group and 5.6 years (95% CI, 3.8 to 6.6) in the placebo group (hazard ratio, 0.76; 95% CI, 0.59 to 0.98; P=0.03). Overall survival data were not mature at the time of data cutoff. Dose reductions because of adverse events were more frequent in the sunitinib group than in the placebo group (34.3% vs. 2%), as were dose interruptions (46.4% vs. 13.2%) and discontinuations (28.1% vs. 5.6%). Grade 3 or 4 adverse events were more frequent in the sunitinib group (48.4% for grade 3 events and 12.1% for grade 4 events) than in the placebo group (15.8% and 3.6%, respectively). There was a similar incidence of serious adverse events in the two groups (21.9% for sunitinib vs. 17.1% for placebo); no deaths were attributed to toxic effects.

    CONCLUSIONS: Among patients with locoregional clear-cell renal-cell carcinoma at high risk for tumor recurrence after nephrectomy, the median duration of disease-free survival was significantly longer in the sunitinib group than in the placebo group, at a cost of a higher rate of toxic events. (Funded by Pfizer; S-TRAC ClinicalTrials.gov number, NCT00375674 .).

  • 259. Reza, Mariana
    et al.
    Ohlsson, Mattias
    Kaboteh, Reza
    Anand, Aseem
    Franck-Lissbrant, Ingela
    Damber, Jan-Erik
    Widmark, Anders
    Thellenberg-Karlsson, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Budaeus, Lars
    Steuber, Thomas
    Eichenauer, Till
    Wollmer, Per
    Edenbrandt, Lars
    Tragardh, Elin
    Bjartell, Anders
    Bone Scan Index as an Imaging Biomarker in Metastatic Castration-resistant Prostate Cancer: A Multicentre Study Based on Patients Treated with Abiraterone Acetate (Zytiga) in Clinical Practice2016Inngår i: European Urology Focus, ISSN 2405-4569, Vol. 2, nr 5, s. 540-546Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Abiraterone acetate (AA) prolongs survival in metastatic castration-resistant prostate cancer (mCRPC) patients. To measure treatment response accurately in bone, quantitative methods are needed. The Bone Scan Index (BSI), a prognostic imaging biomarker, reflects the tumour burden in bone as a percentage of the total skeletal mass calculated from bone scintigraphy.

    Objective: To evaluate the value of BSI as a biomarker for outcome evaluation in mCRPC patients on treatment with AA according to clinical routine.

    Design, setting, and participants: We retrospectively studied 104 mCRPC patients who received AA following disease progression after chemotherapy. All patients underwent whole-body bone scintigraphy before and during AA treatment. Baseline and follow-up BSI data were obtained using EXINI Bone(BSI) software (EXINI Diagnostics AB, Lund, Sweden).

    Outcome measurements and statistical analysis: Associations between change in BSI, clinical parameters at follow-up, and overall survival (OS) were evaluated using the Cox proportional hazards regression models and Kaplan-Meier estimates. Discrimination between variables was assessed using the concordance index (C-index).

    Results and limitations: Patients with an increase in BSI at follow-up of at most 0.30 (n = 54) had a significantly longer median survival time than those with an increase of BSI >0.30 (n = 50) (median: 16 vs 10 mo; p = 0.001). BSI change was also associated with OS in a multivariate Cox analysis including commonly used clinical parameters for prognosis (C-index = 0.7; hazard ratio: 1.1; p = 0.03). The retrospective design was a limitation.

    Conclusions: Change in BSI was significantly associated with OS in mCRPC patients undergoing AA treatment following disease progression in a postchemotherapy setting. BSI may be a useful imaging biomarker for outcome evaluation in this group of patients, and it could be a valuable complementary tool in monitoring patients with mCRPC on second-line therapies.

    Patient summary: Bone Scan Index (BSI) change is related to survival time in metastatic castration-resistant prostate cancer (mCRPC) patients on abiraterone acetate. BSI may be a valuable complementary decision-making tool supporting physicians monitoring patients with mCRPC on second-line therapies.

  • 260. Roberts, Neil A.
    et al.
    Hilton, Emma N.
    Lopes, Filipa M.
    Singh, Subir
    Randles, Michael J.
    Gardiner, Natalie J.
    Chopra, Karl
    Coletta, Riccardo
    Bajwa, Zunera
    Ha, Robert J.
    Yue, Wyatt W.
    Schaefer, Franz
    Weber, Stefanie
    Henriksson, Roger
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Stuart, Helen M.
    Hedman, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Newman, William G.
    Woolf, Adrian S.
    Lrig2 and Hpse2, mutated in urofacial syndrome, pattern nerves in the urinary bladder2019Inngår i: Kidney International, ISSN 0085-2538, E-ISSN 1523-1755, Vol. 95, nr 5, s. 1138-1152Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Mutations in leucine-rich-repeats and immunoglobulin-likedomains 2 (LRIG2) or in heparanase 2 (HPSE2) cause urofacial syndrome, a devastating autosomal recessive disease of functional bladder outlet obstruction. It has been speculated that urofacial syndrome has a neural basis, but it is unknown whether defects in urinary bladder innervation are present. We hypothesized that urofacial syndrome features a peripheral neuropathy of the bladder. Mice with homozygous targeted Lrig2 mutations had urinary defects resembling those found in urofacial syndrome. There was no anatomical blockage of the outflow tract, consistent with a functional bladder outlet obstruction. Transcriptome analysis revealed differential expression of 12 known transcripts in addition to Lrig2, including 8 with established roles in neurobiology. Mice with homozygous mutations in either Lrig2 or Hpse2 had increased nerve density within the body of the urinary bladder and decreased nerve density around the urinary outflow tract. In a sample of 155 children with chronic kidney disease and urinary symptoms, we discovered novel homozygous missense LRIG2 variants that were predicted to be pathogenic in 2 individuals with non-syndromic bladder outlet obstruction. These observations provide evidence that a peripheral neuropathy is central to the pathobiology of functional bladder outlet obstruction in urofacial syndrome, and emphasize the importance of LRIG2 and heparanase 2 for nerve patterning in the urinary tract.

  • 261.
    Robinson, David
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Garmo, Hans
    Bill-Axelson, Anna
    Mucci, Lorelei
    Holmberg, Lars
    Stattin, Pär
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Use of 5 alpha-reductase inhibitors for lower urinary tract symptoms and risk of prostate cancer in Swedish men: nationwide, population based case-control study2013Inngår i: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 346, s. f3406-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective To assess the association between 5 alpha-reductase inhibitor (5-ARI) use in men with lower urinary tract symptoms and prostate cancer risk. Design Nationwide, population based case-control study for men diagnosed with prostate cancer in 2007-09 within the Prostate Cancer data Base Sweden 2.0. Setting The National Prostate Cancer Register, National Patient Register, census, and Prescribed Drug Register in Sweden, from which we obtained data on 5-ARI use before date of prostate cancer diagnosis. Participants 26 735 cases and 133 671 matched controls; five controls per case were randomly selected from matched men in the background population. 7815 men (1499 cases and 6316 controls) had been exposed to 5-ARI. 412 men had been exposed to 5-ARI before the diagnosis of a cancer with Gleason score 8-10. Main outcome measures Risk of prostate cancer calculated as odds ratios and 95% confidence intervals by conditional logistic regression analyses. Results Risk of prostate cancer overall decreased with an increasing duration of exposure; men on 5-ARI treatment for more than three years had an odds ratio of 0.72 (95% confidence interval 0.59 to 0.89; P<0.001 for trend). The same pattern was seen for cancers with Gleason scores 2-6 and score 7 (both P<0.001 for trend). By contrast, the risk of tumours with Gleason scores 8-10 did not decrease with increasing exposure time to 5-ARI (for 0-1 year of exposure, odds ratio 0.96 (95% confidence interval 0.83 to 1.11); for 1-2 years, 1.07 (0.88 to 1.31); for 2-3 years, 0.96 (0.72 to 1.27); for >3 years, 1.23 (0.90 to 1.68); P=0.46 for trend). Conclusions Men treated with 5-ARI for lower urinary tract symptoms had a decreased risk of cancer with Gleason scores 2-7, and showed no evidence of an increased risk of cancer with Gleason scores 8-10 after up to four years' treatment.

  • 262.
    Robinson, David
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi. Department of Urology, Ryhov County Hospital, 551 85 Jönköping, Sweden.
    Garmo, Hans
    Bill-Axelson, Anna
    Mucci, Lorelei
    Holmberg, Lars
    Stattin, Pär
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi. Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
    Use of 5α-reductase inhibitors for lower urinary tract symptoms and risk of prostate cancer in Swedish men: nationwide, population based case-control study2013Inngår i: BMJ (Clinical Research Edition), ISSN 0959-8138, Vol. 346, artikkel-id f3406Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To assess the association between 5α-reductase inhibitor (5-ARI) use in men with lower urinary tract symptoms and prostate cancer risk.

    DESIGN: Nationwide, population based case-control study for men diagnosed with prostate cancer in 2007-09 within the Prostate Cancer data Base Sweden 2.0.

    SETTING: The National Prostate Cancer Register, National Patient Register, census, and Prescribed Drug Register in Sweden, from which we obtained data on 5-ARI use before date of prostate cancer diagnosis.

    PARTICIPANTS: 26,735 cases and 133,671 matched controls; five controls per case were randomly selected from matched men in the background population. 7815 men (1499 cases and 6316 controls) had been exposed to 5-ARI. 412 men had been exposed to 5-ARI before the diagnosis of a cancer with Gleason score 8-10.

    MAIN OUTCOME MEASURES: Risk of prostate cancer calculated as odds ratios and 95% confidence intervals by conditional logistic regression analyses.

    RESULTS: Risk of prostate cancer overall decreased with an increasing duration of exposure; men on 5-ARI treatment for more than three years had an odds ratio of 0.72 (95% confidence interval 0.59 to 0.89; P<0.001 for trend). The same pattern was seen for cancers with Gleason scores 2-6 and score 7 (both P<0.001 for trend). By contrast, the risk of tumours with Gleason scores 8-10 did not decrease with increasing exposure time to 5-ARI (for 0-1 year of exposure, odds ratio 0.96 (95% confidence interval 0.83 to 1.11); for 1-2 years, 1.07 (0.88 to 1.31); for 2-3 years, 0.96 (0.72 to 1.27); for >3 years, 1.23 (0.90 to 1.68); P=0.46 for trend).

    CONCLUSIONS: Men treated with 5-ARI for lower urinary tract symptoms had a decreased risk of cancer with Gleason scores 2-7, and showed no evidence of an increased risk of cancer with Gleason scores 8-10 after up to four years' treatment.

  • 263.
    Robinson, David
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Garmo, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Lindahl, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Van Hemelrijck, Mieke
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Adolfsson, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Bratt, Ola
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Holmberg, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Stattin, Pär
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Ischemic heart disease and stroke before and during endocrine treatment for prostate cancer in PCBaSe Sweden2012Inngår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 130, nr 2, s. 478-487Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In observational studies of men with prostate cancer, men on endocrine treatment (ET) have had an increased risk of ischemic heart disease (IHD) and stroke. However, prostate cancer per se may increase risk of IHD and stroke and men on ET may have been at increased risk already prior to initiation of ET. We assessed the incidence of IHD and stroke in men with prostate cancer before and during different endocrine treatments. The hazard ratio (HR) of IHD and stroke in 39,051 men with prostate cancer vs. a matched control population without prostate cancer was assessed by use of Cox proportion hazard models. An increased risk was found among 30,883 men with prostate cancer who did not receive ET, with a HR of 1.08 (95% CI 1.00–1.18) for IHD and 1.10 (95%CI 1.00–1.21) for stroke. In 8,168 men who initiated ET during the observation period, the risk of IHD was significantly higher (p = 0.014), during ET (HR 1.40, 95% CI 1.17–1.67) compared with before initiation of ET (HR of 0.98, 95% CI 0.72–1.33), whereas no such increase was found for stroke. Regardless of treatment, men with prostate cancer had a small increase in risk of IHD and stroke and initiation of ET was associated with a further increase in risk of IHD. Our data underline the importance of a proper indication for ET because many men with low-risk prostate cancer currently receive ET.

  • 264. Robinson, David
    et al.
    Garmo, Hans
    Lissbrant, Ingela Franck
    Widmark, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Pettersson, Andreas
    Gunnlaugsson, Adalsteinn
    Adolfsson, Jan
    Bratt, Ola
    Nilsson, Per
    Stattin, Pär
    Prostate Cancer Death After Radiotherapy or Radical Prostatectomy: A Nationwide Population-based Observational Study2018Inngår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 73, nr 4, s. 502-511Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: There are no conclusive results from randomized trials on radiotherapy (RT) versus radical prostatectomy (RP) for prostate cancer. Numerous observational studies have suggested that RP is associated with a lower risk of prostate cancer death, but whether results have been biased due to limited adjustments for confounding factors is unknown.

    Objective: To compare the risk of prostate cancer death after RT versus RP.

    Design, setting, and participants: Nationwide population-based observational study of men in the Prostate Cancer data Base Sweden 3.0 who had undergone RT or RP between 1998 and 2012.

    Outcome measurements and statistical analysis: Prostate cancer deaths were compared. Hazard ratios (HRs) were calculated in Cox regression models, including clinical T stage, M stage, Gleason grade group, serum levels of prostate-specific antigen, proportion of biopsy cores with cancer, mode of detection, comorbidity, age, educational level, and civil status. Period analysis with left truncation was performed.

    Results and limitations: Primary treatment was RT or RP for 41 503 men. Treatment effect was associated with disease severity. In univariate analysis of RT versus RP, risk of prostate cancer death was higher after RT-low-and intermediate-risk cancer, HR 1.82 (95% confidence interval [CI]: 1.53-2.16), and high-risk cancer, HR 1.57 (95% CI: 1.33-1.85). After full adjustment in period analysis, this difference between the treatments was attenuated-low-and intermediate-risk cancer, HR 1.24 (95% CI: 0.97-1.58), and high-risk cancer, HR 1.03 (95% CI: 0.81-1.31). Confounding remained due to nonrandom allocation to treatment.

    Conclusions: In comparison with previous studies, the difference in prostate cancer mortality after RT and RP was much smaller.

    Patient summary: The difference in prostate cancer mortality after contemporary radiotherapy and radical prostatectomy was small in contrast to previous studies, indicating that potential side effects should be more emphasized when selecting treatment.

  • 265.
    Robinson, David
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi. Department of Urology, Ryhov County Hospital, Jönköping, Sweden .
    Garmo, Hans
    Department of Urology, Ryhov County Hospital, Jönköping, Sweden; Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden.
    Stattin, Pär
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Michaëlsson, Karl
    Uppsala, Sweden.
    Risk of Fractures and Falls during and after 5-alpha Reductase Inhibitor Use: A Nationwide Cohort Study2015Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, nr 10, artikkel-id e0140598Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Lower urinary tract symptoms are common among older men and 5-alpha reductase inhibitors (5-ARI) are a group of drugs recommended in treating these symptoms. The effect on prostate volume is mediated by a reduction in dihydrotestosterone; however, this reduction is counterbalanced by a 25% rise in serum testosterone levels. Therefore, 5-ARI use might have systemic effects and differentially affect bone mineral density, muscular mass and strength, as well as falls, all of which are major determinants of fractures in older men. Methods We conducted a nationwide cohort study of all Swedish men who used 5-ARI by comparing their risk of hip fracture, any type of fracture and of falls with matched control men randomly selected from the population and unexposed to 5-ARI. Results During 1 417 673 person-years of follow-up, 10 418 men had a hip fracture, 19 570 any type of fracture and 46 755 a fall requiring hospital care. Compared with unexposed men, current users of 5-ARI had an adjusted hazard ratio (HR) of 0.96 (95% CI 0.91-1.02) for hip fracture, an HR of 0.94 (95% CI 0.90-0.98) for all fracture and an HR of 0.99 (95% CI 0.96-1.02) for falls. Former users had an increased risk of hip fractures (HR 1.10, 95% CI 1.01-1.19). Conclusion 5-ARI is safe from a bone health perspective with an unaltered risk of fractures and falls during periods of use. After discontinuation of 5-ARI, there is a modest increase in the rate of fractures and falls.

  • 266. Rodhe, Nils
    et al.
    Englund, Lars
    Mölstad, Sigvard
    Samuelsson, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Research and Development Unit, Jämtland County Council, Sweden.
    Bacteriuria is associated with urge urinary incontinence in older women2008Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 26, nr 1, s. 35-39Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To investigate the association between bacteriuria and frequency and type of urinary incontinence in elderly people living in the community. Bacteriuria and urinary incontinence are common conditions and often coexisting in this population; the authors have previously reported the prevalence of bacteriuria to be 22.4% in women and 9.4% in men.

    DESIGN: Cross-sectional study.

    SETTING: The catchment area of a primary healthcare centre in a Swedish middle-sized town.

    SUBJECTS: Residents, except for those in nursing homes, aged 80 and over. Participation rate: 80.3% (431/537).

    MAIN OUTCOME MEASURES: Urinary cultures and questionnaire data on urinary incontinence.

    RESULTS: In women the OR for having bacteriuria increased with increasing frequency of urinary incontinence; the OR was 2.83 (95% CI 1.35-5.94) for women who were incontinent daily as compared with continent women. Reporting urge urinary incontinence increased the risk of having bacteriuria: 3.36 (95% CI 1.49-7.58) in comparison with continent women while there was no significant association between stress urinary incontinence and bacteriuria. The prevalence of bacteriuria among men was too low to make any meaningful calculations about the association between bacteriuria and frequency and type of incontinence.

    CONCLUSION: Bacteriuria is associated with more frequent leakage and predominantly with urge urinary incontinence. The causes of this association and their clinical implications remain unclear. There might be some individuals who would benefit from antibiotic treatment, but further studies are warranted.

  • 267. Rosen, Raymond C.
    et al.
    Wu, Frederick
    Behre, Hermann M.
    Porst, Hartmut
    Meuleman, Eric J. H.
    Maggi, Mario
    Romero-Otero, Javier
    Martinez-Salamanca, Juan I.
    Jones, Thomas Hugh
    Debruyne, Frans M. J.
    Kurth, Karl-Heinz
    Hackett, Geoff I.
    Quinton, Richard
    Ströberg, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Reisman, Yacov
    Pescatori, Edoardo S.
    Morales, Antonio
    Bassas, Lluis
    Cruz, Natalio
    Cunningham, Glenn R.
    Wheaton, Olivia A.
    Quality of Life and Sexual Function Benefits of Long-Term Testosterone Treatment: Longitudinal Results From the Registry of Hypogonadism in Men (RHYME)2017Inngår i: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 14, nr 9, s. 1104-1115Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The benefits and risks of long-term testosterone administration have been a topic of much scientific and regulatory interest in recent years. Aim: To assess long-term quality of life (QOL) and sexual function benefits of testosterone replacement therapy (TRT) prospectively in a diverse, multinational cohort of men with hypogonadism. Methods: A multinational patient registry was used to assess long-term changes associated with TRT in middle-age and older men with hypogonadism. Comprehensive evaluations were conducted at 6, 12, 24, and 36 months after enrollment into the registry. Outcomes: QOL and sexual function were evaluated by validated measures, including the Aging Males' Symptom (AMS) Scale and the International Index of Erectile Function (IIEF). Results: A total of 999 previously untreated men with hypogonadism were enrolled at 25 European centers, 750 of whom received TRT at at least one visit during the period of observation. Patients on TRT reported rapid and sustained improvements in QOL, with fewer sexual, psychological, and somatic symptoms. Modest improvements in QOL and sexual function, including erectile function, also were noted in RHYME patients not on TRT, although treated patients showed consistently greater benefit over time in all symptom domains compared with untreated patients. AMS total scores for patients on TRT were 32.8 (95% confidence interval = 31.3-34.4) compared with 36.6 (95% confidence interval = 34.8-38.5) for untreated patients (P < .001). Small but significant improvements in IIEF scores over time also were noted with TRT. Approximately 25% of treated and untreated men also used phosphodiesterase type 5 inhibitors, with notable differences in the frequency of phosphodiesterase type 5 inhibitor prescription use according to physician specialty and geographic site location. Clinical Implications: TRT-related benefits in QOL and sexual function are well maintained for up to 36 months after initiation of treatment. Strengths and Limitations: The major strengths are the large, diverse patient population being treated in multidisciplinary clinical settings. The major limitation is the frequency of switching from one formulation to another. Conclusion: Overall, we confirmed the broad and sustained benefits of TRT across major QOL dimensions, including sexual, somatic, and psychological health, which were sustained over 36 months in our treatment cohort. Copyright (C) 2017, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

  • 268.
    Rosenblatt, Robert
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi. Department of Urology, Stockholm South General Hospital, Karolinska Institutet, Stockholm, Sweden.
    Johansson, Markus
    Alamdari, Farhood
    Sidiki, Alexander
    Holmström, Benny
    Hansson, Johan
    Vasko, Janos
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Marits, Per
    Gabrielsson, Susanne
    Riklund, Katrine
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Winqvist, Ola
    Sherif, Amir
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Sentinel node detection in muscle-invasive urothelial bladder cancer is feasible after neoadjuvant chemotherapy in all pT stages, a prospective multicenter report2017Inngår i: World journal of urology, ISSN 0724-4983, E-ISSN 1433-8726, Vol. 35, nr 6, s. 921-927Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: To determine whether sentinel node detection (SNd) in muscle-invasive urothelial bladder cancer (MIBC) can be performed in patients undergoing neoadjuvant chemotherapy (NAC) and determine whether SNd is feasible in all pT stages, including pT0.

    BACKGROUND: Previous published series of SNd in MIBC have not included patients undergoing NAC, and systematic reports of pT0 patients w/wo NAC were absent. Translational immunological tumor research on MIBC focusing on SNd, in the era of NAC, requires technical feasibility. Additionally, SNd in MIBC requests further evaluations as a method for nodal staging.

    MATERIALS AND METHODS: Ninety-nine patients with suspected urothelial MIBC were prospectively selected from six urological centers. After TUR-B and primary staging, 65 MIBC patients qualified for radical cystectomy. Precystectomy staging was cT2a-T4aN0M0, including 47 NAC patients and 18 chemo-naïve patients. All 65 patients underwent intraoperative SNd by peritumoral injection of 80 Mbq Technetium and Geiger probe detection. Postcystectomy staging was pT0-T4aN0-N2M0. SNs were defined by two calculations, SNdef1 and SNdef2.

    RESULTS: Totally 1063 lymph nodes were removed (total SNs; 222-227). NAC patients with pT0 (n = 24) displayed a true positive detection in 91.7 % by either SNdef, with a median of 3.0 SNs. NACpT >0 patients had a true positive detection in 87 % (SNdef1) and 91.3 % (SNdef2). In a univariate analysis, patient group neither NAC nor tumor downstaging influenced detection rates, regardless of SN definition. In total eight patients, 4/22 metastatic nodes were SNs while 18/22 were non-SNs.

    CONCLUSIONS: Sentinel node detection in MIBC is feasible also in NAC patients, regardless of pT stage. SNd played no role in nodal staging.

  • 269.
    Rosenblatt, Robert
    et al.
    Umeå universitet.
    Sandström, Gabriella
    Umeå universitet.
    Bahar, Maryam
    Umeå universitet.
    Asad, Danna
    Umeå universitet.
    Forsman, Ramona
    Umeå universitet.
    Johansson, Markus
    Shareef, Marwan
    Alamdari, Farhood
    Bergh, Anders
    Winqvist, Ola
    Sherif, Amir
    Umeå universitet.
    Blood transfusions during neoadjuvant chemotherapy for muscle-invasive urinary bladder cancer may have a negative impact on overall survival2019Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, s. 35-36Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Introduction: Several studies have demonstrated a decreased overall survival for patients with muscle-invasive bladder cancer (MIBC) receiving allogenic peri- and postoperative blood transfusions at cystectomy. However, the extent and the effect of blood transfusions given during neoadjuvant chemotherapy (NAC) has never been addressed. The purpose of the present study, was to assess the impact of blood transfusions given during NAC on survival in patients with MIBC undergoing NAC and radical cystectomy.

    Materials and Methods: A cohort of 120 consecutive patients with MIBC (cT2-T4aN0M0) undergoing NAC and radical cystectomy at four Swedish centers was retrospectively evaluated. Clinical and pathoanatomical data was obtained, including data SCANDINAVIAN JOURNAL OF UROLOGY 35 on administeredallogenic blood at consecutive time-intervals. Overall survival was analyzed by Kaplan-Meier plotting and Cox regression.

    Results: One third of the cohort (n ¼ 40) received blood transfusions during NAC-therapy. The five-year overall survival rates were significantly lower in this group compared to the non-transfused patients (39.7% and 58.9% respectively, p ¼ 0.047). In a univariate analysis, blood transfusions, nodal status and locally advanced tumor growth (pT >2), were negative prognostic factors for survival. In multivariate analysis, only pNx and pT >2 remained significant negative prognostic factors. In subgroup analysis of localized and non-disseminated patients only (n ¼ 96), blood transfused patients showed a 18,5% absolute risk increase compared to blood naïve patients (p¼ 0.197).

    Conclusions: This is the first time that the extent and the effect of allogenic blood transfusions during NAC is examined in MIBC. Data suggest that there may be an association between blood transfusion and poor pathological and oncological outcome. Firm conclusions are difficult to draw due to the limited number of study participants and the retrospective nature of the study.

  • 270.
    Ruge, Toralph
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Carlsson, Axel C.
    Larsson, Tobias E.
    Carrero, Juan-Jesus
    Larsson, Anders
    Lind, Lars
    Arnlov, Johan
    Endostatin Level is Associated with Kidney Injury in the Elderly: Findings from Two Community-Based Cohorts2014Inngår i: American Journal of Nephrology, ISSN 0250-8095, E-ISSN 1421-9670, Vol. 40, nr 5, s. 417-424Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: We aimed to investigate the associations between circulating endostatin and the different aspects of renal dysfunction, namely, estimated (cystatin C) glomerular filtration rate (GFR) and urine albumin-creatinine ratio (ACR). Methods: Two independent longitudinal community-based cohorts of elderly. ULSAM, n = 786 men; age 78 years; median GFR 74 ml/min/1.73 m(2); median ACR 0.80 mg/mmol); and PIVUS, n = 815; age 75 years; 51% women; median GFR; 67 ml/min/1.73 m(2); median ACR 1.39 mg/mmol. Cross-sectional associations between the endostatin levels and GFR as well as ACR, and longitudinal association between endostatin at baseline and incident CKD (defined as GFR <60 ml/min/1.73 m(2)) were assessed. Results: In cross-sectional regression analyses adjusting for age, gender, inflammation, and cardiovascular risk factors, serum endostatin was negatively associated with GFR (ULSAM: B-coefficient per SD increase -0.51, 95% CI (-0.57, -0.45), p < 0.001; PIVUS -0.47, 95% CI (-0.54, -0.41), p < 0.001) and positively associated with ACR (ULSAM: B-coefficient per SD increase 0.24, 95% CI (0.15, 0.32), p < 0.001; PIVUS 0.13, 95% CI (0.06-0.20), p < 0.001) in both cohorts. Moreover, in longitudinal multivariable analyses, higher endostatin levels were associated with increased risk for incident CKD defined as GFR < 60 ml/min/1.73 m(2) at re-investigations in both ULSAM (odds ratio per SD increase of endostatin 1.39 (95% CI 1.01-1.90) and PIVUS 1.68 (95% CI 1.36-2.07)). Conclusions: Higher circulating endostatin is associated with lower GFR and higher albuminuria and independently predicts incident CKD in elderly subjects. Further studies are warranted to investigate the underlying mechanisms linking endostatin to kidney pathology, and to evaluate the clinical relevance of our findings. (C) 2014 S. Karger AG, Basel

  • 271.
    Rundberg, Matilda
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Testicular cancer - an extended genealogical study of patients with testicular cancer in Västerbotten between 2000-20152018Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 272. Russell, Beth
    et al.
    Sherif, Amir
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Häggström, Christel
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Josephs, Debra
    Kumar, Pardeep
    Malmström, Per-Uno
    Van Hemelrijck, Mieke
    Neoadjuvant chemotherapy for muscle invasive bladder cancer: a nationwide investigation on survival2019Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, nr 4, s. 206-212Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Randomised controlled trials (RCTs) have investigated the use of neoadjuvant chemotherapy (NAC) and its effect on survival patients with non-metastatic muscle-invasive bladder cancer (MIBC). However, these RCTs have limited external validity and generalisability and, therefore, the current study aims to use real world evidence in the form of observational data to identify the effect that NAC may have on survival, compared to the use of radical cystectomy (RC) alone.

    Materials and methods: The study cohort (consisting of 944 patients) was selected as a target trial from the Bladder Cancer Data Base Sweden (BladderBaSe). This study calculated 5-year survival and risk of bladder cancer (BC)-specific and overall death by Cox proportional hazard models for the study cohort and a propensity score (PS) matched cohort.

    Results: Those who had received NAC had higher 5-year survival proportions and decreased risk of both overall and BC specific death (HR = 0.71, 95% CI = 0.52-0.97 and HR = 0.67, 95% CI = 0.48-0.94), respectively, as compared to patients who did not receive NAC. The PS matched cohort showed similar estimates, but with larger statistical uncertainty (Overall death: HR = 0.76, 95% CI = 0.53-1.09 and BC-specific death: HR = 0.73, 95% CI = 0.50-1.07).

    Conclusion: Results from the current observational study found similar point estimates for 5-year survival and of relative risks as previous studies. However, the results based on real world evidence had larger statistical variability, resulting in a non-statistically significant effect of NAC on survival. Future studies with detailed validated data can be used to further investigate the effect of NAC in narrower patient groups.

  • 273. Rönningås, Ulrika
    et al.
    Fransson, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Cancercentrum, Norrlands University Hospital, Umeå, Sweden.
    Holm, Maja
    Wennman-Larsen, Agneta
    Prostate-specific antigen (PSA) and distress: a cross-sectional nationwide survey in men with prostate cancer in Sweden2019Inngår i: BMC Urology, ISSN 1471-2490, E-ISSN 1471-2490, Vol. 19, artikkel-id 66Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The prostate-specific antigen (PSA) -value is often used during the prostate cancer trajectory as a marker of progression or response to treatment. Concerns about PSA-values are often expressed by patients in clinical situations. Today there is a lack of larger studies that have investigated the association between PSA-value and distress. The aim was to investigate the association between PSA-values and distress adjusted for sociodemographic factors, hormonal therapy and quality of life (QoL), among men with prostate cancer.

    Methods: In this cross-sectional survey of 3165 men with prostate cancer, members of the Swedish Prostate Cancer Federation, answered questions about sociodemographic factors, PSA, distress, QoL and treatments. Descriptive statistics, and bivariate and multivariable analyses were performed. The result was presented based on four PSA-value groups: 0–19, 20–99, 100–999, and ≥ 1000 ng/ml.

    Results: Of the men, 53% experienced distress. An association between distress and PSA-values was found where higher PSA-values were associated with higher OR:s for experiencing distress in the different PSA-groups: 0–19 ng/ml (ref 1), 20–99 ng/ml (OR 1.25, 95% CI 1.01–1.55), 100–999 ng/ml (OR 1.47, 95% CI 1.12–1.94), ≥1000 ng/ml (OR 1.77, 95% CI 1.11–2.85). These associations were adjusted for sociodemographic factors and hormonal therapy. In the multivariable analyses, beside PSA-values, higher levels of distress were associated with being without partner or hormonal therapy. When adding QoL in the multivariable analysis, the association between PSA and distress did not remain significant.

    Conclusion: These results indicate that the PSA-values are associated with distress, especially for those with higher values. However, to be able to support these men, continued research is needed to gain more knowledge about the mechanisms behind the association between emotional distress and PSA-values.

  • 274. Sabir, Emad F.
    et al.
    Holmäng, Sten
    Liedberg, Fredrik
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Malmström, Per-Uno
    Månsson, Wiking
    Wijkström, Hans
    Jahnson, Staffan
    Impact of hospital volume on local recurrence and distant metastasis in bladder cancer patients treated with radical cystectomy in Sweden2013Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 47, nr 6, s. 483-490Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: This study evaluated the impact of hospital volume on local recurrence and distant metastasis in a population-based series of radical cystectomy patients in Sweden. Material and methods: All patients who underwent cystectomy for bladder cancer in 1997-2002 in Sweden and were reported to the National Bladder Cancer Registry were included. A high-volume hospital (HVH) was defined as one with >= 10 cystectomies/year and a low-volume hospital (LVH) as one with <10 cystectomies/year. Information on preoperative tumour, node, metastasis (TNM) classification, operative procedure, postoperative course and follow-up was obtained from medical records. Results: Of the 1126 patients, 827 (74%) were males. The mean age was 66 years and median follow-up 47 months. Of the 610 (54%) HVH patients, 68 (11%) were pT0, 123 (20%) <pT2, 177 (29%) pT2, 242 (40%) >pT2 and 69 (11%) were microscopic non-radical. Corresponding figures for the 516 (46%) LVH patients were 35 (7%), 68 (13%), 191 (37%), 222 (43%) and 96 (19%). Local recurrence was observed in 245 patients (22%): 113 (19%) at HVHs and 132 (26%) at LVHs. Distant metastasis was found in 363 (32%): 203 (33%) at HVHs and 160 (31%) at LVHs. Perioperative chemotherapy was given to 193 (17%). Multivariate Cox proportional hazards analysis showed that local recurrence was associated with LVHs and non-organ-confined disease, whereas distant metastasis was correlated with non-organ-confined disease and lymph-node metastases. Conclusions: In this retrospective analysis, local tumour recurrence after cystectomy was common, particularly in patients with non-organ-confined disease. Furthermore, local recurrence was more frequent at LVHs than HVHs, and overall survival was better at HVHs. These findings suggest that concentrating cystectomies in HVHs may improve outcomes such as local recurrence and overall survival.

  • 275. Salem, Rany M.
    et al.
    Todd, Jennifer N.
    Sandholm, Niina
    Cole, Joanne B.
    Chen, Wei-Min
    Andrews, Darrell
    Pezzolesi, Marcus G.
    McKeigue, Paul M.
    Hiraki, Linda T.
    Qiu, Chengxiang
    Nair, Viji
    Di Liao, Chen
    Cao, Jing Jing
    Valo, Erkka
    Onengut-Gumuscu, Suna
    Smiles, Adam M.
    McGurnaghan, Stuart J.
    Haukka, Jani K.
    Harjutsalo, Valma
    Brennan, Eoin P.
    van Zuydam, Natalie
    Ahlqvist, Emma
    Doyle, Ross
    Ahluwalia, Tarunveer S.
    Lajer, Maria
    Hughes, Maria F.
    Park, Jihwan
    Skupien, Jan
    Spiliopoulou, Athina
    Liu, Andrew
    Menon, Rajasree
    Boustany-Kari, Carine M.
    Kang, Hyun M.
    Nelson, Robert G.
    Klein, Ronald
    Klein, Barbara E.
    Lee, Kristine E.
    Gao, Xiaoyu
    Mauer, Michael
    Maestroni, Silvia
    Caramori, Maria Luiza
    de Boer, Ian H.
    Miller, Rachel G.
    Guo, Jingchuan
    Boright, Andrew P.
    Tregouet, David
    Gyorgy, Beata
    Snell-Bergeon, Janet K.
    Maahs, David M.
    Bull, Shelley B.
    Canty, Angelo J.
    Palmer, Colin N. A.
    Stechemesser, Lars
    Paulweber, Bernhard
    Weitgasser, Raimund
    Sokolovska, Jelizaveta
    Rovite, Vita
    Pirags, Valdis
    Prakapiene, Edita
    Radzeviciene, Lina
    Verkauskiene, Rasa
    Panduru, Nicolae Mircea
    Groop, Leif C.
    McCarthy, Mark, I
    Gu, Harvest F.
    Möllsten, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Falhammar, Henrik
    Brismar, Kerstin
    Martin, Finian
    Rossing, Peter
    Costacou, Tina
    Zerbini, Gianpaolo
    Marre, Michel
    Hadjadj, Samy
    McKnight, Amy J.
    Forsblom, Carol
    McKay, Gareth
    Godson, Catherine
    Maxwell, A. Peter
    Kretzler, Matthias
    Susztak, Katalin
    Colhoun, Helen M.
    Krolewski, Andrzej
    Paterson, Andrew D.
    Groop, Per-Henrik
    Rich, Stephen S.
    Hirschhorn, Joel N.
    Florez, Jose C.
    Genome-Wide Association Study of Diabetic Kidney Disease Highlights Biology Involved in Glomerular Basement Membrane Collagen2019Inngår i: Journal of the American Society of Nephrology, ISSN 1046-6673, E-ISSN 1533-3450, Vol. 30, nr 10, s. 2000-2016Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Although diabetic kidney disease demonstrates both familial clustering and single nucleotide polymorphism heritability, the specific genetic factors influencing risk remain largely unknown.

    Methods: To identify genetic variants predisposing to diabetic kidney disease, we performed genome-wide association study (GWAS) analyses. Through collaboration with the Diabetes Nephropathy Collaborative Research Initiative, we assembled a large collection of type 1 diabetes cohorts with harmonized diabetic kidney disease phenotypes. We used a spectrum of ten diabetic kidney disease definitions based on albuminuria and renal function.

    Results: Our GWAS meta-analysis included association results for up to 19,406 individuals of European descent with type 1 diabetes. We identified 16 genome-wide significant risk loci. The variant with the strongest association (rs55703767) is a common missense mutation in the collagen type IV alpha 3 chain (COL4A3) gene, which encodes a major structural component of the glomerular basement membrane (GBM). Mutations in COL4A3 are implicated in heritable nephropathies, including the progressive inherited nephropathy Alport syndrome. The rs55703767 minor allele (Asp326Tyr) is protective against several definitions of diabetic kidney disease, including albuminuria and ESKD, and demonstrated a significant association with GBM width; protective allele carriers had thinner GBM before any signs of kidney disease, and its effect was dependent on glycemia. Three other loci are in or near genes with known or suggestive involvement in this condition (BMP7) or renal biology (COLEC11 and DDR1).

    Conclusions: The 16 diabetic kidney disease–associated loci may provide novel insights into the pathogenesis of this condition and help identify potential biologic targets for prevention and treatment.

  • 276.
    Samuelsson, Eva C
    et al.
    Uppsala universitet.
    Victor, F T Arne
    Svärdsudd, Kurt F
    Five-year incidence and remission rates of female urinary incontinence in a Swedish population less than 65 years old2000Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 183, nr 3, s. 568-574Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: We sought to determine the incidence and remission rates of urinary incontinence in a population-based sample of women.

    STUDY DESIGN: A total of 382 (87.6%) of 436 eligible women aged 20 to 59 years answered a questionnaire and underwent a gynecologic examination at baseline and were followed up approximately 5 years later.

    RESULTS: Urinary incontinence was present in 23.6% of women at baseline and in 27.5% at follow-up. The mean annual incidence rate of incontinence was 2.9%, and the mean annual incidence rate of incontinence weekly or more often was 0.5%. Women that were receiving estrogen at baseline were more likely than other women to have incontinence during follow-up. The mean annual remission rate among the 90 women who were incontinent at baseline was 5.9%. The annual net increase of incontinence in the study population was 0. 82%.

    CONCLUSION: Female urinary incontinence seems to be a dynamic condition with a relatively high rate of spontaneous remission, a fact of which physicians should be aware when assessing and planning prevention and treatment strategies.

  • 277.
    Samuelsson, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Krokoms Health Centre and the Research & Development Unit, The County Council of Jämtland.
    Månsson, L
    The Administrative Department, Östersund Hospital, Östersund.
    Milsom, I
    The Department of Obstetrics & Gynaecology, Sahlgrenska University Hospital, Göteborg.
    Incontinence aids in Sweden: users and costs2001Inngår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 88, nr 9, s. 893-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To study age- and sex-specific use and costs of incontinence aids distributed free of charge in Sweden.

    SUBJECTS AND METHODS: The study was conducted in the county of Jämtland, Sweden (132,000 inhabitants). The use and cost of incontinence aids for people living in their homes and the total cost of incontinence aids for residents of special accommodation (e.g. nursing homes, homes for the elderly and sheltered housing) was obtained from a central database constructed for the purpose. Individual usage of incontinence aids by those in special accommodation was studied in two districts of Jämtland, representing 18% of the population.

    RESULTS: Free incontinence products were used by 6.4% of all women and 2.4% of all men in the county. There was a sharp increase in usage from the age of 75 years. Of the users, 21% lived in special accommodation. If the data from Jämtland are extrapolated nationally, then 274,000 women and 93,000 men in Sweden (total population 8.8 million) are using free incontinence products. The total cost of incontinence aids for Jämtland during 1999 was 15.4 million Swedish krona (SK), and those in special accommodation accounted for 46% of these costs. This corresponds to an estimated total cost in Sweden of approximately 925 million SK. Although 75% of the users were women, women only contributed 61% of the total costs. The mean annual cost of incontinence aids for an incontinent man was twice that of an incontinent woman. More than half of the costs were attributable to those aged >or=80 years.

    CONCLUSIONS: The estimated national costs of free incontinence aids accounts for 0.5% of the total costs of Swedish healthcare, including the care and nursing of older and disabled people, and for 0.05% of the gross national product.

  • 278.
    Samuelsson, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Nyström, Emma
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Söderstrom, L.
    TREATMENT FOR STRESS URINARY INCONTINENCE WITH THE SUPPORT OF A MOBILE APPLICATION IS EFFECTIVE WHEN IMPLEMENTED FOR FREE USE2016Inngår i: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 35, nr S4, s. S92-S94Artikkel i tidsskrift (Annet vitenskapelig)
  • 279.
    Samuelsson, Eva
    et al.
    Uppsala University, Uppsala and Mid Sweden University, Östersund.
    Victor, Arne
    Mid Sweden University, Östersund.
    Svärdsudd, Kurt
    Uppsala University.
    Determinants of urinary incontinence in a population of young and middle-aged women2000Inngår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 79, nr 3, s. 208-15Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Urinary incontinence and genital prolapse are prevalent conditions in the female population. The aim of this study was to study possible determinants of female urinary incontinence in a population-based sample of young and middle-aged women.

    METHODS: Of 641 eligible women aged 20-59 years in a primary health care district, 487 (76%) responded to a questionnaire and accepted an invitation to a gynecological examination. The examination included digital assessment of the pelvic floor muscle strength (PFMS). Genital prolapse presence (cystocele, rectocele, uterine prolapse or absence of the urethrovesical crease) was graded in relation to the vaginal introitus.

    RESULTS: The prevalence of urinary incontinence was 28%, 3.5% having daily leakage. Stress urinary incontinence was the dominant type. The odds ratio (OR) of having incontinence increased from 1 to 3.5 with increasing age and from 1 to 2.7 with increasing parity. The OR also increased with decreasing PFMS; from 1 in the group with the best PFMS to 3.4 in the group unable to contract their pelvic musculature. In addition, women with cystocele and/or absence of the urethrovesical crease had a 2.5-fold increased OR of incontinence (95% CI 1.5-4.2), smoking increased the OR 1.9 times (95% CI 1.1-3.2) and estrogen replacement therapy (ERT) increased the OR 2.9 times (95% CI 1.4-5.9). There were no significant correlations with the presence of chronic disease, episiotomy or the birth weights of children but small non-significant correlations with performed hysterectomy and the woman's weight.

    CONCLUSIONS: Urinary incontinence is a frequent symptom in the female general population and related to age, pelvic floor muscle strength, genital prolapse, smoking, parity and estrogen replacement therapy.

  • 280.
    Samuelsson, Eva
    et al.
    Uppsala University, Uppsala and Zätägrands Primary Health Care, Center, Östersund.
    Victor, Arne
    Tibblin, Gösta
    A population study of urinary incontinence and nocturia among women aged 20-59 years: prevalence, well-being and wish for treatment1997Inngår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 76, nr 1, s. 74-80Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The aim was to study urinary incontinence (UI) and nocturia in a female population; prevalence, effect on well-being, wish for treatment and result of treatment in primary health care.

    METHODS: A postal questionnaire was sent to all women aged 20-59 years who were scheduled for gynecological health examination by midwives in a primary health care district during one year. Questions concerning well-being were based on the Gothenburg QOL instrument. All women with incontinence were offered treatment by a midwife and a family doctor.

    RESULTS: Of the included 641 women, 491 (77%) answered the questionnaire. The prevalence of urinary incontinence was 27.7%, 3.5% having daily leakage. Nocturia occurred in 32 women (6.5%), 12 of whom were also incontinent. Self-assessed health, sleep, fitness and satisfaction with work situation decreased significantly with increased frequency of incontinence. Well-being was not correlated to type of incontinence. Nocturia correlated to poor health and sleep. About a quarter of the incontinent women started treatment when offered and 80% of those who completed the treatment program were subjectively improved. Wish for treatment was directly correlated to frequency of incontinence but not to type.

    CONCLUSIONS: Urinary incontinence and nocturia affect well-being in a negative way. Well-being and wish for treatment correlate to frequency of incontinence but not to type of incontinence. Most women with UI accept it, only about a quarter of incontinent women, or 6-7% of all women in the studied age group, want treatment. Treatment of female urinary incontinence in primary health care is successful.

  • 281.
    Sandgren, Kristina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Westerlinck, Philippe
    Jonsson, Joakim H
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Blomqvist, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Thellenberg Karlsson, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Nyholm, Tufve
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper. Department of Immunology, Genetics, and Pathology, Medical Radiation Science, Uppsala University, Uppsala, Sweden.
    Dirix, Piet
    Imaging for the Detection of Locoregional Recurrences in Biochemical Progression After Radical Prostatectomy: A Systematic Review2019Inngår i: European Urology Focus, ISSN 2405-4569, Vol. 5, nr 4, s. 550-560Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Context: Local and regional recurrence after radical prostatectomy (RP) can be treated using salvage radiotherapy (SRT). If the recurrence can be delineated on diagnostic imaging, this could allow for increasingly individualized SRT.

    Objective: This systematic review aimed at evaluating the evidence regarding the usefulness of positron emission tomography (PET) and magnetic resonance imaging (MRI) in identifying local and regional recurrences, with the aim to further individualize the SRT treatment.

    Evidence acquisition: A systematic PubMed/Medline search was conducted in December 2015. Studies included were imaging studies of post-RP patients focusing on local and/or regional recurrence where sensitivity and specificity of MRI or PET were the primary end points. Only studies using biopsy, other histological analysis, and/or treatment follow-up as reference standard were included. Quality Assessment of Diagnostic Accuracy Studies-2 was used to score the study quality. Twenty-five articles were deemed of sufficient quality and included in the review.

    Evidence synthesis: [11C]Acetate had the highest pooled sensitivity (92%), while [11C]choline and [18F]choline had pooled sensitivities of 71% and 84%, respectively. The PET tracer with highest pooled specificity was [11C]choline (86%). Regarding MRI, MR spectroscopy combined with dynamic contrast enhanced (DCE) MRI showed the highest pooled sensitivity (89%). High pooled sensitivities were also seen using multiparametric MRI (84%), diffusion-weighted MRI combined with T2-weigthed (T2w) imaging (82%), and DCE MRI combined with T2w imaging (82%). These also showed high pooled specificities (85%, 89%, and 92%, respectively).

    Conclusions: Both MRI and PET have adequate sensitivity and specificity for the detection of prostate cancer recurrences post-RP. Multiparametric MRI, using diffusion-weighted and/or DCE imaging, and the choline-labeled tracers showed high pooled sensitivity and specificity, although their ranges were broad.

    Patient summary: After reviewing imaging studies of recurrent prostate cancer after prostatectomy, we concluded that choline positron emission tomography and diffusion-weighted magnetic resonance imaging can be proposed as the current standard, with high sensitivity and specificity.

  • 282.
    Sandström, Gabriella
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Blood transfusions during neoadjuvant chemotherapy for muscle-invasive urinary bladder cancer may result in a reduction in overall survival.2019Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 283. Sartor, Oliver
    et al.
    Heinrich, Daniel
    Mariados, Neil
    Mendez Vidal, Maria Jose
    Keizman, Daniel
    Thellenberg-Karlsson, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Peer, Avivit
    Procopio, Giuseppe
    Frank, Stephen J.
    Pulkkanen, Kalevi
    Rosenbaum, Eli
    Severi, Stefano
    Trigo, Jose
    Trandafir, Lucia
    Wagner, Volker
    Li, Rui
    Nordquist, Luke T.
    Re-treatment with radium-223: 2-year follow-up from an international, open-label, phase 1/2 study in patients with castration-resistant prostate cancer and bone metastases2019Inngår i: The Prostate, ISSN 0270-4137, E-ISSN 1097-0045, Vol. 79, nr 14, s. 1683-1691Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Radium-223 dichloride (radium-223) is approved for patients with castration-resistant prostate cancer (CRPC), symptomatic bone metastases, and no visceral disease using a dosing regimen of 6 injections (55 kBq/kg intravenously; 1 injection every 4 weeks). Early results from international, open-label, phase 1/2 study NCT01934790 showed that re-treatment with radium-223 was well tolerated with favorable effects on disease progression. Here we report safety and efficacy findings from 2-year follow-up of the radium-223 re-treatment study.

    Methods: Patients with CRPC and bone metastases who completed 6 initial radium-223 injections with no disease progression in bone and later progressed were eligible for radium-223 re-treatment (up to 6 additional radium-223 injections), provided that hematologic parameters were adequate and chemotherapy had not been administered after the initial course of radium-223. Concomitant cytotoxic agents were not allowed during re-treatment but were allowed at the investigator's discretion during follow-up; other concomitant agents for prostate cancer (including abiraterone acetate or enzalutamide) were allowed at investigator's discretion. The primary objective was safety. Exploratory objectives included time to radiographic bone progression, radiographic progression-free survival (rPFS), time to total alkaline phosphatase (tALP), and prostate-specific antigen (PSA) progression, overall survival (OS), time to first symptomatic skeletal event (SSE), and SSE-free survival, all calculated from re-treatment start. Evaluation of safety and exploratory efficacy objectives included active 2-year follow-up. Safety results from active follow-up and updated efficacy are reported.

    Results: Overall, 44 patients were re-treated with radium-223; 29 (66%) completed all 6 injections, and 34 (77%) entered 2-year active follow-up, during which no new safety concerns and no serious drug-related adverse events were noted. rPFS events (progression or death) occurred in 19 (43%) of 44 patients; median rPFS was 9.9 months. Radiographic bone progression occurred in 5 (11%) of 44 patients. Median OS was 24.4 months. Median times to first SSE and SSE-free survival were 16.7 and 12.8 months, respectively. Median time to tALP progression was not reached; median time to PSA progression was 2.2 months.

    Conclusions: Re-treatment with radium-223 in this selected patient population was well tolerated, led to minimal hematologic toxicity, and provided continued disease control in bone at 2-year follow-up.

  • 284. Scelo, Ghislaine
    et al.
    Purdue, Mark P.
    Brown, Kevin M.
    Johansson, Mattias
    Wang, Zhaoming
    Eckel-Passow, Jeanette E.
    Ye, Yuanqing
    Hofmann, Jonathan N.
    Choi, Jiyeon
    Foll, Matthieu
    Gaborieau, Valerie
    Machiela, Mitchell J.
    Colli, Leandro M.
    Li, Peng
    Sampson, Joshua N.
    Abedi-Ardekani, Behnoush
    Besse, Celine
    Blanche, Helene
    Boland, Anne
    Burdette, Laurie
    Chabrier, Amelie
    Durand, Geoffroy
    Le Calvez-Kelm, Florence
    Prokhortchouk, Egor
    Robinot, Nivonirina
    Skryabin, Konstantin G.
    Wozniak, Magdalena B.
    Yeager, Meredith
    Basta-Jovanovic, Gordana
    Dzamic, Zoran
    Foretova, Lenka
    Holcatova, Ivana
    Janout, Vladimir
    Mates, Dana
    Mukeriya, Anush
    Rascu, Stefan
    Zaridze, David
    Bencko, Vladimir
    Cybulski, Cezary
    Fabianova, Eleonora
    Jinga, Viorel
    Lissowska, Jolanta
    Lubinski, Jan
    Navratilova, Marie
    Rudnai, Peter
    Szeszenia-Dabrowska, Neonila
    Benhamou, Simone
    Cancel-Tassin, Geraldine
    Cussenot, Olivier
    Baglietto, Laura
    Boeing, Heiner
    Khaw, Kay-Tee
    Weiderpass, Elisabete
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Sitaram, Raviprakash T.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Bruinsma, Fiona
    Jordan, Susan J.
    Severi, Gianluca
    Winship, Ingrid
    Hveem, Kristian
    Vatten, Lars J.
    Fletcher, Tony
    Koppova, Kvetoslava
    Larsson, Susanna C.
    Wolk, Alicja
    Banks, Rosamonde E.
    Selby, Peter J.
    Easton, Douglas F.
    Pharoah, Paul
    Andreotti, Gabriella
    Freeman, Laura E. Beane
    Koutros, Stella
    Albanes, Demetrius
    Mannisto, Satu
    Weinstein, Stephanie
    Clark, Peter E.
    Edwards, Todd L.
    Lipworth, Loren
    Gapstur, Susan M.
    Stevens, Victoria L.
    Carol, Hallie
    Freedman, Matthew L.
    Pomerantz, Mark M.
    Cho, Eunyoung
    Kraft, Peter
    Preston, Mark A.
    Wilson, Kathryn M.
    Gaziano, J. Michael
    Sesso, Howard D.
    Black, Amanda
    Freedman, Neal D.
    Huang, Wen-Yi
    Anema, John G.
    Kahnoski, Richard J.
    Lane, Brian R.
    Noyes, Sabrina L.
    Petillo, David
    Teh, Bin Tean
    Peters, Ulrike
    White, Emily
    Anderson, Garnet L.
    Johnson, Lisa
    Luo, Juhua
    Buring, Julie
    Lee, I-Min
    Chow, Wong-Ho
    Moore, Lee E.
    Wood, Christopher
    Eisen, Timothy
    Henrion, Marc
    Larkin, James
    Barman, Poulami
    Leibovich, Bradley C.
    Choueiri, Toni K.
    Lathrop, G. Mark
    Rothman, Nathaniel
    Deleuze, Jean-Francois
    Mckay, James D.
    Parker, Alexander S.
    Wu, Xifeng
    Houlston, Richard S.
    Brennan, Paul
    Chanock, Stephen J.
    Genome-wide association study identifies multiple risk loci for renal cell carcinoma2017Inngår i: Nature Communications, ISSN 2041-1723, E-ISSN 2041-1723, Vol. 8, artikkel-id 15724Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Previous genome-wide association studies (GWAS) have identified six risk loci for renal cell carcinoma (RCC). We conducted a meta-analysis of two new scans of 5,198 cases and 7,331 controls together with four existing scans, totalling 10,784 cases and 20,406 controls of European ancestry. Twenty-four loci were tested in an additional 3,182 cases and 6,301 controls. We confirm the six known RCC risk loci and identify seven new loci at 1p32.3 (rs4381241, P = 3.1 x 10(-10)), 3p22.1 (rs67311347, P = 2.5 x 10(-8)), 3q26.2 (rs10936602, P = 8.8 x 10(-9)), 8p21.3 (rs2241261, P = 5.8 x 10(-9)), 10q24.33-q25.1 (rs11813268, P = 3.9 x 10(-8)), 11q22.3 (rs74911261, P = 2.1 x 10(-10)) and 14q24.2 (rs4903064, P = 2.2 x 10(-24)). Expression quantitative trait analyses suggest plausible candidate genes at these regions that may contribute to RCC susceptibility.

  • 285.
    Schönebeck, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Studies on Candida infection of the urinary tract and on the antimycotic drug 5-flourocytosine1972Doktoravhandling, med artikler (Annet vitenskapelig)
  • 286. Segelmark, Mårten
    et al.
    Simonsen, Ole
    Ljungman, Susanne
    Hylander, Britta
    Heimbürger, Olof
    Johansson, Ann-Cathrine
    Malmsten, Gudrun
    Stegmayr, Bernd
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Ojämn tillgång till vård i landet: assisterad peritonealdialys erbjuds inte till alla som behöver det2012Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, nr 9-10, s. 452-453Artikkel i tidsskrift (Annet vitenskapelig)
  • 287.
    Shah, Carl-Henrik
    et al.
    Stockholm, Sweden.
    Viktorsson, Kristina
    Stockholm, Sweden.
    Kanter, Lena
    Stockholm, Sweden.
    Sherif, Amir
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Asmundsson, Jurate
    Stockholm, Sweden.
    Rosenblatt, Robert
    Stockholm, Sweden.
    Lewensohn, Rolf
    Stockholm, Sweden.
    Ullén, Anders
    Stockholm, Sweden.
    Vascular endothelial growth factor receptor 2, but not S100A4 or S100A6, correlates with prolonged survival in advanced urothelial carcinoma2014Inngår i: Urologic Oncology, ISSN 1078-1439, E-ISSN 1873-2496, Vol. 32, nr 8, s. 1215-1224Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: A major challenge in muscle-invasive urothelial carcinoma (UC) is to identify biomarkers that can predict disease prognosis and treatment response after cystectomy. Therefore, we analyzed the potential prognostic value of the proteins vascular endothelial growth factor receptor 2 (VEGFR2), S100A4, and S100A6 in UC.

    METHODS: Retrospective outcome data and tumor specimens from 83 cystectomy patients with histologically confirmed invasive UC were included. Expression levels of VEGFR2 (also called flk-1 and KDR), S100A4, and S100A6 were analyzed in primary tumor tissue by immunohistochemistry.

    RESULTS: Immunohistochemical staining and analysis of VEGFR2, S100A4, and S100A6 showed localization mainly in tumor cell cytoplasm. High VEGFR2 expression and low tumor category were independent variables associated with longer overall survival (OS) and disease-free survival, revealed by a bivariate Cox proportional hazards regression model (both P<0.001). In addition, the univariate log-rank test and the Cox model demonstrated that OS beyond 2 years was significantly greater among patients with low S100A6 expression than in those with high S100A6 expression (P = 0.017 and 0.022, respectively). Differences in tumor expression of S100A4 were not significantly associated with outcome.

    CONCLUSION: In this study, VEGFR2 expression was significantly correlated with risk of disease relapse and OS in a defined cohort of patients with UC of the bladder treated by cystectomy.

  • 288. Sherif, A. M.
    et al.
    Eriksson, E.
    Thorn, M.
    Vasko, Janos
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Öhberg, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Riklund, Katrine
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi. Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI).
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Sentinel node detection in renal cell carcinoma. A feasibility study2012Inngår i: European urology. Supplement, ISSN 1569-9056, E-ISSN 1878-1500, Vol. 11, nr 1, s. E927-U948Artikkel i tidsskrift (Annet vitenskapelig)
  • 289.
    Sherif, Amir
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    B cells in tumor draining lymph nodes act asefficient antigen presenting cells in cancer patients2015Konferansepaper (Annet (populærvitenskap, debatt, mm))
  • 290.
    Sherif, Amir
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    The long perspective in emergence of neoadjuvant chemotherapy for bladder cancer in Ontario, Canada: space for improvement with regular and organized multidisciplinary team meetings2018Inngår i: Translational Andrology and Urology, ISSN 2223-4683, Vol. 7, nr 3, s. 508-510Artikkel i tidsskrift (Fagfellevurdert)
  • 291.
    Sherif, Amir
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    The risk of oversimplification in risk-stratification of neoadjuvant chemotherapy-responses in muscle invasive bladder cancer2019Inngår i: Translational Andrology and Urology, ISSN 2223-4683, Vol. 8, nr Suppl 3, s. S337-S340Artikkel i tidsskrift (Annet vitenskapelig)
  • 292.
    Sherif, Amir
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Hasan, Mudhar N
    Radecka, Eva
    Rodriguez, Alvaro Lozano
    Shabo, Sarab
    Karlsson, Mona
    Schumacher, Martin C
    Marits, Per
    Winqvist, Ola
    Pilot study of adoptive immunotherapy with sentinel node-derived T cells in muscle-invasive urinary bladder cancer2015Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 49, nr 6, s. 453-462Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The aim of this study was to determine by computed tomography (CT) whether treatment with tumor-draining lymph-node-derived expanded autologous T lymphocytes results in objective responses and/or improved survival in patients with metastatic urinary bladder cancer (UBC) and to record the toxicity of the treatment.

    MATERIALS AND METHODS: Eighteen patients with metastatic UBC were prospectively selected from two centers. The preoperative staging was T2-T4bN1-2 and/or M0-M1 or MX. Tumor-draining lymph nodes were harvested at intended cystectomy for the extraction of T lymphocytes. This was followed by expansion of the T lymphocytes in a cell culture, and subsequent reinfusion of these autologous tumor-specific T lymphocytes. Responses to therapy were evaluated by CT scans according to Response Evaluation Criteria In Solid Tumors (RECIST) and clinical follow-up, according to the research protocol.

    RESULTS: Nine out of 18 patients were treated. Treatment was feasible and safe. In two out of nine immunologically treated patients, objective responses were detected in terms of diminished or obliterated nodal metastases. When excluding three patients with disseminated osseous metastases plus one with a T4b tumor left in situ, a success rate of two out of six treated patients was seen. The two responders had survival times of 35 and 11 months, respectively. No toxicity was recorded.

    CONCLUSIONS: Infusion of expanded autologous tumor-specific T lymphocytes is feasible and safe, and objective responses according to RECIST were recorded. One objective responder to immunotherapy displayed notably long overall survival.

  • 293.
    Sherif, Amir
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Rosenblatt, Robert
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Johansson, Markus
    Almadari, Farhood
    Sidiki, Alexander
    Holmström, Benny
    Hansson, Johan
    Vasko, Janos
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap.
    Marits, Per
    Gabrielsson, Susanne
    Riklund, Katrine
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Winqvist, Ola
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Sentinel node detection in muscle invasive urothelial bladder cancer is feasible after neoadjuvant chemotherapy in all pT-stages2017Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, s. 37-37Artikkel i tidsskrift (Annet vitenskapelig)
  • 294.
    Sherif, Amir
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Winerdal, Malin
    Winqvist, Ola
    Immune responses to neoadjuvant chemotherapy in muscle invasive bladder cancer2018Inngår i: Bladder cancer, ISSN 2352-3727, Vol. 4, nr 1, s. 1-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The secondary effects of chemotherapy, with bone marrow depression and risk of leukopenia, has traditionally been considered being detrimental for the immune system. However, growing evidence suggests a main role for chemotherapy in antitumor immunomodulation. With reference to cisplatin, which is the basis of neoadjuvant chemotherapy in muscle invasive bladder cancer, four different aspects of immunomodulation has thus far been described; increased MHC class I expression, recruitment and proliferation of effector cells, enhancement of tumor-lytic activity of cytotoxic effectors and downregulation of immunosuppressive actors in the microenvironment. Consequently, the role of chemotherapy in cancer is changing from a therapy solely aimed at inducing tumor cell death, to a potent inducer of immune responses and a potential future major partaker in cancer immunotherapy. This is a great opportunity for the urological community to broaden research in this field in order to increase knowledge, optimize and improve the neoadjuvant regimens of muscle invasive bladder cancer to ultimately improve patient outcome.

  • 295.
    Sherif, Amir
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Winerdal, ME
    Winqvist, O
    Sentinel lymph node detection in urinary bladder cancer: a gateway to advanced translational research and cellular immunotherapy Minireview2016Inngår i: Egyptian Journal Of Urology, ISSN 1110-5712, Vol. 22, s. 1-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Patients with advanced urothelial urinary bladder cancer (UBC) have a pessimistic prognosis, although modern urology can offer preoperative chemotherapy followed by radical surgery. Attempts to find additional, other than adjuvant cytotoxic treatment options need to be explored. The field of immune therapy may be of particular value in UBC since immunotherapy of superficial UBC using an unspecific immunotherapy modality, namely BCG, has been so successful. In addition, UBC is one of the most genetically unstable cancers carrying many neo-antigens as potential targets for T lymphocyte recognition. A tempting option aiming at highly individualized treatment could be autologous cell therapy based on the concepts of sentinel node detection. The sentinel nodes, representing the foremost arena for the struggle between the immune system of the patient and the tumor assault, can offer high quantities of highly specialized T lymphocytes. These T cells have evolved in response to a number of specific tumor antigens reaching the tumor draining sentinel nodes en route. Adoptive immunotherapy within this framework entails possibilities of harvesting tumor specific T cells from the sentinel nodes and allowing them to expand in vitro. Expanded and strengthened T cells can then be reinfused as a safe and non-toxic adjuvant immunotherapy. The first pilot trials have been published utilizing this method in two solid cancers, colon and UBC. Results demonstrate objective responses in some patients without any negative side effects. The future challenge is to increase the translational research in this specific field, to further improve immunobiological techniques, to optimize patient selection and to perform larger randomized controlled clinical trials.

  • 296. Silagy, Andrew W.
    et al.
    Sanchez, Alejandro
    Manley, Brandon J.
    Bensalah, Karim
    Bex, Axel
    Karam, Jose A.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Shuch, Brian
    Hakimi, A. Ari
    Harnessing the Genomic Landscape of the Small Renal Mass to Guide Clinical Management2019Inngår i: European Urology Focus, ISSN 2405-4569, Vol. 5, nr 6, s. 949-957Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Context: Small renal masses (SRMs; tumors <4 cm) encompass a diagnostic and therapeutic challenge. Genomic profiling has the potential to improve risk stratification and personalize treatment selection.

    Objective: Herein, we review the evidence regarding the utility, challenges, and potential implications of genomic profiling in the management of SRMs.

    Evidence acquisition: Pertinent publications available on PubMed database pertaining to kidney cancer, tumor size, genomics, and clinical management were reviewed.

    Evidence synthesis: Compared with larger tumors, SRMs range from benign to lethal, necessitating strategies for improved treatment selection. Recent advances in the molecular characterization of renal cell carcinoma have improved our understanding of the disease; however, utility of these tools for the management of SRMs is less clear. While intratumoral heterogeneity (ITH) reduces the accuracy and reliability of sequencing, relative genomic uniformity of SRMs somewhat lessens the impact of ITH. Therefore, renal mass biopsy of SRMs represents an appealing opportunity to evaluate how incorporation of molecular profiles may improve management strategies.

    Conclusions: Ongoing research into the genomic landscape of SRMs has advanced our understanding of the spectrum of disease aggressiveness and may hold promise in matching disease biology to treatment intensity.

    Patient summary: Small renal masses are a clinical challenge, as they range from benign to lethal. Genomic profiling may eventually improve treatment selection, but more research is needed.

  • 297.
    Sjökvist, Oskar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Blood transfusions & sex-mismatch in cystectomized patients with invasive bladder cancer Retrospective evaluations of the association of blood transfusions and sex-mismatched blood transfusions on long term survival in cystectomized patients with muscle invasive urothelial bladder cancer.2017Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 298. Sjölund, Jonas
    et al.
    Boström, Anna-Karin
    Lindgren, David
    Manna, Sugata
    Moustakas, Aristidis
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Johansson, Martin
    Fredlund, Erik
    Axelson, Håkan
    The notch and TGF-β signaling pathways contribute to the aggressiveness of clear cell renal cell carcinoma2011Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 6, nr 8, s. e23057-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    An extensive cross-talk between the Notch and TGF-β signaling cascades is present in CCRCC and the functional properties of these two pathways are associated with the aggressiveness of this disease.

  • 299. Sjöström, Carin
    et al.
    Thorstenson, Andreas
    Ströck, Viveka
    Hosseini-Aliabad, Abolfazl
    Aljabery, Firas
    Liedberg, Fredrik
    Sherif, Amir
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Malmström, Per-Uno
    Rosell, Johan
    Gårdmark, Truls
    Jahnson, Staffan
    Treatment according to guidelines may bridge the gender gap in outcome for patients with stage T1 urinary bladder cancer2018Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 52, nr 3, s. 186-193Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The aim of this investigation was to study differences between male and female patients with stage T1 urinary bladder cancer (UBC) regarding intravesical instillation therapy, second resection and survival.

    MATERIALS AND METHODS: This study included all patients with non-metastatic primary T1 UBC reported to the Swedish National Register of Urinary Bladder Cancer (SNRUBC) from 1997 to 2014, excluding those treated with primary cystectomy. Differences between groups were evaluated using chi-squared tests and logistic regression, and survival was investigated using Kaplan-Meier and log-rank tests and Cox proportional hazards analysis.

    RESULTS: In all, 7681 patients with T1 UBC (77% male, 23% female) were included. Females were older than males at the time of diagnosis (median age at presentation 76 and 74 years, respectively; p < .001). A larger proportion of males than females underwent intravesical instillation therapy (39% vs 33%, p < .001). Relative survival was lower in women aged ≥75 years and women with G3 tumours compared to men. However, women aged ≥75 years who had T1G3 tumours and underwent second resection followed by intravesical instillation therapy showed a relative survival equal to that observed in men.

    CONCLUSIONS: This population-based study demonstrates that women of all ages with T1 UBC undergo intravesical instillation therapy less frequently than men, and that relative survival is poorer in women aged ≥75 years than in men of the same age when intravesical instillation therapy and second resection are not used. However, these disparities may disappear with treatment according to guidelines.

  • 300.
    Sjöström, Malin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Jämtland Cty Council, Res Unit, S-83157 Östersund, Sweden.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Johansson, S
    Jämtland Cty Council, Res Unit, S-83157 Östersund, Sweden.
    Umefjord, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Samuelsson, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Stress urinary incontinence and quality of life: a reliability study of a condition-specific instrument in paper and web-based versions2012Inngår i: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 31, nr 8, s. 1242-1246Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims Quality of life is an important outcome measure in studies of urinary incontinence. Electronic collection of data has several advantages. We examined the reliability of the Swedish version of the highly recommended condition-specific quality of life questionnaire International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol), in paper and web-based formats in women with stress urinary incontinence.

    Methods Women aged 1870 years, with stress urinary incontinence at least once weekly, were recruited via the project's website and answered the ICIQ-LUTSqol questionnaire. Respondents completed either the paper version twice (n?=?78), or paper and web-based versions once each (n?=?54). The ICIQ validation protocol was followed.

    Results The mean interval between answers was 18.1 (SD?=?3.1) days in the paper versus paper setting and 15.0 (SD?=?7.8) days in the paper versus web-based setting. Internal consistency was excellent, with Cronbach's alpha coefficients of 0.87 for the paper version and 0.86 for the web-based version. There was a high degree of agreement of overall scores with intraclass correlations in the paper versus paper and paper versus web-based settings: 0.95 (P?<?0.001) and 0.92 (P?<?0.001), respectively. The mean of each individual item's weighted kappa value was 0.61 in both settings.

    Conclusions The questionnaire is reliable in women with stress urinary incontinence, and it can be used in either a paper or a web-based version.

    Neurourol. Urodynam. 31:12421246, 2012. (C) 2012 Wiley Periodicals, Inc.

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