Papillary type 2 versus clear cell renal cell carcinoma: survival outcomes

Publication date: Available online 22 August 2016
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Giuseppe Simone, Gabriele Tuderti, Mariaconsiglia Ferriero, Rocco Papalia, Leonardo Misuraca, Francesco Minisola, Manuela Costantini, Riccardo Mastroianni, Steno Sentinelli, Salvatore Guaglianone, Michele Gallucci
AimTo compare the cancer specific survival (CSS) between p2-RCC and a Propensity Score Matched (PSM) cohort of cc -RCC patients.MethodsFifty-five (4.6%) patients with p2-RCC and 920 cc-RCC patients were identified within a prospectively maintained institutional dataset of 1205 histologically proved RCC patients treated with either RN or PN. Univariable and multivariable Cox regression analyses were used to identify predictors of CSS after surgical treatment.A 1:2 PSM analysis based on independent predictors of oncologic outcomes was employed and CSS was compared between PSM selected cc-RCC patients using Kaplan Meier and Cox regression analysis.ResultsOverall, 55 (4.6%) p2-RCC and 920 (76.3%) cc-RCC patients were selected from the database; p2-RCC were significantly larger (p=0.001), more frequently locally advanced(p<0.001) and node positive(p<0.001) and had significantly higher Fuhrman grade (p<0.001) than cc-RCC.On multivariable Cox regression analysis age(p=0.025), histologic subtype(p=0.029), pN stage (p=0.006), size, pT stage, cM stage, sarcomatoid features and Fuhrman grade(all p<0.001) were independent predictors of CSS.After applying the PSM, 82 cc-RCC selected cases were comparable to 41 p2RCC for age(p=0.81), tumor size(p=0.39), pT(p=1.00) and pN(p=0.62) stages, cM stage(p=0.71) and Fuhrman grade (p=1).In this PSM cohort, 5 yr CSS was significantly lower in the p2-RCC (63% vs 72.4%;p=0.047). At multivariable Cox analysis p2 histology was an independent predictor of CSM (HR 2.46, 95% CI 1.04-5.83;p=0.041).ConclusionsWe confirmed the tendency of p2-RCC to present as locally advanced and metastatic disease more frequently than cc-RCC and demonstrated p2-RCC histology as an independent predictor of worse oncologic outcomes.



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Misoprostol Vaginal Insert in Labor Induction: A Cost–Consequences Model for 5 European Countries—An Economic Evaluation Supported with Literature Review and Retrospective Data Collection

Abstract

Introduction

The present study aimed to assess the costs and consequences of using an innovative medical technology, misoprostol vaginal insert (MVI), for the induction of labor (IOL), in place of alternative technologies used as a standard of care.

Methods

This was a retrospective study on cost and resource utilization connected with economic model development. Target population were women with an unfavorable cervix, from 36 weeks of gestation, for whom IOL is clinically indicated. Data on costs and resources was gathered via a dedicated questionnaire, delivered to clinical experts in five EU countries. The five countries participating in the project and providing completed questionnaires were Austria, Poland, Romania, Russia and Slovakia. A targeted literature review in Medline and Cochrane was conducted to identify randomized clinical trials meeting inclusion criteria and to obtain relative effectiveness data on MVI and the alternative technologies. A hospital perspective was considered as most relevant for the study. The economic model was developed to connect data on clinical effectiveness and safety from randomized clinical trials with real life data from local clinical practice.

Results

The use of MVI in most scenarios was related to a reduced consumption of hospital staff time and reduced length of patients' stay in hospital wards, leading to lower total costs with MVI when compared to local comparators.

Conclusions

IOL with the use of MVI generated savings from a hospital perspective in most countries and scenarios, in comparison to alternative technologies.

Funding

Sponsorship, article processing charges, and the open access charge for this study were funded by Ferring Pharmaceuticals Poland.

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How Can I Tell If My Child Has An Eating Disorder?

Dr. Sarah Garwood, a Washington University pediatrician at St. Louis Children's Hospital, discusses how to tell if your child has an eating disorder and what puts kids at risk for eating disorders.

While doctors don't know exactly what causes an eating disorder, different genetic and environmental factors contribute to an increased risk. Adolescence is the peak time for the development of eating disorders, but younger children even display concerns with their appearance and body size and shape.

Some of the signs that your child is developing an eating disorder include:

• A sudden change in eating habits: One example of this is if your child used to eat hamburgers for every meal but is now suddenly a vegetarian.
• Eliminating entire food groups: This might look like your child is choosing not to eat red meat, desserts, or eliminating carbohydrates completely from their diet.
• Not meeting growth expectations. This is especially a common sign of an eating disorder in younger children, who are typically expected to exhibit certain gains in height and weight relative to their age. In these circumstances, a possible sign of an eating disorder would be completely stunted growth.
• Obsession with food. Some adolescents will follow rigid rules around eating, preparing large meals and not engaging in those meals themselves.

How can you prevent your child from having an eating disorder? While there is no clear strategy for preventing eating disorders, as a parent you can try your best to encourage a healthy environment in your home. One way you can do this is trying to avoid talking about your weight in front of your kids. If you are constantly talking about being on a diet, it may make your children concerned about their size as well. A second way to prevent eating disorders in your children is to encourage them to be healthy and strong. Help them to be proud of what their bodies can do instead of constantly focusing on how they look.

If you suspect that your child has an eating disorder, learn more about the signs and symptoms and seek help early. Early intervention helps kids have a better prognosis than if you let the symptoms of an eating disorder continue. Contact the Family Resource Center at St. Louis Children's Hospital at 314.454.2350 or ask your pediatrician for more advice.

The post How Can I Tell If My Child Has An Eating Disorder? appeared first on ChildrensMD.

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Transitioning Kids Back to a School Sleep Schedule

Dr. Kelly Ross, Pediatrician at St. Louis Children's Hospital, talks about how to transition your child into a back to school sleeping schedule. First, it is important to begin easing your child into a regular sleeping schedule a couple of weeks in advance. It is not fair to expect your child to fall asleep at a bed time the night before the first day of school if there was no preparation. Most parents forget that just like going into your first day of work, the first day of school can be a huge stressor for kids and it can be even more difficult for them to fall asleep if a regular sleeping schedule is not in place in advance.

You want your kids to be at their very best for the first day of school, but that is difficult when they are sleep deprived. That is why it is so important to be proactive in getting your child in a regular sleeping schedule before the first day.

Many parents ask, "At what point do you hand this responsibility over to the kids?" Dr. Ross explains that her kids are teenagers, and they have even learned the consequences of not getting enough sleep. You don't want to force your kids into a regular sleeping schedule, but it is important that they learn these processes in a gentle, happy sort of way.

When your child is starting to be able to tell time, it is a good idea to practice by having an alarm clock in the room. However, it is too much to expect younger children to wake up on their own with an alarm clock.

As kids mature and head toward middle school or high school, waking up on their own with an alarm clock is a reasonable expectation.  About a month before that change occurs, you want to have your kids set their alarm and then follow up to make sure that they are actually getting out of bed.

The post Transitioning Kids Back to a School Sleep Schedule appeared first on ChildrensMD.

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Is Your Child Ready For Kindergarten? Q&A with STL Children’s MomDocs

Dr. Dehra Harris, Pediatric Psychiatrist with Washington University at St. Louis Children's Hospital, gives advice on how to know if your child is ready for kindergarten. For parents, Dr. Harris explains, it is important to understand that there is nothing magical about the cutoff date for your child to start school. It is far more important to think about if your child is really ready for kindergarten. There are a few things you can do to determine your child's kindergarten readiness if you are unsure.

First, talk to your pediatrician. At every well child visit, your pediatrician will be doing developmental screenings to assess whether your child is on track and identify whether there are things you need to be concerned about. You can also get formal assessments from the school to ensure that your child has all the basics to be ready for the first day.

Next it's important to think about what skills your child needs to get through a typical day in kindergarten. These include fine motor skills such as using scissors or being able to draw basic letters. Watch when you are working at home together and see if these fine motor skills are being used.

Social skills are another large piece of assessing whether your child is ready for kindergarten. Observe how your child plays at the playground or with cousins at family events can help you see if they are ready.

Another useful indicator of kindergarten readiness is analyzing how your child responds to challenges. Some kids need a lot of challenges to keep from being bored and sometimes these are the kids who are better off if they begin school earlier. Other kids need a lot of early 'wins', so waiting another year to enroll them in kindergarten would help them be much more confident when they start.

If your child get's through the year in kindergarten and you still feel like they are struggling or falling behind, talk to the schools and get additional services to help or consider having your child repeat if necessary.

The post Is Your Child Ready For Kindergarten? Q&A with STL Children's MomDocs appeared first on ChildrensMD.

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Retinoblastoma-binding protein 2 (RBP2) is frequently expressed in neuroendocrine tumors and promotes the neoplastic phenotype

Retinoblastoma-binding protein 2 (RBP2) is frequently expressed in neuroendocrine tumors and promotes the neoplastic phenotype

Oncogenesis 5, e257 (August 2016). doi:10.1038/oncsis.2016.58

Authors: E C Maggi, J Trillo-Tinoco, A P Struckhoff, J Vijayaraghavan, L Del Valle & J S Crabtree

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Resistance gene naming and numbering: is it a new gene or not?--authors' response

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