RAFAEL FERREIRA COELHO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina
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- Correlation of a microRNA expression profile and the prognosis of penile cancer: A prospective study using microarray data analysis(2018) FURUYA, Tatiane K.; MURTA, Claudio B.; PONTES JR., Jose; UNO, Miyuki; CARRASCO, Alexis; SICHERO, Laura C.; VILLA, Luisa L.; COELHO, Rafael F.; GUGLIELMETTI, Giuliano B.; CORDEIRO, Mauricio D.; LEITE, Katia R.; SROUGI, Miguel; CHAMMAS, Roger; NAHAS, William C.
- Pentafecta: A New Concept for Reporting Outcomes of Robot-Assisted Laparoscopic Radical Prostatectomy(2011) PATEL, Vipul R.; SIVARAMAN, Ananthakrishnan; COELHO, Rafael F.; CHAUHAN, Sanket; PALMER, Kenneth J.; ORVIETO, Marcelo A.; CAMACHO, Ignacio; COUGHLIN, Geoff; ROCCO, BernardoBackground: Widespread use of prostate-specific antigen screening has resulted in younger and healthier men being diagnosed with prostate cancer. Their demands and expectations of surgical intervention are much higher and cannot be adequately addressed with the classic trifecta outcome measures. Objective: A new and more comprehensive method for reporting outcomes after radical prostatectomy, the pentafecta, is proposed. Design, setting, and participants: From January 2008 through September 2009, details of 1111 consecutive patients who underwent robot-assisted radical prostatectomy performed by a single surgeon were retrospectively analyzed. Of 626 potent men, 332 who underwent bilateral nerve sparing and who had 1 yr of follow-up were included in the study group. Measurements: In addition to the traditional trifecta outcomes, two perioperative variables were included in the pentafecta: no postoperative complications and negative surgical margins. Patients who attained the trifecta and concurrently the two additional outcomes were considered as having achieved the pentafecta. A logistic regression model was created to evaluate independent factors for achieving the pentafecta. Results and limitations: Continence, potency, biochemical recurrence-free survival, and trifecta rates at 12 mo were 96.4%, 89.8%, 96.4%, and 83.1%, respectively. With regard to the perioperative outcomes, 93.4% had no postoperative complication and 90.7% had negative surgical margins. The pentafecta rate at 12 mo was 70.8%. On multivariable analysis, patient age (p = 0.001) was confirmed as the only factor independently associated with the pentafecta. Conclusions: A more comprehensive approach for reporting prostate surgery outcomes, the pentafecta, is being proposed. We believe that pentafecta outcomes more accurately represent patients' expectations after minimally invasive surgery for prostate cancer. This approach may be beneficial and may be used when counseling patients with clinically localized disease.
article ROBOT-ASSISTED EXTENDED PELVIC LYMPH NODE DISSECTION IN PROSTATE CANCER, WHEN AND HOW?(2019) SIERRA, Pablo S.; LESTINGI, Jean F. P.; ALBUQUERQUE, Emanuel V.; PONTES JR., Jose; CARVALHO, Paulo A. de; CAVALCANTE, Alexandre; GUGLIELMETTI, Giuliano B.; NAHAS, William C.; COELHO, Rafael F.OBJECTIVE: To review the literature evaluating the role of the extended pelvic lymph node dissection ePLND during robot assisted radical prostatectomy (RARP) in the management of PCa patients, as well as the preoperative clinic pathologic factors that predict lymph node metastases (LNM). The technique and current outcomes of robotic ePLND will be presented. METHODS: Medline (R)/Pubmed (R) were searched up to august 2018 to find comparative studies of different anatomic limits of pelvic lymph node dissection (PLND) during RARP, open or pure laparoscopic surgery that reported number of nodes retrieved, oncologic outcomes and complications. The search was complemented to identify studies that evaluated diagnostic images and factors that predict LNM. Overall, 44 articles were included for full text review. RESULTS: There is not an imaging technique with an acceptable performance to select patients for PLND, the decision to perform a PLND is based on clinical characteristics described on validated nomograms. Median lymph node yield at RARP range from 5 to 21 depending on the extent of PLND, positivity rate of LN as high as 37% depending on the risk stratification of patients. Robot-assisted can be carried out to any extent with lymph node yields and safety concerns comparable to the open approach. CONCLUSION: Extended pelvic lymph node dissection is recommended to be performed at the time of RARP in intermediate and high-risk patients and cannot be replaced by other modalities. A benefit in terms of oncologic outcomes remains to be established. The robot assisted approach offers shorter length of hospital stay, lower transfusion rates and comparable outcomes compared to other surgical approaches.- Tratamento cirúrgico da litíase vesical: revisão de literatura(2013) TORRICELLI, Fabio Cesar Miranda; MAZZUCCHI, Eduardo; DANILOVIC, Alexandre; COELHO, Rafael Ferreira; SROUGI, MiguelBladder stones are rare and most cases occur in adult men with bladder outlet obstruction. Currently, there are few data on the best treatment of this disease. The aim of this review is to discuss some aspects of pathogenesis and treatment approaches for bladder lithiasis. A comprehensive search of the database of the ""National Library of Medicine"" /pubmed was conducted with the following key words and descriptors: ""bladder"" or ""vesical"" associated with ""calculus"", ""stone"" or ""lithiasis"", and ""cistolithotripsy "". One hundred and seventy-one articles were identified. The articles were independently assessed by two reviewers with expertise in urolithiasis. They were included in the study when the results, complications and follow-up were clearly reported. In the end, 32 studies met the inclusion criteria. Several options for the treatment of bladder lithiasis are available, but no randomized trials comparing them. Different rates of calculus-free patients are described in each of them, as follows: extracorporeal shock wave lithotripsy (75-100%), transurethral cistolithotripsy (63-100%), percutaneous cistolithotripsy (89-100%) and open surgery (100 %). The percutaneous approach has lower morbidity, with similar results to the transurethral treatment, while extracorporeal lithotripsy has the lowest rate of elimination of calculi and is reserved for patients at high surgical risk.
- Value of 3-Tesla multiparametric magnetic resonance imaging and targeted biopsy for improved risk stratification in patients considered for active surveillance(2017) PESSOA, Rodrigo R.; VIANA, Publio C.; MATTEDI, Romulo L.; GUGLIELMETTI, Giuliano B.; CORDEIRO, Mauricio D.; COELHO, Rafael F.; NAHAS, William C.; SROUGI, MiguelObjective To evaluate the role of multiparametric magnetic resonance imaging (mpMRI) of the prostate and transrectal ultrasonography guided biopsy (TRUS-Bx) with visual estimation in early risk stratification of patients with prostate cancer on active surveillance (AS). Patients and Methods Patients with low-risk, low-grade, localised prostate cancer were prospectively enrolled and submitted to a 3-T 16-channel cardiac surface coil mpMRI of the prostate and confirmatory biopsy (CBx), which included a standard biopsy (SBx) and visual estimation-guided TRUS-Bx. Cancersuspicious regions were defined using Prostate Imaging Reporting and Data System (PI-RADS) scores. Reclassification occurred if CBx confirmed the presence of a Gleason score >= 7, greater than three positive fragments, or >= 50% involvement of any core. The performance of mpMRI for the prediction of CBx results was assessed. Univariate and multivariate logistic regressions were performed to study relationships between age, prostate-specific antigen (PSA) level, PSA density (PSAD), number of positive cores in the initial biopsy, and mpMRI grade on CBx reclassification. Our report is consistent with the Standards of Reporting for MRItargeted Biopsy Studies (START) guidelines. Results In all, 105 patients were available for analysis in the study. From this cohort, 42 (40%) had PI-RADS 1, 2, or 3 lesions and 63 (60%) had only grade 4 or 5 lesions. Overall, 87 patients underwent visual estimation TRUS-Bx. Reclassification among patients with PI-RADS 1, 2, 3, 4, and 5 was 0%, 23.1%, 9.1%, 74.5%, and 100%, respectively. Overall, mpMRI sensitivity, specificity, positive predictive value, and negative predictive value for disease reclassification were 92.5%, 76%, 81%, and 90.5%, respectively. In the multivariate analysis, only PSAD and mpMRI remained significant for reclassification (P < 0.05). In the crosstabulation, SBx would have missed 15 significant cases detected by targeted biopsy, but SBx did detect five cases of significant cancer not detected by targeted biopsy alone. Conclusion Multiparametric magnetic resonance imaging is a significant tool for predicting cancer severity reclassification on CBx among AS candidates. The reclassification rate on CBx is particularly high in the group of patients who have PI-RADS grades 4 or 5 lesions. Despite the usefulness of visual-guided biopsy, it still remains highly recommended to retrieve standard fragments during CBx in order to avoid missing significant tumours.
- Histological Variants of Urothelial Carcinoma Predict No Response to Neoadjuvant Chemotherapy(2022) LEITE, Katia Ramos Moreira; BORGES, Leonardo Lima; RIBEIRO FILHO, Leopoldo; CHADE, Daher; COELHO, Rafael Ferreira; CORDEIRO, Mauricio; SROUGI, Miguel; NAHAS, Willian CarlosMicroabstract: This study shows that the presence of divergent histological differentiation and the immunexpression of CAIX in muscle invasive urothelial carcinoma, predicts no response to cisplatin based neoadjuvant chemotherapy. Background: Platinum-based neoadjuvant chemotherapy (NAC) in muscle-invasive urothelial bladder cancer (MIBC) has been adopted as a standard of care related to better survival outcomes. However, there is a considerable number of patients who do not respond, experiencing toxicity and delay in the surgical treatment. Our aim is to find biomarkers of response that could be easily adopted in the clinical practice. Methods: Between January 2009 and July 2016, 52 patients with MIBC were submitted to radical cystectomy after NAC. A tissue microarray containing 25 cases, who met the inclusion criteria was built for immunohistochemical analysis of Cytokeratins 5/6, 7, and 20, GATA3, Her2, EGFR, p63, p53, Carbonic-anhydrase IX (CAIX), MLH1, MSH2, MSH6, and PMS2. The surgery was performed in a mean time of 58.7 (+/- 21) days after the end of the NAC. Fisher's exact test was used to analyze the relationship between response (<= pT1) and histopathological and immunohistochemical results and Kaplan-Meier curves were designed for survival analysis. Results: Ten (40.0%) patients presented response to NAC. Histological variants of the urothelial carcinoma characterized by squamous, sarcomatous/rhabdoid, plasmacytoid, and micropapillary was present in 36.0% and none responded to NAC (P = .002). CAIX was expressed by 53.3% and none responded to NAC (P= .005). Lymph-node metastasis, divergent differentiation, and expression of cytokeratin 5/6 were related to short cancer specific survival. Conclusion: Histological variants and CAIX immune-expression are biomarkers of nonresponse to NAC of MIBC, and might be easily used in the clinical practice to select patients to be submitted to surgery upfront.
- Does the Presence of Median Lobe Affect Outcomes of Robot-Assisted Laparoscopic Radical Prostatectomy?(2012) COELHO, Rafael F.; CHAUHAN, Sanket; GUGLIELMETTI, Giuliano B.; ORVIETO, Marcelo A.; SIVARAMAN, Ananthakrishnan; PALMER, Kenneth J.; ROCCO, Bernardo; COUGHLIN, Geoff; HASSAN, Rayan El; DALL'OGLIO, Marcos F.; PATEL, Vipul R.Purpose: To determine whether the presence of median lobe (ML) affects perioperative outcomes, positive surgical margin (PSM) rates, and recovery of urinary continence after robot-assisted radical prostatectomy (RARP). Patients and Methods: We analyzed 1693 consecutive patients undergoing RARP performed by a single surgeon. Patients were analyzed in two groups based on the presence or not of a ML identified during RARP. Perioperative outcomes, PSM rates, and recovery of urinary continence were compared between the groups. Continence was assessed using validated questionnaires, and it was defined as the use of ""no pads"" postoperatively. Results: A ML was identified in 323 (19%) patients. Both groups had similar estimated blood loss, length of hospital stay, pathologic stage, complication rates, anastomotic leakage rates, overall PSM rates, and PSM rate at the bladder neck. The median overall operative time was slightly greater in patients with ML (80 vs 75 min, P < 0.001); however, there was no difference in the operative time when stratifying this result by prostate weight. Continence rates were also similar between patients with and without ML at 1 week (27.8% vs 27%, P = 0.870), 4 weeks (42.3% vs 48%, P = 0.136), 12 weeks (82.5% vs 86.8%, P = 0.107), and 24 weeks (91.5% vs 94.1%, P = 0.183) after catheter removal. Finally, the median time to recovery of continence was similar between the groups (median: 5 wks, 95% confidence interval [CI]: 4.41-5.59 vs median: 5 wks, CI 4.66-5.34; log rank test, P = 0.113). Conclusion: The presence of a ML does not affect outcomes of RARP performed by an experienced surgeon.
- Predictive factors for prolonged hospital stay after retropublic radical prostatectomy in a high-volume teaching center(2018) COELHO, Rafael F.; CORDEIRO, Mauricio D.; PADOVANI, Guilherme P.; LOCALLI, Rafael; FONSECA, Limirio; PONTES JUNIOR, Jose; GUGLIELMETTI, Giuliano B.; SROUGI, Miguel; NAHAS, William CarlosObjective: To evaluate the length hospital stay and predictors of prolonged hospitalization after RRP performed in a high-surgical volume teaching institution, and analyze the rate of unplanned visits to the office, emergency care, hospital readmissions and perioperative complications rates. Materials and Methods: Retrospective analysis of prospectively collected data in a standardized database for patients with localized prostate cancer undergoing RRP in our institution between January/2010 - January/2012. A logistic regression model including preoperative variables was initially built in order to determine the factors that predict prolonged hospital stay before the surgical procedure; subsequently, a second model including both pre and intraoperative variables was analyzed. Results: 1011 patients underwent RRP at our institution were evaluated. The median hospital stay was 2 days, and 217 (21.5%) patients had prolonged hospitalization. Predictors of prolonged hospital stay among the preoperative variables were ICC (OR. 1.40 p=0.003), age (OR 1.050 p<0.001), ASA score of 3 (OR. 3.260 p<0.001), prostate volume on USG-TR (OR, 1.005 p=0.038) and African-American race (OR 2.235 p=0.004); among intra and postoperative factors, operative time (OR 1.007 p=0.022) and the presence of any complications (OR 2.013 p=0.009) or major complications (OR 2.357 p=0.01) were also correlated independently with prolonged hospital stay. The complication rate was 14.5%. Conclusions: The independent predictors of prolonged hospitalization among preoperative variables were CCI, age, ASA score of 3, prostate volume on USG-TR and African-American race; amongst intra and postoperative factors, operative time, presence of any complications and major complications were correlated independently with prolonged hospital stay.
- Case 297: Mucinous Adenocarcinoma of the Prostate(2022) KANAS, Alexandre Fligelman; FENELON, Sandro Santos; SANTOS, Joao Manoel Miranda Magalhaes; COELHO, Rafael Ferreira; GUGLIELMETTI, Giuliano Betoni; NAHAS, William Carlos; VIANA, Publio Cesar Cavalcante
- A prognostic model for survival after palliative urinary diversion for malignant ureteric obstruction: a prospective study of 208 patients(2016) CORDEIRO, Maurcio D.; COELHO, Rafael F.; CHADE, Daher C.; PESSOA, Rodrigo R.; CHAIB, Mateus S.; COLOMBO-JUNIOR, Jose R.; PONTES-JUNIOR, Jose; GUGLIELMETTI, Giuliano B.; SROUGI, MiguelObjective To identify factors associated with survival after palliative urinary diversion (UD) for patients with malignant ureteric obstruction (MUO) and create a risk-stratification model for treatment decisions. Patients and Methods We prospectively collected clinical and laboratory data for patients who underwent palliative UD by ureteric stenting or percutaneous nephrostomy (PCN) between 1 January 2009 and 1 November 2011 in two tertiary care university hospitals, with a minimum 6-month follow-up. Inclusion criteria were age >18 years and MUO confirmed by computed tomography, ultrasonography or magnetic resonance imaging. Factors related to poor prognosis were identified by Cox univariable and multivariable regression analyses, and a risk stratification model was created by Kaplan-Meier survival estimates at 1, 6 and 12 months, and log-rank tests. Results The median (range) survival was 144 (0-1084) days for the 208 patients included after UD (58 ureteric stenting, 150 PCN); 164 patients died, 44 (21.2%) during hospitalisation. Overall survival did not differ by UD type (P = 0.216). The number of events related to malignancy (>= 4) and Eastern Cooperative Oncology Group (ECOG) index (> 2) were associated with short survival on multivariable analysis. These two risk factors were used to divide patients into three groups by survival type: favourable (no factors), intermediate (one factor) and unfavourable (two factors). The median survival at 1, 6, and 12 months was 94.4%, 57.3% and 44.9% in the favourable group; 78.0%, 36.3%, and 15.5% in the intermediate group; and 46.4%, 14.3%, and 7.1% in the unfavourable group (P < 0.001). Conclusions Our stratification model may be useful to determine whether UD is indicated for patients with MUO.