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Author Nicholas Chakiryan

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Geospatial Cellular Distribution of Cancer-Associated Fibroblasts Significantly Impacts Clinical Outcomes in Metastatic Clear Cell Renal Cell Carcinoma

Nicholas Chakiryan, Gregory Kimmel, Youngchul Kim, Joseph Johnson, Noel Clark, Ali Hajiran, Andrew Chang, Ahmet Aydin, Logan Zemp, Esther Katende, Jad Chahoud, Meghan Ferrall-Fairbanks, Philippe Spiess, Natasha Francis, Michelle Fournier, Jasreman Dhillon, Jong Park, Liang Wang, James Mule, Philipp Altrock, Brandon Manley,

Cancer-associated fibroblasts (CAF) are highly prevalent cells in the tumor microenvironment in clear cell renal cell carcinoma (ccRCC). CAFs exhibit a pro-tumor effect in vitro and have been implicated in tumor cell proliferation, metastasis, and treatment resistance. Our objective is to analyze the geospatial distribution of CAFs with proliferating and ... Read more >>

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Correlating Immune Cell Infiltration Patterns with Recurrent Somatic Mutations in Advanced Clear Cell Renal Cell Carcinoma.

Nicholas H Chakiryan, Ali Hajiran, Youngchul Kim, Ahmet M Aydin, Logan Zemp, Esther Katende, Jonathan Nguyen, Wenyi Fan, Chia-Ho Cheng, Neale Lopez-Blanco, Jad Chahoud, Philippe E Spiess, Michelle Fournier, Jasreman Dhillon, Liang Wang, Carlos Moran-Segura, James Mulé, Dongliang Du, Sean J Yoder, Anders Berglund, Jamie K Teer, Brandon J Manley,

<h4>Background</h4>Clear cell renal cell carcinoma (ccRCC) tumors have low frequencies of genetic alterations compared with other malignancies, but very high levels of immune cell infiltration and favorable response rates to immunotherapy. Currently, the interplay between specific ccRCC somatic mutations and immune infiltration pattern is unclear.<h4>Objective</h4>To analyze the associations between common ... Read more >>

Eur Urol Focus (European urology focus)
[2021, :]

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Editorial Comment.

Nicholas Chakiryan, Alice Yu,

J Urol (The Journal of urology)
[2021, :101097JU000000000000178601]

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Patterns of Recurrence Following Inguinal Lymph Node Dissection for Penile Cancer: Optimizing Surveillance Strategies.

Nicholas H Chakiryan, Aaron Dahmen, Marco Bandini, Filippo Pederzoli, Laura Marandino, Maarten Albersen, Eduard Roussel, Yao Zhu, Ding-Wei Ye, Antonio A Ornellas, Mario Catanzaro, Oliver W Hakenberg, Axel Heidenreich, Friederike Haidl, Nick Watkin, Michael Ager, Jad Chahoud, Alberto Briganti, Roberto Salvioni, Francesco Montorsi, Andrea Necchi, Philippe E Spiess,

<h4>Purpose</h4>Our primary objective is to detail the incidence, site, and timing of pSCC recurrence after ILND.<h4>Methods</h4>Retrospective analysis of 551 patients who underwent ILND for pSCC, from 2000 to 2017. The primary outcome was pSCC recurrence after ILND. Recurrences were identified and stratified by site. Timing of recurrence was determined. Multivariable ... Read more >>

J Urol (The Journal of urology)
[2021, :101097JU0000000000001790]

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Pathologic Downstaging and Survival Outcomes Associated with Neoadjuvant Chemotherapy for Variant Histology Muscle Invasive Bladder Cancer.

Nicholas H Chakiryan, Da David Jiang, Kyle A Gillis, Elizabeth Green, Ali Hajiran, Lee Hugar, Logan Zemp, Jingsong Zhang, Rohit Jain, Jad Chahoud, Michael Poch, Brandon J Manley, Roger Li, Wade Sexton, Scott M Gilbert,

<h4>Purpose</h4>Patients with muscle invasive bladder cancer (MIBC) of variant histology have a poor prognosis. It is unclear if neoadjuvant chemotherapy prior to radical cystectomy is associated with pathologic downstaging or improved overall survival (OS) for patients with variant histology. Our objective was to assess for associations between receipt of neoadjuvant ... Read more >>

J Urol (The Journal of urology)
[2021, :101097JU0000000000001855]

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Real-World Survival Outcomes Associated With First-Line Immunotherapy, Targeted Therapy, and Combination Therapy for Metastatic Clear Cell Renal Cell Carcinoma.

Nicholas H Chakiryan, Da David Jiang, Kyle A Gillis, Elizabeth Green, Ali Hajiran, Lee Hugar, Logan Zemp, Jingsong Zhang, Rohit K Jain, Jad Chahoud, Philippe E Spiess, Wade Sexton, Scott M Gilbert, Brandon J Manley,

<h4>Importance</h4>Clinical trials have shown an overall survival (OS) benefit associated with first-line immunotherapy (IT) and combination targeted therapy (TT) and IT regimens compared with TT among patients with metastatic clear cell renal cell carcinoma (RCC). Generalizability of these findings in a real-world cohort outside of a clinical trial setting is ... Read more >>

JAMA Netw Open (JAMA network open)
[2021, 4(5):e2111329]

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Spatial clustering of CD68+ tumor associated macrophages with tumor cells is associated with worse overall survival in metastatic clear cell renal cell carcinoma.

Nicholas H Chakiryan, Gregory J Kimmel, Youngchul Kim, Ali Hajiran, Ahmet M Aydin, Logan Zemp, Esther Katende, Jonathan Nguyen, Neale Lopez-Blanco, Jad Chahoud, Philippe E Spiess, Michelle Fournier, Jasreman Dhillon, Liang Wang, Carlos Moran-Segura, Asmaa El-Kenawi, James Mulé, Philipp M Altrock, Brandon J Manley,

Immune infiltration is typically quantified using cellular density, not accounting for cellular clustering. Tumor-associated macrophages (TAM) activate oncogenic signaling through paracrine interactions with tumor cells, which may be better reflected by local cellular clustering than global density metrics. Using multiplex immunohistochemistry and digital pathologic analysis we quantified cellular density and ... Read more >>

PLoS One (PloS one)
[2021, 16(4):e0245415]

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Reliability of Serum Tumor Marker Measurement to Diagnose Recurrence in Patients with Clinical Stage I Nonseminomatous Germ Cell Tumors Undergoing Active Surveillance: A Systematic Review.

Nicholas H Chakiryan, Aaron Dahmen, Vito Cucchiara, Alberto Briganti, Francesco Montorsi, Andrea Salonia, Philippe E Spiess, Andrea Necchi,

<h4>Purpose</h4>Men with nonseminomatous germ cell tumors of the testicle without evidence of residual disease after radical orchiectomy (clinical stage I) are increasingly managed with active surveillance. The guideline-recommended cornerstones of surveillance are conventional serum tumor markers and computerized tomography. The reliability of serum tumor markers as a tool to diagnose ... Read more >>

J Urol (The Journal of urology)
[2021, 205(6):1569-1576]

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Misaligned Incentives in Benign Prostatic Enlargement Surgery: More Complex and Efficacious Procedures Are Earning Fewer Relative Value Units.

Da David Jiang, Mitchell Hayes, Kyle A Gillis, Ruslan Korets, Andrew A Wagner, Jason C Hedges, Nicholas H Chakiryan,

<b><i>Background:</i></b> Relative value units (RVUs) are the measure of value used in US Medicare reimbursement. Medicare determines physician work RVUs (wRVUs) from the Relative Value Update Committee (RUC) for a procedure based on operative time, technical skill and effort, mental effort and judgment, and stress. In theory, work RVUs should ... Read more >>

J Endourol (Journal of endourology)
[2021, :]

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Retroperitoneal Lymph Node Dissection Versus Surveillance for Adult Early Stage Pure Testicular Teratoma: A Nationwide Analysis.

Ali Hajiran, Mounsif Azizi, Ahmet M Aydin, Nicholas H Chakiryan, Charles C Peyton, David C Boulware, Brandon J Manley, Scott M Gilbert, Wade J Sexton,

<h4>Purpose</h4>Following radical orchiectomy, surveillance and primary retroperitoneal lymph node dissection (RPLND) are acceptable options for the management of early stage pure testicular teratoma in adult patients; however, there is no uniform consensus. The aim of this study was to investigate survival outcomes of adults with early stage pure testicular teratoma ... Read more >>

Ann Surg Oncol (Annals of surgical oncology)
[2021, 28(7):3648-3655]

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Spatial Clustering of CD68+ Tumor Associated Macrophages with Tumor Cells is Associated with Worse Overall Survival in Metastatic Clear Cell Renal Cell Carcinoma

Nicholas Chakiryan, Gregory Kimmel, Youngchul Kim, Ali Hajiran, Ahmet Aydin, Logan Zemp, Esther Katende, Jonathan Nguyen, Neale Lopez-Blanco, Jad Chahoud, Philippe Spiess, Michelle Fournier, Jasreman Dhillon, Liang Wang, Carlos Moran-Segura, Asmaa El-Kenawi, James Mulé, Philipp Altrock, Brandon Manley,

<h4>ABSTRACT</h4> Immune infiltration is typically quantified using cellular density, not accounting for cellular clustering. Tumor-associated macrophages (TAM) activate oncogenic signaling through paracrine interactions with tumor cells, which may be better reflected by local cellular clustering than global density metrics. Using multiplex immunohistochemistry and digital pathologic analysis we quantified cellular density ... Read more >>

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Will Dynamic Sentinel Lymph Node Biopsy Become the New International Standard for Evaluating High-risk Penile Cancer in Patients with Clinically Negative Lymph Nodes?

Ahmet Murat Aydin, Nicholas H Chakiryan, Philippe E Spiess,

Eur Urol (European urology)
[2020, 78(6):873-874]

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Relative value units do not adequately account for operative time in pediatric urology.

Da David Jiang, Nicholas H Chakiryan, Kyle A Gillis, Ann Martinez Acevedo, Yiyi Chen, J Christopher Austin, Casey A Seideman,

<h4>Background</h4>Relative value units (RVUs) are the measure of value used in United States Medicare and Medicaid reimbursement. The Relative Update Committee (RUC) determines physician work RVU (wRVUs) based on operative time, technical skill and effort, mental effort and judgment, and stress. The primary aim of this study was to assess ... Read more >>

J Pediatr Surg (Journal of pediatric surgery)
[2021, 56(5):883-887]

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RUC Operative Time Estimates are Inaccurate, Resulting in Decreased Work RVU Assignments for Longer Urologic Procedures.

Nicholas H Chakiryan, Da David Jiang, Kyle A Gillis, Yiyi Chen, Ann Martinez Acevedo, Kamran P Sajadi,

OBJECTIVE:To assess whether inaccurate operative time estimates utilized by the Relative Value Update Committee (RUC) contribute to the undervaluation of longer urologic procedures. METHODS:The National Surgical Quality Improvement Program (NSQIP) and Centers for Medicare and Medicaid Services (CMS) data sets were reviewed from 2015 to 2017. NSQIP operative time is ... Read more >>

Urology (Urology)
[2020, 142:94-98]

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Work relative value units do not account for complexity and operative time in hypospadias surgery.

Da David Jiang, Kyle A Gillis, Nicholas H Chakiryan, Ann Martinez Acevedo, J Christopher Austin, Casey A Seideman,

INTRODUCTION:Relative value units (RVU) are the measure of value used in United States Medicare and Medicaid reimbursement. The Relative Update Committee (RUC) determine physician work RVU (wRVU) based on operative time, technical skill and effort, mental effort and judgement, and stress. In theory, wRVU should account for the complexity and ... Read more >>

J Pediatr Urol (Journal of pediatric urology)
[2020, 16(4):459.e1-459.e5]

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Perioperative complications within 30 days of hypospadias surgery: Results from NSQIP-Pediatrics.

Da David Jiang, Nicholas H Chakiryan, Kyle A Gillis, Ann Martinez Acevedo, J Christopher Austin, Casey A Seideman,

<h4>Introduction</h4>There are no large multi-institutional studies reporting on perioperative complications of hypospadias repairs. We sought to determine perioperative complications of hypospadias repairs from the National Surgical Quality Improvement Program Pediatrics (NSQIP-P) to aid in patient counseling.<h4>Study design</h4>This cohort study from 2012 to 2017 was conducted using NSQIP-P database. Pediatric patients ... Read more >>

J Pediatr Urol (Journal of pediatric urology)
[2020, 16(3):316.e1-316.e7]

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Survival outcomes and practice trends for off-label use of adjuvant targeted therapy in high-risk locoregional renal cell carcinoma.

Nicholas H Chakiryan, Ann Martinez Acevedo, Mark A Garzotto, Yiyi Chen, Jen-Jane Liu, Sudhir Isharwal, Christopher L Amling, Ryan P Kopp,

<h4>Importance</h4>The appropriate use of adjuvant targeted therapy (TT) for high-risk locoregional renal cell carcinoma (RCC) after nephrectomy is currently unclear due to mixed results from the relevant randomized controlled trials. National-level survival outcomes and practice trends for the use of adjuvant TT in the United States have not been reported.<h4>Objective</h4>To ... Read more >>

Urol Oncol (Urologic oncology)
[2020, 38(6):604.e1-604.e7]

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Patterns of Industry Payments to Urologists From 2014-2018.

Emily K Clennon, Michael Lam, Annalise Manley, Nicholas H Chakiryan, Martinez Acevedo, Brian Duty, Kamran P Sajadi,

OBJECTIVES:To evaluate the patterns of financial transaction between industry and urologists in the first 5 years of reporting in the Open Payments Program (OPP) by comparing transactions over time, between academic and nonacademic urologists, and by provider characteristics among academic urologists. METHODS:The Center for Medicare & Medicaid Services OPP database ... Read more >>

Urology (Urology)
[2020, 140:44-50]

Cited: 1 time

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Relative Value Units do Not Adequately Account for Operative Time of Urological Surgery.

Nicholas H Chakiryan, Da David Jiang, Kyle A Gillis, Yiyi Chen, Ann Martinez Acevedo, Kamran P Sajadi,

PURPOSE:Physician work relative value units are determined based on operative time, technical skill, mental effort and stress. In theory, work relative value units should account for the operative time involved in a procedure, resulting in similar work relative value units per unit time for short and long procedures. We assessed ... Read more >>

J Urol (The Journal of urology)
[2020, 203(5):1003-1007]

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The estimated prevalence of missed positive lymph nodes based on extent of lymphadenectomy at radical prostatectomy.

Nicholas H Chakiryan, Ann Martinez Acevedo, Michael J Conlin, Mark Garzotto, Yiyi Chen, Jen-Jane Liu, Christopher L Amling, Ryan P Kopp,

<h4>Purpose</h4>To determine practice patterns for the extent of lymphadenectomy at radical prostatectomy and associations with detection of pN1 prostate cancer, as well as the impact of lymphadenectomy extent on underdetection of pN1 disease and overall survival.<h4>Materials and methods</h4>Prostatectomy cases in the NCDB from 2004 to 2013 were included. Lymphadenectomy extent ... Read more >>

Urol Oncol (Urologic oncology)
[2019, 37(9):574.e1-574.e9]

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Optimizing the Sequence of Chemotherapy for Upper Tract Urothelial Carcinoma with Clinically Positive Regional Lymph Nodes.

Nicholas Chakiryan, Ann Martinez, Lina Gao, Jen-Jane Liu, Christopher Amling, Mark Garzotto, Ryan P Kopp,

PURPOSE:Upper tract urothelial carcinoma with clinically positive regional lymph nodes is an aggressive disease state with a high propensity for metastasis and death. The current literature is limited regarding national practice patterns and outcomes in this patient population. MATERIALS AND METHODS:We identified 1,658 patients in the NCDB (National Cancer Database) ... Read more >>

J Urol (The Journal of urology)
[2019, 202(1):76-82]

Cited: 2 times

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Retroperitoneal Leydig cell tumor recurrence presenting 14 years after orchiectomy.

Nicholas H Chakiryan, Phil W Raess, Kevin Turner, Jason C Hedges, Jen-Jane Liu,

Malignant Leydig cell tumor is a rare entity that has been previously described as rapidly progressive and uniformly fatal. We present the case of a malignant Leydig cell tumor that presented 14 years after orchiectomy with an isolated retroperitoneal metastasis. Our patient underwent a retroperitoneal lymph node dissection and has ... Read more >>

Can J Urol (The Canadian journal of urology)
[2018, 25(1):9210-9213]

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Secondary pelvic congestion syndrome: description and radiographic diagnosis.

Andrew G Winer, Nicholas H Chakiryan, Ryan P Mooney, Daniel Verges, Mazyar Ghanaat, Atabak Allaei, Luke Robinson, Harry Zinn, Erich K Lang,

<h4>Introduction</h4>Pelvic congestion syndrome (PCS) is a complex condition of the pelvic venous system leading to nonspecific pelvic pain that was initially described in females alone. The underlying abnormalities, though diverse, all result in increased pressure in the left gonadal vein which is transmitted retrograde into the pelvic venous system. Our ... Read more >>

Can J Urol (The Canadian journal of urology)
[2014, 21(4):7365-7368]

Cited: 4 times

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