Clinical genitourinary cancer最新文献

{"title":"Development of a Nomogram Model to Identify Appropriate Candidates from Cytoreductive Nephrectomy in Metastatic Renal Cell Carcinoma Based on the Surveillance, Epidemiology and End Results Database","authors":"Kong Ren ,&nbsp;Hao Ning ,&nbsp;Hai-hu Wu ,&nbsp;Fei Wu ,&nbsp;Jia-ju Lyu","doi":"10.1016/j.clgc.2024.02.013","DOIUrl":"10.1016/j.clgc.2024.02.013","url":null,"abstract":"<div><h3>Background</h3><p>Although a survival benefit was observed in patients with metastatic renal cell carcinoma (mRCC) who underwent cytoreductive nephrectomy (CN), there is a lack of effective tools for predicting which individuals are likely to benefit from surgical intervention. Herein, we developed a predictive model using data from the Surveillance, Epidemiology, and End Results (SEER) database.</p></div><div><h3>Materials and Methods</h3><p>Patients diagnosed with mRCC were screened from the SEER database (2010-2020), supplemented by patients from East Asia. Patients were categorized into surgical and non-surgical groups, with propensity score matching conducted to balance baseline characteristics. Logistic regression analysis was performed to identify independent factors associated with benefits and a nomogram was constructed based on these factors.</p></div><div><h3>Results</h3><p>This study included 11,044 cases from the SEER database and 50 cases from an external validation cohort. CN was identified as an independent protective factor for OS. A nomogram was established, and it performed well in the training and validation sets. The calibration curves and DCA confirmed that the nomogram model could precisely predict the probability of surgical benefit. We used the nomogram to classify surgical patients into benefit and non-benefit groups. Then, we found that OS was significantly higher in the benefit group than in the non-benefit group. The external validation cohort observed the same result (P=0.035).</p></div><div><h3>Conclusion</h3><p>While CN offers potential benefits for patients with mRCC, its applicability varies across the patient population. Our study constructed a nomogram that quantitatively assesses the likelihood of surgical benefit in mRCC patients, facilitating more tailored therapeutic decision-making.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140072080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Toxicity Associated With Androgen Receptor Axis-Targeted Agents in Patients With Prostate Cancer: A Meta-analysis of Randomized Controlled Trials","authors":"Susu Zhou ,&nbsp;Parissa Alerasool ,&nbsp;Noriko Kishi ,&nbsp;Himanshu Joshi ,&nbsp;Gagan Sahni ,&nbsp;Che-Kai Tsao","doi":"10.1016/j.clgc.2024.102066","DOIUrl":"10.1016/j.clgc.2024.102066","url":null,"abstract":"<div><h3>Introduction</h3><p>Second-generation androgen receptor axis-targeting (ARAT) agents have become a standard treatment for patients with advanced prostate cancer (PC), however much remains unknown about the potential cardiovascular toxicities.</p></div><div><h3>Patients and Methods</h3><p>We performed a systematic search of PubMed, Embase, Web of Science, and Cochrane library for randomized controlled trials of patients receiving ARAT agents for PC from inception to March 2023. The odds ratios (ORs) of all-grade and high-grade cardiovascular adverse events (CVAEs) for patients treated with and without ARAT agents were pooled for meta-analysis. Subgroup analyses based on PC type and treatment regimen were conducted.</p></div><div><h3>Results</h3><p>A total of 15 double-blind placebo-controlled phase 3 trials comprising 15,842 patients were included. In addition to hot flush and hypertension of any degree of severity, inclusion of ARAT agents was associated with a significantly higher risk of acute myocardial infarction (OR: 1.96, 95% CI: 1.05-3.68, <em>P = .</em>04), myocardial infarction (OR: 2.44, 95% CI: 1.27-4.66, <em>P = .</em>007) and angina pectoris (OR: 2.00, 95% CI: 1.00-4.02, <em>P = .</em>05). With regard to individual ARAT agents, enzalutamide was associated with a significantly higher risk of acute myocardial infarction (OR: 3.11, 95% CI: 1.17-8.28, <em>P = .</em>02), coronary artery disease (OR: 8.33, 95% CI: 1.54-44.95, <em>P = .</em>01), and high-grade hypertension (OR: 4.94, 95% CI: 1.11-22.06, <em>P = .</em>04), while abiraterone and apalutamide were associated with a significantly higher risk of angina pectoris (OR: 5.48, 95% CI: 1.23-24.33, <em>P = .</em>03) and myocardial infarction (OR: 7.00, 95% CI: 1.60-30.62, <em>P = .</em>01), respectively.</p></div><div><h3>Conclusion</h3><p>The inclusion of ARAT agents was associated with a significantly higher risk of several CVAEs. Clinicians should remain vigilant, both in pre-treatment screening and monitoring for clinical symptoms and signs, when considering ARAT agent particularly for patients with pre-existing risk factors.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140072124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Characteristics, Treatment Patterns, and Outcomes for Patients With Renal Cell Carcinoma in England: A Retrospective Cohort Study","authors":"Prantik Das ,&nbsp;Alison Booth ,&nbsp;Robert Donaldson ,&nbsp;Noami Berfeld ,&nbsp;Beth Nordstrom ,&nbsp;Robert Carroll ,&nbsp;Poonam Dhokia ,&nbsp;Andrew Clark ,&nbsp;Luis Vaz","doi":"10.1016/j.clgc.2024.102081","DOIUrl":"10.1016/j.clgc.2024.102081","url":null,"abstract":"<div><h3>Background and Objective</h3><p>Considering the rapidly evolving treatment landscape of renal cell carcinoma (RCC), recent descriptions of the RCC population in the UK are lacking, as are real-world data on treatment and patient outcomes. To analyse the demographic and clinical characteristics, treatment patterns, and overall survival of patients with RCC using national data sets in England.</p></div><div><h3>Patients and Methods</h3><p>This was a retrospective cohort study of patients diagnosed with RCC (all stages) between 2014-2018 using demographic, clinical, cancer registration, and treatment data. Patients were followed until death or study end (December 31, 2020). Treatments administered in each line were described to understand treatment sequencing. Kaplan–Meier methods were used for time-to-event analyses. Factors associated with discontinuation and survival were identified using Cox proportional hazard models.</p></div><div><h3>Results and Limitations</h3><p>Among 32,577 included patients, the median age at diagnosis was 66 years, 63.4% were male, and 6,786 (20.8%) had metastatic RCC at diagnosis. Tyrosine kinase inhibitor (TKI) monotherapy was the most common treatment class across lines. Over three quarters of patients (78.5% [95% CI: 78.0-78.9]) were alive one year after diagnosis (93.2% in the non-metastatic at diagnosis subgroup and 37.1% among patients with metastases at diagnosis). At three years post initial diagnosis, 18.0% patients were alive in the metastatic at diagnosis subgroup. Rapid evolution of the treatment landscape limits the results regarding lines of therapy.</p></div><div><h3>Conclusion</h3><p>This large-scale study provides insight on characteristics of patients with RCC, and it highlights the need for better treatment options to improve survival.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1558767324000521/pdfft?md5=06aef7be9174f9b54ace24458efcc2c4&pid=1-s2.0-S1558767324000521-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140576826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant Chemotherapy and Survival After Radical Cystectomy in Histologic Subtype Bladder Cancer","authors":"Elizabeth L. Koehne ,&nbsp;Dimitra R. Bakaloudi ,&nbsp;Fady Ghali ,&nbsp;Yaw Nyame ,&nbsp;George R. Schade ,&nbsp;Petros Grivas ,&nbsp;Todd A. Yezefski ,&nbsp;Jessica E. Hawley ,&nbsp;Evan Y. Yu ,&nbsp;Andrew C. Hsieh ,&nbsp;R Bruce Montgomery ,&nbsp;Sarah P. Psutka ,&nbsp;John L. Gore ,&nbsp;Jonathan L. Wright","doi":"10.1016/j.clgc.2024.102100","DOIUrl":"10.1016/j.clgc.2024.102100","url":null,"abstract":"<div><h3>Objectives</h3><p>Patients with histologic subtype bladder cancer (HSBC) suffer worse outcomes than those with conventional urothelial carcinoma (UC). We sought to characterize the use of adjuvant chemotherapy (AC) in HSBC after radical cystectomy (RC) using the National Cancer Database (NCDB).</p></div><div><h3>Materials and Methods</h3><p>We retrospectively queried the NCDB (2006-2019) for patients with non-metastatic bladder cancer (BC) who underwent RC (<em>N</em> = 45,797). Patients were stratified by histologic subtype and receipt of AC. Multivariable logistic regression determined associations of demographic and clinicopathologic features with receipt of AC. Multivariable Cox regression evaluated associations between receipt of any AC and overall survival (OS).</p></div><div><h3>Results</h3><p>We identified 4,469 patients with HSBC classified as squamous, adenocarcinoma, small cell, sarcomatoid, micropapillary, or plasmacytoid. Squamous comprised 31% of the HSBC cohort, followed by small cells and micropapillary. Black patients were presented with a higher prevalence of adenocarcinoma (119/322, 37.0%). Use of AC was highest in plasmacytoid and small cell (30% each) and lowest in squamous (11%). Neuroendocrine histology was independently associated with greater odds of receiving AC (HR 1.6, 95% CI 1.37-1.87), while squamous cell histology was associated with lower odds (HR 0.61, 95% CI 0.53-0.71). On multivariable Cox regression analysis, treatment with AC was associated with significantly longer OS (HR 0.69, 95% CI 0.59-0.81) and for squamous, sarcomatoid, and micropapillary cohorts after stratified by subtype.</p></div><div><h3>Conclusions</h3><p>AC was variably used among patients with HSBC and was associated with OS benefit in such patients.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140772937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Cabozantinib Dose Reductions for Toxicity With Clinical Effectiveness in Metastatic Renal Cell Carcinoma (mRCC): Results From the Canadian Kidney Cancer Information System (CKCis)","authors":"Jeffrey Graham ,&nbsp;Sunita Ghosh ,&nbsp;Rodney H. Breau ,&nbsp;Lori Wood ,&nbsp;Simon Tanguay ,&nbsp;Dominick Bosse ,&nbsp;Aly-Khan Lalani ,&nbsp;Bimal Bhindi ,&nbsp;Daniel Heng ,&nbsp;Antonio Finelli ,&nbsp;Nazanin Fallah-Rad ,&nbsp;Vincent Castonguay ,&nbsp;Naveen S. Basappa ,&nbsp;Denis Soulières ,&nbsp;Frédéric Pouliot ,&nbsp;Christian Kollmannsberger ,&nbsp;Georg A. Bjarnason","doi":"10.1016/j.clgc.2024.02.011","DOIUrl":"10.1016/j.clgc.2024.02.011","url":null,"abstract":"<div><h3>Background</h3><p>Cabozantinib, an oral multi-targeted tyrosine kinase inhibitor (TKI), has demonstrated efficacy in metastatic renal cell carcinoma (mRCC). The association between toxicity and therapeutic effectiveness has been established with other TKIs. We investigated whether cabozantinib dose reductions, a surrogate for toxicity and adequate drug exposure, were associated with improved clinical outcomes in mRCC.</p></div><div><h3>Methods</h3><p>Employing the CKCis database, we analyzed patients treated with cabozantinib in the second line or later between 2011 to 2021. The cohort was stratified into those needing dose reductions (DR) during treatment and those not (no-DR). Outcomes, including objective response rate (ORR), time to treatment failure (TTF), and overall survival (OS), were compared based on dose reduction status. The influence of the initial dose on outcomes was also explored.</p></div><div><h3>Results</h3><p>Among 319 cabozantinib-treated patients, 48.3% underwent dose reductions. Response rates exhibited no significant difference between the DR and no-DR groups (15.1% vs. 18.2%, <em>P</em> = .55). Patients with DR had superior median OS (26.15 vs. 15.47 months, <em>P</em> = .019) and TTF (12.74 vs. 6.44 months, <em>P</em> = .022) compared to no-DR patients. These differences retained significance following adjustment for IMDC risk group (OS HR = 0.67, <em>P</em> = .032; TTF HR = 0.65, <em>P</em> = .008). There was no association between the initial dose and ORR, OS, or TTF.</p></div><div><h3>Conclusion</h3><p>This study highlights the link between cabozantinib dose reductions due to toxicity and improved survival and time to treatment failure in mRCC patients. These findings underscore the potential of using on-treatment toxicity as an indicator of adequate drug exposure to individualize dosing and optimize treatment effectiveness. Larger studies are warranted to validate these results and develop individualized strategies for cabozantinib when given alone or in combination with immunotherapy.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139952393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial Differences in Cutaneous Events Among Patients Receiving Enfortumab Vedotin","authors":"Evangelia Vlachou ,&nbsp;Ronac Mamtani ,&nbsp;Noah M. Hahn ,&nbsp;Burles Johnson III ,&nbsp;Jean Hoffman-Censits ,&nbsp;Vivek Nimgaonkar","doi":"10.1016/j.clgc.2024.102090","DOIUrl":"10.1016/j.clgc.2024.102090","url":null,"abstract":"<div><h3>Introduction</h3><p>Enfortumab vedotin (EV) is an antibody–drug conjugate approved alone and in combination with pembrolizumab for advanced urothelial cancer (UC). EV-related-cutaneous-events (EVCEs) are common and rarely life-threatening. Black patients are frequently under-represented in oncology trials, and dermatologic conditions may vary with race.</p></div><div><h3>Methods</h3><p>Therefore, this retrospective analysis investigated differences in EVCE frequency between Black and White patients in an urban cohort (Johns Hopkins [JH]) and a US-based, nationwide electronic health record (EHR)-derived deidentified database (Flatiron Health [FH]) with sub-group analysis of those who had received prior pembrolizumab.</p></div><div><h3>Results</h3><p>The study included 12 Black patients in the JH Cohort (17.1%) and 24 Black patients in the FH Cohort (7.6%). In both cohorts, the frequency of EVCEs among Black patients was higher compared to White patients (JH: 66.7% vs. 33.3%; FH: 25.0% vs. 15.8%), though not statistically significant. In the larger FH Cohort EVCEs were significantly more common among Black compared to White patients treated with prior pembrolizumab (Odds Ratio [OR]: 4.76 [95%CI: 1.42, 15.95]) and recent pembrolizumab (within 90 days of EV initiation) (OR 9.00 [95%CI: 1.94, 41.66]).</p></div><div><h3>Conclusion</h3><p>This hypothesis-generating retrospective study, comprising the largest population of EV-treated Black patients reported to date, emphasizes the importance of attentiveness to EVCEs among Black patients, particularly with receipt of pembrolizumab.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140756661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mainstream Model of Genetic Testing for Prostate Cancer at a Large Tertiary Cancer Centre","authors":"Xin Wang ,&nbsp;Larissa Waldman ,&nbsp;Yael Silberman ,&nbsp;Michael Wang ,&nbsp;Caleb Tackey ,&nbsp;Lilian Hanna ,&nbsp;Danny Vesprini ,&nbsp;Urban Emmenegger ,&nbsp;Andrea Eisen ,&nbsp;Martin Smoragiewicz","doi":"10.1016/j.clgc.2024.02.003","DOIUrl":"10.1016/j.clgc.2024.02.003","url":null,"abstract":"<div><h3>Background</h3><p>An estimated 20% to 30% of men with advanced prostate cancer carry a mutation in DNA damage repair genes, of which half are estimated to be germline. Eligibility criteria for germline genetic testing expanded significantly for Ontario patients in May 2021 and many centers adopted a “mainstream” model, defined as oncologist-initiated genetic testing.</p></div><div><h3>Methods</h3><p>We conducted a retrospective chart review to report on the first-year mainstream experience of a large tertiary oncologic center, the Sunnybrook Odette Cancer Centre. All patients who underwent mainstream at the discretion of their treating physician were included. A subset underwent somatic profiling as part of clinical trial screening. Descriptive statistics were used to report baseline clinicopathologic characteristics and treatments received.</p></div><div><h3>Results</h3><p>Between May 1, 2021, and May 30, 2022, 174 patients with prostate cancer underwent mainstream germline genetic testing with a 19-gene panel. Median age was 75 (IQR 68-80), and 82% of patients were diagnosed with either de novo metastatic or high-risk localized prostate adenocarcinoma. Fourteen patients (8%; 95% CI 4%-12%) were found to have a deleterious germline mutation, including pathogenic or likely pathogenic variants in <em>BRCA1/2, ATM, CHEK2, PMS2, RAD51C, HOXB13,</em> and <em>BRIP1</em>. Forty-nine patients (28%; 95% CI 21%-35%) were found to have a variant of uncertain significance. Thirty-four patients also had next-generation sequencing (NGS) of their somatic tissue. Among this subset, 8 of 34 (23%) had an alteration in homologous recombination repair (HRR) genes. Of the 14 patients with a germline mutation, none had a prior personal history of malignancy and 6 (43%) did not have any first- or second-degree relatives with history of prostate, pancreatic, breast, or ovarian cancer.</p></div><div><h3>Conclusion</h3><p>We report on the real-world characteristics of prostate cancer patients who underwent mainstream germline genetic testing. Personal history and family history of cancer cannot reliably stratify patients for the presence of pathogenic germline variants.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139832578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Adjuvant Chemotherapy in Variant Histology Upper Tract Urothelial Carcinoma Following Radical Nephroureterectomy: Stabilized Inverse Probability Treatment Weighting Analysis of Single Center Experience","authors":"Inkeun Park ,&nbsp;Jungyo Suh ,&nbsp;Bumjin Lim ,&nbsp;Cheryn Song ,&nbsp;Dalsan You ,&nbsp;In Gab Jeong ,&nbsp;Jun Hyuk Hong ,&nbsp;Hanjong Ahn ,&nbsp;Yong Mee Cho ,&nbsp;Jaelyun Lee ,&nbsp;Bumsik Hong","doi":"10.1016/j.clgc.2024.102069","DOIUrl":"10.1016/j.clgc.2024.102069","url":null,"abstract":"<div><h3>Purpose</h3><p>The study aimed to investigate the impact of adjuvant chemotherapy on time to recurrence (TTR) and overall survival (OS) in patients with histologic variants of upper tract urothelial carcinoma (VUTUC) following radical nephroureterectomy (RNU).</p></div><div><h3>Materials and methods</h3><p>A retrospective review of 131 VUTUC patients' medical records, from a pool of 368 non-metastatic localized or locally advanced UTUC cases, treated at a single tertiary referral center between January 2011 and January 2021. The intervention was adjuvant chemotherapy administration post-RNU. TTR and OS were evaluated using Kaplan-Meier and Cox proportional hazard regression, covariates adjusted for age, postoperative GFR, history of neoadjuvant chemotherapy, T and N stage with stabilized inverse probability of treatment weighting (sIPTW).</p></div><div><h3>Results</h3><p>The application of adjuvant chemotherapy showed a significant extension in TTR (<em>P</em> = .01), but no substantial impact on OS (<em>P</em> = .19) after sIPTW adjustment for covariates. Multivariate analysis revealed adjuvant chemotherapy, tumor size, and lymphovascular invasion as significant prognostic factors for TTR. In contrast, only tumor size and perineural invasion were significant for OS. Adjuvant chemotherapy reduced the progression risk in certain VUTUC subtypes (squamous or glandular/micropapillary), but not in sarcomatoid variants.</p></div><div><h3>Conclusions</h3><p>Adjuvant chemotherapy appears to improve TTR, albeit without a significant effect on OS, in nonmetastatic localized and locally advanced VUTUC patients post-RNU. While beneficial to some VUTUC subtypes, it did not yield significant advantages for sarcomatoid variants. Despite adjustments for known confounders, the study's findings may be subject to potential selection bias and unmeasured confounding factors.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140072037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Radical Cystectomy in Clinically Node Positive Bladder Cancer: A US Veterans Health Administration Study","authors":"Margaret Meagher ,&nbsp;Kylie M. Morgan ,&nbsp;Leah Deshler ,&nbsp;Dhruv Puri ,&nbsp;Kit Yuen ,&nbsp;Aditya Bagrodia ,&nbsp;Brent Rose ,&nbsp;Tyler Stewart ,&nbsp;Amirali Salmasi","doi":"10.1016/j.clgc.2024.02.006","DOIUrl":"10.1016/j.clgc.2024.02.006","url":null,"abstract":"<div><h3>Introduction</h3><p>The role of local definitive therapy in addition to systemic treatment in clinically positive regional lymph node (cN+) bladder cancer is yet to be determined. Herein, we sought to investigate the role of radical cystectomy (RC) in management of patients with cN+ bladder cancer at US Veterans Health Administration Facilities.</p></div><div><h3>Methods</h3><p>We identified patients diagnosed with cN+ bladder cancer between 2000-2017 using the Department of Veterans Affairs (VA) Informatics and Computing Infrastructure (VINCI). We employed a combination of database/registry coded values and chart review for data collection. To minimize mortality bias, we excluded patients who died within 90 days of diagnosis. We divided the patients into cystectomy (C) versus “no cystectomy” (NOC) cohorts. Propensity score matching was performed based on predictors of undergoing RC. Multivariable Cox models and Kaplan-Meier survival curves were used to estimate overall survival (OS) and cancer specific survival (CCS).</p></div><div><h3>Result</h3><p>After matching, 158 patients were included in the C and NOC groups. In the C-group, 85(54%) patients received pre-cystectomy chemotherapy, and 73(46%) patients underwent post-cystectomy chemotherapy. In the C-group, 65(41%) patients and in the NOC-group, 66(42%) patients had clinical N1 disease (<em>P</em> = .77). In multivariable Cox model, undergoing RC was associated with improved OS (HR0.62; 95%CI 0.47-0.81), <em>P</em> &lt; .001) and CSS (HR0.58; 95%CI 0.42-0.80; <em>P</em> &lt; .001).</p></div><div><h3>Conclusion</h3><p>As part of multimodal treatment, undergoing RC was associated with improved OS and CSS in subset of patients with cN+ bladder cancer. Prospective randomized trials are warranted to further investigate the role of local definitive therapy in this specific patient population.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139828022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Linear Muscle Segmentation for Metastatic Renal Cell Carcinoma: Changes in Clinic-Friendly Estimation Predict Survival Following Cytoreductive Nephrectomy","authors":"Edouard H. Nicaise ,&nbsp;Benjamin N. Schmeusser ,&nbsp;Adil Ali ,&nbsp;Eric Midenberg ,&nbsp;Arnold R. Palacios ,&nbsp;Blaise Hartsoe ,&nbsp;Ethan Kearns ,&nbsp;Sriram Ambadi ,&nbsp;Dattatraya H. Patil ,&nbsp;Shreyas S. Joshi ,&nbsp;Vikram M. Narayan ,&nbsp;Sarah P. Psutka ,&nbsp;Bassel Nazha ,&nbsp;Jacqueline T. Brown ,&nbsp;Kenneth Ogan ,&nbsp;Mehmet A. Bilen ,&nbsp;Viraj A. Master","doi":"10.1016/j.clgc.2024.02.007","DOIUrl":"10.1016/j.clgc.2024.02.007","url":null,"abstract":"<div><h3>Introduction</h3><p>Baseline sarcopenia and postoperative changes in muscle mass are independently associated with overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) undergoing cytoreductive nephrectomy (CN). Here we examine the relationships between preoperative (baseline), postoperative changes in muscle quantity, and survival outcomes following CN as determined by linear segmentation, a clinic-friendly tool that rapidly estimates muscle mass.</p></div><div><h3>Materials and Methods</h3><p>Our nephrectomy database was reviewed for patients with metastatic disease who underwent CN for RCC. Linear segmentation of the bilateral psoas/paraspinal muscles was completed for baseline imaging within 60 days of surgery and imaging 30 to 365 days postoperatively. Kruskal-Wallis for numerical and Fisher's exact test for categorical variables were used to test for differences between groups according to percent change in linear muscle index (LMI, cm²/m²). Multivariable Cox proportional hazards models evaluated associations between LMI percent change and cancer-specific (CSM) and all-cause mortality (ACM). Kaplan Meier curves estimated cancer-specific (CSS) and overall survival (OS).</p></div><div><h3>Results</h3><p>From 2004-2020, 205 patients were included of whom 52 demonstrated stable LMI (25.4%; LMI change &lt; 5% [0Δ]), 60 increase (29.3%; LMI +5% [+Δ]), and 92 decrease (44.9%; LMI -5% [-Δ]). Median time from baseline imaging to surgery was 18 days, and time from surgery to postoperative imaging was 133 days. Median CSS and OS were highest among patients with 0Δ LMI (CSS: 133.6 [0Δ] vs. 61.9 [+Δ] vs. 37.4 [-Δ] months; <em>P = .</em>0018 || OS: 67.2 [0Δ] vs. 54.8 [+Δ] vs. 29.5 [-Δ] months; <em>P = .</em>0007). Stable LMI was a protective factor for CSM (HR 0.48; <em>P = .</em>024) and ACM (HR 0.59; <em>P = .</em>040) on multivariable analysis.</p></div><div><h3>Discussion</h3><p>Change in muscle mass after CN, as measured by the linear muscle segmentation technique, is independently associated with OS and CSS in patients following CN. Of note, lack of change was associated with longer survival.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139918596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}