Pub Date : 2024-06-04DOI: 10.1016/j.clgc.2024.102135
Ye Han , Lei Yuan , Jingliang Zhang , Zunjian Xiao , Jianhua Jiao , Fan Shen , Weijun Qin , Yi Huan , Jing Ren
Introduction
Prostate cancer (PCa) located in the peripheral zone (PZ) and transitional zone (TZ) showed a different clinical and pathological characteristic. This passage aims to preliminarily evaluate the relationship between the zonal heterogeneity of PCa quantitatively assessed by bpMRI and pathological risk stratification of the primary lesion.
Methods
This prospective study was conducted from January 2019 to February 2023. A total of 113 PCa patients whose bpMRI data indicated that the lesions located in only 1 single zone of the prostate were selected. A transrectal ultrasound and MRI-targeted biopsy were performed to verify the bpMRI results, and then radical prostatectomy (RP) was performed in 3 weeks after the biopsy. The high-risk (HR) group was defined as ISUP grades ≥ 3. Binary regression was performed to evaluate if the zonal heterogeneity could be an independent predictor of the HR group. The receiver operator characteristic (ROC) curve was performed to analyze the added value of zonal location in predicting the HR group.
Results
PSA, T staging, and ISUP grades, incidence of positive surgical margins were significantly lower in the TZ PCa, and the ADCmin, and ADCmean values in the TZ PCa were significantly higher (all P < .01). The zonal heterogeneity could independently predict the HR group patients (OR: 5.170 [1.663-16.067], P = .005) and improve the predicting efficiency of HR patients (AUC 0.824, 95% CI, 0.741-0.889).
Conclusions
BpMRI could quantitively assess the zonal heterogeneity of PCa precisely and increase the predicting efficacy of HR patients, which can provide better help for clinical individualized treatment.
{"title":"Bi-Parameter MRI Could Quantitatively Assess the Zonal Heterogeneity of Prostate Cancer","authors":"Ye Han , Lei Yuan , Jingliang Zhang , Zunjian Xiao , Jianhua Jiao , Fan Shen , Weijun Qin , Yi Huan , Jing Ren","doi":"10.1016/j.clgc.2024.102135","DOIUrl":"10.1016/j.clgc.2024.102135","url":null,"abstract":"<div><h3>Introduction</h3><p>Prostate cancer (PCa) located in the peripheral zone (PZ) and transitional zone (TZ) showed a different clinical and pathological characteristic. This passage aims to preliminarily evaluate the relationship between the zonal heterogeneity of PCa quantitatively assessed by bpMRI and pathological risk stratification of the primary lesion.</p></div><div><h3>Methods</h3><p>This prospective study was conducted from January 2019 to February 2023. A total of 113 PCa patients whose bpMRI data indicated that the lesions located in only 1 single zone of the prostate were selected. A transrectal ultrasound and MRI-targeted biopsy were performed to verify the bpMRI results, and then radical prostatectomy (RP) was performed in 3 weeks after the biopsy. The high-risk (HR) group was defined as ISUP grades ≥ 3. Binary regression was performed to evaluate if the zonal heterogeneity could be an independent predictor of the HR group. The receiver operator characteristic (ROC) curve was performed to analyze the added value of zonal location in predicting the HR group.</p></div><div><h3>Results</h3><p>PSA, T staging, and ISUP grades, incidence of positive surgical margins were significantly lower in the TZ PCa, and the ADCmin, and ADCmean values in the TZ PCa were significantly higher (all <em>P</em> < .01). The zonal heterogeneity could independently predict the HR group patients (OR: 5.170 [1.663-16.067], <em>P</em> = .005) and improve the predicting efficiency of HR patients (AUC 0.824, 95% CI, 0.741-0.889).</p></div><div><h3>Conclusions</h3><p>BpMRI could quantitively assess the zonal heterogeneity of PCa precisely and increase the predicting efficacy of HR patients<strong>,</strong> which can provide better help for clinical individualized treatment.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141408707","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}
Pub Date : 2024-06-04DOI: 10.1016/j.clgc.2024.102133
Introduction
We evaluate the predictive and prognostic value of insulin-like growth factor-I (IGF-1), IGF binding protein-2 (IGFBP-2) and -3 (IGFBP-3) in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).
Methods
This is a retrospective analysis of a multi-institutional database comprising 753 patients who underwent RNU for UTUC and had a preoperative plasma available. Logistic and Cox regression analyses were performed. The discriminative ability and clinical utility of the models was calculated using the lasso regression test, area under receiver operating characteristics curves, C-index, and decision curve analysis (DCA).
Results
Lower preoperative plasma levels of IGFBP-2 and -3 independently correlated with increased risks of lymph node metastasis, pT3/4 disease, nonorgan confined disease, and worse recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) (all P ≤ .004). The addition of both IGFBP-2 and -3 to a postoperative multivariable model, that included standard clinicopathologic characteristics, improved the model's concordance index by 10%, 9%, and 8% for RFS, CSS, and OS, respectively. On DCA, addition of both IGFBP-2 and -3 to base models improved their performance for RFS, CSS, and OS by a statistically and clinically significant margin. Plasma IGF-1 was not associated with any of outcomes.
Conclusions
We confirmed that a lower plasma levels of IGFBP-2 and -3 both are independent and clinically significant predictors of adverse pathological features and survival outcomes in UTUC patients treated with RNU. These findings might help guide the clinical decision-making regarding perioperative systemic therapy and follow-up scheduling.
{"title":"Preoperative Plasma Insulin-Like Growth Factor-I and Its Binding Proteins-Based Risk Stratification of Patients Treated With Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma","authors":"","doi":"10.1016/j.clgc.2024.102133","DOIUrl":"10.1016/j.clgc.2024.102133","url":null,"abstract":"<div><h3>Introduction</h3><p>We evaluate the predictive and prognostic value of insulin-like growth factor-I (IGF-1), IGF binding protein-2 (IGFBP-2) and -3 (IGFBP-3) in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).</p></div><div><h3>Methods</h3><p>This is a retrospective analysis of a multi-institutional database comprising 753 patients who underwent RNU for UTUC and had a preoperative plasma available. Logistic and Cox regression analyses were performed. The discriminative ability and clinical utility of the models was calculated using the lasso regression test, area under receiver operating characteristics curves, C-index, and decision curve analysis (DCA).</p></div><div><h3>Results</h3><p>Lower preoperative plasma levels of IGFBP-2 and -3 independently correlated with increased risks of lymph node metastasis, pT3/4 disease, nonorgan confined disease, and worse recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) (all <em>P</em> ≤ .004). The addition of both IGFBP-2 and -3 to a postoperative multivariable model, that included standard clinicopathologic characteristics, improved the model's concordance index by 10%, 9%, and 8% for RFS, CSS, and OS, respectively. On DCA, addition of both IGFBP-2 and -3 to base models improved their performance for RFS, CSS, and OS by a statistically and clinically significant margin. Plasma IGF-1 was not associated with any of outcomes.</p></div><div><h3>Conclusions</h3><p>We confirmed that a lower plasma levels of IGFBP-2 and -3 both are independent and clinically significant predictors of adverse pathological features and survival outcomes in UTUC patients treated with RNU. These findings might help guide the clinical decision-making regarding perioperative systemic therapy and follow-up scheduling.</p></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1558767324001046/pdfft?md5=90fd732d4d9b2a44e78fdad37fd82230&pid=1-s2.0-S1558767324001046-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141391345","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}
Pub Date : 2024-06-01DOI: 10.1016/j.clgc.2024.102079
Jakob Klemm , Shahrokh F. Shariat , Ekaterina Laukhtina , Pawel Rajwa , Malte W. Vetterlein , Victor M. Schuettfort , Markus von Deimling , Roland Dahlem , Margit Fisch , Michael Rink
Introduction and Objectives
We examined the impact of preoperative plasma potassium levels (PPLs) on outcomes in patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB), hypothesizing that potassium imbalances might influence outcomes.
Patients and Methods
In this retrospective study, 501 UCB patients undergoing RC from 2009 to 2017 at a tertiary center were analyzed. Blood samples collected a week prior to surgery defined normal and abnormal PPL based on institutional standards. We assessed overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), postoperative complications, 30-day mortality, and non-organ confined disease. Kaplan-Meier estimates, Cox proportional hazards, logistic regression, and decision curve analyses (DCA) were employed.
Results
63 (13%) patients had abnormal preoperative PPLs, with 50 (10%) elevated and 13 (2.5%) decreased. In a 59 months median follow-up, 152 (31%) had disease recurrence, 197 (39%) died from any cause, and 119 (24%) from UCB. Multivariable cox regression analyses adjusting for perioperative parameters demonstrated abnormal PPL was associated with worse OS (HR=1.9, P=0.009), CSS (HR=2.8, P<0.001) and RFS (HR=2.1; P=0.007). Elevated preoperative PPLs also demonstrated significant associations with adverse outcomes in OS, CSS, and RFS (all P<0.05). In multivariable logistic regression analyses, abnormal and elevated PPLs were not associated with 30-day mortality, major 30-day postoperative complications, positive nodal disease, pT3/4 stage, and non-organ confined disease (all P>0.05).
Conclusion
Abnormal and elevated preoperative PPLs correlate with adverse oncologic outcomes in UCB patients treated with RC. Pending external validation, preoperative PPLs might be a cost-effective, easily obtainable supplemental biomarker for enriching accuracy of outcome prediction in this highly variable maladie.
{"title":"Impact of Preoperative Plasma Potassium Levels on Oncological Outcomes, Major Complications, and 30-Day Mortality in Bladder Cancer Patients Undergoing Radical Cystectomy","authors":"Jakob Klemm , Shahrokh F. Shariat , Ekaterina Laukhtina , Pawel Rajwa , Malte W. Vetterlein , Victor M. Schuettfort , Markus von Deimling , Roland Dahlem , Margit Fisch , Michael Rink","doi":"10.1016/j.clgc.2024.102079","DOIUrl":"10.1016/j.clgc.2024.102079","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><p>We examined the impact of preoperative plasma potassium levels (PPLs) on outcomes in patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB), hypothesizing that potassium imbalances might influence outcomes.</p></div><div><h3>Patients and Methods</h3><p>In this retrospective study, 501 UCB patients undergoing RC from 2009 to 2017 at a tertiary center were analyzed. Blood samples collected a week prior to surgery defined normal and abnormal PPL based on institutional standards. We assessed overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), postoperative complications, 30-day mortality, and non-organ confined disease. Kaplan-Meier estimates, Cox proportional hazards, logistic regression, and decision curve analyses (DCA) were employed.</p></div><div><h3>Results</h3><p>63 (13%) patients had abnormal preoperative PPLs, with 50 (10%) elevated and 13 (2.5%) decreased. In a 59 months median follow-up, 152 (31%) had disease recurrence, 197 (39%) died from any cause, and 119 (24%) from UCB. Multivariable cox regression analyses adjusting for perioperative parameters demonstrated abnormal PPL was associated with worse OS (HR=1.9, <em>P</em>=0.009), CSS (HR=2.8, <em>P</em><0.001) and RFS (HR=2.1; <em>P</em>=0.007). Elevated preoperative PPLs also demonstrated significant associations with adverse outcomes in OS, CSS, and RFS (all <em>P</em><0.05). In multivariable logistic regression analyses, abnormal and elevated PPLs were not associated with 30-day mortality, major 30-day postoperative complications, positive nodal disease, pT3/4 stage, and non-organ confined disease (all <em>P</em>>0.05).</p></div><div><h3>Conclusion</h3><p>Abnormal and elevated preoperative PPLs correlate with adverse oncologic outcomes in UCB patients treated with RC. Pending external validation, preoperative PPLs might be a cost-effective, easily obtainable supplemental biomarker for enriching accuracy of outcome prediction in this highly variable maladie.</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/S1558767324000508/pdfft?md5=e308907a56f50d112897d2f8abb9a483&pid=1-s2.0-S1558767324000508-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140270775","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}
Pub Date : 2024-06-01DOI: 10.1016/j.clgc.2024.102065
Robert H. Mbilinyi , Pavlos Msaouel , Priya Rao , Jose A. Karam , Nizar M. Tannir , Chad Tang
•
This study addresses the clinical management of renal medullary carcinoma (RMC), a rare and aggressive cancer primarily affecting young individuals of African descent with sickle cell trait. Unlike renal cell carcinoma (RCC), RMC is known for its poor prognosis, with a survival rate of less than 5% beyond three years and limited response to standard systemic treatments effective in other renal cancers.
•
The key findings of this study are significant. It shows that combining definitive radiation and systemic therapies, especially in patients with oligometastatic or oligoprogressive RMC, can greatly improve outcomes. In some cases, this approach resulted in over 12 months of disease-free survival, a substantial improvement over current treatment outcome. Notably, patients receiving this combined treatment exhibited complete radiographic responses lasting more than 12 months, highlighting the substantial benefits of this strategy.
•
Clinically, these findings could reshape RMC treatment by endorsing an aggressive, personalized, and multimodal approach. we recommend early integration of radiation with systemic therapy. Additionally, we recommend an aggressive combinational regimen especially post-relapse, contrasting with conventional treatments. Insights, like minimizing therapy interruptions and careful systemic therapy selection, may enhance outcomes in this historically challenging disease.
•
The significance of this study lies in its potential to influence clinical practice by offering a promising treatment approach for RMC, a condition in need of more effective therapeutic regimen. Further research is necessary to validate these findings and refine the integration of radiation therapy in RMC treatment.
{"title":"Radiation Therapy for the Management of Renal Medullary Carcinoma: A Multi-Case Study","authors":"Robert H. Mbilinyi , Pavlos Msaouel , Priya Rao , Jose A. Karam , Nizar M. Tannir , Chad Tang","doi":"10.1016/j.clgc.2024.102065","DOIUrl":"10.1016/j.clgc.2024.102065","url":null,"abstract":"<div><p></p><ul><li><span>•</span><span><p>This study addresses the clinical management of renal medullary carcinoma (RMC), a rare and aggressive cancer primarily affecting young individuals of African descent with sickle cell trait. Unlike renal cell carcinoma (RCC), RMC is known for its poor prognosis, with a survival rate of less than 5% beyond three years and limited response to standard systemic treatments effective in other renal cancers.</p></span></li><li><span>•</span><span><p>The key findings of this study are significant. It shows that combining definitive radiation and systemic therapies, especially in patients with oligometastatic or oligoprogressive RMC, can greatly improve outcomes. In some cases, this approach resulted in over 12 months of disease-free survival, a substantial improvement over current treatment outcome. Notably, patients receiving this combined treatment exhibited complete radiographic responses lasting more than 12 months, highlighting the substantial benefits of this strategy.</p></span></li><li><span>•</span><span><p>Clinically, these findings could reshape RMC treatment by endorsing an aggressive, personalized, and multimodal approach. we recommend early integration of radiation with systemic therapy. Additionally, we recommend an aggressive combinational regimen especially post-relapse, contrasting with conventional treatments. Insights, like minimizing therapy interruptions and careful systemic therapy selection, may enhance outcomes in this historically challenging disease.</p></span></li><li><span>•</span><span><p>The significance of this study lies in its potential to influence clinical practice by offering a promising treatment approach for RMC, a condition in need of more effective therapeutic regimen. Further research is necessary to validate these findings and refine the integration of radiation therapy in RMC treatment.</p></span></li></ul></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":"140072079","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}
The CheckMate274 trial has reported enhanced disease-free survival rates in patients with stage pT3–4/ypT2–4 or pN+ urothelial carcinoma (UC) undergoing adjuvant nivolumab therapy. This study compares prognostic differences between urothelial carcinoma of the bladder (UCB) and upper tract urothelial carcinoma (UTUC).
Methods
We retrospectively analyzed data from 719 patients with UC who underwent radical surgery, stratifying to patients at stage pT3–4 and/or pN+ without neoadjuvant chemotherapy (NAC) or at ypT2–4 and/or ypN+ with NAC (potential candidates for adjuvant immunotherapy), and to those who were not candidates for adjuvant immunotherapy. We used Kaplan–Meier curves to assess oncological outcomes, particularly nonurothelial tract recurrence-free survival (NUTRFS), cancer-specific survival (CSS), and overall survival (OS). Risk factors were identified by Cox regression analysis.
Results
Kaplan–Meier curves showed significantly lower NUTRFS, CSS, and OS for potential adjuvant immunotherapy candidates than for noncandidates in each UCB and UTUC group. NUTRFS, CSS, and OS did not differ significantly between adjuvant immunotherapy candidates with UBC or UTUC. Trends were similar among patients ineligible for adjuvant immunotherapy. Pathological T stage (pT3–4 or ypT2–4), pathological N stage, and lymphovascular invasion (LVI) were independent predictors of oncological outcomes on multivariate analysis.
Conclusion
The criteria for adjuvant immunotherapy candidates from the CheckMate 274 trial can also effectively stratify UC patients after radical surgery. Substantial clinical significance is attached to LVI status as well as to pathological T and N status, suggesting that LVI status should be considered when selecting suitable candidates for adjuvant immunotherapy.
背景CheckMate274试验报告称,接受尼妥珠单抗辅助治疗的pT3-4/ypT2-4期或pN+期尿路上皮癌(UC)患者的无病生存率有所提高。本研究比较了膀胱尿路上皮癌(UCB)和上尿路上皮癌(UTUC)的预后差异。方法我们回顾性分析了719例接受根治术的UC患者的数据,将患者分为未接受新辅助化疗(NAC)的pT3-4期和/或pN+期患者,或接受NAC的ypT2-4期和/或ypN+期患者(辅助免疫疗法的潜在候选者),以及不适合接受辅助免疫疗法的患者。我们使用卡普兰-梅耶曲线评估肿瘤学结果,尤其是非尿道无复发生存率(NUTRFS)、癌症特异性生存率(CSS)和总生存率(OS)。结果Kaplan-Meier曲线显示,在UCB和UTUC各组中,潜在辅助免疫疗法候选者的NUTRFS、CSS和OS明显低于非候选者。UBC或UTUC辅助免疫疗法候选者的NUTRFS、CSS和OS没有明显差异。不符合辅助免疫治疗条件的患者的趋势相似。在多变量分析中,病理 T 分期(pT3-4 或 ypT2-4)、病理 N 分期和淋巴管侵犯(LVI)是肿瘤结局的独立预测因素。LVI状态以及病理T和N状态具有重要的临床意义,这表明在选择合适的辅助免疫疗法候选者时应考虑LVI状态。
{"title":"Site-Specific Differences of Eligibility for Adjuvant Immunotherapy Among Urothelial Carcinoma Patients Treated With Radical Surgery: Results From a Multicenter Cohort Study","authors":"Chisato Narita , Fumihiko Urabe , Wataru Fukuokaya , Kosuke Iwatani , Yu Imai , Keiji Yasue , Keiichiro Mori , Koichi Aikawa , Takafumi Yanagisawa , Shoji Kimura , Kojiro Tashiro , Shunsuke Tsuzuki , Yuta Yamada , Steffi Kar Kei Yuen , Jeremy Yuen-Chun Teoh , Tatsuya Shimomura , Hiroki Yamada , Akira Furuta , Jun Miki , Takahiro Kimura","doi":"10.1016/j.clgc.2024.102082","DOIUrl":"10.1016/j.clgc.2024.102082","url":null,"abstract":"<div><h3>Background</h3><p>The CheckMate274 trial has reported enhanced disease-free survival rates in patients with stage pT3–4/ypT2–4 or pN+ urothelial carcinoma (UC) undergoing adjuvant nivolumab therapy. This study compares prognostic differences between urothelial carcinoma of the bladder (UCB) and upper tract urothelial carcinoma (UTUC).</p></div><div><h3>Methods</h3><p>We retrospectively analyzed data from 719 patients with UC who underwent radical surgery, stratifying to patients at stage pT3–4 and/or pN+ without neoadjuvant chemotherapy (NAC) or at ypT2–4 and/or ypN+ with NAC (potential candidates for adjuvant immunotherapy), and to those who were not candidates for adjuvant immunotherapy. We used Kaplan–Meier curves to assess oncological outcomes, particularly nonurothelial tract recurrence-free survival (NUTRFS), cancer-specific survival (CSS), and overall survival (OS). Risk factors were identified by Cox regression analysis.</p></div><div><h3>Results</h3><p>Kaplan–Meier curves showed significantly lower NUTRFS, CSS, and OS for potential adjuvant immunotherapy candidates than for noncandidates in each UCB and UTUC group. NUTRFS, CSS, and OS did not differ significantly between adjuvant immunotherapy candidates with UBC or UTUC. Trends were similar among patients ineligible for adjuvant immunotherapy. Pathological T stage (pT3–4 or ypT2–4), pathological N stage, and lymphovascular invasion (LVI) were independent predictors of oncological outcomes on multivariate analysis.</p></div><div><h3>Conclusion</h3><p>The criteria for adjuvant immunotherapy candidates from the CheckMate 274 trial can also effectively stratify UC patients after radical surgery. Substantial clinical significance is attached to LVI status as well as to pathological T and N status, suggesting that LVI status should be considered when selecting suitable candidates for adjuvant 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":"140272277","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}
Pub Date : 2024-06-01DOI: 10.1016/j.clgc.2024.102083
Gabriel Berlingieri Polho , Mateus Trinconi Cunha , Maiana Hamdan Melo Coelho , Jamile Almeida-Silva , Cassio Murilo Hidalgo Filho , Erick Menezes Xavier , Nathalia de Souza Crusoe , Marcelo Junqueira Atanazio , Vitor Fiorin de Vasconcellos , Vivian Naomi Horita , Guilherme Fialho Freitas , David Queiroz Muniz , Vanderson Rocha , Jose Mauricio Mota
Background
High-dose chemotherapy followed by stem cell transplant (HDCT) is potentially curative for patients with refractory germ cell tumors (rGCT). There is scarce real-world data supporting its implementation in low- and middle-income countries. We described the experience of our tertiary cancer center in Sao Paulo, Brazil.
Methods
We identified male patients ≥18 years-old with rGCT referred to HDCT after board discussion. Clinical data, including delays in HDCT protocol, were extracted from medical records, and survival outcomes were estimated using the Kaplan-Meier method. The log-rank test and Cox proportional hazard were used to determine effects on overall survival (OS).
Results
From January 2013 to January 2023, 34 patients were referred and considered eligible to receive 2 cycles of HDCT. Most patients had primary testicular tumors (82%), nonseminomatous histology (88%), and poor International Germ Cell Collaborative Group (IGCCCG) (79%). Twenty-three patients received HDCT (1 cycle, n = 8; 2 cycles, n = 15). Main reasons for not receiving any HDCT were death due to progressive disease (n = 1), performance deterioration (n = 7), and failure of stem cell mobilization (n = 3). OS at 2 years was 36.7% for the eligible population, 56.1% for patients who underwent at least 1 HDCT, and 77.1% for those who had ≥2 cycles. The 2-year OS rate for patients not given HDCT was 0%. All patients had delays in protocol, and poor-risk patients had longer intervals from referral to protocol initiation (0.7 vs. 1.8 month, P < .01).
Conclusion
Outcomes of patients who received ≥1 HDCT were encouraging; however, only 15 from 34 eligible patients were able to receive the planned 2 cycles of HDCT. Further strategies to minimize treatment delays in low- and middle-income countries are needed.
{"title":"High Dose Chemotherapy With Autologous Stem Cell Transplant for Patients With Advanced Germ Cell Tumors: Real-World Evidence From a Tertiary Cancer Center in Brazil","authors":"Gabriel Berlingieri Polho , Mateus Trinconi Cunha , Maiana Hamdan Melo Coelho , Jamile Almeida-Silva , Cassio Murilo Hidalgo Filho , Erick Menezes Xavier , Nathalia de Souza Crusoe , Marcelo Junqueira Atanazio , Vitor Fiorin de Vasconcellos , Vivian Naomi Horita , Guilherme Fialho Freitas , David Queiroz Muniz , Vanderson Rocha , Jose Mauricio Mota","doi":"10.1016/j.clgc.2024.102083","DOIUrl":"10.1016/j.clgc.2024.102083","url":null,"abstract":"<div><h3>Background</h3><p>High-dose chemotherapy followed by stem cell transplant (HDCT) is potentially curative for patients with refractory germ cell tumors (rGCT). There is scarce real-world data supporting its implementation in low- and middle-income countries. We described the experience of our tertiary cancer center in Sao Paulo, Brazil.</p></div><div><h3>Methods</h3><p>We identified male patients ≥18 years-old with rGCT referred to HDCT after board discussion. Clinical data, including delays in HDCT protocol, were extracted from medical records, and survival outcomes were estimated using the Kaplan-Meier method. The log-rank test and Cox proportional hazard were used to determine effects on overall survival (OS).</p></div><div><h3>Results</h3><p>From January 2013 to January 2023, 34 patients were referred and considered eligible to receive 2 cycles of HDCT. Most patients had primary testicular tumors (82%), nonseminomatous histology (88%), and poor International Germ Cell Collaborative Group (IGCCCG) (79%). Twenty-three patients received HDCT (1 cycle, n = 8; 2 cycles, n = 15). Main reasons for not receiving any HDCT were death due to progressive disease (n = 1), performance deterioration (n = 7), and failure of stem cell mobilization (n = 3). OS at 2 years was 36.7% for the eligible population, 56.1% for patients who underwent at least 1 HDCT, and 77.1% for those who had ≥2 cycles. The 2-year OS rate for patients not given HDCT was 0%. All patients had delays in protocol, and poor-risk patients had longer intervals from referral to protocol initiation (0.7 vs. 1.8 month, <em>P</em> < .01).</p></div><div><h3>Conclusion</h3><p>Outcomes of patients who received ≥1 HDCT were encouraging; however, only 15 from 34 eligible patients were able to receive the planned 2 cycles of HDCT. Further strategies to minimize treatment delays in low- and middle-income countries are needed.</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":"140398571","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}
Pub Date : 2024-06-01DOI: 10.1016/j.clgc.2024.102074
Veronica Mollica , Francesco Massari , Marco Maruzzo , Davide Bimbatti , Melanie Claps , Brigida Anna Maiorano , Maria Giuseppa Vitale , Roberto Iacovelli , Paola Ermacora , Giandomenico Roviello , Fabio Calabrò , Orazio Caffo , Francesca Vignani , Francesco Grillone , Francesco Pierantoni , Marilena Di Napoli , Alessia Mennitto , Andrea Marchetti , Alvise Mattana , Alessia Cavo , Sebastiano Buti
Introduction
Penile squamous cell carcinoma (PSCC) is a rare tumor with an aggressive behavior. The Meet-URO 23/I-RARE registry includes rare genitourinary malignancies. We extracted patients with PSCC to conduct a retrospective study aimed at assessing clinical outcomes and prognostic factors.
Patients and Methods
Primary endpoints were overall survival and progression-free survival. Prognostic factors for OS and PFS were analyzed using univariate and multivariate analysis.
From the Meet-URO 23/I-RARE database, we extracted 128 patients with diagnosis of PSCC. About 48% of patients underwent first-line of therapy.
Results
In the overall population, median OS from diagnosis was 34.6 months. Significant differences in median OS were observed according to ECOG PS at diagnosis (57.3 months vs. 8.3 months; P < .001), and median age (≤77y 88.8 months vs. >77y 26 months; P = .013). At multivariate analysis, ECOG PS 2-4 at diagnosis (HR 3.04) and lymph node metastases (HR 2.49) were independently associated with a higher risk of death.
Among patients undergoing first-line therapy (n = 61), median OS was 12.3 months, and a statistically significant difference was found according to type of response to first-line (DCR 24.4 months vs. PD 7.1 months; P < .001). Multivariate analysis showed that only age >77 years was associated with a worse OS (HR 2.16). A statistically significant difference in PFS was found according to platinum plus 5-fluorouracil versus platinum plus taxane (4.9 vs. 3.4 months; P = .036) and regimens with 2 versus 3 drugs (3.4 vs. 8.6 months; P = .019). At the multivariate analysis only regimens with platinum plus taxane were associated with worse PFS (HR 2.83).
Conclusion
In our registry study, PSCC is confirmed to be an aggressive disease. Poor ECOG PS, presence of lymph node metastases, and higher age at diagnosis appear to be associated with worse survival outcomes.
{"title":"Clinical Outcomes and Prognostic Factors in Patients With Penile Carcinoma: A Sub-Analysis From Meet-URO 23 (I-RARE) Registry Study","authors":"Veronica Mollica , Francesco Massari , Marco Maruzzo , Davide Bimbatti , Melanie Claps , Brigida Anna Maiorano , Maria Giuseppa Vitale , Roberto Iacovelli , Paola Ermacora , Giandomenico Roviello , Fabio Calabrò , Orazio Caffo , Francesca Vignani , Francesco Grillone , Francesco Pierantoni , Marilena Di Napoli , Alessia Mennitto , Andrea Marchetti , Alvise Mattana , Alessia Cavo , Sebastiano Buti","doi":"10.1016/j.clgc.2024.102074","DOIUrl":"10.1016/j.clgc.2024.102074","url":null,"abstract":"<div><h3>Introduction</h3><p>Penile squamous cell carcinoma (PSCC) is a rare tumor with an aggressive behavior. The Meet-URO 23/I-RARE registry includes rare genitourinary malignancies. We extracted patients with PSCC to conduct a retrospective study aimed at assessing clinical outcomes and prognostic factors.</p></div><div><h3>Patients and Methods</h3><p>Primary endpoints were overall survival and progression-free survival. Prognostic factors for OS and PFS were analyzed using univariate and multivariate analysis.</p><p>From the Meet-URO 23/I-RARE database, we extracted 128 patients with diagnosis of PSCC. About 48% of patients underwent first-line of therapy.</p></div><div><h3>Results</h3><p>In the overall population, median OS from diagnosis was 34.6 months. Significant differences in median OS were observed according to ECOG PS at diagnosis (57.3 months <em>vs.</em> 8.3 months; <em>P</em> < .001), and median age (≤77y 88.8 months <em>vs.</em> >77y 26 months; <em>P</em> = .013). At multivariate analysis, ECOG PS 2-4 at diagnosis (HR 3.04) and lymph node metastases (HR 2.49) were independently associated with a higher risk of death.</p><p>Among patients undergoing first-line therapy (n = 61), median OS was 12.3 months, and a statistically significant difference was found according to type of response to first-line (DCR 24.4 months <em>vs.</em> PD 7.1 months; <em>P</em> < .001). Multivariate analysis showed that only age >77 years was associated with a worse OS (HR 2.16). A statistically significant difference in PFS was found according to platinum plus 5-fluorouracil <em>versus</em> platinum plus taxane (4.9 <em>vs.</em> 3.4 months; <em>P</em> = .036) and regimens with 2 <em>versus</em> 3 drugs (3.4 <em>vs.</em> 8.6 months; <em>P</em> = .019). At the multivariate analysis only regimens with platinum plus taxane were associated with worse PFS (HR 2.83).</p></div><div><h3>Conclusion</h3><p>In our registry study, PSCC is confirmed to be an aggressive disease. Poor ECOG PS, presence of lymph node metastases, and higher age at diagnosis appear to be associated with worse survival outcomes.</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":"140203967","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}
To date, no studies have compared the treatment outcomes of second-line therapies in patients with metastatic clear cell renal cell carcinoma (ccRCC). This study retrospectively evaluated the efficacy of cabozantinib and axitinib as second-line treatments in patients with metastatic ccRCC who previously received immune-oncology combination therapy.
Patients and Methods
Patients with metastatic ccRCC treated with cabozantinib and axitinib as second-line therapy after nivolumab-ipilimumab treatment were identified among 243 patients with RCC treated between August 1, 2018 and January 31, 2022 at 34 institutions belonging to the Japanese Urological Oncology Group. Patients were assessed for treatment outcomes, including progression-free survival (PFS), overall survival, objective response rate (ORR), and incidence rate of treatment-related adverse events (AEs).
Results
Forty-eight patients treated with cabozantinib and 60 treated with axitinib as second-line therapy after nivolumab-ipilimumab treatment for metastatic ccRCC were identified. The median PFS (95% confidence interval) was 11.0 months (9.0–16.0) with cabozantinib and 9.5 months (6.0–13.0) with axitinib. The ORRs were 37.5% (cabozantinib) and 38.3% (axitinib). The rates of any-grade AEs and grade ≥3 AEs were 79.2% (cabozantinib) versus 63.3% (axitinib; P = .091) and 35.4% (cabozantinib) versus 23.3% (axitinib; P = .202), respectively. In the poor-risk group, PFS was longer in the cabozantinib group than in the axitinib group (P = .033).
Conclusion
The efficacy and safety of cabozantinib and axitinib were comparable. In the poor-risk group, cabozantinib was more effective than axitinib. These findings provide valuable insights into the selection of second-line treatment options after nivolumab-ipilimumab treatment in patients with metastatic ccRCC.
{"title":"Comparison of Cabozantinib and Axitinib as Second-line Therapy After Nivolumab Plus Ipilimumab in Patients With Metastatic Clear Cell Renal Cell Carcinoma: A Comparative Analysis of Retrospective Real-world Data","authors":"Ryotaro Tomida , Masayuki Takahashi , Yuto Matsushita , Takahiro Kojima , Kazutoshi Yamana , Shuya Kandori , Yukari Bando , Naotaka Nishiyama , Shimpei Yamashita , Hisanori Taniguchi , Keisuke Monji , Ryo Ishiyama , Shuichi Tatarano , Kimihiko Masui , Ayumu Matsuda , Tomoyuki Kaneko , Takanobu Motoshima , Yusuke Shiraishi , Satoru Kira , Takaya Murashima , Junya Furukawa","doi":"10.1016/j.clgc.2024.102094","DOIUrl":"10.1016/j.clgc.2024.102094","url":null,"abstract":"<div><h3>Background</h3><p>To date, no studies have compared the treatment outcomes of second-line therapies in patients with metastatic clear cell renal cell carcinoma (ccRCC). This study retrospectively evaluated the efficacy of cabozantinib and axitinib as second-line treatments in patients with metastatic ccRCC who previously received immune-oncology combination therapy.</p></div><div><h3>Patients and Methods</h3><p>Patients with metastatic ccRCC treated with cabozantinib and axitinib as second-line therapy after nivolumab-ipilimumab treatment were identified among 243 patients with RCC treated between August 1, 2018 and January 31, 2022 at 34 institutions belonging to the Japanese Urological Oncology Group. Patients were assessed for treatment outcomes, including progression-free survival (PFS), overall survival, objective response rate (ORR), and incidence rate of treatment-related adverse events (AEs).</p></div><div><h3>Results</h3><p>Forty-eight patients treated with cabozantinib and 60 treated with axitinib as second-line therapy after nivolumab-ipilimumab treatment for metastatic ccRCC were identified. The median PFS (95% confidence interval) was 11.0 months (9.0–16.0) with cabozantinib and 9.5 months (6.0–13.0) with axitinib. The ORRs were 37.5% (cabozantinib) and 38.3% (axitinib). The rates of any-grade AEs and grade ≥3 AEs were 79.2% (cabozantinib) versus 63.3% (axitinib; <em>P</em> = .091) and 35.4% (cabozantinib) versus 23.3% (axitinib; <em>P</em> = .202), respectively. In the poor-risk group, PFS was longer in the cabozantinib group than in the axitinib group (<em>P</em> = .033).</p></div><div><h3>Conclusion</h3><p>The efficacy and safety of cabozantinib and axitinib were comparable. In the poor-risk group, cabozantinib was more effective than axitinib. These findings provide valuable insights into the selection of second-line treatment options after nivolumab-ipilimumab treatment in patients with metastatic ccRCC.</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":"140781491","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}
Pub Date : 2024-06-01DOI: 10.1016/j.clgc.2024.02.012
Dengxiong Li , Ruicheng Wu , Jie Wang , Junjiang Ye , Qingxin Yu , Dechao Feng , Ping Han
Background
There is an urgent need to identify a robust predictor for BCG response in patients with non–muscle-invasive bladder cancer (NMIBC). We aimed to employ the Lasso regression model for the selection and construction of an index (BCGI) utilizing inflammation and nutrition indicators to predict the response to BCG therapy.
Methods
After acquiring the ethics approval, we searched the electric medical records in our institution and performed data screening. Then, we developed the BCGI using a Lasso regression model and subsequently evaluated its performance in both the train and internal test datasets through Kaplan-Meier survival curves and Cox regression analysis. Then, we also evaluated the prognostic value of BCGI alongside the EAU2021 model.
Results
The training dataset and internal test dataset contained 295 and 196 patients, respectively. Referring to the Lasso results, BCGI consisted of hemoglobin, albumin, and platelet count, which could significantly predict the recurrence of NMIBC patients who accepted BCG in train (P = .012) and test (P = .004) datasets. The BCGI also exhibited statistically prognostic value in no smoking history, World Health Organization high grade, and T1 subgroups, both in train and test datasets. In multivariable analysis, BCGI exhibited independent prognostic value in train (P = .012) and test (P = .012) datasets. Finally, we constructed a nomogram that consisted of smoking history, T stage, World Health Organization grade, tumor size, and BCGI. Then, BCGI demonstrated significant independent prognostic value in NMIBC patients treated with BCG, a result not observed with the EAU2021 score or classification.
Conclusion
Based on the results, we reasonably suggest that BCGI may be a useful predictor for NMIBC patients who accepted BCG. Furthermore, we have demonstrated the efficacy of constructing a prognostic index using clinical factors and a Lasso regression model, a versatile approach applicable to various medical conditions.
{"title":"A Prognostic Index Derived From LASSO-Selected Preoperative Inflammation and Nutritional Markers for Non–Muscle-Invasive Bladder Cancer","authors":"Dengxiong Li , Ruicheng Wu , Jie Wang , Junjiang Ye , Qingxin Yu , Dechao Feng , Ping Han","doi":"10.1016/j.clgc.2024.02.012","DOIUrl":"10.1016/j.clgc.2024.02.012","url":null,"abstract":"<div><h3>Background</h3><p>There is an urgent need to identify a robust predictor for BCG response in patients with non–muscle-invasive bladder cancer (NMIBC). We aimed to employ the Lasso regression model for the selection and construction of an index (BCGI) utilizing inflammation and nutrition indicators to predict the response to BCG therapy.</p></div><div><h3>Methods</h3><p>After acquiring the ethics approval, we searched the electric medical records in our institution and performed data screening. Then, we developed the BCGI using a Lasso regression model and subsequently evaluated its performance in both the train and internal test datasets through Kaplan-Meier survival curves and Cox regression analysis. Then, we also evaluated the prognostic value of BCGI alongside the EAU2021 model.</p></div><div><h3>Results</h3><p>The training dataset and internal test dataset contained 295 and 196 patients, respectively. Referring to the Lasso results, BCGI consisted of hemoglobin, albumin, and platelet count, which could significantly predict the recurrence of NMIBC patients who accepted BCG in train (<em>P</em> = .012) and test (<em>P</em> = .004) datasets. The BCGI also exhibited statistically prognostic value in no smoking history, World Health Organization high grade, and T1 subgroups, both in train and test datasets. In multivariable analysis, BCGI exhibited independent prognostic value in train (<em>P</em> = .012) and test (<em>P</em> = .012) datasets. Finally, we constructed a nomogram that consisted of smoking history, T stage, World Health Organization grade, tumor size, and BCGI. Then, BCGI demonstrated significant independent prognostic value in NMIBC patients treated with BCG, a result not observed with the EAU2021 score or classification.</p></div><div><h3>Conclusion</h3><p>Based on the results, we reasonably suggest that BCGI may be a useful predictor for NMIBC patients who accepted BCG. Furthermore, we have demonstrated the efficacy of constructing a prognostic index using clinical factors and a Lasso regression model, a versatile approach applicable to various medical conditions.</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":"140017698","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}
Pub Date : 2024-06-01DOI: 10.1016/j.clgc.2024.02.008
Kassandra Dindinger-Hill , Siqi Hu , Atticus Hickman , Mouneeb Choudry , Jeffrey Vehawn , John Snyder , Vikrant Deshmukh , Michael Newman , Ankita Date , Carlos Galvao , Manish Kohli , Brock O'Neil , Bogdana Schmidt , Christopher Dechet , Mia Hashibe , Alejandro Sanchez
Introduction
Obesity in prostate cancer survivors may increase mortality. Better characterization of this effect may allow better counseling on obesity as a targetable lifestyle factor to reduce mortality in prostate cancer survivors. The purpose of this study was to determine whether pre- and post-diagnostic obesity and weight change affect all-cause mortality, cardiovascular disease specific mortality, and prostate cancer specific mortality in patients with nonmetastatic prostate cancer.
Patients and Methods
We performed a retrospective cohort analysis of 5,077 patients diagnosed with localized prostate cancer from 1997 to 2017 with median follow-up of 15.5 years. The Utah Population Database linked to the Utah Cancer Registry was used to identify patients at a variety of treatment centers.
Results
Pre-diagnosis obesity was associated with a 62% increased risk of cardiovascular disease specific mortality and a 34% increased risk of all-cause mortality (HR 1.62, 95% CI 1.05-2.50; HR 1.34, 95% CI 1.07-1.67, respectively). Post-diagnosis obesity increased the risk of cardiovascular disease specific mortality (HR 1.83, 95% CI 1.31-2.56) and all-cause mortality (HR 1.37, 95% CI 1.16-1.64) relative to non-obese men. We found no association between pre-diagnostic obesity or post-diagnostic weight gain and prostate cancer specific mortality.
Conclusion
Our study strengthens the conclusion that pre-, post-diagnostic obesity and weight gain increase cardiovascular disease and all-cause mortality but not prostate cancer specific mortality compared to healthy weight men. An increased emphasis on weight management may improve mortality for prostate cancer survivors who are obese.
前列腺癌幸存者肥胖可能会增加死亡率。如果能更好地描述这种影响,就可以将肥胖作为一种有针对性的生活方式因素,为降低前列腺癌幸存者的死亡率提供更好的咨询。本研究旨在确定诊断前后肥胖和体重变化是否会影响非转移性前列腺癌患者的全因死亡率、心血管疾病特异性死亡率和前列腺癌特异性死亡率。我们对 1997 - 2017 年间诊断为局部前列腺癌的 5077 名患者进行了回顾性队列分析,中位随访时间为 15.5 年。我们使用与犹他州癌症登记处相连的犹他州人口数据库来识别不同治疗中心的患者。诊断前肥胖与心血管疾病特异性死亡风险增加 62% 和全因死亡风险增加 34% 相关(分别为 HR 1.62,95% CI 1.05-2.50;HR 1.34,95% CI 1.07-1.67)。与非肥胖男性相比,诊断后肥胖会增加心血管疾病特异性死亡风险(HR 1.83,95% CI 1.31-2.56)和全因死亡风险(HR 1.37,95% CI 1.16-1.64)。我们没有发现诊断前肥胖或诊断后体重增加与前列腺癌特定死亡率之间存在关联。与体重健康的男性相比,诊断前、诊断后肥胖和体重增加会增加心血管疾病和全因死亡率,但不会增加前列腺癌特定死亡率,我们的研究加强了这一结论。加强对体重管理的重视可能会改善肥胖前列腺癌幸存者的死亡率。前列腺癌幸存者肥胖可能会增加死亡率。我们对 1997 - 2017 年间确诊为局部前列腺癌的 5077 名患者进行了回顾性队列分析。我们发现,与非肥胖男性相比,确诊后肥胖会增加心血管疾病特异性和全因死亡风险。加强对体重管理的重视可能会改善肥胖前列腺癌幸存者的死亡率。
{"title":"Association of Baseline Pre-Diagnosis and Post-Diagnosis Obesity and Weight Change with Cardiovascular Risk and Survival Among Nonmetastatic Prostate Cancer Survivors","authors":"Kassandra Dindinger-Hill , Siqi Hu , Atticus Hickman , Mouneeb Choudry , Jeffrey Vehawn , John Snyder , Vikrant Deshmukh , Michael Newman , Ankita Date , Carlos Galvao , Manish Kohli , Brock O'Neil , Bogdana Schmidt , Christopher Dechet , Mia Hashibe , Alejandro Sanchez","doi":"10.1016/j.clgc.2024.02.008","DOIUrl":"10.1016/j.clgc.2024.02.008","url":null,"abstract":"<div><h3>Introduction</h3><p>Obesity in prostate cancer survivors may increase mortality. Better characterization of this effect may allow better counseling on obesity as a targetable lifestyle factor to reduce mortality in prostate cancer survivors. The purpose of this study was to determine whether pre- and post-diagnostic obesity and weight change affect all-cause mortality, cardiovascular disease specific mortality, and prostate cancer specific mortality in patients with nonmetastatic prostate cancer.</p></div><div><h3>Patients and Methods</h3><p>We performed a retrospective cohort analysis of 5,077 patients diagnosed with localized prostate cancer from 1997 to 2017 with median follow-up of 15.5 years. The Utah Population Database linked to the Utah Cancer Registry was used to identify patients at a variety of treatment centers.</p></div><div><h3>Results</h3><p>Pre-diagnosis obesity was associated with a 62% increased risk of cardiovascular disease specific mortality and a 34% increased risk of all-cause mortality (HR 1.62, 95% CI 1.05-2.50; HR 1.34, 95% CI 1.07-1.67, respectively). Post-diagnosis obesity increased the risk of cardiovascular disease specific mortality (HR 1.83, 95% CI 1.31-2.56) and all-cause mortality (HR 1.37, 95% CI 1.16-1.64) relative to non-obese men. We found no association between pre-diagnostic obesity or post-diagnostic weight gain and prostate cancer specific mortality.</p></div><div><h3>Conclusion</h3><p>Our study strengthens the conclusion that pre-, post-diagnostic obesity and weight gain increase cardiovascular disease and all-cause mortality but not prostate cancer specific mortality compared to healthy weight men. An increased emphasis on weight management may improve mortality for prostate cancer survivors who are obese.</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/S1558767324000302/pdfft?md5=4ed61b149e7dc56aea53ebfdadf2e0a7&pid=1-s2.0-S1558767324000302-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139918591","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}