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The Association of Statin Use With Survival Outcomes in Patients With Metastatic Castration-Resistant Prostate Cancer (mCRPC) Treated With Androgen Receptor Targeted Therapies (ART) 他汀类药物的使用与接受雄激素受体靶向疗法 (ART) 治疗的转移性钙化抗性前列腺癌 (mCRPC) 患者的生存结果之间的关系。
IF 2.3 3区 医学 Q3 ONCOLOGY Pub Date : 2024-09-24 DOI: 10.1016/j.clgc.2024.102227
Zakaria Chakrani , Mann Patel , George Mellgard , Stephen McCroskery , Nathaniel Saffran , Nicole Taylor , Bobby C. Liaw , Matthew Galsky , William Oh , Che-Kai Tsao , Teja Ganta , Vaibhav Patel

Background

Statins may provide a compounded effect on ART by decreasing cholesterol levels thus decreasing de novo androgen synthesis and tumor cell viability. We investigated the clinical efficacy of concurrent statin use on outcomes of patients with mCRPC taking ART.

Methods

A single-institution retrospective analysis of patients with mCRPC receiving ART from 2010 to 2021 was performed. Our primary outcome was PSA progression free survival (PFS), and our secondary outcomes were overall survival (OS). Patient characteristics were collected in addition to ART treatment course, statin treatment, and survival outcomes. Cox proportional hazards regression model was used to estimate hazard ratios (HR) for OS and PSA PFS and multivariable logistic regression to determine risk factors.

Results

153 patients with mCRPC treated with ART were included. A total of 67 patients (43.8%) received concurrent statins. Median PSA PFS was 20.4 months for patients that received statins versus 15.3 months for patients who did not receive statins. Median OS was 45.1 months for patients who received concurrent statins versus 29.7 months for patients who did not. On univariate and multivariate survival analyses, there was no statistically significant difference between groups for PSA PFS (HR 0.7; CI 0.44-1.1; P = .123) and OS (HR 0.67; CI 0.42-1.06; P = .089).

Conclusions

Our analysis suggests that statins do not significantly improve clinical outcomes in patients with mCRPC. Ultimately, current understanding remains limited, and prospective studies are needed, but here we provide a cost-effective, timely, and selective preliminary analysis.
背景:他汀类药物可降低胆固醇水平,从而减少雄激素的合成,降低肿瘤细胞的活力,从而为抗逆转录病毒疗法提供复合效应。我们研究了同时使用他汀类药物对服用抗逆转录病毒疗法的 mCRPC 患者的临床疗效:我们对 2010 年至 2021 年期间接受抗逆转录病毒疗法的 mCRPC 患者进行了单机构回顾性分析。我们的主要结果是PSA无进展生存期(PFS),次要结果是总生存期(OS)。除 ART 治疗过程、他汀类药物治疗和生存结果外,我们还收集了患者的特征。采用Cox比例危险回归模型估算OS和PSA无进展生存期的危险比(HR),并采用多变量逻辑回归确定风险因素:共纳入153例接受抗逆转录病毒疗法治疗的mCRPC患者。共有67名患者(43.8%)同时服用了他汀类药物。接受他汀类药物治疗的患者中位 PSA PFS 为 20.4 个月,而未接受他汀类药物治疗的患者为 15.3 个月。同时接受他汀类药物治疗的患者的中位 OS 为 45.1 个月,而未接受他汀类药物治疗的患者的中位 OS 为 29.7 个月。在单变量和多变量生存分析中,PSA PFS(HR 0.7;CI 0.44-1.1;P = .123)和OS(HR 0.67;CI 0.42-1.06;P = .089)组间差异无统计学意义:我们的分析表明,他汀类药物并不能显著改善mCRPC患者的临床预后。我们的分析表明,他汀类药物并不能明显改善mCRPC患者的临床预后。归根结底,目前的认识仍然有限,需要进行前瞻性研究,但我们在此提供了一项具有成本效益、及时且有选择性的初步分析。
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引用次数: 0
Distinct Gene Expression Patterns Identify Patients who Relapse After Neoadjuvant Pembrolizumab and Radical Cystectomy in the PURE-01 Study 在 PURE-01 研究中,通过不同的基因表达模式识别新辅助 Pembrolizumab 和根治性膀胱切除术后复发的患者。
IF 2.3 3区 医学 Q3 ONCOLOGY Pub Date : 2024-09-20 DOI: 10.1016/j.clgc.2024.102214
Moritz J. Reike , Daniele Raggi , Chiara Mercinelli , Antonio Cigliola , Valentina Tateo , Damiano Alfio Patanè , Emanuele Crupi , Tiago Costa de Padua , Peter C. Black , Ewan A. Gibb , Andrea Necchi

Purpose

The PURE-01 clinical trial reported the use of neoadjuvant treatment with pembrolizumab prior to radical cystectomy (RC) in patients with muscle-invasive bladder. Specific molecular subtypes and immune signatures were reported to be associated with a favorable survival. However, reports on the detailed tumor biology of patients relapsing after neoadjuvant pembrolizumab are lacking.

Materials and Methods

Microarray data from transurethral resection of the bladder tumor (TURBT; n = 102) and matched RC (N = 25) tissue from patients in PURE-01 who experience a disease relapse were analyzed, with gene expression signatures and molecular subtypes. The Kaplan–Meier method was used to estimate differences in patient outcomes. Immune-signatures were split by median for survival analysis. All significance testing used a two-sided t-test at a threshold of P < .05.

Results

The study cohort consisted of 102 patients, of whom N = 19 (19%) experienced relapse. Molecular subtyping revealed that neuroendocrine-like tumors had the worst outcomes, while tumors classified as Claudin-low did show only one recurrence event. Differential gene expression analysis identified genes associated with relapse, including KRT20, H19, and immune-associated genes such as CXCL9 and CXCL11.

Conclusion

This study provides a detailed characterization of patients who relapsed after neoadjuvant pembrolizumab and RC and identifies distinct gene expression patterns associated with relapse. These findings may have implications for predicting patient response and guiding treatment decisions in the neoadjuvant setting.
目的:PURE-01 临床试验报告了在对肌肉浸润性膀胱患者进行根治性膀胱切除术(RC)前使用 pembrolizumab 进行新辅助治疗的情况。据报道,特定的分子亚型和免疫特征与良好的生存率有关。然而,关于新辅助治疗后复发的患者的详细肿瘤生物学情况还缺乏报道:分析了 PURE-01 中复发患者经尿道膀胱肿瘤切除术(TURBT;n = 102)和匹配的 RC(n = 25)组织的微阵列数据,以及基因表达特征和分子亚型。采用 Kaplan-Meier 法估计患者预后的差异。免疫特征按中位数分割,用于生存分析。所有显著性检验均采用双侧 t 检验,阈值为 P <.05:研究队列由102名患者组成,其中19人(19%)复发。分子亚型分析显示,神经内分泌样肿瘤的预后最差,而被归类为Claudin-low的肿瘤仅有一次复发。差异基因表达分析确定了与复发相关的基因,包括KRT20、H19和免疫相关基因,如CXCL9和CXCL11:这项研究详细描述了新辅助治疗彭博利珠单抗和RC后复发患者的特征,并确定了与复发相关的不同基因表达模式。这些发现可能会对预测患者反应和指导新辅助治疗决策产生影响。
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引用次数: 0
Analysis of Neoadjuvant Chemotherapy Utilization, Pathologic Response, and Overall Survival in Upper Tract Urothelial Carcinoma 上尿路上皮癌的新辅助化疗使用、病理反应和总生存率分析
IF 2.3 3区 医学 Q3 ONCOLOGY Pub Date : 2024-09-17 DOI: 10.1016/j.clgc.2024.102224
Vincent E. Xu , Oluwafolajimi Adesanya , Sarah Azari , Samita Islam , Matthew Klein , Arthur Drouaud , Ryan M. Antar , Phat Chang , Armine Smith , Michael J Whalen

Introduction

Upper tract urothelial carcinoma (UTUC) is a rare malignancy with poor prognosis. Radical nephroureterectomy (RNU) remains the standard treatment for high-risk UTUC. Considering the decline in renal function with RNU and results from prospective trials, NAC has emerged as a favored perioperative treatment for chemo-eligible patients with UTUC. However, strong evidence of the efficacy of NAC and predictors for its use are scarce. We aimed to assess trends in NAC utilization and pathologic outcomes and survival with NAC use.

Methods

The National Cancer Database was queried for patients with high-grade cTanyNanyM0 UTUC treated with RNU from 2004 to 2019. Outcomes included overall survival (OS), pathologic response (pR) and pathologic complete response (pCR), defined as ≤pT1pN0/X and pT0pN0/X, respectively.

Results

Of 6,645 patients treated with RNU, 209 received RNU NAC. Greater distance from treatment facility decreased the likelihood of receiving NAC. Higher cT stages (OR 1.72, P = .028), cN+ status (OR 7.40, P < .001) and treatment at an academic facility (OR 2.02, P < .001) predicted NAC treatment. NAC was associated with 34.0% pR and 5.3% pCR. In multivariable analysis, patients with pR and pCR had improved OS (HR = 0.176, P < .014).

Conclusion

We report significant response rates with NAC and improved OS in patients who experienced pR or pCR. Over a 15-year study period, NAC was underutilized, especially in nonacademic settings and among patients living farther from care facilities, underscoring the need for improved regionalization and multidisciplinary approaches in UTUC management.
导言上尿路上皮癌(UTUC)是一种罕见的恶性肿瘤,预后较差。根治性肾切除术(RNU)仍是高危UTUC的标准治疗方法。考虑到 RNU 会导致肾功能下降以及前瞻性试验的结果,NAC 已成为符合化疗条件的 UTUC 患者首选的围手术期治疗方法。然而,有关 NAC 疗效的有力证据以及使用 NAC 的预测因素却很少。我们旨在评估NAC的使用趋势以及使用NAC后的病理结果和生存率。方法查询了2004年至2019年接受RNU治疗的高级别cTanyNanyM0 UTUC患者的国家癌症数据库。结果在接受RNU治疗的6645名患者中,有209人接受了RNU NAC治疗。与治疗机构的距离越远,接受 NAC 的可能性越小。较高的 cT 分期(OR 1.72,P = .028)、cN+ 状态(OR 7.40,P < .001)和在学术机构接受治疗(OR 2.02,P < .001)预示着 NAC 治疗。NAC与34.0%的pR和5.3%的pCR相关。在多变量分析中,pR 和 pCR 患者的 OS 有所改善(HR = 0.176,P < .014)。在长达15年的研究期间,NAC的使用率较低,尤其是在非学术环境和远离医疗机构的患者中,这说明在UTUC管理中需要改进区域化和多学科方法。
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引用次数: 0
Efficacy and Safety of Pembrolizumab plus Axitinib combination for Metastatic Renal Cell Carcinoma in a Real-World Scenario: Data From the Prospective ProPAXI Study Pembrolizumab联合阿西替尼治疗转移性肾细胞癌在真实世界中的有效性和安全性:来自前瞻性 ProPAXI 研究的数据
IF 2.3 3区 医学 Q3 ONCOLOGY Pub Date : 2024-09-14 DOI: 10.1016/j.clgc.2024.102225
Annalisa Guida , Alessio Gili , Claudia Mosillo , Marco Maruzzo , Eleonora Lai , Francesco Pierantoni , Davide Bimbatti , Umberto Basso , Giuseppe Fornarini , Sara Elena Rebuzzi , Fabio Calabrò , Linda Cerbone , Claudia Caserta , Grazia Sirgiovanni , Debora Serafin , Orazio Caffo , Sarah Scagliarini , Sergio Bracarda

Background

Pembrolizumab/Axitinib combination is approved as first-line therapy in mRCC. The aim of this study is to evaluate outcomes of PAXI combo in the real-world in Italy.

Methods

This is a prospective study including patients diagnosed with mRCC who received combination as first-line therapy in recruiting Italian Centers. Data about patient characteristics, safety and outcome were collected.

Results

170 pts have been treated from December 2020 to September 2023. The majority had clear-cell histology (83%). Sarcomatoid feature was present in 33%of available cases. About one half of patients (55%) had synchronous metastasis. In 58% of cases nephrectomy was performed, of which 27% were cytoreductive and 4% were deferred nephrectomies. Lung metastases were identified in 106 patients (62%), bone and liver involvement in 66 and 29 patients (38.8% and 17.1%) respectively. Stratifying by IMDC criteria, 32 patients (18.8%) were at favorable-risk, 106 (62.4%) at intermediate-risk, and 32 (18.8%) at poor-risk. At time of analysis, treatment was ongoing in 49% of patients. Progression occurred in 45% of patients. Median PFS was 19.2 months (95% CI: 15-NR). With a median follow-up of 19.3 months (range 1.3-34.5), at 24-months and 36-months landmark analysis 62% (95% CI, 53-70) and 58% (95% CI, 47-69) of treated patients are still alive respectively. Disease control rate was achieved in 84.6% of patients: 4.3% reached a complete response, 52% had a partial response and 28.8% a stable disease. Primary progression was observed in 15.3% of patients. In the multivariate analysis, the prognostic significance of age ≥ 65 years, non-clear cell histology, IMDC score, and adverse events and gender interaction as predictors of worse OS were confirmed.

Conclusion

This is the first available prospective study on first-line Pembrolizumab/Axitinib combination in real world scenario. Our findings support the effectiveness and safety of first-line this combination in mRCC and reveal that gender emerged as a prognostic factor in relation to the occurrence of adverse events.
背景Pembrolizumab/Axitinib联合疗法被批准作为mRCC的一线疗法。本研究的目的是评估 PAXI 联合疗法在意大利真实世界中的疗效。方法这是一项前瞻性研究,包括在意大利招募中心接受联合疗法一线治疗的 mRCC 患者。结果从2020年12月到2023年9月,170名患者接受了治疗。大多数患者为透明细胞组织学(83%)。33%的病例具有肉瘤样特征。约一半的患者(55%)有同步转移。58%的病例进行了肾切除术,其中27%为细胞切除术,4%为延期肾切除术。106名患者(62%)发现肺转移,66名和29名患者(38.8%和17.1%)分别发现骨和肝转移。根据IMDC标准进行分层,32名患者(18.8%)风险较高,106名患者(62.4%)风险中等,32名患者(18.8%)风险较低。分析时,49%的患者正在接受治疗。45%的患者病情出现进展。中位 PFS 为 19.2 个月(95% CI:15-NR)。中位随访时间为 19.3 个月(1.3-34.5 个月),在 24 个月和 36 个月的地标分析中,分别有 62% (95% CI,53-70)和 58% (95% CI,47-69)的治疗患者仍然存活。84.6%的患者达到了疾病控制率:4.3%的患者获得完全应答,52%的患者获得部分应答,28.8%的患者病情稳定。15.3%的患者出现了原发性病情进展。在多变量分析中,年龄≥65岁、非透明细胞组织学、IMDC评分、不良事件和性别交互作用作为较差OS的预测因素,其预后意义得到了证实。我们的研究结果表明,在 mRCC 中,一线联合用药既有效又安全,并发现性别是不良事件发生的预后因素。
{"title":"Efficacy and Safety of Pembrolizumab plus Axitinib combination for Metastatic Renal Cell Carcinoma in a Real-World Scenario: Data From the Prospective ProPAXI Study","authors":"Annalisa Guida ,&nbsp;Alessio Gili ,&nbsp;Claudia Mosillo ,&nbsp;Marco Maruzzo ,&nbsp;Eleonora Lai ,&nbsp;Francesco Pierantoni ,&nbsp;Davide Bimbatti ,&nbsp;Umberto Basso ,&nbsp;Giuseppe Fornarini ,&nbsp;Sara Elena Rebuzzi ,&nbsp;Fabio Calabrò ,&nbsp;Linda Cerbone ,&nbsp;Claudia Caserta ,&nbsp;Grazia Sirgiovanni ,&nbsp;Debora Serafin ,&nbsp;Orazio Caffo ,&nbsp;Sarah Scagliarini ,&nbsp;Sergio Bracarda","doi":"10.1016/j.clgc.2024.102225","DOIUrl":"10.1016/j.clgc.2024.102225","url":null,"abstract":"<div><h3>Background</h3><div>Pembrolizumab/Axitinib combination is approved as first-line therapy in mRCC. The aim of this study is to evaluate outcomes of PAXI combo in the real-world in Italy.</div></div><div><h3>Methods</h3><div>This is a prospective study including patients diagnosed with mRCC who received combination as first-line therapy in recruiting Italian Centers. Data about patient characteristics, safety and outcome were collected.</div></div><div><h3>Results</h3><div>170 pts have been treated from December 2020 to September 2023. The majority had clear-cell histology (83%). Sarcomatoid feature was present in 33%of available cases. About one half of patients (55%) had synchronous metastasis. In 58% of cases nephrectomy was performed, of which 27% were cytoreductive and 4% were deferred nephrectomies. Lung metastases were identified in 106 patients (62%), bone and liver involvement in 66 and 29 patients (38.8% and 17.1%) respectively. Stratifying by IMDC criteria, 32 patients (18.8%) were at favorable-risk, 106 (62.4%) at intermediate-risk, and 32 (18.8%) at poor-risk. At time of analysis, treatment was ongoing in 49% of patients. Progression occurred in 45% of patients. Median PFS was 19.2 months (95% CI: 15-NR). With a median follow-up of 19.3 months (range 1.3-34.5), at 24-months and 36-months landmark analysis 62% (95% CI, 53-70) and 58% (95% CI, 47-69) of treated patients are still alive respectively. Disease control rate was achieved in 84.6% of patients: 4.3% reached a complete response, 52% had a partial response and 28.8% a stable disease. Primary progression was observed in 15.3% of patients. In the multivariate analysis, the prognostic significance of age ≥ 65 years, non-clear cell histology, IMDC score, and adverse events and gender interaction as predictors of worse OS were confirmed.</div></div><div><h3>Conclusion</h3><div>This is the first available prospective study on first-line Pembrolizumab/Axitinib combination in real world scenario. Our findings support the effectiveness and safety of first-line this combination in mRCC and reveal that gender emerged as a prognostic factor in relation to the occurrence of adverse events.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102225"},"PeriodicalIF":2.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437945","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}
引用次数: 0
Evaluation of the Prognostic Role of TP53 Gene Mutations in Prostate Cancer Outcome: A Systematic Review and Meta-Analysis 评估 TP53 基因突变在前列腺癌预后中的作用:系统回顾与元分析》。
IF 2.3 3区 医学 Q3 ONCOLOGY Pub Date : 2024-09-14 DOI: 10.1016/j.clgc.2024.102226
Mohammad Moein Maddah, Akbar Hedayatizadeh-Omran, Mahmood Moosazadeh, Reza Alizadeh-Navaei

Introduction

Prostate cancer, 1 of the most common cancers in men, is influenced by age, genetics, race, and lifestyle. The TP53 gene, encoding the p53 protein crucial for cell cycle regulation and DNA repair, is frequently mutated in metastatic prostate cancers. These mutations impact prognosis and resistance to treatments, underscoring the role of genetic factors in disease progression and therapeutic challenges.

Methods

Databases such as PubMed, Scopus, and ISI were searched using the keywords "prostate cancer," "P53," "TP53," "survival," and "prognosis," along with manual searches in other sources. Initial screening and selection of articles were conducted independently and blinded by 2 reviewers, focusing on titles abstracts, and full texts when necessary. The Newcastle-Ottawa Scale (NOS) was used for full-text evaluation. Data were analyzed using STATA 11, with heterogeneity assessed using the I² index.

Results

Overall survival (OS) for prostate cancer patients with TP53 mutations was approximately 13% lower than for those without mutations at 1 year, 20% lower at 3 years, and 16% lower at 5 years. TP53 mutations were also associated with faster disease progression and a 15% reduction in progression-free survival (PFS) over 1 year. The hazard ratio (HR) for death in patients with TP53 mutations was 1.76, and for PFS, it was 1.62, indicating a 76% increased risk of death and a 62% increased risk of disease progression.

Conclusion

TP53 mutations are associated with shorter survival and faster disease progression in prostate cancer, underscoring the importance of precise evaluation and management of these mutations in treatment.
导言:前列腺癌是男性最常见的癌症之一,受年龄、遗传、种族和生活方式的影响。在转移性前列腺癌中,编码对细胞周期调节和 DNA 修复至关重要的 p53 蛋白的 TP53 基因经常发生突变。这些突变会影响预后和抗药性,突出了遗传因素在疾病进展和治疗挑战中的作用:方法:使用关键词 "前列腺癌"、"P53"、"TP53"、"生存 "和 "预后 "对 PubMed、Scopus 和 ISI 等数据库进行检索,并对其他来源进行人工检索。文章的初步筛选由两名审稿人独立完成,并进行盲审,重点审查标题摘要,必要时审查全文。全文评估采用纽卡斯尔-渥太华量表(NOS)。使用 STATA 11 对数据进行分析,并使用 I² 指数评估异质性:结果:TP53基因突变的前列腺癌患者的总生存期(OS)在1年时比无突变者低约13%,3年时低20%,5年时低16%。TP53 基因突变还与疾病进展速度加快以及一年内无进展生存期(PFS)缩短 15% 有关。TP53突变患者的死亡危险比(HR)为1.76,PFS为1.62,表明死亡风险增加76%,疾病进展风险增加62%:结论:TP53 基因突变与前列腺癌患者生存期缩短和疾病进展加快有关,强调了在治疗过程中对这些基因突变进行精确评估和管理的重要性。
{"title":"Evaluation of the Prognostic Role of TP53 Gene Mutations in Prostate Cancer Outcome: A Systematic Review and Meta-Analysis","authors":"Mohammad Moein Maddah,&nbsp;Akbar Hedayatizadeh-Omran,&nbsp;Mahmood Moosazadeh,&nbsp;Reza Alizadeh-Navaei","doi":"10.1016/j.clgc.2024.102226","DOIUrl":"10.1016/j.clgc.2024.102226","url":null,"abstract":"<div><h3>Introduction</h3><div>Prostate cancer, 1 of the most common cancers in men, is influenced by age, genetics, race, and lifestyle. The TP53 gene, encoding the p53 protein crucial for cell cycle regulation and DNA repair, is frequently mutated in metastatic prostate cancers. These mutations impact prognosis and resistance to treatments, underscoring the role of genetic factors in disease progression and therapeutic challenges.</div></div><div><h3>Methods</h3><div>Databases such as PubMed, Scopus, and ISI were searched using the keywords \"prostate cancer,\" \"P53,\" \"TP53,\" \"survival,\" and \"prognosis,\" along with manual searches in other sources. Initial screening and selection of articles were conducted independently and blinded by 2 reviewers, focusing on titles abstracts, and full texts when necessary. The Newcastle-Ottawa Scale (NOS) was used for full-text evaluation. Data were analyzed using STATA 11, with heterogeneity assessed using the I² index.</div></div><div><h3>Results</h3><div>Overall survival (OS) for prostate cancer patients with TP53 mutations was approximately 13% lower than for those without mutations at 1 year, 20% lower at 3 years, and 16% lower at 5 years. TP53 mutations were also associated with faster disease progression and a 15% reduction in progression-free survival (PFS) over 1 year. The hazard ratio (HR) for death in patients with TP53 mutations was 1.76, and for PFS, it was 1.62, indicating a 76% increased risk of death and a 62% increased risk of disease progression.</div></div><div><h3>Conclusion</h3><div>TP53 mutations are associated with shorter survival and faster disease progression in prostate cancer, underscoring the importance of precise evaluation and management of these mutations in treatment.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102226"},"PeriodicalIF":2.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407385","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}
引用次数: 0
Impact of Baseline Renal Insufficiency on Piflufolastat F-18 Performance and Investigation of Changes in Renal Function Following Piflufolastat F-18 Administration: Results From the OSPREY Trial 基线肾功能不全对匹氟司特 F-18 性能的影响以及匹氟司特 F-18 用药后肾功能变化的调查:OSPREY试验的结果。
IF 2.3 3区 医学 Q3 ONCOLOGY Pub Date : 2024-09-13 DOI: 10.1016/j.clgc.2024.102223
Meera R. Chappidi , Amir Iravani , Nancy Stambler , Saradha Baskaran , Vincent A. DiPippo , Bela S. Denes , Daniel W. Lin

Introduction

Piflufolastat F-18, a prostate-specific membrane antigen (PSMA)-targeted radiopharmaceutical, is predominantly eliminated via urinary excretion, and the kidneys have one of the highest absorbed doses. Therefore, this subgroup analysis aimed to investigate the impact of piflufolastat F-18 on renal function and its diagnostic performance in patients stratified by baseline renal function.

Patients and Methods

The OSPREY clinical trial enrolled 2 cohorts: A—high-risk patients undergoing radical prostatectomy with pelvic lymphadenectomy, and B—patients with suspected recurrent/metastatic prostate cancer on conventional imaging. Baseline estimated glomerular filtration rates were calculated, and patients were stratified by baseline chronic kidney disease (CKD) stage. Changes in serum creatinine within 28 days postdose and diagnostic performance of piflufolastat F-18 were assessed for each CKD stage group in both cohorts.

Results

385 patients (cohort A, n = 268; cohort B, n = 117) underwent piflufolastat F-18-PET/CT. Baseline and postpiflufolastat F-18 median creatinine levels (mg/dL) were similar for patients in cohort A (0.95 [n = 264] vs. 0.95 [n = 252], respectively) and cohort B (0.93 [n = 116] vs. 0.96 [n = 84], respectively). Among 332 men (cohort A, n = 249; cohort B, n = 83) with baseline and postpiflufolastat creatinine measurements, there were minimal changes in creatinine across all baseline CKD stage groups (median change ranged from -0.02 to 0.023 in groups with >1 patient). The diagnostic performance of piflufolastat F-18 showed no meaningful differences when stratified by baseline CKD stage.

Conclusion

Piflufolastat F-18 appears to be safe and effective for imaging prostate cancer, including men with mild/moderate renal insufficiency.
简介前列腺特异性膜抗原(PSMA)靶向放射性药物匹氟司他 F-18 主要通过尿液排泄,而肾脏是吸收剂量最高的器官之一。因此,本亚组分析旨在研究吡氟司特 F-18 对肾功能的影响,以及根据基线肾功能分层的患者的诊断性能:OSPREY临床试验招募了两组患者:A组:接受根治性前列腺切除术和盆腔淋巴结切除术的高危患者;B组:常规影像学检查怀疑为复发/转移性前列腺癌的患者。计算基线估计肾小球滤过率,并根据基线慢性肾病(CKD)分期对患者进行分层。评估了两个队列中每个慢性肾脏病分期组在用药后28天内血清肌酐的变化以及匹氟司特 F-18 的诊断性能:385名患者(A组,268人;B组,117人)接受了匹氟拉司特F-18-PET/CT检查。队列 A(分别为 0.95 [n = 264] vs. 0.95 [n = 252])和队列 B(分别为 0.93 [n = 116] vs. 0.96 [n = 84])患者的基线和氟司特 F-18 中位肌酐水平(mg/dL)相似。在332名男性患者(A组,n = 249;B组,n = 83)的基线血肌酐测量值和氟唑司特治疗后的测量值中,所有基线CKD分期组的血肌酐变化都很小(在大于1名患者的组别中,中位变化范围从-0.02到0.023不等)。根据基线 CKD 分期进行分层后,匹氟司特 F-18 的诊断性能没有明显差异:结论:氟唑司他 F-18 用于前列腺癌成像似乎安全有效,包括轻度/中度肾功能不全的男性。
{"title":"Impact of Baseline Renal Insufficiency on Piflufolastat F-18 Performance and Investigation of Changes in Renal Function Following Piflufolastat F-18 Administration: Results From the OSPREY Trial","authors":"Meera R. Chappidi ,&nbsp;Amir Iravani ,&nbsp;Nancy Stambler ,&nbsp;Saradha Baskaran ,&nbsp;Vincent A. DiPippo ,&nbsp;Bela S. Denes ,&nbsp;Daniel W. Lin","doi":"10.1016/j.clgc.2024.102223","DOIUrl":"10.1016/j.clgc.2024.102223","url":null,"abstract":"<div><h3>Introduction</h3><div>Piflufolastat F-18, a prostate-specific membrane antigen (PSMA)-targeted radiopharmaceutical, is predominantly eliminated via urinary excretion, and the kidneys have one of the highest absorbed doses. Therefore, this subgroup analysis aimed to investigate the impact of piflufolastat F-18 on renal function and its diagnostic performance in patients stratified by baseline renal function.</div></div><div><h3>Patients and Methods</h3><div>The OSPREY clinical trial enrolled 2 cohorts: A—high-risk patients undergoing radical prostatectomy with pelvic lymphadenectomy, and B—patients with suspected recurrent/metastatic prostate cancer on conventional imaging. Baseline estimated glomerular filtration rates were calculated, and patients were stratified by baseline chronic kidney disease (CKD) stage. Changes in serum creatinine within 28 days postdose and diagnostic performance of piflufolastat F-18 were assessed for each CKD stage group in both cohorts.</div></div><div><h3>Results</h3><div>385 patients (cohort A, n = 268; cohort B, n = 117) underwent piflufolastat F-18-PET/CT. Baseline and postpiflufolastat F-18 median creatinine levels (mg/dL) were similar for patients in cohort A (0.95 [n = 264] vs. 0.95 [n = 252], respectively) and cohort B (0.93 [n = 116] vs. 0.96 [n = 84], respectively). Among 332 men (cohort A, n = 249; cohort B, n = 83) with baseline and postpiflufolastat creatinine measurements, there were minimal changes in creatinine across all baseline CKD stage groups (median change ranged from -0.02 to 0.023 in groups with &gt;1 patient). The diagnostic performance of piflufolastat F-18 showed no meaningful differences when stratified by baseline CKD stage.</div></div><div><h3>Conclusion</h3><div>Piflufolastat F-18 appears to be safe and effective for imaging prostate cancer, including men with mild/moderate renal insufficiency.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102223"},"PeriodicalIF":2.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367878","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}
引用次数: 0
Survival Outcomes in Patients With Muscle-Invasive Bladder Cancer Receiving Neoadjuvant Chemotherapy Stratified by Number of Cycles 接受新辅助化疗的肌浸润性膀胱癌患者按周期数分层的生存结果
IF 2.3 3区 医学 Q3 ONCOLOGY Pub Date : 2024-09-11 DOI: 10.1016/j.clgc.2024.102218
Anumita Chakraborty , Jill Hasler , Elizabeth Handorf , Fern Anari , Pooja Ghatalia , Benjamin Miron , Elizabeth R. Plimack , Daniel M. Geynisman , Matthew Zibelman

Introduction

The ≥3 cycles of neoadjuvant cisplatin-based chemotherapy (NAC) are commonly administered to treat MIBC. However, some patients are unable to complete all planned cycles of NAC. Prognosis of patients receiving <3 cycles of NAC has yet to be elucidated.

Methods

This retrospective single-center study quantifies pathologic complete response (pT0N0), recurrence-free survival (RFS), and 5-year overall survival (OS) in patients treated with <3 cycles of NAC compared to ≥3 cycles. Patients with MIBC between 2004 and 2018 receiving at least 1 cycle of cisplatin-based NAC were included. Exclusion criteria were metastasis before initiation of NAC, progression/death during NAC. Patient characteristics were compared using chi-square tests, Fisher's exact tests, and Wilcoxon rank sum tests. Kaplan Meier curves, log-rank tests, and Cox proportional hazards models compared RFS adjusting for patient age, ECOG status, GFR, stage, node positivity, and NAC regimen. 5-year OS was analyzed via logistic regression with the aforementioned patient characteristics in the cohort of patients with 5 years of follow-up, unless deceased prior.

Results

In a cohort of 256 patients, the median RFS was 11.6 months (95% CI 7.79, 28.5) versus 79.5 months (95% CI 62.13, NA) in those receiving ≥3 cycles of NAC. Of 228 patients with documented pathologic stage, complete pathologic response (pT0) was observed in 9.4% of patients receiving <3 cycles, and 27.0% of patients receiving ≥3 cycles of NAC (P = .008). In 195 patients with a minimum of 5 years of follow-up, patients with <3 cycles the 5-year OS was 13.3% with <3 cycles compared to 53.3% with ≥3 cycles of NAC.

Conclusions

In this retrospective, single-center investigation, early cessation of planned NAC was associated with worse pCR rate, RFS, and OS. While further prospective evaluation is required to confirm causality, clinicians should prioritize administering at least 3 cycles of NAC when feasible to optimize outcomes.
简介以顺铂为基础的新辅助化疗(NAC)≥3个周期是治疗MIBC的常用方法。然而,有些患者无法完成所有计划的新辅助化疗周期。接受化疗的患者预后如何?这项回顾性单中心研究量化了接受 NAC 治疗的患者的病理完全反应(pT0N0)、无复发生存率(RFS)和 5 年总生存率(OS):在 256 例患者中,接受≥3 个周期 NAC 治疗的患者的中位 RFS 为 11.6 个月(95% CI 7.79,28.5),而接受≥3 个周期 NAC 治疗的患者的中位 RFS 为 79.5 个月(95% CI 62.13,NA)。在 228 例有病理分期记录的患者中,9.4% 接受结论治疗的患者观察到了完全病理反应(pT0):在这项回顾性单中心调查中,过早停止计划中的 NAC 与较差的 pCR 率、RFS 和 OS 相关。虽然需要进一步的前瞻性评估来确认因果关系,但临床医生应在可行的情况下优先考虑至少 3 个周期的 NAC 治疗,以优化治疗效果。
{"title":"Survival Outcomes in Patients With Muscle-Invasive Bladder Cancer Receiving Neoadjuvant Chemotherapy Stratified by Number of Cycles","authors":"Anumita Chakraborty ,&nbsp;Jill Hasler ,&nbsp;Elizabeth Handorf ,&nbsp;Fern Anari ,&nbsp;Pooja Ghatalia ,&nbsp;Benjamin Miron ,&nbsp;Elizabeth R. Plimack ,&nbsp;Daniel M. Geynisman ,&nbsp;Matthew Zibelman","doi":"10.1016/j.clgc.2024.102218","DOIUrl":"10.1016/j.clgc.2024.102218","url":null,"abstract":"<div><h3>Introduction</h3><div>The ≥3 cycles of neoadjuvant cisplatin-based chemotherapy (NAC) are commonly administered to treat MIBC. However, some patients are unable to complete all planned cycles of NAC. Prognosis of patients receiving &lt;3 cycles of NAC has yet to be elucidated.</div></div><div><h3>Methods</h3><div>This retrospective single-center study quantifies pathologic complete response (pT0N0), recurrence-free survival (RFS), and 5-year overall survival (OS) in patients treated with &lt;3 cycles of NAC compared to ≥3 cycles. Patients with MIBC between 2004 and 2018 receiving at least 1 cycle of cisplatin-based NAC were included. Exclusion criteria were metastasis before initiation of NAC, progression/death during NAC. Patient characteristics were compared using chi-square tests, Fisher's exact tests, and Wilcoxon rank sum tests. Kaplan Meier curves, log-rank tests, and Cox proportional hazards models compared RFS adjusting for patient age, ECOG status, GFR, stage, node positivity, and NAC regimen. 5-year OS was analyzed via logistic regression with the aforementioned patient characteristics in the cohort of patients with 5 years of follow-up, unless deceased prior.</div></div><div><h3>Results</h3><div>In a cohort of 256 patients, the median RFS was 11.6 months (95% CI 7.79, 28.5) versus 79.5 months (95% CI 62.13, NA) in those receiving ≥3 cycles of NAC. Of 228 patients with documented pathologic stage, complete pathologic response (pT0) was observed in 9.4% of patients receiving &lt;3 cycles, and 27.0% of patients receiving ≥3 cycles of NAC (<em>P</em> = .008). In 195 patients with a minimum of 5 years of follow-up, patients with &lt;3 cycles the 5-year OS was 13.3% with &lt;3 cycles compared to 53.3% with ≥3 cycles of NAC.</div></div><div><h3>Conclusions</h3><div>In this retrospective, single-center investigation, early cessation of planned NAC was associated with worse pCR rate, RFS, and OS. While further prospective evaluation is required to confirm causality, clinicians should prioritize administering at least 3 cycles of NAC when feasible to optimize outcomes.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102218"},"PeriodicalIF":2.3,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402351","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}
引用次数: 0
Prognostic Impact of Bone Metastasis in Patients With Metastatic Urothelial Carcinoma Treated With Durvalumab With or Without Tremelimumab in the DANUBE Study DANUBE研究中使用或不使用特瑞莫单抗的转移性尿路上皮癌患者骨转移的预后影响
IF 2.3 3区 医学 Q3 ONCOLOGY Pub Date : 2024-09-07 DOI: 10.1016/j.clgc.2024.102215
Carlos Stecca, Osama Abdeljalil, Srikala S. Sridhar

Introduction

Bone metastases (BM) in metastatic urothelial carcinoma (mUC) may impact patient outcomes, but their independent effect with immune checkpoint inhibitors (ICIs) is uncertain. We aimed to assess the impact of BM and PD-L1 status on outcomes in mUC patients treated with ICIs.

Patients and Methods

This post hoc analysis of the DANUBE study included 1032 mUC patients treated with durvalumab (D), D + tremelimumab (T), or standard chemotherapy (SoC). Patients were categorized by BM status and assessed for median overall survival (mOS) and median progression-free survival (mPFS) stratified by PD-L1 expression and treatment arm. 

Results

Among all patients enrolled in the study, those with BM had a lower mOS than those with no BM (8.7 vs. 15.8 months; P < .0001). Patients with BM and high PD-L1 expression, treated with D or D + T, had numerically longer mOS than patients with BM and low PD-L1 expression. In contrast, in the chemotherapy arm, there was no difference in mOS for BM or no BM, based on PD-L1 expression. Patients with BM had shorter mPFS compared to no BM (2.6 vs. 5.4 months; P < .0001). The study is limited by its post hoc nature.

Conclusion

Presence of BM was associated with worse outcomes across treatment arms. Patients with BM and high PD-L1 expression treated with D or D + T had longer mOS, suggesting potential benefits of ICIs in this subgroup. Consideration of BM and PD-L1 status in treatment decisions for mUC patients receiving ICIs may improve clinical outcomes.
导言:转移性尿路上皮癌(mUC)的骨转移(BM)可能会影响患者的预后,但其对免疫检查点抑制剂(ICIs)的独立影响尚不确定。我们旨在评估BM和PD-L1状态对接受ICIs治疗的mUC患者预后的影响。患者和方法这项DANUBE研究的事后分析纳入了1032名接受durvalumab(D)、D+tremelimumab(T)或标准化疗(SoC)治疗的mUC患者。患者按BM状态分类,并按PD-L1表达和治疗组评估中位总生存期(mOS)和中位无进展生存期(mPFS)。结果在所有参与研究的患者中,有骨髓瘤患者的中位总生存期低于无骨髓瘤患者(8.7 个月 vs. 15.8 个月;P < .0001)。患有骨髓瘤且PD-L1高表达的患者在接受D或D+T治疗后,其mOS在数量上要长于患有骨髓瘤且PD-L1低表达的患者。相比之下,在化疗组中,根据PD-L1表达,有BM或无BM患者的mOS没有差异。与无骨髓瘤患者相比,有骨髓瘤患者的 mPFS 更短(2.6 个月 vs. 5.4 个月;P < .0001)。该研究的局限性在于其事后研究的性质。接受 D 或 D + T 治疗的 BM 和 PD-L1 高表达患者的 mOS 更长,这表明 ICIs 在这一亚组中具有潜在的益处。接受 ICIs 治疗的 mUC 患者在做出治疗决定时考虑 BM 和 PD-L1 状态可能会改善临床预后。
{"title":"Prognostic Impact of Bone Metastasis in Patients With Metastatic Urothelial Carcinoma Treated With Durvalumab With or Without Tremelimumab in the DANUBE Study","authors":"Carlos Stecca,&nbsp;Osama Abdeljalil,&nbsp;Srikala S. Sridhar","doi":"10.1016/j.clgc.2024.102215","DOIUrl":"10.1016/j.clgc.2024.102215","url":null,"abstract":"<div><h3>Introduction</h3><div>Bone metastases (BM) in metastatic urothelial carcinoma (mUC) may impact patient outcomes, but their independent effect with immune checkpoint inhibitors (ICIs) is uncertain. We aimed to assess the impact of BM and PD-L1 status on outcomes in mUC patients treated with ICIs.</div></div><div><h3>Patients and Methods</h3><div>This post hoc analysis of the DANUBE study included 1032 mUC patients treated with durvalumab (D), D + tremelimumab (T), or standard chemotherapy (SoC). Patients were categorized by BM status and assessed for median overall survival (mOS) and median progression-free survival (mPFS) stratified by PD-L1 expression and treatment arm. </div></div><div><h3>Results</h3><div>Among all patients enrolled in the study, those with BM had a lower mOS than those with no BM (8.7 vs. 15.8 months; <em>P</em> &lt; .0001). Patients with BM and high PD-L1 expression, treated with D or D + T, had numerically longer mOS than patients with BM and low PD-L1 expression. In contrast, in the chemotherapy arm, there was no difference in mOS for BM or no BM, based on PD-L1 expression. Patients with BM had shorter mPFS compared to no BM (2.6 vs. 5.4 months; <em>P</em> &lt; .0001). The study is limited by its post hoc nature.</div></div><div><h3>Conclusion</h3><div>Presence of BM was associated with worse outcomes across treatment arms. Patients with BM and high PD-L1 expression treated with D or D + T had longer mOS, suggesting potential benefits of ICIs in this subgroup. Consideration of BM and PD-L1 status in treatment decisions for mUC patients receiving ICIs may improve clinical outcomes.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102215"},"PeriodicalIF":2.3,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142359549","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}
引用次数: 0
A Single Institution Experience in the Management of Localized Neuroendocrine Carcinoma of the Bladder 单个机构治疗膀胱局部神经内分泌癌的经验
IF 2.3 3区 医学 Q3 ONCOLOGY Pub Date : 2024-09-07 DOI: 10.1016/j.clgc.2024.102222
Casey Liveringhouse , Austin J. Sim , Jingsong Zhang , Rohit K. Jain , Shreyas U. Naidu , Lauren Linkowski , Logan W. Zemp , Alice Yu , Wade J. Sexton , Philippe E. Spiess , Scott M. Gilbert , Michael A. Poch , Julio Pow-Sang , Roger Li , Brandon J. Manley , Aram Vosoughi , Jasreman Dhillon , Hongzhi Xu , Javier F. Torres-Roca , Peter A.S. Johnstone , G. Daniel Grass

Background

Neuroendocrine carcinoma of the bladder (NEC-bladder) is a rare disease with poor outcomes and variable treatment approaches.

Materials and Methods

Patients with localized NEC-bladder treated with surgery or radiation between 2001-2021 were retrospectively identified. Rates of pathologic complete response (pCR) and downstaging were evaluated following NAC in surgically-treated patients. Progression-free survival (PFS) and overall survival (OS) were analyzed with univariable (log-rank) and multivariable (MVA; Cox regression) methods.

Results

Sixty-five patients were identified having a median age of 73. The tumor histology distribution was small cell (64.6%) or urothelial with NE differentiation (35.4%). Most patients (69.2%) received NAC. Patients received local therapy by surgery (78.5%) or chemoradiation (21.5%). The majority (62.7%) of surgical patients had ≥ pT2 with 37.3% having nodal involvement (pN+). The pCR and downstaging rates were 21.6% and 35.1%, respectively. At a median follow-up of 60 months (m), the median PFS and OS were 16.4m and 25.9m, respectively. NAC improved PFS (p=0.04) and downstaging improved PFS (p=0.012) and OS (p<0.001). Patients receiving NAC with ypN0 vs. ypN+ had median OS of 69.9m vs 15.3m, respectively (p<0.001). MVA identified receipt of NAC and pN as predictors of PFS; pN was predictive of OS. No differences in PFS or OS were seen between histology of primary tumor. The brain metastasis rate was 10.8% with all patients having small cell histology.

Conclusions

Optimized therapy in NEC-bladder includes NAC followed by local consolidation. Ascertainment of ypN0 is associated with long term survival, while pN+ remains associated with poor outcomes.
背景膀胱神经内分泌癌(NEC-膀胱)是一种罕见的疾病,治疗效果不佳,治疗方法也不尽相同。评估了手术治疗患者NAC后的病理完全反应(pCR)率和降期率。采用单变量(log-rank)和多变量(MVA;Cox回归)方法分析了无进展生存期(PFS)和总生存期(OS)。肿瘤组织学分布为小细胞(64.6%)或伴有NE分化的尿路上皮(35.4%)。大多数患者(69.2%)接受了 NAC 治疗。患者通过手术(78.5%)或化疗(21.5%)接受局部治疗。大多数手术患者(62.7%)≥ pT2,37.3%有结节受累(pN+)。pCR和降期率分别为21.6%和35.1%。中位随访时间为60个月(m),中位PFS和OS分别为16.4m和25.9m。NAC改善了PFS(p=0.04),而降期治疗改善了PFS(p=0.012)和OS(p<0.001)。ypN0与ypN+患者接受NAC治疗的中位OS分别为69.9m与15.3m(p<0.001)。MVA 确定接受 NAC 和 pN 可预测 PFS;pN 可预测 OS。不同原发肿瘤组织学之间的 PFS 或 OS 无差异。脑转移率为10.8%,所有患者均为小细胞组织学。确定ypN0与长期生存有关,而pN+仍与不良预后有关。
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引用次数: 0
Survival Outcomes by Race Following Surgical Treatment for Upper Tract Urothelial Carcinoma 上尿路上皮癌手术治疗后不同种族的生存结果
IF 2.3 3区 医学 Q3 ONCOLOGY Pub Date : 2024-09-06 DOI: 10.1016/j.clgc.2024.102220
Jason Zappia , Courtney Yong , James Slaven , Zhenije Wu , Linhui Wang , Hooman Djaladat , Erika Wood , Alireza Ghoreifi , Firas Abdollah , Matthew Davis , Alex Stephens , Giuseppe Simone , Gabriele Tuderti , Mark L. Gonzalgo , Dinno F. Mendiola , Ithaar H. Derweesh , Sohail Dhanji , Kevin Hakimi , Vitaly Margulis , Jacob Taylor , Chandru P. Sundaram

Objective

Discrepancies in survival outcomes of various genitourinary tract malignancies have been documented across different racial and ethnic groups. Here we sought to examine long-term survival outcomes of patients with upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU) when stratified by race.

Methods

A multicenter retrospective analysis using the ROBUUST (ROBotic surgery for Upper tract Urothelial cancer Study) registry identified patients undergoing RNU for UTUC between 2015 and 2022 at 12 centers across the United States, Europe, and Asia. Patients were stratified by race (white, black, Hispanic, and Asian) and primary outcomes of interest-including recurrence-free survival (RFS), metastasis free survival (MFS) and overall survival (OS) - were assessed using univariate analysis, multivariate Cox regression modeling, and Kaplan-Meier analysis.

Results

1446 patients (white n = 652, black n = 70, Hispanic n = 87, and Asian n = 637) who underwent RNU for treatment of the UTUC were included in our analysis. Cox regression modeling demonstrated pathologic nodal staging to be a significant predictor of RFS (HR 2.25; P = .0010), MFS (HR 2.50; P = .0028), and OS (HR 5.11; P < .0001). When using whites as the reference group, there were no significant differences in RFS, MFS, or OS across racial groups.

Conclusions

Unlike other genitourinary tract malignancies, our study failed to demonstrate a survival disadvantage among minority racial groups with UTUC who underwent RNU. Furthermore, a significant difference in RFS, MFS, and OS was not identified across whites, blacks, Asians, or Hispanics with UTUC who underwent RNU.
目的不同种族和民族群体在各种泌尿生殖道恶性肿瘤的生存结果方面存在差异。在此,我们试图研究根治性肾切除术(RNU)后上尿路膀胱癌(UTUC)患者按种族分层的长期生存结果。方法利用ROBUUST(ROBotic surgery for Upper tract Urothelial cancer Study,上尿路膀胱癌机器人手术研究)登记处进行多中心回顾性分析,确定了2015年至2022年间在美国、欧洲和亚洲12个中心接受RNU治疗的UTUC患者。根据种族(白人、黑人、西班牙裔和亚裔)对患者进行分层,并使用单变量分析、多变量考克斯回归模型和卡普兰-梅耶尔分析评估主要相关结果,包括无复发生存期(RFS)、无转移生存期(MFS)和总生存期(OS)。结果 1446 例接受 RNU 治疗 UTUC 的患者(白人 652 例,黑人 70 例,西班牙裔 87 例,亚裔 637 例)被纳入我们的分析。Cox回归模型显示,病理结节分期是RFS(HR 2.25;P = .0010)、MFS(HR 2.50;P = .0028)和OS(HR 5.11;P < .0001)的重要预测因素。结论与其他泌尿生殖道恶性肿瘤不同,我们的研究未能证明在接受RNU治疗的UTUC少数种族群体中存在生存劣势。此外,接受RNU治疗的白人、黑人、亚洲人或西班牙裔UTUC患者在RFS、MFS和OS方面也未发现明显差异。
{"title":"Survival Outcomes by Race Following Surgical Treatment for Upper Tract Urothelial Carcinoma","authors":"Jason Zappia ,&nbsp;Courtney Yong ,&nbsp;James Slaven ,&nbsp;Zhenije Wu ,&nbsp;Linhui Wang ,&nbsp;Hooman Djaladat ,&nbsp;Erika Wood ,&nbsp;Alireza Ghoreifi ,&nbsp;Firas Abdollah ,&nbsp;Matthew Davis ,&nbsp;Alex Stephens ,&nbsp;Giuseppe Simone ,&nbsp;Gabriele Tuderti ,&nbsp;Mark L. Gonzalgo ,&nbsp;Dinno F. Mendiola ,&nbsp;Ithaar H. Derweesh ,&nbsp;Sohail Dhanji ,&nbsp;Kevin Hakimi ,&nbsp;Vitaly Margulis ,&nbsp;Jacob Taylor ,&nbsp;Chandru P. Sundaram","doi":"10.1016/j.clgc.2024.102220","DOIUrl":"10.1016/j.clgc.2024.102220","url":null,"abstract":"<div><h3>Objective</h3><div>Discrepancies in survival outcomes of various genitourinary tract malignancies have been documented across different racial and ethnic groups. Here we sought to examine long-term survival outcomes of patients with upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU) when stratified by race.</div></div><div><h3>Methods</h3><div>A multicenter retrospective analysis using the ROBUUST (ROBotic surgery for Upper tract Urothelial cancer Study) registry identified patients undergoing RNU for UTUC between 2015 and 2022 at 12 centers across the United States, Europe, and Asia. Patients were stratified by race (white, black, Hispanic, and Asian) and primary outcomes of interest-including recurrence-free survival (RFS), metastasis free survival (MFS) and overall survival (OS) - were assessed using univariate analysis, multivariate Cox regression modeling, and Kaplan-Meier analysis.</div></div><div><h3>Results</h3><div>1446 patients (white <em>n</em> = 652, black <em>n</em> = 70, Hispanic <em>n</em> = 87, and Asian <em>n</em> = 637) who underwent RNU for treatment of the UTUC were included in our analysis. Cox regression modeling demonstrated pathologic nodal staging to be a significant predictor of RFS (HR 2.25; <em>P</em> = .0010), MFS (HR 2.50; <em>P</em> = .0028), and OS (HR 5.11; <em>P</em> &lt; .0001). When using whites as the reference group, there were no significant differences in RFS, MFS, or OS across racial groups.</div></div><div><h3>Conclusions</h3><div>Unlike other genitourinary tract malignancies, our study failed to demonstrate a survival disadvantage among minority racial groups with UTUC who underwent RNU. Furthermore, a significant difference in RFS, MFS, and OS was not identified across whites, blacks, Asians, or Hispanics with UTUC who underwent RNU.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102220"},"PeriodicalIF":2.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322068","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}
引用次数: 0
期刊
Clinical genitourinary cancer
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