Pub Date : 2023-11-30DOI: 10.22465/juo.234600500025
Edouard H. Nicaise, B. Schmeusser, Yash B. Shah, M. Bilen, Ken Ogan, V. Master
The purpose of this review is to provide an up-to-date understanding of the literature describing the impact of body composition on renal cell carcinoma (RCC) prognosis and outcomes. Although obesity is recognized as a risk factor for RCC development, overweight patients with localized and advanced RCC display more favorable outcomes than normal-weight individuals. However, obesity as measured by body mass index is a poor indicator of total body fat, fails to account for lean muscle mass, and inconsistently predicts perioperative and survival outcomes in RCC. Recent studies have suggested that objective measurements of lean and fat body masses from various compartments have strong prognostic utility. Low muscle mass (i.e., sarcopenia) and low visceral adiposity are often associated with poorer survival outcomes in localized and advanced RCC. These patients tend to experience higher rates of recurrence, progression, treatment failure, and death from kidney cancer. Given the influence of body composition in RCC outcomes, further characterization of the role of prehabilitation programs is warranted to evaluate the feasibility and efficacy of interventions targeting these modifiable factors.
{"title":"Influence of Body Composition on the Perioperative and Survival Outcomes of Renal Cell Carcinoma","authors":"Edouard H. Nicaise, B. Schmeusser, Yash B. Shah, M. Bilen, Ken Ogan, V. Master","doi":"10.22465/juo.234600500025","DOIUrl":"https://doi.org/10.22465/juo.234600500025","url":null,"abstract":"The purpose of this review is to provide an up-to-date understanding of the literature describing the impact of body composition on renal cell carcinoma (RCC) prognosis and outcomes. Although obesity is recognized as a risk factor for RCC development, overweight patients with localized and advanced RCC display more favorable outcomes than normal-weight individuals. However, obesity as measured by body mass index is a poor indicator of total body fat, fails to account for lean muscle mass, and inconsistently predicts perioperative and survival outcomes in RCC. Recent studies have suggested that objective measurements of lean and fat body masses from various compartments have strong prognostic utility. Low muscle mass (i.e., sarcopenia) and low visceral adiposity are often associated with poorer survival outcomes in localized and advanced RCC. These patients tend to experience higher rates of recurrence, progression, treatment failure, and death from kidney cancer. Given the influence of body composition in RCC outcomes, further characterization of the role of prehabilitation programs is warranted to evaluate the feasibility and efficacy of interventions targeting these modifiable factors.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"271 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139198597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.22465/juo.234600480024
Jin Noh, S. Song, G. Jung, Sangchul Lee, Sung Kyu Hong, S. Byun, Jung Kwon Kim
Purpose: This study investigated the effects of preoperative renal artery embolization (PRAE) before radical nephrectomy (RN) for advanced nonmetastatic renal cell carcinoma (RCC) on perioperative and oncologic outcomes.Materials and Methods: We analyzed 820 patients who had undergone RN for advanced nonmetastatic RCC (cT3-4/N0-1) between June 2003 and May 2022. Propensity score matching (PSM) at a 1:2 ratio was performed using the nearest-neighbor method, matching 121 PRAE patients to 242 controls. The primary endpoints included recurrence rate, overall survival, cancer-specific survival, and recurrence-free survival.Results: Before PSM, there were differences in sex (p=0.047), clinical stage (p=0.001), and the Fuhrman grade (p<0.001) between the 2 groups. After PSM, the baseline characteristics were well balanced. The mean age at operation was 58.2±13.0 years, and the median follow-up was 42.0 months. The postoperative transfusion rate was higher in PRAE group (18.2% vs. 10.7%, p=0.049). No significant differences were found between the PRAE and control groups in operation time (166.6±95.3 minutes vs. 155.5±74.2 minutes, p=0.263), estimated blood loss (360.4±732.0 mL vs. 293.4±596.6 mL, p=0.384), or length of hospital stay (7.7±4.9 days vs. 7.7±3.7 days, p=0.961) between the 2 groups. Recurrence was significantly less common in the PRAE group than in the control group (20.7% vs. 34.3%, p=0.007). No significant differences were found in cancer-specific death (8.3% vs. 9.1%, p=0.793) or overall death (8.3% vs. 12.0%, p=0.281). In multivariate logistic regression analysis, clinical T stage ≥3 (odds ratio [OR], 4.365; p<0.001), clinical N stage 1 (OR, 2.405; p=0.020) and no PRAE (OR, 2.293; p=0.004) were independent predictors of recurrence.Conclusions: Our results showed that PRAE was related to a lower recurrence rate. Thus, PRAE seems to be useful before RN for nonmetastatic RCC patients.
目的：本研究探讨了晚期非转移性肾细胞癌（RCC）根治性肾切除术（RN）术前肾动脉栓塞（PRAE）对围手术期和肿瘤学结果的影响：我们分析了2003年6月至2022年5月间接受根治性肾切除术治疗晚期非转移性RCC（cT3-4/N0-1）的820例患者。使用最近邻方法按 1:2 的比例进行倾向评分匹配 (PSM)，将 121 名 PRAE 患者与 242 名对照组进行匹配。主要终点包括复发率、总生存率、癌症特异性生存率和无复发生存率：PSM前，两组患者在性别（P=0.047）、临床分期（P=0.001）和Fuhrman分级（P<0.001）方面存在差异。PSM 术后，两组患者的基线特征非常均衡。手术时的平均年龄为 58.2±13.0 岁，中位随访时间为 42.0 个月。PRAE 组的术后输血率更高（18.2% 对 10.7%，P=0.049）。PRAE 组和对照组在手术时间（166.6±95.3 分钟 vs. 155.5±74.2 分钟，P=0.263）、估计失血量（360.4±732.0 毫升 vs. 293.4±596.6 毫升，P=0.384）或住院时间（7.7±4.9 天 vs. 7.7±3.7 天，P=0.961）方面无明显差异。PRAE组复发率明显低于对照组（20.7% vs. 34.3%，P=0.007）。在癌症特异性死亡（8.3% 对 9.1%，P=0.793）或总体死亡（8.3% 对 12.0%，P=0.281）方面没有发现明显差异。在多变量逻辑回归分析中，临床T分期≥3（比值比[OR]，4.365；p<0.001）、临床N分期1（比值比，2.405；p=0.020）和无PRAE（比值比，2.293；p=0.004）是复发的独立预测因素：我们的研究结果表明，PRAE 与较低的复发率有关。因此，在对非转移性RCC患者进行RN治疗之前，PRAE似乎是有用的。
{"title":"Preoperative Renal Artery Embolization Before Radical Nephrectomy for Nonmetastatic Renal Cell Carcinoma: A Propensity Score Matched Analysis","authors":"Jin Noh, S. Song, G. Jung, Sangchul Lee, Sung Kyu Hong, S. Byun, Jung Kwon Kim","doi":"10.22465/juo.234600480024","DOIUrl":"https://doi.org/10.22465/juo.234600480024","url":null,"abstract":"Purpose: This study investigated the effects of preoperative renal artery embolization (PRAE) before radical nephrectomy (RN) for advanced nonmetastatic renal cell carcinoma (RCC) on perioperative and oncologic outcomes.Materials and Methods: We analyzed 820 patients who had undergone RN for advanced nonmetastatic RCC (cT3-4/N0-1) between June 2003 and May 2022. Propensity score matching (PSM) at a 1:2 ratio was performed using the nearest-neighbor method, matching 121 PRAE patients to 242 controls. The primary endpoints included recurrence rate, overall survival, cancer-specific survival, and recurrence-free survival.Results: Before PSM, there were differences in sex (p=0.047), clinical stage (p=0.001), and the Fuhrman grade (p<0.001) between the 2 groups. After PSM, the baseline characteristics were well balanced. The mean age at operation was 58.2±13.0 years, and the median follow-up was 42.0 months. The postoperative transfusion rate was higher in PRAE group (18.2% vs. 10.7%, p=0.049). No significant differences were found between the PRAE and control groups in operation time (166.6±95.3 minutes vs. 155.5±74.2 minutes, p=0.263), estimated blood loss (360.4±732.0 mL vs. 293.4±596.6 mL, p=0.384), or length of hospital stay (7.7±4.9 days vs. 7.7±3.7 days, p=0.961) between the 2 groups. Recurrence was significantly less common in the PRAE group than in the control group (20.7% vs. 34.3%, p=0.007). No significant differences were found in cancer-specific death (8.3% vs. 9.1%, p=0.793) or overall death (8.3% vs. 12.0%, p=0.281). In multivariate logistic regression analysis, clinical T stage ≥3 (odds ratio [OR], 4.365; p<0.001), clinical N stage 1 (OR, 2.405; p=0.020) and no PRAE (OR, 2.293; p=0.004) were independent predictors of recurrence.Conclusions: Our results showed that PRAE was related to a lower recurrence rate. Thus, PRAE seems to be useful before RN for nonmetastatic RCC patients.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139200116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.22465/juo.234600420021
Jiwoong Yu, H. Sung
Bacillus Calmette-Guérin (BCG)-unresponsive non–muscle-invasive bladder cancer (NMIBC) poses a significant clinical challenge, prompting a need for effective treatment options. Although radical cystectomy is a standard approach, it is burdened by high morbidity, mortality, and adverse effects on patients’ quality of life, necessitating the exploration of alternative bladder preservation strategies. This review presents a diverse range of bladder preservation options to improve outcomes in patients with BCG-unresponsive NMIBC. The interventions discussed include intravesical chemotherapy, device-assisted therapy, immunotherapy with checkpoint inhibitors, antibody-drug conjugates, intravesical gene therapy, and combinations of these treatments.
{"title":"Optimal Management of Bacillus Calmette-Guérin–Refractory Non–Muscle-Invasive Bladder Cancer in 2023","authors":"Jiwoong Yu, H. Sung","doi":"10.22465/juo.234600420021","DOIUrl":"https://doi.org/10.22465/juo.234600420021","url":null,"abstract":"Bacillus Calmette-Guérin (BCG)-unresponsive non–muscle-invasive bladder cancer (NMIBC) poses a significant clinical challenge, prompting a need for effective treatment options. Although radical cystectomy is a standard approach, it is burdened by high morbidity, mortality, and adverse effects on patients’ quality of life, necessitating the exploration of alternative bladder preservation strategies. This review presents a diverse range of bladder preservation options to improve outcomes in patients with BCG-unresponsive NMIBC. The interventions discussed include intravesical chemotherapy, device-assisted therapy, immunotherapy with checkpoint inhibitors, antibody-drug conjugates, intravesical gene therapy, and combinations of these treatments.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139201287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.22465/juo.234600520026
S. Kim, B. Rho, Dong Hyuk Kang, D. Y. Chung
Purpose: In present, the use of androgen receptor targeting agents (ARTA) is one of the standard treatments for metastatic castration-resistant prostate cancer (mCRPC) without previous chemotherapy. However, some patients may experience early progression despite ARTA use. Therefore, we analyzed predictors of early progression.Materials and Methods: We retrospectively analyzed patients treated with ARTA for mCRPC before chemotherapy at Inha University Hospital. Patients were divided into an early progression group and a late progression group. The 2 groups were defined as a group that used ARTA for more than 1 year without progression and a group that did not. Clinical and pathological parameters were analyzed to evaluate the oncologic outcomes. Univariate and multivariate logistic regression analyses were used to predict progression markers.Results: The final analysis included 70 patients. The mean progression-free duration with ARTA use was 334.90±364.716 days. There were 44 and 26 patients in the early and late progression groups, respectively. Univariate and multivariate logistic regression analyses did not show statistically significant results for the ARTA medication type, body mass index, Gleason grade group, visceral metastasis, bone metastasis, regional lymph node (LN) metastasis, time to CRPC, and prostate-specific antigen kinetics. In contrast, age (odds ratio [OR], 1.154; 95% confidence interval [CI], 1.043–1.251) and nonregional LN metastasis (OR, 8.819; 95% CI, 1.165–66.746) were significantly associated with the progression-free duration of ARTA use in multivariate logistic regression analysis.Conclusions: We think that nonregional LN metastasis is a predictor of early progression when using ARTA in patients with mCRPC without previous chemotherapy.
{"title":"Nonregional Lymph Node Metastasis as a Predictor of Early Progression When Using Androgen Receptor Targeting Agents in Patients With Metastatic Castration-Resistant Prostate Cancer Without Previous Chemotherapy","authors":"S. Kim, B. Rho, Dong Hyuk Kang, D. Y. Chung","doi":"10.22465/juo.234600520026","DOIUrl":"https://doi.org/10.22465/juo.234600520026","url":null,"abstract":"Purpose: In present, the use of androgen receptor targeting agents (ARTA) is one of the standard treatments for metastatic castration-resistant prostate cancer (mCRPC) without previous chemotherapy. However, some patients may experience early progression despite ARTA use. Therefore, we analyzed predictors of early progression.Materials and Methods: We retrospectively analyzed patients treated with ARTA for mCRPC before chemotherapy at Inha University Hospital. Patients were divided into an early progression group and a late progression group. The 2 groups were defined as a group that used ARTA for more than 1 year without progression and a group that did not. Clinical and pathological parameters were analyzed to evaluate the oncologic outcomes. Univariate and multivariate logistic regression analyses were used to predict progression markers.Results: The final analysis included 70 patients. The mean progression-free duration with ARTA use was 334.90±364.716 days. There were 44 and 26 patients in the early and late progression groups, respectively. Univariate and multivariate logistic regression analyses did not show statistically significant results for the ARTA medication type, body mass index, Gleason grade group, visceral metastasis, bone metastasis, regional lymph node (LN) metastasis, time to CRPC, and prostate-specific antigen kinetics. In contrast, age (odds ratio [OR], 1.154; 95% confidence interval [CI], 1.043–1.251) and nonregional LN metastasis (OR, 8.819; 95% CI, 1.165–66.746) were significantly associated with the progression-free duration of ARTA use in multivariate logistic regression analysis.Conclusions: We think that nonregional LN metastasis is a predictor of early progression when using ARTA in patients with mCRPC without previous chemotherapy.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":" 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139207136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.22465/juo.234600620031
C. Lee, W. Song, Minyong Kang, H. Sung, H. Jeon, S. Seo, S. Jeon, Se Hoon Park, Byong Change Jeong
Purpose: Radical cystectomy (RC) is recommended for patients with non–muscle-invasive bladder cancer (NMIBC) who are unresponsive to intravesical bacillus Calmette-Guérin (BCG) instillation. However, RC is a very risky treatment, and some patients cannot undergo RC due to old age, patient preference, and comorbidities. In this study, we investigated the efficacy of pembrolizumab, a programmed cell death protein 1 inhibitor, in patients with NMIBC unresponsive to intravesical BCG instillation.Materials and Methods: Between December 2016 and February 2023, 24 patients who experienced recurrence after BCG treatment and subsequently received pembrolizumab were enrolled. We evaluated the patients’ response to pembrolizumab therapy using urine cytology, cystoscopic examination (with/without biopsy), and/or computed tomography imaging. The primary endpoint was the complete response (CR) rate 3 months after the first dose of pembrolizumab. Patients were followed up every 3 months for the first 2 years and every 6 months thereafter. Kaplan-Meier survival analysis was used to illustrate CR and the individual treatment course was demonstrated.Results: The median follow-up period was 16 months (range, 2–68 months) and the median number of pembrolizumab administrations was 5 times (range, 3–39 times). Thirteen of the 18 patients (54.2%) with BCG-unresponsive NMIBC achieved CR at 3 months. The median duration of CR maintenance was 15 months (range, 5–47 months). Five patients (20.8%) showed no recurrence for 12 months after pembrolizumab administration. Seven patients underwent RC, and pathological reports showed T2 stage in 3 patients. To date, 1 patient (4.2%) has died.Conclusions: Our early experience with pembrolizumab treatment for BCG-unresponsive NMIBC showed better results than those of the KEYNOTE-057 trial, which reported a CR rate of 40% at 3 months. However, long-term data and more cases are required to establish pembrolizumab therapy in patients with BCG-unresponsive NMIBC in a real-world setting.
{"title":"Early Experience With Pembrolizumab in Bacillus Calmette-Guérin Unresponsive Non–Muscle-Invasive Bladder Cancer","authors":"C. Lee, W. Song, Minyong Kang, H. Sung, H. Jeon, S. Seo, S. Jeon, Se Hoon Park, Byong Change Jeong","doi":"10.22465/juo.234600620031","DOIUrl":"https://doi.org/10.22465/juo.234600620031","url":null,"abstract":"Purpose: Radical cystectomy (RC) is recommended for patients with non–muscle-invasive bladder cancer (NMIBC) who are unresponsive to intravesical bacillus Calmette-Guérin (BCG) instillation. However, RC is a very risky treatment, and some patients cannot undergo RC due to old age, patient preference, and comorbidities. In this study, we investigated the efficacy of pembrolizumab, a programmed cell death protein 1 inhibitor, in patients with NMIBC unresponsive to intravesical BCG instillation.Materials and Methods: Between December 2016 and February 2023, 24 patients who experienced recurrence after BCG treatment and subsequently received pembrolizumab were enrolled. We evaluated the patients’ response to pembrolizumab therapy using urine cytology, cystoscopic examination (with/without biopsy), and/or computed tomography imaging. The primary endpoint was the complete response (CR) rate 3 months after the first dose of pembrolizumab. Patients were followed up every 3 months for the first 2 years and every 6 months thereafter. Kaplan-Meier survival analysis was used to illustrate CR and the individual treatment course was demonstrated.Results: The median follow-up period was 16 months (range, 2–68 months) and the median number of pembrolizumab administrations was 5 times (range, 3–39 times). Thirteen of the 18 patients (54.2%) with BCG-unresponsive NMIBC achieved CR at 3 months. The median duration of CR maintenance was 15 months (range, 5–47 months). Five patients (20.8%) showed no recurrence for 12 months after pembrolizumab administration. Seven patients underwent RC, and pathological reports showed T2 stage in 3 patients. To date, 1 patient (4.2%) has died.Conclusions: Our early experience with pembrolizumab treatment for BCG-unresponsive NMIBC showed better results than those of the KEYNOTE-057 trial, which reported a CR rate of 40% at 3 months. However, long-term data and more cases are required to establish pembrolizumab therapy in patients with BCG-unresponsive NMIBC in a real-world setting.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139198989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Summarizing the Intentions and Outcomes of JUO 2023 Issue 3","authors":"Cheol Kwak","doi":"10.22465/juo.23edi004","DOIUrl":"https://doi.org/10.22465/juo.23edi004","url":null,"abstract":"","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"38 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139203563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.22465/juo.234600440022
Tae Hwan Kim, S. Choo, K. Shim, Sun Il Kim
Purpose: We propose a new potential marker of progression-free survival (PFS) called negative delta-prostate-specific antigen (PSA) time ratio (NDPSATR) and compare it with conventional PSA response, defined as PSA decline ≥50% at 12 weeks from pretreatment baseline (PSAR50) in metastatic castration-resistant prostate cancer (mCRPC) patients treated with first-line enzalutamide (ENZ) or docetaxel (DTX).Materials and Methods: All patients diagnosed as mCRPC at Ajou University Hospital from 2016 were included. Delta-PSA days is PSA change between 2 consecutive measurements during a regimen multiplied by interval days. A negative delta-PSA days value represents a positive PSA response. NDPSATR is calculated by dividing the sum of days on negative delta-PSA days by total days on the regimen. Student t-test was used to compare mean values and Kaplan-Meier survival curves for PFS were obtained.Results: Of 57 patients identified, 22 and 35 were treated with ENZ and DTX, respectively. Rates of PSAR50 for ENZ and DTX were 72.7% and 20.6%, respectively. Mean NDPSATR for ENZ and DTX were 0.40 and 0.46, respectively and the difference was not statistically significant. For ENZ, median PFS (mPFS) of PSAR50 and non-PSAR50 were 14.3 and 4.8 months, respectively and there was significant difference in PFS (p=0.002). For DTX, mPFS of PSAR50 and non-PSAR50 were 15.0 and 6.5 months, respectively but there was no significant difference in PFS (p=0.055). At cutoff value of 0.4, rate of NDPSATR ≥0.4 for ENZ and DTX were 36.4% and 62.9%, respectively. For ENZ, mPFS of NDPSATR ≥0.4 and NDPSATR <0.4 were not achieved and 14.1 months, respectively and there was no significant difference in PFS (p=0.895). For DTX, mPFS of NDPSATR ≥0.4 and NDPSATR <0.4 were 9.7 and 6.3 months, respectively and there was a significant difference in PFS (p=0.045).Conclusions: NDPSATR ≥0.4 may be a good marker of PFS in CRPC patients treated with DTX and may replace PSAR50.
{"title":"Negative Delta-Prostate-Specific Antigen Time Ratio as Potential New Marker of Progression-Free Survival in Castration-Resistant Prostate Cancer Patients Treated With First-Line Enzalutamide or Docetaxel","authors":"Tae Hwan Kim, S. Choo, K. Shim, Sun Il Kim","doi":"10.22465/juo.234600440022","DOIUrl":"https://doi.org/10.22465/juo.234600440022","url":null,"abstract":"Purpose: We propose a new potential marker of progression-free survival (PFS) called negative delta-prostate-specific antigen (PSA) time ratio (NDPSATR) and compare it with conventional PSA response, defined as PSA decline ≥50% at 12 weeks from pretreatment baseline (PSAR50) in metastatic castration-resistant prostate cancer (mCRPC) patients treated with first-line enzalutamide (ENZ) or docetaxel (DTX).Materials and Methods: All patients diagnosed as mCRPC at Ajou University Hospital from 2016 were included. Delta-PSA days is PSA change between 2 consecutive measurements during a regimen multiplied by interval days. A negative delta-PSA days value represents a positive PSA response. NDPSATR is calculated by dividing the sum of days on negative delta-PSA days by total days on the regimen. Student t-test was used to compare mean values and Kaplan-Meier survival curves for PFS were obtained.Results: Of 57 patients identified, 22 and 35 were treated with ENZ and DTX, respectively. Rates of PSAR50 for ENZ and DTX were 72.7% and 20.6%, respectively. Mean NDPSATR for ENZ and DTX were 0.40 and 0.46, respectively and the difference was not statistically significant. For ENZ, median PFS (mPFS) of PSAR50 and non-PSAR50 were 14.3 and 4.8 months, respectively and there was significant difference in PFS (p=0.002). For DTX, mPFS of PSAR50 and non-PSAR50 were 15.0 and 6.5 months, respectively but there was no significant difference in PFS (p=0.055). At cutoff value of 0.4, rate of NDPSATR ≥0.4 for ENZ and DTX were 36.4% and 62.9%, respectively. For ENZ, mPFS of NDPSATR ≥0.4 and NDPSATR <0.4 were not achieved and 14.1 months, respectively and there was no significant difference in PFS (p=0.895). For DTX, mPFS of NDPSATR ≥0.4 and NDPSATR <0.4 were 9.7 and 6.3 months, respectively and there was a significant difference in PFS (p=0.045).Conclusions: NDPSATR ≥0.4 may be a good marker of PFS in CRPC patients treated with DTX and may replace PSAR50.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"916 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139204136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.22465/juo.234604600023
Jaeyoung Cho, J. Suh, D. You, I. Jeong, J. Hong, H. Ahn, B. Lim
Purpose: This study aimed to identify predictive factors for the response to abiraterone in patients with high-risk metastatic hormone-sensitive prostate cancer (mHSPC).Materials and Methods: This study analyzed the clinical characteristics of 167 patients with high-risk mHSPC who received abiraterone. Univariate and multivariable Cox proportional hazard regression analyses were conducted to identify predictive factors for castration-resistant prostate cancer (CRPC)-free survival and cancer-specific survival.Results: The mean age at presentation was 71.62±8.12 years. The prostate-specific antigen level was 218 ng/mL (interquartile range, 70–654 ng/mL). Of the 167 patients, 118 (72%) had a biopsy Gleason grade of 5, 43 patients (28.7%) had CRPC, and 30 patients (18.0%) died after a mean follow-up period of 13.5 months. In the multivariable Cox proportional hazard regression analyses for CRPC-free survival, a Gleason grade of 5 (hazard ratio [HR], 2.888; 95% confidence interval [CI], 1.133–7.361; p=0.026) and bone lesions ≥10 (HR, 4.194; 95% CI, 1.760–9.997; p=0.001) were significantly associated with CRPC-free survival. In the multivariable Cox proportional hazard regression analyses for cancer-specific survival, bone lesions ≥10 (HR, 3.185; 95% CI, 1.215–8.348; p=0.001) was significantly associated with cancer-specific survival.Conclusions: Patients with bone lesions ≥10 and Gleason grade of 5 are at higher risk of developing CRPC, and bone lesions ≥10 is at higher risk of cancer-specific survival in high-risk mHSPC treated with abiraterone.
{"title":"Predictive Factors of Abiraterone Response in Patients With High-Risk Metastatic Hormone-Sensitive Prostate Cancer","authors":"Jaeyoung Cho, J. Suh, D. You, I. Jeong, J. Hong, H. Ahn, B. Lim","doi":"10.22465/juo.234604600023","DOIUrl":"https://doi.org/10.22465/juo.234604600023","url":null,"abstract":"Purpose: This study aimed to identify predictive factors for the response to abiraterone in patients with high-risk metastatic hormone-sensitive prostate cancer (mHSPC).Materials and Methods: This study analyzed the clinical characteristics of 167 patients with high-risk mHSPC who received abiraterone. Univariate and multivariable Cox proportional hazard regression analyses were conducted to identify predictive factors for castration-resistant prostate cancer (CRPC)-free survival and cancer-specific survival.Results: The mean age at presentation was 71.62±8.12 years. The prostate-specific antigen level was 218 ng/mL (interquartile range, 70–654 ng/mL). Of the 167 patients, 118 (72%) had a biopsy Gleason grade of 5, 43 patients (28.7%) had CRPC, and 30 patients (18.0%) died after a mean follow-up period of 13.5 months. In the multivariable Cox proportional hazard regression analyses for CRPC-free survival, a Gleason grade of 5 (hazard ratio [HR], 2.888; 95% confidence interval [CI], 1.133–7.361; p=0.026) and bone lesions ≥10 (HR, 4.194; 95% CI, 1.760–9.997; p=0.001) were significantly associated with CRPC-free survival. In the multivariable Cox proportional hazard regression analyses for cancer-specific survival, bone lesions ≥10 (HR, 3.185; 95% CI, 1.215–8.348; p=0.001) was significantly associated with cancer-specific survival.Conclusions: Patients with bone lesions ≥10 and Gleason grade of 5 are at higher risk of developing CRPC, and bone lesions ≥10 is at higher risk of cancer-specific survival in high-risk mHSPC treated with abiraterone.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"233 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139205072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.22465/juo.234600400020
Dan Bee Lee, Jae Yeon Kim, Yun Ha Lee, Won Hoon Song, Seung Soo Lee, Sungwoo Park, J. Nam
Purpose: The efficacy of standard chemotherapy or radical cystectomy in patients who have urothelial tumors with variant histology (VH) is very limited in terms of their prognosis. This study aimed to investigate the prognosis of bladder cancer (BC) patients with VH who underwent radical cystectomy (RC).Materials and Methods: We retrospectively evaluated 327 BC patients who underwent RC at Pusan National University Yangsan Hospital between February 2010 and June 2021. VH was categorized into less and more aggressive types according to the patient’s mortality risk relative to pure urothelial carcinoma (PUC). More aggressive types included micropapillary, plasmacytoid, and sarcomatoid variants. Less aggressive types comprised other variant types, including squamous differentiation, glandular differentiation, lipoid, and nested. Small cell carcinoma, pure adenocarcinoma, pure squamous cell carcinoma, and lymphoma BC were excluded from analysis. The progression-free survival (PFS) and overall survival (OS) rates were evaluated using Kaplan-Meier analysis and Cox regression.Results: After the exclusion of nonurothelial tumors, data from 299 patients were available for analysis. We identified 244 (74.6%) and 55 patients (16.8%) with PUC and urothelial carcinoma with VH, respectively. VH patients were categorized as having less aggressive (n=35) and more aggressive (n=20) types. Univariate analysis identified significant differences in PFS (p=0.031) between patients with PUC (n=244) and more aggressive VH (n=20). Multivariate analysis showed that more aggressive VH was significantly associated with OS and PFS. In the Kaplan-Meier analysis, a statistically significant difference was observed between PUC and more aggressive VH in OS and PFS.Conclusions: VH patients with more aggressive types showed more advanced TNM stages at presentation than PUC patients. Pathological upstaging after RC was more common in VH patients. Among VH patients, the presence of a more aggressive VH type can be an independent predictor of progression after RC, with a worse prognosis than that of PUC patients.
{"title":"Clinical Outcomes of Patients With Variant Histology of Urothelial Carcinoma After Radical Cystectomy","authors":"Dan Bee Lee, Jae Yeon Kim, Yun Ha Lee, Won Hoon Song, Seung Soo Lee, Sungwoo Park, J. Nam","doi":"10.22465/juo.234600400020","DOIUrl":"https://doi.org/10.22465/juo.234600400020","url":null,"abstract":"Purpose: The efficacy of standard chemotherapy or radical cystectomy in patients who have urothelial tumors with variant histology (VH) is very limited in terms of their prognosis. This study aimed to investigate the prognosis of bladder cancer (BC) patients with VH who underwent radical cystectomy (RC).Materials and Methods: We retrospectively evaluated 327 BC patients who underwent RC at Pusan National University Yangsan Hospital between February 2010 and June 2021. VH was categorized into less and more aggressive types according to the patient’s mortality risk relative to pure urothelial carcinoma (PUC). More aggressive types included micropapillary, plasmacytoid, and sarcomatoid variants. Less aggressive types comprised other variant types, including squamous differentiation, glandular differentiation, lipoid, and nested. Small cell carcinoma, pure adenocarcinoma, pure squamous cell carcinoma, and lymphoma BC were excluded from analysis. The progression-free survival (PFS) and overall survival (OS) rates were evaluated using Kaplan-Meier analysis and Cox regression.Results: After the exclusion of nonurothelial tumors, data from 299 patients were available for analysis. We identified 244 (74.6%) and 55 patients (16.8%) with PUC and urothelial carcinoma with VH, respectively. VH patients were categorized as having less aggressive (n=35) and more aggressive (n=20) types. Univariate analysis identified significant differences in PFS (p=0.031) between patients with PUC (n=244) and more aggressive VH (n=20). Multivariate analysis showed that more aggressive VH was significantly associated with OS and PFS. In the Kaplan-Meier analysis, a statistically significant difference was observed between PUC and more aggressive VH in OS and PFS.Conclusions: VH patients with more aggressive types showed more advanced TNM stages at presentation than PUC patients. Pathological upstaging after RC was more common in VH patients. Among VH patients, the presence of a more aggressive VH type can be an independent predictor of progression after RC, with a worse prognosis than that of PUC patients.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139205761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.22465/juo.234600540027
Hye-Mi Ha, Joo Han Lim
Renal cell carcinoma (RCC) remains a significant challenge in oncology, prompting thorough investigations into adjuvant treatments aimed at enhancing both survival and quality of life for patients. In this review, we explore the complex landscape of adjuvant treatments for managing RCC, highlighting the pivotal roles and efficacy of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs). This review article presents a detailed exploration of both historical and contemporary trials involving TKIs, spotlighting their capabilities, successes, and limitations in the adjuvant setting. Furthermore, we examine the emerging significance of ICIs, analyzing recent trials and assessing their impact on outcomes such as disease-free survival and overall survival. Additionally, this review provides insights into the application, adaptation, and outcomes of these adjuvant therapies within the specific context and circumstances of Korean healthcare.
{"title":"The Future of Adjuvant Therapy in Renal Cell Carcinoma: Recent Insights and Prospects","authors":"Hye-Mi Ha, Joo Han Lim","doi":"10.22465/juo.234600540027","DOIUrl":"https://doi.org/10.22465/juo.234600540027","url":null,"abstract":"Renal cell carcinoma (RCC) remains a significant challenge in oncology, prompting thorough investigations into adjuvant treatments aimed at enhancing both survival and quality of life for patients. In this review, we explore the complex landscape of adjuvant treatments for managing RCC, highlighting the pivotal roles and efficacy of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs). This review article presents a detailed exploration of both historical and contemporary trials involving TKIs, spotlighting their capabilities, successes, and limitations in the adjuvant setting. Furthermore, we examine the emerging significance of ICIs, analyzing recent trials and assessing their impact on outcomes such as disease-free survival and overall survival. Additionally, this review provides insights into the application, adaptation, and outcomes of these adjuvant therapies within the specific context and circumstances of Korean healthcare.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139208155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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