Cancer Control In Patients Research Articles

Association of cannabis use with real-world time to treatment discontinuation (rwTTD) in patients with advanced cancer initiating immune checkpoint inhibition (ICI).

e18846 Background: Studies suggest that the immunomodulatory effect of cannabis may impair responsiveness to ICI in cancer patients. These studies were limited by small sample size in a heterogeneous group. Determining the impact of cannabis on cancer control in patients receiving ICI is critical to informing patients and clinicians. We assessed the relationship of cannabis with cancer treatment outcomes using a large national healthcare claims database linked to retail cannabis purchase data. Methods: Using the Forian Inc database from 2017-2022, we identified adults (age > 18 years) with advanced cancer who had ≥ 90 days of continuous health plan enrollment and received ≥ 1 ICI treatment. Point-of-sale purchase records from 18 state cannabis programs defined cannabis consumers (CC; any purchase prior to first ICI to last known follow-up) and cannabis non-consumers (CNC; no known cannabis purchases). We abstracted data on patient demographics, cancer history, cannabis utilization (dates of purchases, routes, strains), and all cancer-directed therapy claims. rwTTD was calculated from time of first ICI to a defining discontinuation event (change in therapy, gap of > 120 days, or end of enrollment in health plan). Results: From a database of nearly 68 million patients, 20,675 patients met the inclusion criteria (374 CC and 20,301 CNC). Baseline characteristics were similar between the two groups (e.g., age, diagnosis type, time to first ICI) (Table 1). Lung, melanoma and renal cancers account for nearly half of all identified diagnoses. By day 30 after ICI initiation, 45% of CC had made at least one cannabis purchase. Median time from advanced cancer diagnosis to first ICI and median follow up time were also similar (Table 1). The difference in median rwTTD between CC and CNC groups was small relative to the overall variation of this outcome (Table 1) and remained similar (88 days) when restricting analysis to CC with first purchase within 30 days of ICI. Conclusions: Cannabis use does not appear to be associated with rwTTD in advanced cancer patients initiating ICI. Formal statistical testing using inverse probability treatment propensity weighting and adjustment for confounding factors (opioids/glucocorticoids) to assess rwTTD and real-world overall survival is ongoing. Well designed, prospective cohort studies of CC and CNC are needed to minimize selection bias in studies of cannabis use. [Table: see text]

Identification of prognostic factors and nomogram model for patients with advanced lung cancer receiving immune checkpoint inhibitors.

Some patients with lung cancer can benefit from immunotherapy, but the biomarkers that predict immunotherapy response were not well defined. Baseline characteristic of patients may be the most convenient and effective markers. Therefore, our study was designed to explore the association between baseline characteristics of patients with lung cancer and the efficacy of immunotherapy. A total of 216 lung cancer patients from Tianjin Medical University Cancer Institute & Hospital who received immunotherapy between 2017 and 2021 were included in the retrospective analysis. All baseline characteristic data were collected and then univariate log-rank analysis and multivariate COX regression analysis were performed. Kaplan-Meier analysis was used to evaluate patients' progression-free survival (PFS). A nomogram based on significant biomarkers was constructed to predict PFS rate of patients receiving immunotherapy. We evaluated the prediction accuracy of nomogram using C-indices and calibration curves. Univariate analysis of all collected baseline factors showed that age, clinical stage, white blood cell (WBC), lymphocyte (LYM), monocyte (MON), eosinophils (AEC), hemoglobin (HB), lactate dehydrogenase (LDH), albumin (ALB) and treatment line were significantly associated with PFS after immunotherapy. Then these 10 risk factors were included in a multivariate regression analysis, which indicated that age (HR: 1.95, 95% CI [1.01-3.78], P = 0.048), MON (HR: 1.74, 95% CI [1.07-2.81], P = 0.025), LDH (HR: 0.59, 95% CI [0.36-0.95], P = 0.030), and line (HR: 0.57, 95% CI [0.35-0.94], P = 0.026) were significantly associated with PFS in patients with lung cancer receiving immunotherapy. Patients with higher ALB showed a greater trend of benefit compared with patients with lower ALB (HR: 1.58, 95% CI [0.94-2.66], P = 0.084). Patients aged ≥51 years, with high ALB, low LDH, first-line immunotherapy, and high MON had better response rates and clinical benefits. The nomogram based on age, ALB, MON, LDH, line was established to predict the prognosis of patients treated with immune checkpoint inhibitor (ICI). The C-index of training cohort and validation cohort were close, 0.71 and 0.75, respectively. The fitting degree of calibration curve was high, which confirmed the high prediction value of our nomogram. Age, ALB, MON, LDH, line can be used as reliable predictive biomarkers for PFS, response rate and cancer control in patients with lung cancer receiving immunotherapy. The nomogram based on age, ALB, MON, LDH, line was of great significance for predicting 1-year-PFS, 2-year-PFS and 3-year-PFS in patients with advanced lung cancer treated with immunotherapy.

Skin Inflammation Modulation via TNF-α, IL-17, and IL-12 Family Inhibitors Therapy and Cancer Control in Patients with Psoriasis.

The systemic inflammatory syndrome concept is one of the foundations that stand at the basis of revolutionary modern and future therapies, based on the in-depth understanding of the delicate mechanisms that govern the collaboration between the systems and organs of the human body and, at the same time, the fine balance that ensures a reproach-free operation. An interesting concept that we propose is that of the environment-inadequacy status, a concept that non-specifically incorporates all the situations of the organism’s response disorders in the face of imprecisely defined situations of the environment. The correlation between these two concepts will define the future of modern medicine, along with the gene-adjustment mechanisms. Psoriasis is a clear example of an inadequate body response as a result of exposure to as of yet undefined triggers with an excessive systemic inflammatory reaction and hitherto insufficiently controllable. Modern biological therapies, such as TNF-α, IL-12 family, and IL-17 inhibitors, are intended to profoundly reshape the cytokine configuration of patients with inflammatory diseases such as psoriasis, with tremendous success in disease control. Yet, because of the important roles of cytokines in cancer promotion and control, concern was raised about the fact that the use of biologicals may alter immune surveillance and promote cancer progression. Both theoretical and practical data nevertheless showed that the treatment-induced control of cytokines may be beneficial for reducing the inflammatory milieu that promotes cancer and such have a beneficial role in maintaining health. We briefly present the intricate roles of those cytokine families on cancer control, with some debates on if their inhibition might or might not promote additional tumoral development.

Robot-Assisted Radical Prostatectomy for Potential Cancer Control in Patients with Metastatic Prostate Cancer.

Recently, cytoreductive prostatectomy for metastatic prostate cancer (mPCa) has been associated with improved oncological outcomes. This study was aimed at evaluating whether robot-assisted radical prostatectomy (RARP) as a form of cytoreductive prostatectomy can improve oncological outcomes in patients with mPCa. We conducted a retrospective study of twelve patients with mPCa who had undergone neoadjuvant therapy followed by RARP. The endpoints were biochemical recurrence-free survival, treatment-free survival, and de novo metastasis-free survival. At the end of the follow-up period, none of the enrolled patients had died from PCa. The 1- and 2-year biochemical recurrence-free survival rates were 83.3% and 66.7%, respectively, and treatment-free survival rates were 75.0% and 56.3%, respectively. One patient developed de novo bone metastases 6.4 months postoperatively, and castration-resistant prostate cancer 8.9 months postoperatively. After RARP, the median duration of recovery of urinary continence was 5.2 months. One patient had severe incontinence (>2 pads/day) 24 months postoperatively. RARP may be a treatment option in patients with mPCa who have achieved a serum prostate-specific antigen level < 0.2 ng/mL, and present without new lesions on imaging.

HIGH RISK PROSTATE CANCER: COMPARISON OF RADICAL PROSTATECTOMY VERSUS RADIATION THERAPY: EXPERIENCE OF MILITARY HOSPITAL RABAT

Context: To date, there is no Level 1 evidence comparing the efficacy of radical prostatectomy and radiotherapy for patients with clinically-localized prostate cancer. Objective: to evaluate overall survival (OS) and relapse free survival of high risk prostate cancer (PCa) treated either with external beam radiotherapy (EBRT) associated with androgen deprivation therapy (ADT) or radical prostatectomy (RP) with adjuvant or salvage radiotherapy and ADT. Also, it is very interesting to compare different acute and late toxicity of the both approach. Materials and Methods: During a period of 10 years from April 2009 and December 2018, 149 patients with high-risk prostate cancer were admitted to the radiotherapy department of the Mohammed V military hospital in Rabat (HMIMV). Among these patients, 17 underwent surgery followed by EBRT and ADT: this is the experimental arm (Group I) and 34 patients who had benefited from treatment with EBRT with ADT were selected from the other patients by a 1: 2 matching method who will represent the reference group (Group II) to allow a comparison with the experimental arm with the minimum possible bias. Results: The overall survival (OS) at 5 and 10 years was 100 % in the both arms while relapse free survival at 5 years was 91,7 % and 93,1% respectively in group I and II and at 10 years 91,7% in the group multimodal approach and 88,9 % in the EBRT+ADT group without any significant difference. We note more toxicities in the surgical group with more urinary incontinence (p=0,001) and more erectile dysfunction. Conclusion: RP with adjuvant EBRT and EBRT+ADT provided similar long-term cancer control for patients with high-risk prostate cancer but with different toxicity profiles.

PD19-08 A SYSTEMATIC REVIEW OF CYTOREDUCTIVE PROSTATECTOMY OUTCOMES AND COMPLICATIONS IN PATIENTS WITH OLIGOMETASTATIC PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (PD19)1 Sep 2021PD19-08 A SYSTEMATIC REVIEW OF CYTOREDUCTIVE PROSTATECTOMY OUTCOMES AND COMPLICATIONS IN PATIENTS WITH OLIGOMETASTATIC PROSTATE CANCER Andrey Morozov, Leonid Chuvalov, Mikhail Enikeev, Mark Taratkin, and Dmitry Enikeev Andrey MorozovAndrey Morozov More articles by this author , Leonid ChuvalovLeonid Chuvalov More articles by this author , Mikhail EnikeevMikhail Enikeev More articles by this author , Mark TaratkinMark Taratkin More articles by this author , and Dmitry EnikeevDmitry Enikeev More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002008.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Local treatment in generalized disease is a controversial strategy in terms of cancer control and complications. The aim of our systematic review is to analyze the available data on cytoreductive prostatectomy (CRP) in order to understand what role this should play in treatment strategy. METHODS: We have performed a systematic literature search using 3 databases (Medline (PubMed), Scopus, and Web of Science) based on the following search query: “prostate cancer” AND (“оligo metast*” OR “bone metast*”) AND (RPE OR prostatectomy OR surgery OR “cytoreductive prostatectomy”) following PRISMA guidelines. The detailed search strategy and review protocol has been published in Prospero (ID CRD42020192328). The scope of the review according to the PICO process (Patient, Intervention, Comparison, Outcomes) is as follows: P – patients with oligometastatic prostate cancer; I – cytoreductive prostatectomy; C – conventional treatment (ADT, chemotherapy), or local radiotherapy; O – oncological outcomes (CSS, progression-free survival (PFS), overall survival (OS)), functional outcomes (urinary incontinence and erectile function (EF) rates), complications. The primary outcomes were the oncological results: cancer-specific survival (CSS), progression-free survival (PFS), overall survival (OS). The secondary outcomes were complication rates and functional results (urinary continence). RESULTS: In all the studies OS was better or at least comparable in the groups with CRP and no local treatment (NLT). The most essential benefit from CRP was noted by Culp et al. (5-year OS 67.4% for RP vs 22.5 for NLT). CSS showed the same trend. Positive surgical margin rate ranged from 28.6% up to 100%. Urinary continence in CRP was significantly lower, than in RP for localized PCa, 57.4% vs 90.8%, p<0.0001. But severe incontinence occurred seldom (2.5–18.6%). Between 50% and 84.6% of the patients were completely continent. Total complications rate after CRP differed widely, from 7–8.8% to 41.2–43.6%. Rates of grade 1 and 2 events prevailed. The patients on ADT alone also showed a considerable number of complications, varying from 5.9% to 57.7%. A significant proportion (26.8%-44.7%) of them required interventions due to local progression. CONCLUSIONS: CRP improves medium-term cancer control in patients with oligometastatic PCa. This surgery results in what we believe to be an acceptable complication rate with a slightly impaired urinary continence as compared to RP for a localized disease. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e364-e365 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrey Morozov More articles by this author Leonid Chuvalov More articles by this author Mikhail Enikeev More articles by this author Mark Taratkin More articles by this author Dmitry Enikeev More articles by this author Expand All Advertisement Loading ...

Liproca Depot: A New Antiandrogen Treatment for Active Surveillance Patients

BackgroundThere is increasing interest in nonmorbid treatments for low- and intermediate-risk prostate cancer with fewer side effects than surgery or radiotherapy. ObjectiveTo investigate the tolerability, safety, and antitumor effects of the intraprostatic NanoZolid depot formulation Liproca Depot (LIDDS AB, Uppsala, Sweden) with antiandrogen 2-hydroxyflutamide (2-HOF) in men with low- or intermediate-risk localized prostate cancer managed with active surveillance. Design, setting, and participantsThis clinical phase 2b trial, LPC-004, involved 61 patients. The 2-HOF-containing formulation Liproca Depot was injected transrectally into the prostate under ultrasound guidance. A single dose of 35% or 45% of the prostate volume (study part 1) and a fixed dose of 16 or 20 ml (study part 2) of the formulation were evaluated. Outcome measurements and statistical analysesThe primary endpoints were tolerability and the reduction in serum prostate-specific antigen (PSA) 5 mo after injection. Antitumor effects were evaluated with magnetic resonance imaging (MRI) and prostate biopsies. Quality of life was assessed using a validated questionnaire (International Prostate Symptom Score). Results and limitationsAll doses were safe and well tolerated, without hormonal side effects. In part 2 of the study, the PSA reduction was greatest for the group receiving 16 ml, with an average decrease of 14%, and 95% of patients had a PSA reduction. Some 78% of patients showed a prostate volume decrease compared to baseline. Prostate MRI and biopsies confirmed stable or reduced lesion size. However, post treatment biopsies were performed at the discretion of the investigator, and not routinely. Most patients were amenable to a second injection. ConclusionsPSA and prostate volume decreased in most patients. Indications of efficacy were shown by post-treatment MRI and biopsies demonstrating stabilization or regression in the majority of cases. Patient summaryLiproca Depot is a safe, minimally invasive treatment that offers the potential for cancer control in patients with intermediate-risk prostate cancer. Further clinical evaluation is warranted.

Survival of Contemporary Patients With Non-metastatic Small-cell Carcinoma of Urinary Bladder, According to Alternative Treatment Modalities.

The objective of this study was to test the effect of chemotherapy and/or radical cystectomy (RC) and/or radiotherapy (RT) on survival of patients with non-metastatic small-cell carcinoma of the urinary bladder (SCCUB). Within the Surveillance, Epidemiology, and End Results registry (2001-2016), we identified patients with non-metastatic (T1-4, N0, M0) SCCUB. Treatment was defined as: chemotherapy alone, chemotherapy+ RC, and chemotherapy+ RT. Temporal trends, cumulative incidence plots, and multivariable competing risks regression models were used. Of 595 patients with SCCUB, 230 (38.5%), 159 (27%), and 206 (34.5%) were treated with chemotherapy alone, chemotherapy+ RC, and chemotherapy+ RT, respectively. The rates of chemotherapy+ RC increased (estimated annual percentage changes [EAPC],+5.9%; P= .002). Conversely, chemotherapy alone (EAPC,-1.7%; P= .1) and chemotherapy+ RT rates decreased (EAPC:-2.2%; P= .08). Overall, 5-year cancer-specific mortality (CSM) rates were 44%, 29%, and 40% for patients treated with chemotherapy alone, chemotherapy+ RC, and chemotherapy+ RT, respectively (P= .004). Relative to chemotherapy alone, patients treated with chemotherapy+ RC experienced lower CSM (hazard ratio, 0.5; P< .001). Conversely, patients treated with chemotherapy+ RT did not exhibit any CSM benefit (hazard ratio, 0.8; P= .2), when compared with chemotherapy alone. In contemporary patients with SCCUB with non-metastatic disease, the rates of chemotherapy+ RC are increasing. Conversely, the rates of combined chemotherapy with RT and chemotherapy alone are decreasing. These patterns of treatment are in agreement with better cancer control in patients with SCCUB. In consequence, until more robust data become available, the combination of chemotherapy and RC should represent the recommended treatment strategy.

EDITORIAL COMMENT

Adenocarcinoma of the prostate is a major health concern in the United States, with 31,620 deaths estimated for 2019. 1 Siegel RL Miller KD Jemal A Cancer statistics, 2019. CA Cancer J Clin. 2019; 69: 7-34 Crossref PubMed Scopus (13951) Google Scholar A recent population-based study of nearly 400,000 patients found that radical prostatectomy (RP) was the most commonly utilized treatment in the United States for intermediate- and high-risk patients. 2 Chen J Oromendia C Halpern JA Ballman KV National trends in management of localized prostate cancer: a population based analysis 2004-2013. Prostate. 2018; 78: 512-520 Crossref PubMed Scopus (35) Google Scholar In men under aged 70 in these risk groups, RP accounted for 48%-82% of first line therapy. 2 Chen J Oromendia C Halpern JA Ballman KV National trends in management of localized prostate cancer: a population based analysis 2004-2013. Prostate. 2018; 78: 512-520 Crossref PubMed Scopus (35) Google Scholar These patients with intermediate- and high-risk disease represent the population most to be at high risk for recurrence following RP, historically defined by the presence of extracapsular extension, seminal vesicle involvement, or positive surgical margins. The risk of subsequent biochemical failure in men with these adverse pathologic features ranges from 40% to 70%. 3 Bolla M van Poppel H Tombal B et al. Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911). Lancet. 2012; 380: 2018-2027 Abstract Full Text Full Text PDF PubMed Scopus (637) Google Scholar , 4 Briganti A Wiegel T Joniau S et al. Early salvage radiation therapy does not compromise cancer control in patients with pT3N0 prostate cancer after radical prostatectomy: results of a match-controlled multi-institutional analysis. Eur Urol. 2012; 62: 472-487 Abstract Full Text Full Text PDF PubMed Scopus (137) Google Scholar , 5 Karakiewicz PI Eastham JA Graefen M et al. Prognostic impact of positive surgical margins in surgically treated prostate cancer: multi-institutional assessment of 5831 patients. Urology. 2005; 66: 1245-1250 Abstract Full Text Full Text PDF PubMed Scopus (241) Google Scholar , 6 Thompson Jr, IM Tangen CM Paradelo J et al. Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial. JAMA. 2006; 296: 2329-2335 Crossref PubMed Scopus (799) Google Scholar , 7 Wiegel T Bartkowiak D Bottke D et al. Adjuvant radiotherapy versus wait-and-see after radical prostatectomy: 10-year follow-up of the ARO 96-02/AUO AP 09/95 trial. Eur Urol. 2014; 66: 243-250 Abstract Full Text Full Text PDF PubMed Scopus (308) Google Scholar

Radical Prostatectomy in High-Risk Prostate Cancer Patients: Results of a Single- Institution Study

Objective: To evaluate long-term outcomes of radical prostatectomy and bilateral pelvic lymph node dissection (RP) for high-risk prostate cancer (PC).Material and Method: A retrospective review of high-risk PC patients who received RP, identified from medical records. We collected data from Songklanagarind Hospital, Prince of Songkla University from 2007 to 2015. The Kaplan-Meier method and Cox proportional regression models were used to analyze clinical recurrence (CR) and biochemical recurrence (BCR).Results: In 79 patients, the median follow-up was 27.2 months. The 3-year and 5-year biochemical free survival in men with high-risk PC were 67.7% and 62.9% respectively. Multivariate analysis shows that pathologic stage 3a (hazard ratio=4.87; 95% confidence interval=1.01-23.38) was independently associated with cancer control.Conclusion: Data support the belief that RP has a place in the treatment of high-risk PC. RP was a long-term cancer control in patients with high-risk PC. Only pathologic staging was independently associated with cancer control outcome.

Extended radical prostatectomy following neoadjuvant chemohormononal therapy (low dose estrmustine + LHRH agonist/antagonist) contributes to good cancer control for patients with high risk localized prostate cancer.

185 Background: Patients with high-risk prostate cancer (PCa) according to D’Amico risk categories are prone to a pathological diagnosis of positive margins or lymph node invasion and biochemical recurrence, despite having undergone radical prostatectomy (RP). Therefore, it is controversial whether RP should be done for high risk PC patients. Methods: 87 high-risk PCa patients prospectively underwent ‘extended’ RP following neoadjuvant chemohormonal therapy (NAC); primarily 6 months of estramustine phosphate 280 mg bid, along with a LH-RH agonist/antagonist. Our surgical technique was developed to reduce the rates of positive surgical margins. The goal is to approach the muscle layer of the rectum by dissecting the mesorectal fascia and continuing the dissection through the mesorectum until the muscle layer of the rectum is exposed. The procedure was safely performed as a result of good recognition of the structure between the perineal body and the rectal surface. We also performed extended lymphadenectomy if the patients meet two or more of D’Amico risk categories Results: More than 1 year had elapsed after surgery in 69 of the 87 patients with the median follow-up period of 36.2 months. Among those 69 patients, 18 (26.1%) experienced PSA failure. Kaplan-Meier analyses revealed that significant poorer PSA progression-free survival were observed in patients with higher positive biopsy core ratio, lymph node metastasis, and higher pathological stage (pT3a/b). Multivariate Cox-regression analysis revealed that higher pathological stage (pT3a/b) was the only independent valuable for predicting PSA progression failure. These 18 cases received salvage androgen deprivation therapy followed-by external beam radiotherapy and showed no progression after the salvage therapies (median follow-up period, 34.6 months after PSA progression). Conclusions: NAC concordant with extended RP is feasible and contributes to negative surgical margins that might provide good cancer control for patients with high-risk PCa.

Outcomes of salvage radical prostatectomy following more than one failed local therapy.

PurposeTo describe the salvage radical prostatectomy (sRP) experience in patients presenting with recurrent, clinically localized prostate cancer after multiple failed local treatments.Materials and MethodsAmong the 251 sRP performed during 2000–2016, 11 patients had failed multiple local therapies. We describe baseline clinical characteristics at primary cancer diagnosis and prior to sRP, surgical information, complications and oncological outcomes.ResultsThe mean±standard deviation age at sRP was 65±5 years and the median (interquartile range) serum prostate-specific antigen (PSA) level was 2 (1.3) ng/mL. The most common first and subsequent treatments were radiotherapy and cryotherapy, respectively, with median time of 24 months from the last local treatment. The median operative time was 180 minutes and median estimated blood loss was 750 mL. Five (45.5%) patients underwent additional procedures during sRP for pre-operative morbidity from prior treatments (rectourethral fistula, urethral stricture, incontinence). Post-operative complications requiring invasive intervention occurred in 7 (63.6%) patients. Over a median follow-up of 29 (12–96) months, 10 of the 11 men (90.9%) achieved an undetectable PSA in after sRP. Three of these men with an initially undetectable PSA level experienced biochemical recurrence; the remaining 7 are without evidence of disease. Overall, no local recurrence or systemic metastasis was identified at last follow-up.ConclusionssRP is technically feasible and offers durable cancer control in patients with recurrent prostate cancer despite having undergone multiple prior attempts at cure. These patients experience higher rates of post-operative complications and such patients must be appropriately counseled regarding the potential risks and benefits.

Does the Unexpected Presence of Non-organ-confined Disease at Final Pathology Undermine Cancer Control in Patients with Clinical T1N0M0 Renal Cell Carcinoma Who Underwent Partial Nephrectomy?

BackgroundA non-negligible proportion of individuals diagnosed with cT1 renal cell carcinoma (RCC) are upstaged to pT3a at final pathology. Few data on oncological outcomes for these patients are available to determine whether partial nephrectomy (PN) might jeopardise cancer control. ObjectiveTo assess, within an international multi-institutional collaboration, whether PN might undermine cancer control relative to radical nephrectomy (RN) in RCC patients with unexpected pT3a disease. Design, setting, and participantsInternational multi-institutional collaboration including patients with cT1abN0M0–pT3a RCC. InterventionPN or RN. Outcome measurements and statistical analysisWe used Kaplan-Meier analyses, before and after propensity-score matching, to evaluate differences in metastatic progression (MP) and cancer-specific mortality (CSM) rates during follow-up. Univariable and multivariable Cox regression analyses were used to assess predictors of MP and CSM. Results and limitationsOverall, 309 patients with cT1abN0M0 RCC (cT1aN0M0, n=107, 34.6%; cT1bN0M0, n=202, 65.4%) had pT3a disease according to final pathology. Patients were treated with either PN (n=71, 23%) or RN (n=238, 77%). MP at 1, 2, and 5 yr was detected in 9.1%, 13.3%, and 24.1% of patients, respectively. CSM was 3.5%, 10.7%, and 18.4% at 1, 2, and 5 yr, respectively. After matching, no difference in terms of MP or CSM was observed between the PN and RN cohorts (both p>0.3). On multivariable analysis, type of surgery (PN vs RN) was not an independent predictor of either MP (p=0.3) or CSM (p=0.4). Limitations include the retrospective design. ConclusionsIn patients with unexpected pT3a RCC at final pathology, PN does not appear to jeopardise cancer control with regard to MP and CSM. Patient summaryCancer control is similar between patients treated with removal of the entire kidney and those with only partial removal, even if the final histology examination demonstrates a tumour that is unexpectedly not confined within the kidney.

The role of salvage extended lymph node dissection in patients with rising PSA and PET/CT scan detected nodal recurrence of prostate cancer.

Non-prostatic bed recurrence of prostate cancer (PCa) is usually treated with androgen deprivation therapy (ADT). We analyzed the impact of salvage extended lymph node dissection (sLND) on cancer control in patients with rising PSA and lymph node (LN) metastases. Between 2009 and 2016 we performed sLND in 87 patients with biochemical recurrence (BCR) and positive LNs on 18FEC and 68Ga-PSMA positron emission tomography/X-ray computer tomography (PET/CT) after primary treatment (PT) of PCa. Intra- and postoperative complications according to Clavien-Dindo were assessed and the rates of biochemical response (BR), BCR-free and clinical recurrence (CR)-free survival, as well as time to initiation of systemic treatment were evaluated. Mean age of patients and mean PSA at sLND was 66.7 years (46-80 years) and 2.63 ng ml-1 (1.27-3.75 ng ml-1), respectively. With 87.4% radical prostatectomy (RP) was the most common PT. In all, 57.9% of patients additionally underwent adjuvant/salvage radiation therapy (RT) and 18.4% received ADT before sLND. Complete BR (cBR) was diagnosed in 27.5% of patients and incomplete BR in 40.6%. In total, 62.2% of patients remained without ADT at follow-up. With a median follow-up of 21 months (1-75 months), the cancer-specific mortality rate was 3.7%. The 3-year BCR-free, systemic therapy-free and CR-free survival rates for patients with cBR were 69.3%, 77.0% and 75%, respectively. sLND can be performed without significant complications and achieves an immediate BR, thus allowing a significant postponement of systemic therapy in selected patients with BCR and nodal recurrence of PCa. Therefore, sLND following 68Ga-PSMA PET/CT should be considered as part of a multimodal diagnostic and treatment concept for selective patients.

The role of salvage extended lymph node dissection (LND) in patients with rising PSA and PET/CT scan detected nodal recurrence of prostate cancer.

242 Background: According to the risk constellation recurrence rate of prostate cancer following local therapy is up to 60%. Early salvage radiotherapy already showed a benefit in progression-free survival. We analyzed the impact of salvage extended lymph node dissection on cancer control in patients with rising PSA and nodal recurrence in PET/CT scan. Methods: Between 2003 and 2015 we performed a salvage extended lymph node dissection in 95 patients with rising PSA and nodal recurrence in PET/CT scan after previous local therapy for prostate cancer. The extent of resection field was adjusted to the pre-operative imaging. Results: We identified 95 patients with rising PSA and nodal recurrence in PET/CT scan with a mean age of 66 years (55-76 years). There were no significant intraoperative complications. Postoperatively, 12% had Clavien/Dindo grade 3 complications. Complete PSA response, defined as a postoperative PSA level &lt; 0.2 ng/ml, was diagnosed in 36% of patients. With a median follow-up of 19 months (1-101 months) cancer-specific mortality rate was less than 1%. Median progression-free survival was 7 months (1-43 months). The interval until the initiation of systemic treatment was 12 months (1-43 months). Conclusions: Salvage LND can be performed without significant complications. Immediate complete PSA response can be achieved in one third of patients and systemic therapy can be delayed by one year. For a general treatment recommendation individual predictive markers are currently still missing.

MP57-08 SIGNIFICANCE OF GERIATRIC NUTRITIONAL RISK INDEX AS A PROGNOSTIC PREDICTOR IN PATIENTS WITH NON-METASTATIC RENAL CELL CARCINOMA UNDERGOING SURGICAL RESECTION

You have accessJournal of UrologyKidney Cancer: Surgical Therapy II1 Apr 2015MP57-08 SIGNIFICANCE OF GERIATRIC NUTRITIONAL RISK INDEX AS A PROGNOSTIC PREDICTOR IN PATIENTS WITH NON-METASTATIC RENAL CELL CARCINOMA UNDERGOING SURGICAL RESECTION Hiromoto Tei, Hideaki Miyake, and Masato Fujisawa Hiromoto TeiHiromoto Tei More articles by this author , Hideaki MiyakeHideaki Miyake More articles by this author , and Masato FujisawaMasato Fujisawa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1996AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To date, several studies have reported that nutritional status related to cellular metabolism could be an important prognostic factor of patients with renal cell carcinoma (RCC). Geriatric Nutritional Risk Index (GNRI) is an objective screening index of nutrition-related risk that correlates with the severity of malnutrition and mortality rate in hospitalized patients. The objective of this study was to assess whether GNRI has a significant impact on the prognosis of patients with non-metastatic RCC who underwent surgical resection. METHODS This study included a total of 432 consecutive patients with non-metastatic RCC who received complete surgical resection of primary disease by either partial or radical nephrectomy at our institution. We evaluated the significance of several conventional clinicopathological parameters as well as GNRI, defined as 1.487 × serum albumin (g/l) + 41.7 × present/usual weight (kg), as postoperative prognostic indicators in these 432 patients. RESULTS Of the 432 patients, 107 (24.8%) and 325 (75.2%) were classified into low (GNRI ≤ 98) and high (98 < GNRI) nutritional groups, respectively. The serum level of preoperative C-reactive protein (CRP), pathological stage and incidence of microvascular invasion in low nutritional group were significantly higher than those in high nutritional group. Both recurrence-free survival (RFS) and cancer-specific survival (CSS) were significantly poor in low nutritional group compared with those in high nutritional group. Despite the lack of an independent significance as a predictor of RFS, GNRI, in addition to microvascular invasion, appeared to be independently associated with CSS on multivariate analysis. Furthermore, there were significant differences in CSS according to positive numbers of these 2 independent factors; that is, cancer-specific death occurred in 2 of 232 patients who were negative for risk factors (0.009%), 10 of 157 positive for one risk factor (6.4%) and 12 of 42 positive for two risk factors (28.6%). CONCLUSIONS These findings suggest that low nutritional status may have an unfavorable impact on postoperative cancer control in patients with non-metastatic RCC who received surgical resection; therefore, the combined evaluation of GNRI with conventional prognostic parameters would contribute to the accurate prognostic prediction in patients with non-metastatic RCC following surgical resection. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e692-e693 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hiromoto Tei More articles by this author Hideaki Miyake More articles by this author Masato Fujisawa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Long-term oncologic outcomes of laparoscopic renal cryoablation as primary treatment for small renal masses

IntroductionData regarding long-term oncologic outcomes of laparoscopic renal cryoablation (LRC) as first treatment for small renal masses (SRMs) are lacking. We hypothesized that LRC might provide an effective long-term cancer control in patients with a single cT1a SRM without a previous history of renal cell carcinoma (RCC). Materials and methodsThe study design was a retrospective analysis of 174 consecutive patients who received LRC as first treatment for a single computed tomography or magnetic resonance imaging contrast-enhancing cT1a SRM between 2000 and 2013. Patients with a previous history of RCC were excluded. Treatment failure was evaluated 1 day after surgery. Local recurrence, metachronous SRM, systemic progression, disease relapse, cancer-specific mortality, and all-cause mortality were evaluated 10 years after surgery. Kaplan-Meier plots were used to depict outcome-free survival rate. ResultsMedian patient age was 66 years. Median tumor size was 20mm. Median follow-up was 48 months. Among patients with biopsy-proven RCC (63%, n = 109), the treatment failure–free rate was 98%. The 10-year recurrence-free survival rate was 95% and the 10-year metachronous SRM–free survival rate was 87%. The 10-year systemic progression–free survival rate was 100% and the 10-year disease relapse–free survival rate was 81%. The cancer-specific mortality–free survival rate was 100%, and the all-cause mortality–free survival rate was 61%. ConclusionsLRC provides safe long-term cancer control in patients newly diagnosed with a single cT1a SRM. Treatment failure and local recurrence are uncommon. Systemic progression–free survival and cancer-specific–free survival are optimal.

Prediction of Outcome Following Early Salvage Radiotherapy Among Patients with Biochemical Recurrence After Radical Prostatectomy

BackgroundEarly salvage radiotherapy (eSRT) represents the only curative option for prostate cancer patients experiencing biochemical recurrence (BCR) for local recurrence after radical prostatectomy (RP). ObjectiveTo develop and internally validate a novel nomogram predicting BCR after eSRT in patients treated with RP. Design, setting, and participantsUsing a multi-institutional cohort, 472 node-negative patients who experienced BCR after RP were identified. All patients received eSRT, defined as local radiation to the prostate and seminal vesicle bed, delivered at prostate-specific antigen (PSA) ≤0.5 ng/ml. Outcome measurement and statistical analysisBCR after eSRT was defined as two consecutive PSA values ≥0.2 ng/ml. Uni- and multivariable Cox regression models predicting BCR after eSRT were fitted. Regression-based coefficients were used to develop a nomogram predicting the risk of 5-yr BCR after eSRT. The discrimination of the nomogram was quantified with the Harrell concordance index and the calibration plot method. Two hundred bootstrap resamples were used for internal validation. Results and limitationsMean follow-up was 58 mo (median: 48 mo). Overall, 5-yr BCR-free survival rate after eSRT was 73.4%. In univariable analyses, pathologic stage, Gleason score, and positive surgical margins were associated with the risk of BCR after eSRT (all p ≤ 0.04). These results were confirmed in multivariable analysis, where all the previously mentioned covariates as well as pre-RT PSA were significantly associated with BCR after eSRT (all p ≤ 0.04). A coefficient-based nomogram demonstrated a bootstrap-corrected discrimination of 0.74. Our study is limited by its retrospective nature and use of BCR as an end point. ConclusionseSRT leads to excellent cancer control in patients with BCR for presumed local failure after RP. We developed the first nomogram to predict outcome after eSRT. Our model facilitates risk stratification and patient counselling regarding the use of secondary therapy for individuals experiencing BCR after RP. Patient summarySalvage radiotherapy leads to optimal cancer control in patients who experience recurrence after radical prostatectomy. We developed a novel tool to identify the best candidates for salvage treatment and to allow selection of patients to be considered for additional forms of therapy.

Paraneoplastic bullous pemphigoid: an update

Bullous pemphigoid (BP) are often associated with malignancies such as haematological malignancy,prostatic carcinoma,gastric cancer,etc.Most malignancies occur synchronously with or after BP.The pathogenesis of paraneoplastic bullous pemphigoid (PNBP) has not been clarified,and its treatment is different from that of classic BP.The improvement of skin lesions is often an accompaniment of cancer control in patients with PNBP.Dermatologists should pay attention to associated malignancies in patients with BP,so as to improve the quality of life of patients by early detection,diagnosis and treatment of malignancies. Key words: Pemphigoid,bullous; Neoplasms

Risk Stratification of Patients with Extraprostatic Extension and Negative Lymph Nodes at Radical Prostatectomy: Identifying Optimal Candidates for Adjuvant Therapy

Randomized trials demonstrate a benefit to adjuvant radiation therapy after radical prostatectomy in patients with pathologically locally advanced tumors. However, limited data exist on natural history, specifically in men with extraprostatic extension, and wide variability in outcomes has been reported. We evaluated long-term outcomes in patients with pT3aN0 disease and determined predictors of recurrence in these men. We evaluated 20,744 patients who underwent radical prostatectomy at our clinic between 1987 and 2011. Of these men 1,073 with pT3aN0 disease were identified who did not receive neoadjuvant or adjuvant therapy. Biochemical recurrence-free survival was estimated using the Kaplan-Meier method. Multivariate stepwise selection was used to develop a prognostic model for biochemical recurrence. Median followup after radical prostatectomy was 10.9 years, during which 449 patients experienced biochemical recurrence. On stepwise selection preoperative prostate specific antigen (HR 1.3, p=0.0003), clinical tumor stage (HR 1.2, p=0.001), pathological Gleason score (HR 1.9, p<0.0001), surgical margin status (HR 1.6, p<0.0001) and detectable first postoperative prostate specific antigen (HR 2.2, p<0.0001) were significantly associated with biochemical recurrence. Cumulative weighted scores of these variables were used to stratify patients into quintiles according to biochemical recurrence risk. The 15-year biochemical recurrence-free survival rate in the lowest to the highest risk group was 70%, 56%, 44%, 34% and 25%, respectively (p<0.0001). The c-index for this model was 0.69. We present a model to individualize the estimation of biochemical recurrence in men with pT3aN0 disease at radical prostatectomy. These data may be used for patient counseling, specifically in regard to risk stratification when discussing secondary therapy.