Cancer-specific Mortality In Patients Research Articles

Health benefits and costs of screening for colorectal cancer in people on dialysis or who have received a kidney transplant

Despite the higher risk of colorectal cancer (CRC) in people with chronic kidney disease, it remains uncertain whether early detection through screening is cost-effective in this setting. We aimed to determine the costs and health benefits of CRC screening in people on dialysis or who have received a kidney transplant. Using a government health perspective, three probabilistic Markov models were constructed to compare the cost-effectiveness and cost-utility of annual immunochemical faecal occult blood test (iFOBT) screening against no-screening in a cohort of 1000 patients (age 50-70 years) on dialysis and with kidney transplants. A series of one-way, multi-way and probabilistic sensitivity analyses were conducted to assess the robustness of the model structure and the extent in which the model's assumptions were sensitive to the uncertainties within the input variables. The incremental cost-effectiveness ratios (ICERs) of CRC screening compared with no-screening were $138 828 per quality-adjusted life year [QALY; $122 977 per life year saved (LYS)], $121 973 per QALY ($ 85 095 per LYS) and $44 790 per QALY ($25 036 per LYS) for dialysis patients not listed on the transplant waiting list, patients on the transplant waiting list and patients with kidney transplants, respectively. The test specificity of iFOBT, the starting age of screening and cancer prevalence were influential factors that determined the overall cost-effectiveness of screening in this setting. Screening for CRC using iFOBT may reduce cancer-specific mortality in patients on dialysis and with kidney transplants. However, the benefits and costs of screening CRCs in patients on dialysis, especially for those deemed not suitable for transplantation, greatly exceeded the typical thresholds for acceptable cost-effectiveness.

Active surveillance for small renal tumors: Have clinical concerns been addressed so far?

The incidence of small renal masses is increasing, as a result of the wide adoption of imaging exams. Their management, however, is complicated, especially in patients with decreased life expectancy or comorbidities. Approximately 20% of small renal masses are benign and, even if malignant, just 10% show aggressive pathological features. Furthermore, competing cause mortality seems to exceed the cancer-specific mortality in patients aged over 70 years. The role of percutaneous tumor biopsy is still not well defined. All these observations raise the concern as to whether surgery might represent an overtreatment for some cases of small renal masses, calling into question the role of active surveillance. The aim of this review was to evaluate the current evidence pertaining to several hot questions that need to be addressed when contemplating active surveillance for small renal masses. The most relevant publications on this subject available in the literature were selected. Five representative series of active surveillance along with the main related variables were identified. Some relevant items surrounding the field of active surveillance were identified and submitted to an evidence-based discussion. According to the recent evidence, small renal masses under active surveillance tend to show an indolent course with a low probability of disease progression, the latter being triggered most of the time by a tendency to grow faster. Unfortunately, we are currently unable to predict those few cases with aggressive behavior. According to the current evidence, active surveillance is feasible and safe in elderly and comorbid patients.

A population-based analysis of the effect of marital status on overall and cancer-specific mortality in patients with squamous cell carcinoma of the penis

The association between marital status and tumor stage and grade, as well as overall mortality (OM) and cancer-specific mortality (CSM) received little attention in patients with squamous cell carcinoma of the penis (SCCP). We relied on the surveillance, epidemiology, and end results (SEER) 17 database to identify patients diagnosed with primary SCCP. Logistic and Cox regression models, respectively, addressed the effect of marital status on the rate of locally advanced disease and its effect on OM and CSM. Covariates consisted of age, race, socioeconomic status, year of surgery, and SEER registries. Between 1988 and 2006, 1,884 patients with SCCP were identified. At surgery, 1,192 (63.3%) were married and 966 (51.3%) had locally advanced disease. In multivariable logistic regression models predicting locally advanced disease at surgery, unmarried men had a 1.5-fold higher (p<0.001) risk than others. In multivariable Cox models predicting CSM, marital status had no effect [hazard ratio (HR)=1.3, p=0.1]. Finally, in multivariable Cox models predicting OM, unmarried men had a 1.3-fold higher (p=0.001) risk than others. Unmarried men tend to present with less favorable disease stage at SCCP. Moreover, unmarried men tend to live less long than their married counterparts. However, marital status has no effect on CSM.

Nodal involvement at nephrectomy is associated with worse survival: A stage‐for‐stage and grade‐for‐grade analysis

To examine cancer-specific mortality in patients with nodal metastases relative to patients without nodal involvement at nephrectomy for non-metastatic renal cell carcinoma in a population-based cohort. A total of 11 374 non-metastatic renal cell carcinoma patients who underwent a lymph node dissection at nephrectomy were identified using the Surveillance, Epidemiology and End Results database (1988-2008). The 5-year cancer-specific mortality-free survival rates were examined according to the presence or absence of nodal involvement within the entire cohort, and stratified according to pathological tumor stage (pT1 vs pT2 vs pT3 vs pT4) and Fuhrman grade (I vs II vs III vs IV). Cox regression analyses for prediction of cancer-specific mortality were modeled to assess the effect of nodal metastases versus no nodal involvement in the entire population. Finally, separate Cox regression models were fitted within each pathological stage and grade. Overall, 1260 (11%) patients had nodal metastases at nephrectomy. The overall 5-year cancer-specific mortality-free survival rates were 38.4 versus 83.8% in patients with nodal metastases and without nodal metastases, respectively. In multivariable analyses, amongst pT1, pT2, pT3 and pT4, patients with nodal metastases were 6.0-, 3.6-, 3.2- and 2.0-fold, respectively, more likely to die after nephrectomy (all P < 0.001). Similarly, amongst Fuhrman grade I, Fuhrman grade II, Fuhrman grade III and Fuhrman grade IV, patients with nodal metastases were 3.9-, 3.5-, 3.1- and 2.7-fold, respectively, more likely to die of cancer-specific mortality (all P < 0.001). Nodal involvement is an important determinant of higher cancer-specific mortality after nephrectomy. The detrimental effect of nodal metastases is particularly strong amongst patients with low-stage or low-grade non-metastatic renal cell carcinoma.

Improved Overall Survival Trends of Men with Newly Diagnosed M1 Prostate Cancer: A SWOG Phase III Trial Experience (S8494, S8894 and S9346)

Frequent prostate specific antigen testing for screening and monitoring prostate cancer has led to significant stage migration. We evaluated whether overall survival in hormone naïve patients with metastatic prostate cancer has improved during the era of prostate specific antigen use. We also assessed whether any patient subsets benefited differentially during this period. We compared overall survival in 3 sequential phase III trials of 3,096 men with hormone naïve, metastatic prostate cancer who received similar androgen deprivation therapy, including 2 trials performed before the prostate specific antigen era (S8494 and S8894) and the other done during this era (S9346). Overall survival was adjusted for patient and disease risk factors in the latter 2 trials. Subgroups were evaluated by interactions of risk factors with trial. Median overall survival was 30 months in S8494, 33 months in S8894 and 49 months in S9346. Adjusting for risk factors, there was a 22% lower risk of death in S9346 than in S8894 (HR 0.78, 95% CI 0.70, 0.87, p <0.001). The improvement in overall survival was greater in black American men (test of interaction p = 0.008). In S8494 and S8894 median survival for black men was 27 months, and 34 and 35 months for nonblack men, respectively. This racial difference disappeared in S9346 with overall survival of 48 and 49 months in black and nonblack men, respectively. Adjusting for risk factors, overall survival was significantly improved in the post-prostate specific antigen era trial. However, it cannot be concluded that this was attributable only to prostate specific antigen monitoring. Black men now have overall survival comparable to that of white men. Current estimates of survival should be used to design new trials in this population.

Osteoporosis Self-assessment Tool for Asians as a simple risk index of identifying a poor prognosis in women surgically treated for colorectal cancer

BackgroundOsteoporosis and colorectal cancer (CRC) in older women are considered enormous public health burdens. The effects of osteoporosis on the oncologic outcome of CRC surgery are poorly understood. We evaluated the use of the Osteoporosis Self-assessment Tool for Asians (OSTA) for predicting postoperative outcome in older women after receiving surgical treatment of CRC. Materials and methodsThe present single-institution retrospective study analyzed patients who had undergone surgery for CRC in 2002–2008. To characterize the major population of women with osteoporosis, which consists of postmenopausal women, only patients aged 50 years and older were analyzed. Their OSTA scores were evaluated for correlations with cancer-specific survival after surgery for CRC by performing univariate, multivariate, and survival analyses. ResultsDuring a 7-year period, 440 women were studied. The cancer-specific mortality and overall mortality rate was 28.4% and 33.4%, respectively. The univariate analyses revealed that significant predictors of cancer-specific mortality after CRC surgery were the International Union Against Cancer (UICC) stage, OSTA category, histologic grading, lymph node metastases, and tumor invasion depth. After risk adjustment, the UICC stage and OSTA risk index were independent predictors of mortality. A comparison of OSTA risk index among patients with different UICC stages showed that the accuracy of the index in predicting cancer-specific survival after CRC surgery was greatest for patients with stage II and III disease. ConclusionsThe UICC stage and OSTA risk status showed independent positive associations with postoperative mortality in aged female patients with CRC. Moreover, the OSTA index had a particularly strong association with cancer-specific mortality in patients with UICC stage II and III.

Impact of Smoking on Oncologic Outcomes of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy

BackgroundCigarette smoking is a common risk factor for developing upper tract urothelial carcinoma (UTUC). ObjectiveTo assess the impact of cigarette smoking status, cumulative smoking exposure, and time from cessation on oncologic UTUC outcomes in patients treated with radical nephroureterectomy (RNU). Design, setting, and participantsA total of 864 patients underwent RNU at five institutions. The median follow-up in this retrospective study was 50 mo. Smoking history included smoking status, quantity of cigarettes per day (CPD), duration in years, and years from smoking cessation. The cumulative smoking exposure was categorized as light-short-term (≤19 CPD and ≤19.9 yr), moderate (all combinations except light-short-term and heavy-long-term), and heavy-long-term (≥20 CPD and ≥20 yr). InterventionsRNU with or without lymph node dissection. No patient received neoadjuvant chemotherapy. Outcome measurements and statistical analysisUnivariable and multivariable logistic regression and competing risk regression analyses assessed the effects of smoking on oncologic outcomes. Results and limitationsA total of 244 patients (28.2%) never smoked; 297 (34.4%) and 323 (37.4%) were former and current smokers, respectively. Among smokers, 87 (10.1%), 331 (38.3%), and 202 (23.4%) were light-short-term, moderate, and heavy-long-term smokers, respectively. Current smoking status, smoking ≥20 CPD, ≥20 yr, and heavy-long-term smoking were associated with advanced disease (p values ≤0.004), greater likelihood of disease recurrence (p values ≤0.01), and cancer-specific mortality (p values ≤0.05) on multivariable analyses that adjusted for standard features. Patients who quit smoking ≥10 yr prior to RNU did not differ from never smokers regarding advanced tumor stages, disease recurrence, and cancer-specific mortality, but they had better oncologic outcomes then current smokers and those patients who quit smoking <10 yr prior to RNU. The study is limited by its retrospective nature. ConclusionsCigarette smoking is significantly associated with advanced disease stages, disease recurrence, and cancer-specific mortality in patients treated with RNU for UTUC. Current smokers and those with a heavy and long-term smoking exposure have the highest risk for poor oncologic outcomes. Smoking cessation >10 yr prior to RNU seems to mitigate some detrimental effects. These results underscore the need for smoking cessation and prevention programs.

Insulin Therapy and Cancer-Specific Mortality in Patients With Colorectal Cancer and Diabetes

Insulin Therapy and Cancer-Specific Mortality in Patients With Colorectal Cancer and Diabetes

387 PROSPECTIVE EVALUATION OF CELL CYCLE BIOMARKERS FOR PREDICTION OF CANCER-SPECIFIC MORTALITY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyUrothelial Cancer: Natural History & Pathophysiology/Marker1 Apr 2012387 PROSPECTIVE EVALUATION OF CELL CYCLE BIOMARKERS FOR PREDICTION OF CANCER-SPECIFIC MORTALITY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA Aditya Bagrodia, Ramy Youssef, Oussama Darwish, Chase Cannon, Michael Belsante, Payal Kapur, Yair Lotan, and Vitaly Margulis Aditya BagrodiaAditya Bagrodia Dallas, TX More articles by this author , Ramy YoussefRamy Youssef Dallas, TX More articles by this author , Oussama DarwishOussama Darwish Dallas, TX More articles by this author , Chase CannonChase Cannon Dallas, TX More articles by this author , Michael BelsanteMichael Belsante Dallas, TX More articles by this author , Payal KapurPayal Kapur Dallas, TX More articles by this author , Yair LotanYair Lotan Dallas, TX More articles by this author , and Vitaly MargulisVitaly Margulis Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.451AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is a paucity of information regarding patient and pathological characteristics that accurately predict clinical outcomes for patients with upper tract urothelial carcinoma (UTUC). The purpose of the present study is to prospectively evaluate whether a biomarker panel of cell-cycle regulators can be used for prediction of cancer-specific mortality (CSM) in patients with UTUC. METHODS Between 1/2007 and 6/2011, 71 patients underwent nephroureterectomy for biopsy-proven high grade UTUC. Patient and tumor characteristics were recorded, and primary tumors were prospectively evaluated for immunohistochemical expression of a panel including 4 biomarkers: p21, p27, p53, Ki-67/pRb. Unfavorable biomarker profile was defined as >2 altered markers. Multivariate Cox regression analysis (MVA) integrating the following pathologic features was performed: 1) non-organ confined disease (>T2 and/or N+), 2) lymphovascular invasion (LVI), 3) unfavorable biomarker panel. CSM was evaluated using the Kaplan-Meier method. RESULTS Mean age and follow-up were 69 years (range 38-89) and 12.4 months (range 1-42), respectively. p21, p27, p53, and Ki-67 and/or pRb were altered in 14 (20%), 35 (49%), 32 (45%), and 62 (87%) patients, respectively. 51% (n=36) of tumors were organ confined (T stage <2, N=0), 31% (n=22) had LVI, and 32% (n=23) had an unfavorable panel. At the time of analysis, 18 (25%) patients had disease progression and 14 (20%) died from UTUC. On MVA, non-organ confined disease (HR=14.26, p<0.05) and unfavorable marker profile (HR= 3.1, p<0.05) were significantly associated with CSM. Patients with a favorable marker profile demonstrated improved CSM, compared to those with unfavorable score (73% vs 47%, p=0.03, Figure 1). CONCLUSIONS The urothelial carcinoma biomarker panel is a promising clinical tool for accurate identification of patients at high risk of adverse oncologic outcomes from UTUC. Incorporating this panel into clinical practice may allow for enhanced patient counseling, individualized (neo)adjuvant chemotherapy recommendations, and patient-specific surveillance regimens. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e158-e159 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aditya Bagrodia Dallas, TX More articles by this author Ramy Youssef Dallas, TX More articles by this author Oussama Darwish Dallas, TX More articles by this author Chase Cannon Dallas, TX More articles by this author Michael Belsante Dallas, TX More articles by this author Payal Kapur Dallas, TX More articles by this author Yair Lotan Dallas, TX More articles by this author Vitaly Margulis Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Competing-Risks Mortality After Radiotherapy vs. Observation for Localized Prostate Cancer: A Population-based Study

Contemporary patients with localized prostate cancer (PCa) are more frequently treated with radiotherapy. However, there are limited data on the effect of this treatment on cancer-specific mortality (CSM). Our objective was to test the relationship between radiotherapy and survival in men with localized PCa and compare it with those treated with observation. A population-based cohort identified 68,797 men with cT1-T2 PCa treated with radiotherapy or observation between the years 1992 and 2005. Propensity-score matching was used to minimize potential bias related to treatment assignment. Competing-risks analyses tested the effect of treatment type (radiotherapy vs. observation) on CSM, after accounting to other-cause mortality. All analyses were carried out within PCa risk, baseline comorbidity status, and age groups. Radiotherapy was associated with more favorable 10-year CSM rates than observation in patients with high-risk PCa (8.8 vs. 14.4%, hazard ratio [HR]: 0.59, 95% confidence interval [CI]: 0.50-0.68). Conversely, the beneficial effect of radiotherapy on CSM was not evident in patients with low-intermediate risk PCa (3.7 vs. 4.1%, HR: 0.91, 95% CI: 0.80-1.04). Radiotherapy was beneficial in elderly patients (5.6 vs. 7.3%, HR: 0.70, 95% CI: 0.59-0.80). Moreover, it was associated with improved CSM rates among patients with no comorbidities (5.7 vs. 6.5%, HR: 0.81, 95% CI: 0.67-0.98), one comorbidity (4.6 vs. 6.0%, HR: 0.87, 95% CI: 0.75-0.99), and more than two comorbidities (4.2 vs. 5.0%, HR: 0.79, 95% CI: 0.65-0.96). Radiotherapy substantially improves CSM in patients with high-risk PCa, with little or no benefit in patients with low-/intermediate-risk PCa relative to observation. These findings must be interpreted within the context of the limitations of observational data.

Node‐positive renal cell carcinoma in the absence of distant metastases: predictors of cancer‐specific mortality in a population‐based cohort

Nodal metastases, even in the absence of distant metastases, portend a bad prognosis. The percentage of positive nodes (PPN) represents an important predictor of cancer-specific mortality (CSM) in patients in the group T(any) N(1) M(0) . In consequence, universal inclusion of PPN should be considered in prospective and retrospective CSM analyses. To examine the outcomes of patients with node-positive renal cell carcinoma (RCC) in the absence of distant metastases in a large population-based cohort of patients To examine the ability of standard risk factors to predict cancer-specific mortality (CSM). Using the Surveillance, Epidemiology, and End Results database, a total of 799 patients with RCC nodal metastases and absence of distant metastases undergoing nephrectomy were identified. Univariable and multivariable analyses was performed with the aim of identifying independent predictors of CSM in this cohort of patients. Specifically, we examined the effect of the number of removed nodes (NRN), the number of positive nodes (NPN) and the percentage of positive nodes (PPN) on CSM. Actuarial survival estimates showed that 53.2, 37.8 and 25.7% of patients survived at 24, 60 and 120 months after nephrectomy. In Kaplan-Meier analyses, NRN failed to clearly discriminate between recorded CSM rates (log rank P = 0.07). Discrimination was noted when CSM was stratified according to NPN (log rank P = 0.02) and PPN (log rank P = 0.001). In multivariable analyses, age, Fuhrman grade, histological subtype, T stage and PPN were independent predictors of CSM. Our data indicate that CSM of patients with exclusive nodal metastases differs according to PPN. Consequently, PPN warrants consideration in future prognostic schemes.

The Impact of Tumor Multifocality on Outcomes in Patients Treated With Radical Nephroureterectomy

Background The prognostic impact of multifocal upper-tract urothelial carcinoma (UTUC) is poorly understood. Objective To investigate the association between tumor multifocality and clinicopathologic features and outcomes of UTUC in patients managed by radical nephroureterectomy (RNU). Design, setting, and participants The study included 2492 patients treated with either open or laparoscopic RNU. Tumor and patient characteristics included tumor stage, tumor grade, lymph node status, lymphovascular invasion (LVI), tumor architecture, tumor location, unifocal or multifocal disease, gender, age, history of bladder cancer (BCa), Eastern Cooperative Oncology Group (ECOG) performance status (PS), and adjuvant chemotherapy. tumor multifocality of UTUC was defined as the synchronous presence of multiple tumors in the renal pelvis or ureter. Intervention All patients were treated with either open or laparoscopic RNU. Measurements Univariable and multivariable models tested the effect of tumor multifocality on disease progression and cancer-specific mortality. Results and limitations Five hundred ninety patients (23.7%) had tumor multifocality at the time of RNU. The median follow-up was 45 mo (interquartile range [IQR]: 0–101). Tumor multifocality was significantly associated with a history of previous BCa ( p = 0.032), lymph node involvement ( p = 0.036), tumor location in the ureter ( p = 0.003), higher tumor stage ( p < 0.001), higher tumor grade ( p < 0.001), sessile tumor architecture ( p = 0.003), and LVI ( p = 0.001). In organ-confined patients, tumor multifocality was an independent predictor of both disease progression (hazard ratio [HR]: 1.43; p = 0.019) and cancer-specific mortality (HR: 1.46; p = 0.027). When assessed in all patients, tumor multifocality was associated with both disease progression and cancer-specific mortality in univariable ( p = 0.005 and p = 0.006, respectively) but not in multivariable analyses ( p = 0.468 and p = 0.798, respectively). The main limitation is the retrospective design of the study. Conclusions Tumor multifocality is an independent prognosticator of disease progression and cancer-specific mortality in patients with organ-confined UTUC treated with RNU. Multifocal organ-confined patients with UTUC may need closer follow-up. Integration of tumor multifocality with other factors may help identify those patients who would benefit from multimodal therapy.

Survival after radical cystectomy of non‐bilharzial squamous cell carcinoma vs urothelial carcinoma: a competing‐risks analysis

• To test the effect of histological subtype (NBSCC vs UC) on cancer-specific mortality (CSM), after adjusting for other-cause mortality (OCM). • In Western countries, non-bilharzial squamous cell carcinoma (NBSCC) is the second most common histological subtype in bladder cancer (BCa) after urothelial carcinoma (UC). • We identified 12,311 patients who were treated with radical cystectomy (RC) between 1988 and 2006, within 17 Surveillance, Epidemiology and End Results (SEER) registries. • Univariable and multivariable competing-risks analyses tested the relationship between histological subtype and CSM, after accounting for OCM. • Covariates consisted of age, sex, year of surgery, race, pathological T and N stages, as well as tumour grade. • Histological subtype was NBSCC in 614 (5%) patients vs UC in 11,697 (95%) patients. • At RC, the rate of non-organ confined (NOC) BCa was higher in NBSCC patients than in their UC counterparts (71.7% vs 52.2%; P < 0.001). • After adjustment for OCM, The 5-year cumulative CSM rates were 25.0% vs 19.8% (P= 0.2) for patients with NBSCC vs UC organ confined (OC) BCa, respectively. The same rates were 46.3% vs 49.3% in patients with NOC BCa (P= 0.1). • In multivariable competing-risks analyses, histological subtype (NBSCC vs UC) failed to achieve independent predictor status of CSM in patients with OC (hazard ratio, 1.2; P= 0.06) or NOC BCa (hazard ratio, 1.1; P= 0.1). • At RC, the rate of NOC BCa is higher in NBSCC patients than in their UC counterparts. • Despite a more advanced stage at surgery, NBSCC histological subtype is not associated with a less favourable CSM than UC histological subtype, after accounting for OCM and the extent of the disease (OC vs NOC).

PSA velocity may not be of value in prostate cancer detection

PSA velocity may not be of value in prostate cancer detection

The Association between pre‐operative PSA and prostate cancer‐specific mortality in patients with long‐term follow‐up after radical prostatectomy

The clinical and pathologic predictors of prostate cancer-specific mortality (PCSM) many years after radical prostatectomy (RP) remain to be fully elucidated. We explored the association between pre-operative prostate-specific antigen (PSA) and other pathologic predictors and PCSM in men who have undergone (RP). We report on 459 patients with PCSM data after RP who were followed prospectively over a 23-year period between 1987 and 1997. Cox regression and Kaplan-Meier analysis were used to evaluate pre-operative PSA, pathologic Gleason sum, pathologic stage, and surgical margin status as predictors of PCSM. The median PSA was 6.6 ng/ml (± 9.9) and the median follow-up time was 9.4 (± 4.9) years. Fourteen patients (3.1%) died of PC. On multivariate analysis, only PSA (HR: 1.050; P = 0.001) and binary Gleason sum (HR: 3.402; P = 0.043) remained significant predictors of PCSM. The predicted 10-year PCSM was significantly worse in those patients in the highest PSA tertile compared to those in other tertiles [PSA > 9.9: 87% (82-92%) vs. PSA = 4-9.9: 95% (93.0-97.0%) vs. PSA = 0-3.9: 100.0% (100.0-100.0%)]. We have highlighted the importance of pre-operative PSA in predicting PCSM many years after RP. It is a more significant predictor than Gleason sum and pathologic stage. Thus, PSA may help identify patients with life-threatening PC at a time when their disease is curable with definitive therapy.

1474 PT3-PROSTATE CANCER-POSITIVE SURGICAL MARGIN AT BLADDER NECK IS AN INDEPENDANT PREDICTOR OF LOCAL FAILURE AND PROSTATE CANCER MORTALITY: RESULTS OF A PROSPECTIVE SINGLE INSTITUTION SERIES

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111474 PT3-PROSTATE CANCER-POSITIVE SURGICAL MARGIN AT BLADDER NECK IS AN INDEPENDANT PREDICTOR OF LOCAL FAILURE AND PROSTATE CANCER MORTALITY: RESULTS OF A PROSPECTIVE SINGLE INSTITUTION SERIES Martin Spahn, Alberto Briganti, Umberto Capitanio, Paolo Gontero, Burkhard Kneitz, Pia Bader, Hein Van Poppel, Detlef Frohneberg, and Steven Joniau Martin SpahnMartin Spahn Würzburg, Germany More articles by this author , Alberto BrigantiAlberto Briganti Milan, Italy More articles by this author , Umberto CapitanioUmberto Capitanio Milan, Italy More articles by this author , Paolo GonteroPaolo Gontero Turin, Italy More articles by this author , Burkhard KneitzBurkhard Kneitz Würzburg, Germany More articles by this author , Pia BaderPia Bader Karlsruhe, Germany More articles by this author , Hein Van PoppelHein Van Poppel Leuven, Belgium More articles by this author , Detlef FrohnebergDetlef Frohneberg Karlsruhe, Germany More articles by this author , and Steven JoniauSteven Joniau Leuven, Belgium More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1409AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies have shown a positive correlation between presence of positive surgical margin (SM) and cancer recurrence and mortality. Only few addressed the importance of the location of positive SM.We hypothesized that the outcome of pts. with positive SMs (PSM) varies significantly according to their location in a large pT3 PCa series. METHODS The study included 550 consecutive pts. with high risk pPCa (PSA>20 ng/ml, cT3/cT4, bx Gleason 8–10) treated with RP+ PLND at a single institution. Of these,187 (34%) had pT3a/b disease and did not receive adjuvant radiation therapy.These pts. represented the study cohort. All pts.had detailed pathological data (presence and number of PSM (namely 1,2 or 3) that were collected prospectively. Location of PSM was recorded for all pts. and categorized as apical, posterolateral, urethral,posterior,seminal and bladder. A PSM was defined as presence of tumor cells at the inked margin of resection. Kaplan-Meier curves assessed the time to local failure and cancer specific survival (CSS) according to the number and location of PSM.The association between location of PSM was confirmed at multivariable Cox regression analyses after accounting for pathol. Gleason sum,PSA and use of adjuvant hormonal therapy. RESULTS Overall, 5,8 and 10-year CSS rates were 88, 86 and 86%, respectively, while local recurrence free rate was 82, 80 and 71% at 5–8 and 10-year follow-up, respectively. At Kaplan Meier analysis, only the presence of PSM at bladder neck was associated with both local failure and CSS (all p< 0.001). At 5 and 10 year follow-up, patients with PSM at bladder neck had significantly worse local failure (63 and 63% vs 87 and 74%; all p=0.001) and CSS rate (68 and 68% vs 94 and 91%; p<0.001) as compared to patients with negative margin at bladder neck. Conversely, no association was association between all other PSM location and CSS locations (all p=0.3). These results were confirmed at multivariable Cox regression analysis where the presence of PSM at bladder neck was the only independent predictor of both local failure (p=0.001; HR3.94) 0 and CSS (p=0.001; HR 5.61) even after accounting for all predictors. CONCLUSIONS Our study demonstrated that PSM at bladder neck is a significant predictor of local recurrence and cancer specific mortality in patients with pT3 disease even after accounting for pathological characteristics and use of adjuvant hormonal therapy. Patients with PSM at bladder neck should be thus considered for a combined, multimodal approach. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e591 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Martin Spahn Würzburg, Germany More articles by this author Alberto Briganti Milan, Italy More articles by this author Umberto Capitanio Milan, Italy More articles by this author Paolo Gontero Turin, Italy More articles by this author Burkhard Kneitz Würzburg, Germany More articles by this author Pia Bader Karlsruhe, Germany More articles by this author Hein Van Poppel Leuven, Belgium More articles by this author Detlef Frohneberg Karlsruhe, Germany More articles by this author Steven Joniau Leuven, Belgium More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

590 DEVELOPMENT AND INTERNAL VALIDATION OF A HIGHLY ACCURATE PREOPERATIVE NOMOGRAM FOR PREDICTION OF CANCER-SPECIFIC MORTALITY FOR SQUAMOUS CELL CARCINOMA OF THE PENIS

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease1 Apr 2011590 DEVELOPMENT AND INTERNAL VALIDATION OF A HIGHLY ACCURATE PREOPERATIVE NOMOGRAM FOR PREDICTION OF CANCER-SPECIFIC MORTALITY FOR SQUAMOUS CELL CARCINOMA OF THE PENIS Claudio Jeldres, Niels Graafland, Maxine Sun, Rodolphe Thuret, Paul Perotte, Joost A.P. Leijte, Pierre I. Karakiewicz, and Simon Horenblas Claudio JeldresClaudio Jeldres Montreal, Canada More articles by this author , Niels GraaflandNiels Graafland Amsterdam, Netherlands More articles by this author , Maxine SunMaxine Sun Montreal, Canada More articles by this author , Rodolphe ThuretRodolphe Thuret Montpellier, France More articles by this author , Paul PerottePaul Perotte Montreal, Canada More articles by this author , Joost A.P. LeijteJoost A.P. Leijte Amsterdam, Netherlands More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz Montreal, Canada More articles by this author , and Simon HorenblasSimon Horenblas Amsterdam, Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1422AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with squamous cell carcinoma (SCCP) represent a heterogeneous group. Currently, no model using preoperative characteristics exists for prediction of prognosis in these patients. To address this limitation, we developed a nomogram predicting cancer-specific mortality (CSM) using routinely available preoperative characteristics. METHODS Three-hundred-twenty-three consecutive patients with SCCP were treated with a sentinel node biopsy and/or ILND at a single institution, between years 1988 and 2008. Multivariable Cox regression model for prediction of CSM was fitted. The examined predictors included age (continuously coded), tumor stage (T1, T2, T3–4), and clinical node positivity (negative, unilateral, bilateral). Backward variable selection was applied to identify the most informative and parsimonious model. The model discrimination was quantified using Harrell's concordance index. Calibration plot explored the relationship between predicted and observed estimates. RESULTS Average age was 65 years (median 66). Tumor stage distribution was 26.6, 50.2, and 23.2% for respectively T1, T2 and T3–4 SCCP. Clinical node positivity was negative in 75%, unilateral in 18%, and bilateral in 7%. The two-year CSM-free survival rates were 85.2% (95% CI: 81.4–89.2%). Patients with T3–4 were more likely to die of CSM (hazard ratio [HR]: 2.2, P=0.046). Unilateral or bilateral clinical node positivity portended to an 8- and 14-fold higher rate of CSM (both P<0.001). Model discrimination for CSM-free survival was 85% accurate at 2 years (Figure 1a). Calibration was good between predicted and observed probabilities (Figure 1b). CONCLUSIONS This represents the first preoperative model for prediction of CSM in patients treated with an ILND for SCCP. In the absence of other tools with prognostic ability using preoperative variables, the current tool may be considered useful for clinicians during counselling. Its external validation is awaited. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e238 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Claudio Jeldres Montreal, Canada More articles by this author Niels Graafland Amsterdam, Netherlands More articles by this author Maxine Sun Montreal, Canada More articles by this author Rodolphe Thuret Montpellier, France More articles by this author Paul Perotte Montreal, Canada More articles by this author Joost A.P. Leijte Amsterdam, Netherlands More articles by this author Pierre I. Karakiewicz Montreal, Canada More articles by this author Simon Horenblas Amsterdam, Netherlands More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effects of individual‐level socioeconomic factors on racial disparities in cancer treatment and survival

This is the first study to use the linked National Longitudinal Mortality Study and Surveillance, Epidemiology, and End Results (SEER) data to determine the effects of individual-level socioeconomic factors (health insurance, education, income, and poverty status) on racial disparities in receiving treatment and in survival. This study included 13,234 cases diagnosed with the 8 most common types of cancer (female breast, colorectal, prostate, lung and bronchus, uterine cervix, ovarian, melanoma, and urinary bladder) at age ≥ 25 years, identified from the National Longitudinal Mortality Study-SEER data during 1973 to 2003. Kaplan-Meier methods and Cox regression models were used for survival analysis. Three-year all-cause observed survival for cases diagnosed with local-stage cancers of the 8 leading tumors combined was ≥ 82% regardless of race/ethnicity. More favorable survival was associated with higher socioeconomic status. Compared with whites, blacks were less likely to receive first-course cancer-directed surgery, perhaps reflecting a less favorable stage distribution at diagnosis. Hazard ratio (HR) for cancer-specific mortality was significantly higher among blacks compared with whites (HR, 1.2; 95% confidence interval [CI], 1.1-1.3) after adjusting for age, sex, and tumor stage, but not after further controlling for socioeconomic factors and treatment (HR, 1.0; 95% CI, 0.9-1.1). HRs for all-cause mortality among patients with breast cancer and for cancer-specific mortality in patients with prostate cancer were significantly higher for blacks compared with whites after adjusting for socioeconomic factors, treatment, and patient and tumor characteristics. Favorable survival was associated with higher socioeconomic status. Racial disparities in survival persisted after adjusting for individual-level socioeconomic factors and treatment for patients with breast and prostate cancer.

Tumor Grade Improves the Prognostic Ability of American Joint Committee on Cancer Stage in Patients With Penile Carcinoma

Penile cancer is rare. Thus, predicting cancer specific mortality may be difficult. We devised an accurate and yet easily applicable predictive rule that compares favorably with 2 previous models (73.8% and 74.7% accuracy, respectively). We identified patients treated with primary tumor excision for all stages of penile squamous cell carcinoma between 1998 and 2006. Disease stage definitions using Surveillance, Epidemiology and End Results stage, American Joint Committee on Cancer stage and TNM classification, and tumor grade were used to predict cancer specific mortality. Predictive accuracy estimates were compared using the DeLong method for related AUCs. Surveillance, Epidemiology and End Results stage alone (1 predictor variable) was least accurate (74.5%). American Joint Committee on Cancer stage with tumor grade (2 predictor variables) was the most simple and most accurate (80.9%, p <0.001). A benefit similar to that of American Joint Committee on Cancer stage with tumor grade was seen for TNM classification and TG (80.7%, p = 0.8). However, this rule (4 predictor variables) was more complex than American Joint Committee on Cancer stage and tumor grade. American Joint Committee on Cancer stage combined with tumor grade is the simplest, most accurate cancer specific mortality prediction rule after primary tumor excision for penile squamous cell carcinoma. This method is also more accurate than 2 previous cancer specific mortality prediction rules.

Preoperative Prostate Specific Antigen Doubling Time is Not a Useful Predictor of Biochemical Progression After Radical Prostatectomy

Postoperative prostate specific antigen doubling time may be used as a surrogate for prostate cancer specific mortality in patients with biochemical recurrence after radical prostatectomy. Less is known about the usefulness of preoperative prostate specific antigen doubling time for the initial prediction of prostatectomy outcomes. Preoperative prostate specific antigen doubling time was calculated in 1,208 men from a large prostate cancer screening study who were treated with radical prostatectomy. We examined the relationship of prostate specific antigen doubling time with tumor features and biochemical progression-free survival. Overall prostate specific antigen doubling time was associated with nonorgan confined disease (OR 0.996, 95% CI 0.992-0.999, p = 0.013) but not with biochemical progression (HR 1.000, 95% CI 0.998-1.001, p = 0.66). Using previously published 18 and 36-month thresholds for prostate specific antigen doubling time there was no significant relationship between doubling time and specific adverse pathological features or biochemical progression. Using the concordance index prostate specific antigen doubling time did not enhance the prediction of biochemical progression beyond that achieved by a model with prostate specific antigen, clinical stage and biopsy Gleason score. In our series of men with newly diagnosed, clinically localized prostate cancer shorter preoperative prostate specific antigen doubling time was associated with nonorgan confined disease but not with biochemical progression after radical prostatectomy. All calculations of prostate specific antigen kinetics may not be equivalent. Caution should be exercised when using prostate specific antigen doubling time in the pretreatment setting.